Hyperechogenic Area Research Articles

Changes in the correlation between substantia nigra hyperechogenicity area and Parkinson's disease severity at different Hoehn and Yahr stages.

It is debatable whether the area of substantia nigra hyperechogenicity (SN+) in transcranial sonography (TCS) is related to Parkinson's disease (PD) severity. Iron deposition, which is associated with the formation of SN+, may have different effects on dopamine nerve function as PD progresses. However, little research has explored the association between the SN + area and disease severity of PD in stages. 612 PD patients with sufficient bone window were retrospectively included from a PD database, and disease severity was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) scores. Based on the Hoehn and Yahr (H-Y) scale, we classified the patients into seven groups (H-Y stage 1, 1.5, 2, 2.5, 3, 4, and 5) and then analyzed the correlations between the SN + area and the UPDRS scores separately. Our results indicated a U-shaped relationship between the initial-SN + area and disease severity in PD: In the H-Y stage 1 group, the initial-SN + area was negatively correlated with the UPDRS total score (r = - 0.456, p < 0.001) and UPDRS-III score (r = - 0.497, p < 0.001). No correlation was observed in the groups of H-Y stages 1.5, 2, and 2.5. In the groups of H-Y stage ≥ 3, the initial-SN + area was positively correlated with the UPDRS total score and UPDRS-III score, with strongest correlation in the H-Y stage 5 group (all p values < 0.05). Moreover, the larger SN + area and average SN + area showed a similar evolutionary trend of correlation with UPDRS total score and UPDRS-III score. Our study indicated a U-shaped correlation between the SN + area with the UPDRS total score and UPDRS-III score as H-Y stage progressed. The evolution of the correlation may reflect the evolution of underlying pathological mechanisms related to iron deposition in the substantia nigra.

Transcranial sonography of subcortical structures in tic/tourette disorder

Functional neuroimaging studies demonstrate disinhibition of the cortico-striatal-thalamo-cortical circuit. However, structural imaging studies revealed conflicting results, some suggesting smaller volumes of the caudate nucleus (CN) in children with Gilles de la Tourette syndrome (TS). Here we wanted to find out whether transcranial sonography (TCS) detects alterations of raphe nuclei, substantia nigra, lenticular nucleus (LN), or CN in children with Tic disorder or TS (TIC/TS).The study included 25 treatment-naive children (age: 12.2 ± 2.5 years) with a DSM-V based diagnosis of Tic disorder or TS (10 subjects), without other psychiatric or neurologic diagnosis, and 25 healthy controls (age: 12.17 ± 2.57 years), matched for age and sex. Parental rating of behavioral, emotional abnormalities, somatic complaints and social competencies of the participants were assessed using the Child Behavior Check List (CBCL/4-18R). TCS of deep brain structures was conducted through the preauricular acoustic bone windows using a 2.5-MHz phased-array ultrasound system.Fisher's exact test and Mann-Whitney-U test were used for comparisons between TIC/TS patients and healthy volunteers. The number of participants with hyperechogenic area of left CN in the TIC/TS sample was increased, compared to the healthy control group. TIC/TS patients with hyperechogenic CN showed an increased occurrence of thought- and obsessive-compulsive problems. This TCS study revealed pathologic structural changes in CN, its higher occurrence in TIC/TS compared to healthy controls and the relation to comorbidity of thought problems. Further research should focus on the molecular cause of these alterations, probably the disturbed iron metabolism.

