Echogenic Pattern Research Articles

NEUTROSOPHIC TEXTURE-REGION DIFFERENCE-BASED FUZZY c-MEANS CLUSTERING OF ULTRASOUND TUMOR IMAGES

Owing to its cost effective and non-ionizing procedure, ultrasound imaging has become a primary tool for detection and diagnosis of breast tumors compared to mammography or biopsy. But the precise interpretation of the images obtained is limited due to the intensity inhomogeneties, speckle noise, low contrast, etc. present in the observed images. Also, tumors can appear in different echogenic patterns including visually challenging to detect isoechoic and slightly hypoechoic tumors, and distinguishing the tumor by means of intensity variations only will not suffice. Therefore it is important to preprocess the image to remove unwanted noise and variations, and thereby provide adequate enhancement to highlight the region of interest. In this paper, a segmentation method is proposed where the query images are clustered using fuzzy c-means clustering (FCM) after neutrosophic filtering and enhancement followed by extraction of textural and edge features through the use of Gabor and compass filters. In this work, Prewitt compass filters were implemented to capture the maximum region difference between the tumor and background. By using filters of different orientations, sufficient texture and edge information were able to be captured by using the combination of Gabor and compass filters, which can then aid in the accurate detection of isoechoic and hypoechoic tumors. The neutrosophic preprocessing implemented in this work models the ultrasound noise as combination of Gaussian and Rayleigh distributions, and shows better signal-to-noise ratio than traditionally modeling speckle as Gaussian alone. The proposed method gave an increase of 42.25%, 40.15%, 81.32% and 50.15% and a decrease of 95.83% compared to standard Otsu thresholding, an increase of 23.34%, 19.57%, 24.53% and 24.71% and a decrease of 91.81% compared to simple FCM and an increase of 37.89%, 44.64%, 35.86% and 48.11% and a decrease of 93.68% compared to active contour segmentation in structural similarity index, Jaccard index, Dice coefficient and accuracy and mean square error, respectively. On contrasting with recent learning-based methodologies for tumor segmentation, the proposed method gave comparable accuracy without the need for large training database and expensive graphical processing unit (GPU) computing capabilities.

B-Mode and Doppler Ultrasonography in a Murine Model of Ehrlich Solid Carcinoma With Different Growth Patterns.

Ehrlich solid carcinoma (ESC) is one of the tumor models used in cancer research. Although it is widely used, it has no ultrasonographic descriptions. In this study, serial B-mode and Doppler ultrasonographic examinations were performed for 23 days for ESCs inoculated into 18 Swiss albino mice. The growth patterns were analyzed, and on the basis of their growth curve, the tumors were classified into two groups: fast growth (FG) and slow growth (SG). Ultrasonographic characteristics of the tumor’s capsule, margins, echogenicity, echotexture, vascular index (VI), distribution of vascular flow, and Doppler indices such as the resistive index, pulsatility index, and peak systolic velocity (SV) were analyzed and compared between the two groups. A high VI and earlier blood flow were noted in the FG group (p<0.05). Additionally, SV was higher in the FG group than in the SG group (13.28 ± 0.38 cm/s vs. 8.43 ± 0.26 cm/s). In contrast, a change in echogenicity and flow distribution patterns were observed, especially in FG tumors. Therefore, ESC presented with few ultrasonographic differences between FG and SG tumors, especially vascularization during the initial stages of tumor growth.

Ultrasound imaging evaluation of structural and textural features in asymptomatic achilles tendons in pre-professional dancers: A cross-sectional study

ObjectiveTo evaluate performance descriptors, sociodemographics variables and tendon echogenicity of asymptomatic Achilles tendons and to compare the echotexture from different classification subgroups. DesignA prospective, randomized cross-sectional study was carried out.Setting: laboratory of university. ParticipantsForty-two Achilles tendons (AT) were recruited from pre-professional dancers. Based on the echogenicity pattern, the sample was divided into two groups (n = 21, Heterogeneous group; n = 21, Homogeneous group). Main outocome measuresUltrasound images and ImageJ measurements were performed to evaluate thickness (AT-TH), echointensity (EI) and echovariation (EV), in addition to a balance and endurance test were measured as performance parameter. ResultsEI (p = 0.001) and EV (p = 0.001) reported statistically significant differences between groups. AT-TH, endurance test, balance test, years of dance, training hours per week and average pointe hours per week did not showed differences between groups. A multivariate prediction model between groups and the echotexture variables (EI (R2 = 0.569; EV (R2 = 0.341)) were determined. ConclusionAsymptomatic AT of heterogeneous group showed a lower EI and a higher EV compared to homogeneous group. Tendon echogenicity did not interact with performance variables.

