Clinical Usefulness Of Ultrasonography Research Articles

Axillary Lymph Nodes Suspicious for Breast Cancer Metastasis: Sampling with US-guided 14-Gauge Core-Needle Biopsy—Clinical Experience in 100 Patients

To study the clinical usefulness of ultrasonography (US)-guided core-needle biopsy (CNB) of axillary lymph nodes and the US-depicted abnormalities that may be used to predict nodal metastases. This retrospective study was HIPAA compliant and institutional review board approved; the requirement for informed patient consent was waived. US-guided 14-gauge CNB of abnormal axillary lymph nodes was performed in 100 of 144 patients with primary breast cancer who underwent US assessment of axillary lymph nodes. A biopsy needle with controllable action rather than a traditional throw-type needle was used. US findings were considered suspicious for metastasis if cortical thickening and/or nonhilar blood flow (NHBF) to the lymph node cortex was present. The absence of any discernible fatty hilum was also noted. Nodal metastases were documented at CNB in 64 (64%) of the 100 patients. All 36 patients with negative biopsy results underwent subsequent sentinel lymph node biopsy (SLNB), which yielded negative findings in 32 (89%) patients and revealed metastasis in four (11%). All 44 patients who did not undergo CNB because of negative US results subsequently underwent SLNB, which revealed lymph node metastasis in 12 (27%) patients. Cortical thickening was found in 63 (79%) of the total of 80 metastatic nodes, but only a minority (n = 26 [32%]) of the nodes had an absent fatty hilum. NHBF to the cortex was detected in 52 (65%) metastatic nodes. Both absence of a fatty hilum (metastasis detected in 26 [93%] of 28 nodes) and cortical thickening combined with NHBF (metastasis detected in 52 [81%] of 64 nodes) had a high positive predictive value. No clinically important complications were encountered with the biopsy procedures. Axillary lymph nodes with abnormal US findings can be sampled with high accuracy and without major complications by using a modified 14-gauge CNB technique.

Arthroscopic Verification of Ultrasonographic Diagnosis of Meniscal Pathology in Dogs

To determine the clinical usefulness of ultrasonography for diagnosis of meniscal pathology in dogs. Double-blind prospective study. Dogs (n=10) with lameness localized to the stifle. Sonographic examination of each affected stifle was performed by 1 ultrasonographer unaware of specific historical and clinical data for the dog. Sonographic findings were recorded, but not reviewed until study completion. Arthroscopic examination of the affected stifle was performed within 48 hours of ultrasonography by 1 surgeon unaware of ultrasonographic findings. Arthroscopic findings were recorded, but not reviewed until study completion. Two investigators compared the ultrasonographic and arthroscopic findings at study completion to determine the sensitivity, specificity, positive predictive value, and negative predictive value. Two of the 10 dogs had bilateral stifle evaluation. Twenty-four lateral and medial menisci, with normal and abnormal findings, were examined. The sensitivity and specificity for ultrasonographic diagnosis were 90.0% and 92.9%, respectively; positive and negative predictive values were 90.0% and 92.9%, respectively. Ultrasonography is highly specific and sensitive for diagnosing bucket handle tears of the medial meniscus in dogs. Ultrasonographic evaluation of menisci in dogs is a noninvasive method for accurately and efficiently diagnosing pathology, determining the need for surgical intervention, and providing comprehensive information to clients.

Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of non‐palpable testis

Studies were needed to evaluate the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) for diagnosing non-palpable testis, and to study the clinical usefulness of US and MRI before surgical exploration. Fifty-six patients with non-palpable testis aged 1--12 years were examined between 1993 and 2002. Forty-six patients (55 non-palpable testes) underwent US. Forty patients (47 non-palpable testes) were examined using MRI. Both US and MRI were used in 29 patients (34 non-palpable testes). We used Fisher's exact probability test to compare the results of these graphic examinations with the surgical or laparoscopic findings for the non-palpable testis. Ultrasonography had a sensitivity of 76%, a specificity of 100%, and an accuracy of 84% in the diagnosis of non-palpable testis, whereas MRI had a sensitivity of 86%, a specificity of 79%, and an accuracy of 85%. There were no statistically significant differences in the accuracy rates of US and MRI for diagnosing non-palpable testis. Laparoscopy or inguinal exploration should be performed even if these graphic examinations demonstrate the absence of a testis, because some patients with a non-palpable testis were found to be false negatives. We recommend US as the first step after clinical examination, and MRI could be performed when the US findings are negative preoperatively for a non-palpable testis.