A294 CHOLESTASIS SECONDARY TO XANTHOGRANULOMATOUS CHOLANGITIS: A CASE REPORT

Abstract Background An 86-year-old female presented with four weeks of intermittent abdominal pain, postprandial nausea with an associated 10 lbs weight loss. Initial labs demonstrated a predominantly cholestatic liver enzyme elevation. Imaging revealed a thickened gallbladder with dilated CBD up to 15mm with no calculi, obstruction or pancreatic mass. EUS demonstrated a prominent ampulla with an area of hyperechogenicity, and ERCP was completed with sphincterotomy and biopsy of the ampulla. A cholangiogram showed a prominent common bile duct and a smooth distal taper without filling defects. Tumor markers, ampullary biopsy, and cytology of CBD brushings were negative for malignancy. Repeat ERCP for non-resolving symptoms with an extension of the sphincterotomy, brushings and insertion of a metal stent was completed without improvement in liver enzymes and a standard hepatitis workup returned negative. Her clinical course was further complicated by recurrent gram-negative bacteremia with CT findings of innumerable abscesses or metastasis in the liver. A US-guided targeted liver biopsy revealed large duct periductal tissue expansion by foamy macrophages with admixed neutrophils, eosinophils, plasma cells, and lymphocytes. These features were consistent with xanthogranulomatous cholangitis. We were planning to start ursodiol given the small duct disease however the patient succumbed to recurrent bacteremia and passed away. Aims Review of methods to attain diagnosis of xanthogranulomatous cholangitis. Methods Case Report. Results Diagnosis of xanthogranulomatous cholangitis can be attained from targetted US-guided biopsy, surgical excision, or EUS-guided CBD biopsy. Conclusions Xanthogranulomatous cholangitis is an extremely rare entity described in limited case reports, frequently mimicking neoplastic disease. Pathology is difficult to attain and historically case reports required surgical resections. One recent case reported diagnosis confirmed via EUS-guided FNA of the CBD. In our case, we attained the diagnosis through a targeted liver biopsy. Pathology of xanthogranulomatous cholangitis typically demonstrates foamy histiocytes, lipid-laden macrophages, eosinophils, lymphocytes, plasma cells, and fibrosis indicating xathogranulomas. The pathogenesis is thought to be an extension of xanthogranulomatous cholecystitis in which bile is extravasated into the gallbladder wall through Rokitansky-Aschoff sinuses or ulceration of the mucosa resulting in an inflammation caused by fibroblasts and macrophages as they phagocytose the lipids in bile, resulting in the formation of xanthoma cells. Given the rarity of the disease, there is no guideline on management and a majority of patients reported underwent surgical excision. This case demonstrates the utility of liver biopsy to establish this rare diagnosis, allowing for better detection and subsequently better-studied management. Funding Agencies None

Calcified Sclero-Choroidal Choristomas in Mosaic RASopathies: A Description of a New Imaging Sign

PurposeTo evaluate the imaging and clinical features of unusual calcified lesions seen in the fundus of mosaic RASopathy patients. DesignSingle-center retrospective observational study. SubjectsTen eyes with calcified fundus lesions in 7 mosaic RASopathy patients. MethodsThe lesions were evaluated with fundus photography, oral fundus fluorescein angiography, B-scan ultrasonography, Magnetic Resonance Imaging (MRI), and Computed Tomography (CT) scan where available. Main Outcome MeasuresThe imaging characteristics of calcified fundus lesions were assessed. ResultsWe found seven patients with mosaic RASopathies, 5 males and 2 females (3 with Linear Sebaceous Nevus Syndrome, 3 with Oculoectodermal Syndrome, and 1 with Encephalocraniocutaneous Lipomatosis) with molecular confirmation in 5 cases, all 5 having KRAS-pathogenic variants. Calcified fundus lesions were identified in 10 eyes (bilateral in 3 patients), appearing as slightly elevated, creamy-yellow lesions around or adjacent to the optic nerve, extending supero-nasally; all but two of these lesions involved both the choroid and sclera, with two of them only involving the sclera at the time of examination. One case developed a choroidal neovascular membrane (CNV) necessitating intravitreal bevacizumab injections. All 7 patients had B-scan ultrasonography and the lesion appeared as a hyperechogenic area with an acoustic shadow posteriorly despite reduced gain. Five patients had MRI, and where fundus lesions were present, there was a focal defect in the sclero-choroidal layer. Four patients had a CT scan and all four showed calcifications affecting both the posteromedial sclero-choroid and adjacent medial rectus muscle. Two of these patients had normal eye movements, one had a unilateral fixed adducted eye and a vestigial fibrous medial rectus muscle seen in imaging and intraoperatively, and the fourth had marked exotropia with a right gaze deficit affecting both eyes. ConclusionsWe propose that the lesions seen in this cohort are calcified sclero-choroidal choristomas (CaSCCs) and should be suspected in mosaic RASopathies when creamy-yellow lesions are seen in the fundus. If identified, the possibility of choroidal neovascularization should be considered during follow-up. In all cases where a CT scan was performed, a novel sign of sclero-muscular calcification involving the medial rectus muscle was seen.