Abstract No. 475 Radiologic-pathologic correlation of the echogenic patterns of hepatic lesions undergoing ultrasound-guided biopsy

To examine sonographic radiologic-pathologic correlation of primary and metastatic liver tumors. This may aid the interventional and diagnostic radiologist in procedural guidance and lesion characterization. Between 2010 and 2018, 913 ultrasound-guided biopsies of liver masses were performed at our institution. The echogenicity of a random sampling of 577 of these lesions (mean patient age, 61.5 years; 53% male) were reviewed from the procedural sonographic images of the biopsied lesions and correlated to the biopsy pathology diagnosis. Lesion echogenicity was characterized in reference to the hepatic background parenchyma as either hypoechoic, hyperechoic, or iso/hyperechoic with hypoechoic halo, or isoechoic. This was recorded from biopsy procedural dictation or jointly reviewed by a senior/junior radiology resident. Radiologic-pathologic correlation was confirmed with 2-year follow-up for benign results and repeat imaging/biopsy to amend false negative results. Upon final radiologic-pathologic correlation, 89% (510 of 572, reported in Table 1) were true positive for malignancy, 8% true negative (46) and 3% (16) false negative. Primary tumor class was associated with tumor echogenicity (Table 1). Melanoma, lymphoma and breast cancer were most associated with hypoechoic pattern and neuroendocrine tumors, gastrointestinal adenocarcinomas and hepatocellular carcinoma more associated with hyperechoic pattern (Table 1, P = 0.0002). Smaller lesion size was associated with hypoechoic compared to hyperechoic lesions (Table 1, P = 0.001). 69% of lesions less than 3 cm diameter (140/204) were hypoechoic compared to 50% if larger (162/322) (P <0.001). Histologic tumor differentiation was reported on a subset of cases with hypoechogenicity associated with tumor de-differentiation (P = 0.01) Tumor echogenicity immediately prior to biopsy was associated with the type of primary or metastatic hepatic tumor, tumor size and histologic differentiation. This small pilot study may guide the interventional radiologist in performing a biopsy and expected pathologic results.Table 1Malignant lesionsHypoechoic %(n)Hyperechoic %(n)Hypoechoic halo %(n)Isoechoic %(n)P valueN57% (302)29% (152)10% (50)4% (22)Tumor PrimaryMelanoma82% (31)5% (2)11% (3)4% (1).0002Lymphoma82% (18)9% (2)9% (2)0Breast77% (26)15% (5)6% (2)3% (1)Pancreatic adenocarcinoma70% (56)16% (13)6% (5)8% (6)cholangiocarcinoma66% (21)22% (7)6% (2)6% (2)Genitourinary59% (13)32% (7)5% (1)5% (1)Carcinoma of unknown primary55% (28)28% (14)12% (6)6% (3)Lung54% (14)31% (8)12% (3)4% (1)Hepatocellular carcinoma50% (38)40% (30)11% (8)0Other tumors50% (10)30% (6)12% (3)4% (1)Gastrointestinal carcinoma39% (31)44% (35)14% (11)3% (2)Neuroendocrine35% (16)50% (23)9% (4)7% (3)Biopsied lesion sizelesion size (cm)3.7, SD 2.14.5, SD 2.84.4, SD 1.94.7, SD 2.4.001Tumor histologic differentiationWell37% (18)51% (25)8% (4)4% (2).01Moderate52% (44)30% (25)14% (12)4% (3)Poorly63% (113)24% (44)8% (15)4% (8) Open table in a new tab