The Usefulness of Ultrasound-Guided Fine Needle Aspiration Cytology of Impalpable Neck Nodes in Patients with Lung Cancer

Background:In lung cancer patients, the presence of metastatic neck nodes is a crucial indicator of inoperabilty. So thorough physical examination of neck is always mandatory, but sometimes those are hardly palpable even by the skillful hand. Ultrasonography is a useful diagnostic method in detection of small impalpable lymph nodes and in guidance of fine needle aspiration biopsy. In this study we evaluated the clinical usefulness of ultrasonography(USG) and ultrasound-guided fine needle aspiration cytology(US-FNA) in lung cancer patients without palpable neck nodes.Methods and Materials:From Sep 2002 to Sep 2003, 36 non-small cell lung cancer patients (20 adenocarcinoma, 16 squamous cell cancer) and 10 small cell lung cancer patients without palpable neck nodes on physical examiation were enrolled. patients who had contralateral mediastinal nodal enlargement(>1cm) on chest CT were excluded. After the routine check of USG on the neck, US-FNA was done in cases with enlarged neck nodes (≥5 mm in the short axis). The presence of enlargedAddress for correspondence :Chul Ho Oak, M.D.Department of Internal Medicine, College of Medicine, Kosin University34 Amnam-dong, Suh-ku, Busan, 602-702, KoreaPhone : 051-990-6460 Fax : 051-990-3005 E-mail : oaks70@dreamwiz.com

Something Old and Something New: a Brief History of Thyroid Ultrasound Technology

To discuss both early and recent ultrasound technologic advances and to explore the role of such technology in the evaluation of the thyroid gland. The physics of sound and the history of the use of reflected sound waves are reviewed, and the medical applications of ultrasound, with a particular focus on the thyroid gland, are presented. Since the first reports of thyroid ultrasonography were published in the late 1960s, the field has undergone remarkable evolution. Ultrasound imaging improved in parallel with growth in computing, transducer, and display technology. The transition from A-mode to B-mode to gray-scale imaging was associated with dramatic improvements in clarity and interpretability of ultrasound images. Current high-resolution ultrasound images are able to identify virtually all structural thyroid lesions of clinical significance. Although ultrasound characteristics cannot be used for accurate diagnosis of benign thyroid lesions, certain features such as irregular margins, microcalcifications, and central vascularity suggest the presence of "suspicious" thyroid nodules. Recent advances including the use of contrast agents, tissue harmonic imaging, and multiplanar reconstruction of images will further enhance the resolution and interpretability of ultrasound images. The use of Doppler flow analysis may improve the predictive value for determining the risk of a malignant thyroid lesion, but no current ultrasound technique is capable of determining benignity with an acceptable degree of accuracy. Ultrasound guidance of fine-needle aspiration biopsy has been demonstrated to improve both diagnostic yield and accuracy and will likely become the standard of care. Because high-quality ultrasound systems are now available at a reasonable price, routine clinical use of ultrasonography is considered an important extension of the physical examination by many endocrinologists.

The Usefulness of Ultrasound-Guided Fine Needle Aspiration Cytology of Impalpable Neck Nodes in Patients with Lung Cancer

Background : In lung cancer patients, the presence of metastatic neck nodes is a crucial indicator of inoperabilty. So thorough physical examination of neck is always mandatory, but sometimes those are hardly palpable even by the skillful hand. Ultrasonography is a useful diagnostic method in detection of small impalpable lymph nodes and in guidance of fine needle aspiration biopsy. In this study we evaluated the clinical usefulness of ultrasonography(USG) and ultrasound-guided fine needle aspiration cytology(US-FNA) in lung cancer patients without palpable neck nodes. Methods and Materials : From Sep 2002 to Sep 2003, 36 non-small cell lung cancer patients (20 adenocarcinoma, 16 squamous cell cancer) and 10 small cell lung cancer patients without palpable neck nodes on physical examiation were enrolled. patients who had contralateral mediastinal nodal enlargement(>1cm) on chest CT were excluded. After the routine check of USG on the neck, US-FNA was done in cases with enlarged neck nodes ( in the short axis). The presence of enlarged lymph node on USG, and of malignant cells on cytology were evaluated by the histological type and the patients' clinical stage of lung cancer. Results : Among 36 non-small lung cell cancer patients, 14 (38.8%) had enlarged neck nodes on USG, and 5 of 10 small cell lung carcinoma patients. The mean diameter of the neck nodes was 9.8 mm (range, 7-12 mm). US-FNA of 14 non-small cell lung cancer patients revealed tumor cells in eight patients (57.1%). In 5 small cell lung cancer pateints, tumor cells were found in all cases. By the result of US-FNA, the clinical stage of 8 out of 36 (22.2%) non-small cell lung cancer patients had changed, including two cases of shift from the operable IIIa to the inoperable IIIb. In small cell lung cancer patients their clinical stage was not changed after US-FNA, but their pathological diagnosis was easily done in two cases, in whom endobronchial lesions were not found on bronchoscopy. Conclusions : USG and US-FNA of neck node seem to be safe, sensitive and cost-effective diagnostic tools in the evaluation of lung cancer patients without palpable neck nodes.

AAPM/RSNA physics tutorial for residents: topics in US: Doppler US techniques: concepts of blood flow detection and flow dynamics.