Quantitative Transcranial Sonography Evaluation of Substantia Nigra Hyperechogenicity Is Useful for Predicting Levodopa-Induced Dyskinesia in Parkinson Disease.

Levodopa-induced dyskinesia (LID) is a common motor complication in Parkinson disease (PD). Abnormal substantia nigra hyperechogenicity (SN+), detected by transcranial sonography (TCS), plays an important role in the differential diagnosis of PD. The purpose of this study was to investigate the predictive performance of quantitative SN+ evaluations for LID. Five hundred sixty-two individuals were included in our analysis, and 198 individuals were followed up. These individuals were divided into two groups at baseline: the PD with LID (PD+LID) group and the PD without LID (PD-LID) group. The association between total hyperechogenic area of the SN on both sides (SNT) and LID was analyzed by binary logistic analysis. A binary logistic regression model including SNT was applied to establish a model for discriminating LID. At baseline, 105 (18.7%) individuals were diagnosed with LID. The PD+LID group had a longer disease duration, shorter education duration, higher levodopa equivalent doses, greater disease severity and larger SNT. A model combining clinical features and SNT was further established with better efficiency (area under the receiver operating characteristic curve=0.839). One hundred ninety-eight individuals were followed up; individuals with a larger SNT and a higher predicted probability were more likely to develop LID in our follow-up. Our study determined that quantitative TCS evaluation of SN echogenicity is useful in predicting LID in PD.

Transcranial Sonography in Parkinson’s Disease and Parkinsonism

ABSTRACT Background: Transcranial sonography (TCS) is a noninvasive imaging method that practices ultrasound waves to examine the brain structure changes in many neurological pathologies, including Parkinson’s disease (PD) and parkinsonism. It allows for the visualization of the substantia nigra (SN), which is affected in these conditions and other brain parts. This technique has shown promise in aiding the diagnosis, follow-up, and progress of PD, in addition to differentiating it from other movement disorders. Our research explores the reliability of TCS in the diagnosis of PD and its impact on the differential diagnosis of atypical parkinsonism syndromes. Subjects and Methods: This study involved 52 PD patients, nine with other parkinsonism, and 54 healthy people. The same neurosonologist, blind to the patient’s diagnosis, assessed each individual’s SN, and the hyperechogenic area measurement was obtained. These measurements were compared between PD patients, with other forms of PD, and healthy people. In addition, hyperechogenic regions were compared based on the PD subtypes, dominant disease side, severity, and duration of the disease. Results: PD patients were presented with the highest value of SN hyperechogenic regions. TCS had an 87.5% specificity and a 73.3% sensitivity rate for the diagnosis of PD. The akinetic-rigid subtype of PD showed higher hyperechogenicity. In PD patients, there was no correlation between the disease side, length of the disease, Hoehn and Yahr stage, and SN hyperechogenicity. Conclusion: The results of this research demonstrate that the visualizing of SN hyperechogenicity with TCS in PD has diagnostic significance and may be valuable in the differential diagnosis of atypical parkinsonism disorders. However, the evaluation of only the SN may not be sufficient to advantage from TCS in the diagnosis of other parkinsonisms, and it may be essential to investigate the mesencephalon, other basal ganglia, and the third ventricle.