Image Diagnosis in Extensor Tendons Injuries in the Radiocarpal Region in Horses

Background: Soft tissue injuries are common in sport horses, especially those involving tendons, with few current reports in the literature on the diagnosis of extensor injuries, especially with regard to ultrasound characteristics, being essential for the diagnosis of these injuries. The objective of the study is to characterize the clinical signs and the alterations of images, especially ultrasound, in the diagnosis of these lesions of the dorsal radiocarpal region, through case reports of horses seen at the Medical Clinic of Large Animals of the Federal University of Campina Grande (MCLA/UFCG), Patos-PB, Brazil.Cases: The study includes five “vaquejada” competitions horses, of which two were active and the others were away from the sport before the onset of the problem, with injuries to the extensor tendons in the radiocarpal region. Two of the animals had involvement of the common digital extensor muscle tendon (CDEMT), with acute and chronic tenosynovitis, and three with involvement of the extensor carpi radialis muscle tendon (ECRMT), presenting acute tendonitis, septic tenosynovitis and rupture, all of traumatic etiology, except for one whose cause has not been determined. On physical examination, the affected tendon was noticeable in three cases, and two had other injuries associated with the tendons. Bone alteration in the radiographic examination was observed in two cases, however, one of them related to another disease in the radiocarpal palmar region. Ultrasound images, performed in all cases, showed different characteristics and degrees of the involvement of the tendon and its sheath.Discussion: The scarcity of current reports of extensor tendon injuries in horses can be attributed to the fact that they do not suffer as much overload or effect from biomechanics compared to flexor tendons, in addition to being an area of little soft tissue covering these tendons. Although the involvement of the extensor tendons is more frequent in the pelvic limbs, due to lacerations, the occurrence of lesions in the dorsal radiocarpal region may be related to excess flexion, being easily susceptible to trauma to solid objects. The specific clinical examination, associated with a well-explored anamnesis, can allow us to locate the lesion and achieve a presumptive diagnosis. In three cases, tendon injuries were noticeable on inspection and palpation, important points to guide the diagnosis. However, in two cases with associated injuries this perception became difficult. Regardless of the clinical diagnosis, imaging diagnosis in lesions of the locomotor system was essential, as it allowed us to assess bone involvement, accurately determine the location of the lesion, its extent and prognosis, which would not be possible only in the clinic. Through ultrasonography it was possible to classify the lesions into acute (hypoechoic areas) and chronic (hyperechoic areas or with heterogeneous pattern of variable echogenicity), in addition to the thickness and characteristic of the liquid in the tendon sheath, which are also important aspects for lesion classification. Thus, we conclude that the dorsal region at the carpal level is susceptible to trauma and can easily compromise the extensor tendons. And for the diagnosis and adequate conduct, it is necessary to determine ultrasound image regarding the different types of lesions, which is provided in the present study.

Long-Term Follow-Up Ultrasonographic Findings of Intrathyroidal Thymus in Children.

ObjectiveTo analyze long-term follow-up sonographic findings of intrathyroidal thymus in children.Materials and MethodsAmong 1259 patients with congenital hypothyroidism under 15 years of age who underwent thyroid ultrasonography (US), 41 patients were diagnosed with an intrathyroidal thymus based on US criteria, i.e., hypoechoic solid lesion with punctate and linear echogenicity. In 26 patients aged one to 14 years old, the last follow-up US was performed after 6 to 132 months and compared with the initial US. The lesion was considered to decrease in size if there was a change of more than 2 mm in any dimension. The margin change was divided into well-defined and indistinct, blurred. When the echogenicity changed to a hyperechoic from a characteristic thymic echogenicity pattern, the pattern was considered a hyperechogenic. The changes in size were compared with the changes in shape, margin, and echogenicity pattern. The changes in size, shape, margin, and echogenicity were analyzed the association with the age of last follow-up. Statistical analysis was conducted using the chi-squared test and logistic regression.ResultsFifteen (57.7%) cases were stable in size, and 11 (42.3%) decreased in size, including one that disappeared. Ten (38.5%) cases changed to indistinct margins from initially well-defined margins including one case of initially indistinct margin. Six (23.1%) changed to hyperechogenic, from initially characteristic thymic echogenicity patterns. When follow-up change was compared, decreases in size were significantly associated with lesion changes to indistinct margins (p = 0.004). The age at last follow-up was significantly associated with change to hyperechogenicity (odd ratio, 2.141; 95% confidence interval, 1.144–4.010, p = 0.017).ConclusionOn follow-up US, an intrathyroidal thymus may be decreased in size, with indistinct margins, or show changes to a hyperechoic mass. Decreases in size may be associated with changing to indistinct margins, and changes to hyperechogenicity may be associated with increasing age.

Ultrasonographic, macroscopic and histological characterization of the proximal insertion of the suspensory ligament in Crioulo horses