Techniques of Doppler ultrasonography (US) have been available to clinicians for nearly 40 years. The Doppler effect as developed by sound propagation in human tissues and with the velocities observed for the human vasculature produces shifts in the frequencies of returning echo signals. These signals can be processed in a manner that allows the observer to determine the condition of the blood flow. The instrumentation for Doppler US has evolved to accommodate the expanding clinical use of US. Each development (eg, pulsed-wave Doppler US, color flow imaging) has been motivated by a desire to provide more clinical information about flow in the body. The algorithms used are complex, but increasingly powerful microelectronics have made these methods a reality at a reasonable cost. Users of Doppler US techniques must be aware of the complicated aspects of flow in the body, especially with regard to detection of disease in the human vasculature. The continuing development of US equipment aims to provide a greater understanding of hemodynamics and the relationship between blood flow and various disease processes.

Intrauterine effects of ultrasound: animal studies.

During the past several decades, the use of ultrasound technology in the clinical setting has greatly increased. Because nearly every pregnant woman receives at least one sonographic procedure today, there has been developing concern about the safety of such procedures. Since ultrasound exposure can result in hyperthermia and other physiological effects, the determination of a threshold or no-effect exposure has become a high-priority goal. Animal research has been important to the study of the effects of various exposures at all stages of pregnancy, since the clinical use of ultrasonography can occur during the preimplantation, organogenic, and fetal stages. Animal experiments using various mammalian species have been able to determine no-effect exposure levels for embryonic loss, congenital malformations and neurobehavioral effects. The preponderance of evidence from these studies indicates that, in the absence of a thermal effect, ultrasonography represents no measurable risk when used at recommended intensity levels.

Ultrasonog raphic Findings of Esophageal Varices

Purpose : To demonstrate the clinical usefulness of ultrasonography for detecting esophageal varices.Materials and Methods : In 20 cases of esophaged varix, the authors analysed the transabdominal ultrasono-graphicfindings of the esophagogastric junction and compared mural thickness, the anteroposterior diameter of theesophagus, and the echogenic nature of the esophageal mucosal layer with those of 78 normal patients. Results :The anterior and posterior mural thickeness of normal esophagus was re-spectively, butfor variceal esophagus, the corresponding readings were respective-ly. Theanteroposterior diameter of normal esophagus was and that of variceal esophagus was .There was a stastically significant difference (p

Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears

In this study we assessed the clinical usefulness of ultrasonography as a modality in the diagnosis of rota tor cuff tears. One hundred twenty patients with pre operative ultrasonography were analyzed by diagnostic arthroscopy to evaluate rotator cuff integrity. Two groups, 61 patients with a positive ultrasonogram and 59 patients with a negative ultrasonogram, were ana lyzed. The 61 patients with a positive ultrasonogram preoperatively were found to have 42 full-thickness tears and 19 partial-thickness tears. Diagnostic arthros copy confirmed a sensitivity of 95% for the full-thick ness tears and 41 % for the partial-thickness tears. In the 59 patients with negative ultrasonography, the specificity for full-thickness tears was 93% and in the 19 partial-thickness tears it was 91 %. Our conclusion is that ultrasonography is an effective modality for the assessment of full-thickness tears, but not partial-thick ness tears.

Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears

In this study we assessed the clinical usefulness of ultrasonography as a modality in the diagnosis of rotator cuff tears. One hundred twenty patients with preoperative ultrasonography were analyzed by diagnostic arthroscopy to evaluate rotator cuff integrity. Two groups, 61 patients with a positive ultrasonogram and 59 patients with a negative ultrasonogram, were analyzed. The 61 patients with a positive ultrasonogram preoperatively were found to have 42 full-thickness tears and 19 partial-thickness tears. Diagnostic arthroscopy confirmed a sensitivity of 95% for the full-thickness tears and 41% for the partial-thickness tears. In the 59 patients with negative ultrasonography, the specificity for full-thickness tears was 93% and in the 19 partial-thickness tears it was 91%. Our conclusion is that ultrasonography is an effective modality for the assessment of full-thickness tears, but not partial-thickness tears.

Thyroid ultrasonography related to clinical and laboratory findings in patients with silent thyroiditis.

We summarized the clinical course of 10 patients with silent thyroiditis and evaluated the clinical usefulness of ultrasonography, in combination with clinical and laboratory findings, for the differentiation from Graves' disease. Serum T3 and T4 were increased in all cases, and the ratio of T3/T4 (ng/micrograms) was 17.8 +/- 3.6 (SD). But in 3 of 10 patients the ratio was greater that 20. TSH receptor antibody (TRAb) and thyroid stimulating antibody (TSAb) were negative in all cases. The estimated thyroid volume by ultrasonography was 18.4 +/- 5.5 ml, which was slightly increased but significantly lower than those in Graves' disease (p less than 0.05). The internal texture of the thyroid showed a decreased echogenicity with a mean echo level of 70.4 +/- 15.4. There was a weak positive correlation between the echo level at the onset of thyrotoxicosis and the lowest T3 level during the clinical course (p less than 0.05). It is suggested that ultrasonography gives a useful information to the diagnosis and outcome of patients with silent thyroiditis.