Ultrasonographic Technique Evaluation of Antihypertrophic Scar Activity of M. cavendishii Peel Extract in Newzealand Rabbit Ear Scar Model

Background: Hypertrophic scars are characterized by contin­uous, expansive, slow growth, with spherical shape outward skin, clear margin, progressive expansion, absent skin infiltration and high recurrence rate after injury to the deep dermis. Evaluation of this scar in New Zealand rabbit ear after administration of different doses of Musa cavendeshii peel extracts provide an informative data in monitoring the changes in diameter, length and area using ultrasound scan techniques supported by vancouver scar scale indices.&#x0D; Objective: To establish the use of ultrasound scan techniques in monitoring antihypertrophic scar activity of M. cavendishii peel extracts in rabbits ear scar model.&#x0D; Methodology: Full thickness excisional wound was created to the cartilaginous surface of the ventral region of the rabbit ear marked with blue biro pen of 6 mm in mimic rectangular length of used x-ray film. Vancouver scar scale and high frequency laptop ultrasound (C5® Sonostar, China) was used to evaluate the scar regression for a month in the different doses of the extracts.&#x0D; Results: The results revealed a significant decrease in all the parameters used during the 4 weeks monitoring of the scar. At week one, the result revealed the extract at 5000 mg/kg was able to reduce the hyper-echogenic area of scar (09.48 ± 0.20) as compared to the distilled water group (11.20 ± 0.00). This result shows a statistical reduction of 01.72 mm as noticed by ultrasound monitoring and thread used in Vancouver scar scale. Within the same week of study, the length (12.30 ± 0.20) of the scar was also shown to be reduced by the extract at dose 5000 mg/kg when monitored with the ultrasound and this was the same as the area (0.79 ± 0.03) as compared to the distilled water group. &#x0D; Conclusion: Ultrasound technique was found to be effective in measuring the progress of hypertrophic scar created in rabbit ear scar model after administration of M. cavendishii peel extracts.&#x0D; Key words: Hypertrophic scar, Ultrasound, Musa cavendeshii peel, Rabbit ear

Echocardiographic phenomenon of pericarditis in patients with severe COVID-19 pneumonia. One-year observation

Funding AcknowledgementsType of funding sources: None. Introduction. As seen in practice, such an ultrasound (us) phenomenon as the inflammation of the pericardium caused by COVID-19 is underestimated due to a very tough time pressure in the infection unit, minor effusion and the incorrect interpretation of cardialgia. The study is intended to evaluate the frequency of cases when the pericardium is involved in the COVID- syndrom, describe us-changes and dynamics throughout the year. Methods. We performed TTEchocardiography of pts during the first days of their admission to COVID-centre with pneumonia CT3-4 and during the year following their discharge, once in 4 months. The study was conducted by one observer, one equipment with same brightness settings. Results. 158 of 720 pts returned for a follow-up. 36 pts excluded due to the recurring infection, and 47 ones got vaccinated. Analyzed 75 cases. In the acute phase of infection, circumferential effusion was found in 98% of pts (the max pericardial layer separation by 4[3-6] mm). 2%pts has a thick layer of epicardial fat, which could possibly hide the minor hydropericardium. Furthermore, we captured a moderate increase in the echogenity of pericardium, especially in the inferolateral segments, multiple artifacts like B-lines stretching from pericardium line to the lungs in the basal ventricular segments left and right and around the atria. On 4 months after infection pericardial layer separation by≥3mm was detected in 8% pts (in persisting cases, effusion was 5[3-9] mm). Only the half of the pts had heart failure. The group without effusion demonstrated hyperechogenity of pericardium in the left basal segments, and both atria along perimeter of the free walls, confluent artifacts like the comet tail and the waterfall. In 8 months pericarditis with effusion persevered in 2 pts, with the max pericardial layer separation 5 and 3mm and vertical confluent artifacts. On the other pts, the hyperechogenic area of the pericardium reduced down to the basal inferolateral segments of left ventricle, base of the left atrium in 82% and the base of the right atrium in 18%. In 12 months, 1 pt had the recurring pericarditis, notwithstanding the therapy. The minimum hyperechogenity in the basal inferolateral segments of the left ventricle persisted in 61% of pts. The number of separate, narrow vertical artifacts was not different from the pts without COVID-19 (1-4 per view). ConclusionsPerhaps, the pericardium is a target organ for COVID-19, since it is involved in the acute phase of pneumonia in 98% of cases. Us-signs of the pericarditis persevere throughout many months after the pt’s discharge. Even the minor hydropericardium should be observed, since the clinic may deteriorate in 85% of cases in 4 months after the infection even in those pts who have no heart failure. Pericarditis, as an us-phenomenon, demonstrates the predictable dynamics of visual changes throughout the year. To interpret the changes, vertical artifacts of the pericardium should be evaluated. Figure. 56yo, acute COVID-CT3, effusion, bright Figure. same pt, 3mo after:effusion, comet-tale