ABSTRACT: Although ultrasound (US) is a routine diagnostic modality, it still presents limitations for the diagnosis of lesions such as those in the proximal insertion of the suspensory ligament (PISL) because of its composition, which includes muscle fibers and adipose tissue interspersed with the ligament fibers. The objective of the present study was to describe the ultrasonographic, macroscopic and histological aspects of the PISL of thoracic limbs (TL) and pelvic limbs (PL) in Crioulo horses (CH). We selected 34 specimens of TL (right and left) and 10 specimens of PL of horses with a mean age of 5.7 years, from a private clinic or sent to the Department of Veterinary Pathology of UFSM, which died from different causes. The animals had no previous history of lameness in selected limbs associated with PISL injuries. The 34 specimens of PISL of TL were divided into CH (n=25) and Thoroughbred horses (TBH) (n=9), which composed the control group, and 11 specimens of PISL of PL were divided into CH (n=8) and TBH (n=3), which also served as control. The US examination was performed in the PISL using a Sonosite Edge device, 5-10 MHz linear transducer, with cross-sectional and longitudinal palmaromedial and palmarolateral images of the proximal surface of metacarpus III, II and IV (MCIII/MCII/MCIV). In PL, the evaluation was performed four centimeters below the chestnut in the plantaromedial aspect of metatarsus III and II (MTIII/MTII). PISL lobulated shape and size were compared with those of the contralateral limb, as well as the regularity of the palmar bone surface of MC III, II and IV. Subsequently, dissection of the PISL lobes was performed, as well as its macroscopic evaluation, which preceded the histological processing of the samples. In specimens of the CH breed, PISL showed echogenicity varying from peripheral dorsal hyperechogenic zones that merge into echogenic and hypoechogenic zones, where lobulation occurs. In the samples from the TBH group, PISL was also lobulated, but with differences in the echogenicity pattern such as diffuse hypoechogenicity and echogenicity. Macroscopically, CH samples presented a large amount of adipose tissue that corresponds to the dorsal peripheral zone of PISL, which ends in the connective tissue that delimits the ligamentous lobes. On a macroscopic cross-section of PISL, muscle fibers in red are mixed with white ligament fibers in the center of the ligament. This macroscopic finding was not observed in TBH samples, in which muscle fibers overlap ligament fibers throughout the ligament extension and a small amount of fat is present in the dorsal periphery of the ligament. PISL of PL had a triangular shape with echogenicity characteristics very similar to those observed in TL. In ultrasonographic, macroscopic and histological evaluation, PISL samples of TL and PL in CH showed a larger amount of peripheral dorsal adipose tissue, as well as a larger number of merged ligament and muscle fibers compared with those in TBH.

US and MRI findings of Synovial Lipoma Arborescens of the hip: a case report

Lipoma arborescens is a rare intra-articular lesion consisting of villous lipomatous proliferation of the synovium that tends to occur in the knee joint, especially in the suprapatellar pouch. The lesion has been observed in other locations, including the glenohumeral joint, subdeltoid bursa, hip, and elbow. We report a case of a lipoma arborescens of a unilateral hip joint in a 62-year-old man. Ultrasonography and MRI were performed. In addition, a surgical synovectomy was performed and microscopic examination of the tumor revealed multiple variable-sized villous masses composed of mature fat tissue and lined by synovial cells which confirmed the diagnosis of lipoma arborescens. Synovial lipoma arborescens is a rare disorder of unknown etiology and is characterized by a villolipomatous proliferation of the synovial tissue. However, its association with chronic inflammatory disease such as a rheumatoid arthritis, degenerative lesions, or trauma is frequently reported. This case of lipoma arborescens was diagnosed by ultrasonography because MRI showed no difference between synovial osteochondromatosis and lipoma arborescens. On MRI, the signal of the lesion was similar to that of fat on T1-weighted, T2-weighted, and fat saturated images. The differential diagnosis includes intra-articular lipoma, synoval hemangioma, and synovial osetochondroma. On ultrasonography, the villous fatty projections of lipoma arborescens typically display echogenic pattern, similar to that of adjacent subcutaneous fat, and may undulate in real time within the surrounding effusion. The mass is usually soft in consistency and compressible.

ULTRASOUND STUDY OF PATIENTS WITH KELOID SCARS OF THE MAXILLOFACIAL AREA

Despite the possibility of modern surgery and dermatological cosmetology, the problem of differential diagnosis of patients with keloid scars remains relevant and significant at present. As clinical practice shows, not just the presents and the size of functional or aesthetic defect in scar tissue changes are important, but also the degree of their negative influence on the process of physical, psychological and social adaptation of the patient. The aim of our study was to optimize and improve the effectiveness of treatment of facial keloid scarring by identifying the type of scarred skin of the head and neck, and using ultrasound examination. The ultrasound method of investigation was performed on 50 patients with keloid scars of the head and neck. Clinical study of the general characteristics of the scar was supplemented by an additional analysis of the structural features of the cicatricial tissues by ultrasound examination. For the purpose of comparison, intact skin was used. Analysis of ultrasonography allowed to determine the color echogenic pattern of keloid scars, which differed substantially from the dermis of intact skin. Among the echogenic signs of postoperative keloid scarring, one should point out an increase in the depth of cicatrix of the tissue in comparison with the thickness of the intact derma, an average of 8-11%, an average thickness of the epidermis is 18-26%, a clear boundary between intact skin and keloid scar is traced, which is a clear differential sign of this type of scar. Only in 7% of cases, we have visualized the border with the hypodermis in the peripheral edges of the scar, which indicates the infiltration character of the growth of the keloid and again proves its similarity with the tumor. Today, there is no universal method for differential diagnosis of various types of scars of the head and neck. Therefore, it is necessary to develop an informative and economically expedient method of diagnostics. Ultrasonography of scarring is a non-invasive survey method that can objectively, informatively and safely evaluate numerous anatomical structures, determine the type and depth of scar formation.

Ultrasonography guidance for total splenectomy in donkeys

There are varieties of surgical approaches reported for equine splenectomy and all of them were dealing with the most reachable situation of splenic hilus and easy handling of the spleen. The aim of this work was to establish the normal ultrasound parameters of spleen in donkeys (normal echogenicity, hilus situation, topographic location and correlation with neighboring organs) as a guide to select the best approach for total splenectomy in donkeys. Splenic ultrasound was carried out on six normal donkeys before experimental total splenectomy in the standing position. The splenic topographic location was recorded among 4 rows including 30 squares. These animals were divided into two groups according to the surgical approach of total splenectomy. Total splenectomy after left 16th and 17th ribs partial resection in standing position was carried out in group1 and group 2, respectively. Ultrasonographically, the spleen had homogenously echogenic pattern and appeared hyperechoic to the liver. Only one third of the spleen was located in front of the 16th rib where the hilus and splenic blood vessels were nearly under the 16th rib. The splenic artery and splenic vein were ultrasonographically visualized between the left 16th and 17th ribs 10–15 cm from dorsal midline. This area was the site of the important ligation during total splenectomy. In conclusion, ultrasonography guidance for total splenectomy in donkeys assisted the surgical findings and proved that technique following partial resection of the 17th rib at the standing position is the most convenient surgical approach for total splenectomy in donkeys.

Development and validation of an ultrasound-based nomogram to improve the diagnostic accuracy for malignant thyroid nodules.

The aim of this study was to develop an ultrasound-based nomogram to improve the diagnostic accuracy of the identification of malignant thyroid nodules. A total of 1675 histologically proven thyroid nodules (1169 benign, 506 malignant) were included in this study. The nodules were grouped into the training dataset (n = 700), internal validation dataset (n = 479), or external validation dataset (n = 496). The grayscale ultrasound features included the nodule size, shape, aspect ratio, echogenicity, margins, and calcification pattern. We applied least absolute shrinkage and selection operator (lasso) regression to select the strongest features for the nomogram. Nomogram discrimination (area under the receiver operating characteristic curve, AUC) and calibration were assessed. The nomogram was subjected to bootstrapping validation (1000 bootstrap resamples) to calculate a mean AUC and 95% confidence interval (CI). The nomogram showed good discrimination in the training dataset, with an AUC of 0.936 (95% CI: 0.918-0.953) and good calibration. Application of the nomogram to the internal validation dataset also resulted in good discrimination (AUC: 0.935; 95% CI, 0.915-0.954) and good calibration. The model tested in an external validation dataset demonstrated a lower AUC of 0.782 (95% CI: 0.776-0.789). This ultrasound-based nomogram can be used to quantify the probability of malignant thyroid nodules. • Ultrasound examination is helpful in the differential diagnosis of malignant and benign thyroid nodules. • However, ultrasound accuracy relies heavily on examiner experience. • A less subjective diagnostic model is desired, and the developed nomogram for thyroid nodules showed good discrimination and good calibration.

Abdominal B-mode and Doppler ultrasonography of chemically restrained agouti (Dasyprocta prymnolopha Wagler, 1831)

ABSTRACT: Agoutis are small-sized wild animals whose body weight can reach up to 4kg, and are found throughout Brazil. They are considered important seed dispersers, especially for big trees and there are species that rely almost exclusively on these animals for their territorial distribution. The objective of the present study was B scan and Doppler ultrasound characterization of the abdominal organs of healthy agoutis reared in captivity. Fifteen agoutis, chemically restrained, were used from the Nucleus for Wild Animal Studies and Conservation (Núcleo de Estudos e Preservação de Animais Silvestres - NEPAS), CCA-UFPI, submitted to B scan and Doppler ultrasound examination. The urinary bladder wall was hyperechogenic, thin, smooth and regular throughout its anatomic path, with 0.09±0.03cm mean thickness. The kidneys showed fine and homogeneous echotexture, preserved global echogenicity, hyperechogenic in relation to the spleen and isoechogenic or discreetly hyperechogenic in relation to the liver. The spectral Doppler trace showed systolic and diastolic peaks, wide and thread-like, with low flow resistance and a continuous and full diastolic portion that decreased gradually during the diastole (75.83±1.42cm/s, for the right kidney and 80.43±1.22cm/s, for the left kidney). The right adrenal gland was 0.61-1.18cm long and 0.17-0.32cm in diameter, while the left adrenal gland was 0.62-1.16 long with 0.14-0.25cm diameter. The agouti spleen was filiform in shape, with pointed poles and 1.02±0.18cm in diameter. The agouti liver occupied all the abdominal cavity cranial space in direct contact with the diaphragm. The intrahepatic vascular flow allowed individualization of the portal vein (PV) and hepatic vein (HV). The portal veins were distinguished from the hepatic veins mainly by their wall echogenic pattern. The pancreas was 0.51±0.1 cm thick and the pancreatic duct measured 0.12±0.02cm. The stomach was placed to the left the spleen and to the right of the proximal intestine and the transversal colon and the walls were 0.16±0.05cm thick. The abdominal aorta was 0.43±0.04cm in diameter and showed 95.2±2.16cm/s vascular flow. This study characterized agouti organs and abdominal blood vessels by B scan and Doppler ultrasound, that permitted definition of the size, shape, position, echogenicity and echotexture of the anatomic constituents and established reference values for the vascular network and blood flow in the species.

Musculoskeletal ultrasound for intra‐articular bleed detection: a highly sensitive imaging modality compared with conventional magnetic resonance imaging

Background There is increasing demand for musculoskeletal ultrasound (MSKUS) to detect hemophilic joint bleeding, but there is uncertainty regarding blood detection concentration thresholds or if magnetic resonance imaging (MRI) is more accurate. Aims Compare the sensitivity of blood detection by MSKUS and MRI. Methods Increasing blood concentrations in plasma were imaged with MSKUS and MRI 1-2h, 3-4days and 7days after blood withdrawal invitro, and after injection into cadaveric pig joints. Additionally, effusions in the joints of two patients with hemophilia joints were imaged, followed by aspiration. MSKUS was performed using an 8-18-MHz linear transducer; MRI was performed at 3T using T1-weighted and T2-weighted fat-suppressed sequences. Images were reviewed by a hematologist certified in MSKUS and a musculoskeletal radiologist. Results MSKUS permitted the detection of blood invitro and in pig joint spaces at concentrations as low as 5%, demonstrated by the presence of echogenic signals that were absent with plasma alone. In contrast, no differences between fluids were discernible on the T1-weighted or T2-weighted MRI images. Results were confirmed in the two patients with hemophilia. Blood clots demonstrated varying and dynamic echogenicity patterns over time and, using MRI, were visualized best with T2 sequences. Conclusion MSKUS is extremely sensitive in detecting low concentrations of intra-articular blood and in discriminating between bloody and non-bloody fluid, whereas conventional MRI is not. These observations demonstrate the advantages of MSKUS over MRI in detecting intra-articular blood, and show that MSKUS is ideal for rapid bleed detection in the clinic.

Ultrasonographic-based predictive factors influencing successful return to racing after superficial digital flexor tendon injuries in flat racehorses: A retrospective cohort study in 469 Thoroughbred racehorses in Hong Kong.

SummaryBackgroundSuperficial digital flexor tendon (SDFT) injury is an important health and welfare concern in racehorses. It is generally diagnosed with ultrasonography, but predictive ultrasonographic features have not been reported.ObjectivesTo determine ultrasonographic features of forelimb SDFT injury at initial presentation in Thoroughbred racehorses that could predict a successful return to racing (completing ≥5 races).Study designRetrospective cohort study.MethodsDigitised ultrasonographic images of 469 horses with forelimb SDFT injuries from the Hong Kong Jockey Club (2003–2014) were evaluated, using a previously validated ultrasonographic scoring system. Six ultrasonographic parameters were evaluated (type and extent of the injury, location, echogenicity, cross‐sectional area and longitudinal fibre pattern of the maximal injury zone [MIZ]), as well as horse signalment, retirement date and number of races before and after injury. Data were analysed by generalised linear regression with significance at P<0.05.ResultsCases were divided into two groups: 1) For cases of SDFT tendonitis with core lesions, cross‐sectional area at the MIZ was the most significant factor determining a successful return to racing (P = 0.03). If the lesion was <50% of the total cross‐sectional area, horses had 29–35% probability of successfully racing again, but if it was ≥50% this decreased to 11–16%. 2) For cases of SDFT tendonitis without a core lesion, longitudinal fibre pattern at the MIZ best predicted a successful return to racing (P = 0.002); if the affected longitudinal fibre pattern was <75% of the total, horses had 49–99% probability of successfully return to racing, but if it was ≥75% this decreased to 14%.Main limitationsPrognostic information may not be applicable to other breeds/disciplines.ConclusionsThis is the first study to describe ultrasonographic features of forelimb SDFT injuries at initial presentation that were predictive of successful return to racing. The outcomes will assist with early, evidence‐based decisions on prognosis in Thoroughbred racehorses.

Does Pretrigger Echogenic Endometrium in Assisted Reproductive Technology Cycles Reflect Raised Serum Progesterone Level?

Background:Serum progesterone is the main hormone of the luteal phase. The hyperechoic pattern of the endometrium in the luteal phase is believed to be induced by raised serum progesterone. Serum progesterone is found to be raised cases of controlled ovarian stimulation (COS) cycle on the day of ovulation trigger.Aim:This study aims to find the association between echogenicity of endometrium and raised serum progesteroneObjective:The objective of this study is to determine whether raised pretrigger serum progesterone influences the echogenicity of the endometriumMaterials and Methods:In this prospective observational study, we evaluated 221 patients who underwent COS. Echogenic patterns of the endometrium on transvaginal sonography were described as hypoechoic/trilaminar endometrium (Type A), isoechoic (Type B), and hyperechoic (Type C). The endometrial pattern and serum progesterone levels were evaluated on the day of ovulation trigger and value of ≥1 ng/ml was considered as elevated.Results:A total of 168 patients out of 221 patients (76.01%) had elevated serum progesterone levels on the day of ovulation trigger. Type A endometrium was found in a total of 174 patients, of these 132 patients (75.86%) had raised serum progesterone. Type B endometrium was found in 35 patients, of these 27 patients (77.14%) had raised serum progesterone. Type C endometrium was seen in 12 patients, out of these 9 patients (75.00%) had raised serum progesterone level. There was no statistically significant difference in the echogenic patterns of endometrium in patients with raised progesterone (≥1 ng/ml). On intergroup comparison, the difference in the progesterone levels between type A and type C was statistically significant (P = 0.02), and on receiver operating characteristic curve analysis, echogenic endometrium was found to predict progesterone level of 1.57 ng/ml with a sensitivity of 58.3% and specificity of 58.4% only.Conclusion:Echogenicity of the endometrium does not reliably predict raised serum progesterone on the day of ovulation trigger.

Ultrasonography Appearance of the Equine Proximal Palmar Metacarpal Region After Local Anesthetic Infiltration

Suspensory ligament (SL) disease is a common source of lameness in the horse. Once injury of the proximal SL is suspected, based on the clinical examination and response to analgesia, diagnostic imaging of the region is often performed. The aim was to describe the presence of ultrasonographic artifacts in the palmar metacarpal area after 20 minutes and at 24 hours after infiltration of local anesthetic solution using the lateral approach. In the present study, SL and other proximal palmar metacarpal structures were ultrasonographically evaluated before and after perineural injection of mepivacaine 2% in eight forelimbs of four horses. The limbs were divided into two groups: group 1: needle not filled with anesthetic (right forelimbs); group 2: needle filled with anesthetic (left forelimbs). The ultrasonographic examination of the palmar metacarpal structures was performed after 20 minutes and at 24 hours after injection to evaluate qualitative postinjection changes and to perform measures. In the present study, there were no significant differences in the SL and other palmar metacarpal structures between baseline measurement and pattern and postinjection measurements. No changes in echogenicity or fiber pattern of the tendons and ligaments were found. Alterations consistent with gas echoes were detected in one limb in group 1 at 20 minutes after injection, whereas no gas patterns were visualized at 24 hours. Gas or fluid artifacts, due to local anesthetic infiltration, may be present. This suggests that diagnostic ultrasonography of the origin of the SL should be interpreted with caution if performed within 24 hours after diagnostic analgesia.

Ultrasonographic scoring system for superficial digital flexor tendon injuries in horses: intra- and inter-rater variability

Superficial digital flexor tendon (SDFT) tendinopathy is an important musculoskeletal problem in horses. The study objective was to validate an ultrasonographic scoring system for SDFT injuries. Ultrasonographic images from 14...

The use of ultrasonography in the reproductive evaluation of boars.

The objective was to study the use of ultrasound as a complementary test in the breeding soundness evaluation in male pigs and study the pattern of echogenicity of the testicular parenchyma in boars of different racial groups. Twenty-six adult boars from four different racial groups were used, 10 from the Piau breed (group 1), four from the commercial and finishing group (group 2), six Pietrain breed (group 3) and six from the Duroc breed (group 4). All animals were evaluated for breeding soundness evaluation and the ultrasound examination of the testicles. The groups of animals that were evaluated showed no difference in the main semen parameters that were evaluated, except for the sperm volume, concentration of the ejaculated sperm and the supravital staining; the lowest figures were for the animals from the Piau breed (group 1). In relation to the testicular biometrics, Duroc animals (group 4) had a greater scrotal width compared to the other groups. But when we assessed the intensity of pixels of the testicles, there was a difference between groups. The groups 2 (finishing animals), 3 (Pietrain) and 4 had no difference between themselves. Group 3 had greater pixel intensity in relation to group 1. Of the 26 animals studied, five showed an abnormality during ultrasound evaluation, like hydrocele, hyperechoic mass in the testicular parenchyma, cyst in the head of the epididymis and the presence of fluid in the head and tail of the epididymis. The various animal groups studied did not differ in the principal reproductive parameters evaluated, showing that despite the great variability of reproductive traits between breeds and within the same breed, the breeding soundness evaluation, the more complete it is, is essential for the selection of breeders and the ultrasonography of the reproductive system becomes an important addition in this examination.

Does noninvasive follicular thyroid neoplasm with papillary-like nuclear features have distinctive features on sonography?

The noninvasive encapsulated follicular variant of papillary carcinoma (nEFVPTC) has recently been reclassified to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)," removing this entity from the malignant category. This re-categorization has had major implications for clinical management. NIFTP has overlapping cytohistologic features with papillary thyroid carcinoma (PTC) and with follicular adenomas (FA), but sonographic data comparing NIFTP to PTC and FA is lacking. Our study examines the sonographic features of NIFTP as compared with PTC and FA. Ultrasound scans and Doppler blood flow from subjects who had pre-surgical sonograms and fine needle aspiration biopsies with final surgical pathology diagnoses of NIFTP/nEFVPTC, classical PTC, and FA between 01/2013-08/2016 were assessed. Sonographic and Doppler features as well as Bethesda System (TBS) diagnoses were recorded and analyzed. 40 NIFTP, 58 classical PTC, and 23 FA cases were included. The most common NIFTP pre-surgical TBS cytology diagnosis was Atypia of Undetermined Significance (AUS/FLUS) (40%). NIFTP cases predominantly displayed wider-than-tall shape (100%), smooth borders (75%), occurrence in multinodular glands (82.5%), heterogeneous echogenicity (50%), both perinodular and intranodular Doppler flow patterns (70%), minimal Doppler flow grade (62.5%), and no calcifications (90%). Our study demonstrates that NIFTP, PTC, and FA display several distinguishing and overlapping sonographic and Doppler features. Sonographic features appear to complement cytology findings and may help raise pre-operative concern for NIFTP in the proper clinical setting, potentially leading to a more conservative management approach.

Comparison of sonographic characteristics of primary thyroid lymphoma and anaplastic thyroid carcinoma.

Although primary thyroid lymphoma (PTL) and anaplastic thyroid carcinoma (ATC) both account for a rare portion of the morbidity of all thyroid malignancies, the therapeutic methods and prognosis for these two diseases are different. The purpose of this study was to investigate the sonographic characteristics of PTL and ATC and to compare the sonographic findings of PTL and ATC. The study included 42 patients with histopathologically proven PTL (n=27) and ATC (n=15). The Clinical characteristics and sonographic findings were retrospectively reviewed and compared between the two groups. The mean age of patients with ATC was not significantly different from that in patients with PTL (P=0.601). The female-to-male ratio of patients with ATC was significantly lower than that of patients with PTL (P=0.029). Both PTL and ATC commonly present as a relatively large, solid mass on sonography with compressive symptoms, in which hoarseness was seen more frequently in ATC group (66.7%) than in PTL group (14.8%) (P=0.001). There is no significant difference in thyroid size, nodular size, margin, shape, echo texture, echogenicity, cystic change, vascularity and local invasion on sonography between ATC and PTL groups. Echogenic strands, markedly hypoechoic and enhanced posterior echo were seen more frequently in PTL group (92.6%, 92.6%, and 85.2%, respectively) than those in ATC group (6.7%, 60.0%, and 33.3%, respectively) (P<0.05), and calcification was seen more frequently in ATC group (80.0%) than in PTL group (0%) (P<0.001). Three ultrasound patterns were observed for PTL including diffuse type (25.9%), nodular type (48.2%) and mixed type (25.9%), while all ATC cases presented with nodular type (100.0%). Associated Hashimoto's thyroiditis occurred more frequently in PTL group (59.3%) than in ATC group (20.0%) (P=0.023). Certain sonographic features as a markedly hypoechogenicity, the presence of an enhanced posterior echo and linear echogenic strands, lack of calcification and associated Hashimoto's thyroiditis were valuable for distinguishing PTL from ATC. In contrast, heterogeneous echogenicity, uncircumscribed margin, irregular shape, and vascular pattern were not specific features for differential diagnosis.