Ультразвуковое исследование блуждающих нервов у пациентов с болезнью Паркинсона

Parkinson’s disease (PD) is a neurodegenerative multisystem disorder characterized by pathologic α-synuclein aggregation affecting, among other things, vagal fibers. The aim of this study was to investigate the cross-sectional area (CSA) of the vagus nerve (VN) in patients with PD using ultrasound imaging. The study was conducted in 32 patients with PD (15 men and 17 women; mean age 58 ± 10 years) and 32 healthy controls comparable with the main group in terms of sex and age. All study participants underwent ultrasound examination of the VN using a high-resolution transducer. Left VN CSA was significantly smaller in patients with PD than in the control group (1.78 ± 0.52 mm2 vs 2.11 ± 0.41 mm2; р = 0.007). A similar result was obtained for right VN CSA at the trend level. ROC analysis demonstrated that the threshold CSA value of &lt; 2.10 mm2 for the left VN has low diagnostic sensivity (59%) for VN atrophy in patients with PD. Right VN CSA was significantly larger than left VN CSA in both groups (p &lt; 0.001). The analysis of the PD group did not reveal any associations between VN CSA and age, duration and stage of the disease, motor (UPDRS III) and non-motor (NMSQ) scores. Patients with akinetic-rigid form of PD had smaller left VN CSA than patients with the mixed form of the disease (р &lt; 0.05). A moderate inverse correlation was established between left VN CSA and the area of substantia nigra hyperechogenicity on both sides (р &lt; 0.04); for the right VN a similar correlation was established at the trend level. High-resolution ultrasound of patients with PD demonstrated atrophy of the VN and the association of VN CSA with the clinical form of the disease and the ultrasound features of the substantia nigra.

A case of mediastinal mesenchymal tumor resembling hemopericardium.

Mediastinal neoplasms are rare in the elderly, and clinical suspicion is the first and most important step of differential diagnosis. Mediastinal tumors can be misdiagnosed because their symptoms or signs can overlap with cardiovascular diseases, which have a higher prevalence among the older population. The diagnostic process should be managed with multimodality imaging and clinical judgement. Here, the case of a 74-year-old male patient, who presented with shortness of breath, is examined. A chest X-ray revealed an increased cardiothoracic ratio, and he was diagnosed with hemopericardium following an emergent chest computed tomography. In the echocardiography, it was suspected that a hyperechogenic area adjacent to the heart might be due to a mass, and further examinations confirmed a mediastinal neoplasm. A surgical biopsy was performed, and it was determined to be a mesenchymal tumor. To conclude, clinicians should keep in mind the possibility of paracardiac neoplasm in the elderly, as well as in other age groups, when encountering mediastinal widening so that the patient can be protected from unnecessary interventions such as pericardiocentesis.

Une insuffisance ventriculaire droite chronique révélant un volumineux kyste hydatique compressif au service de cardiologie de l’hôpital Aristide le Dantec (Dakar, Sénégal)

Hydatidosis, an anthropozoonosis caused by the development of the Echinococcus granulosus larva in human, is a parasitic infection that is endemic in many countries. Pericardial localization in the absence of other cardiac involvement is extremely rare. Its spontaneous evolution is serious because of the risk of rupture. We report the case of a 65-year-old patient, who received limb edema that had been going on for 4 months, and in whom the physical examination noted a 3/6 tricuspid regurgitation and a right heart failure syndrome. Transthoracic echocardiography revealed an intra-pericardial mass whose contents appeared fluid with hyperechogenic area. It measured 86x61 mm and significantly compressed the straight cavities. Thoracic computed tomography showed an appearance in favor of an aged intrapericardic hydatid cyst (GHARBI V) with mass effect on the right cavities. The hydatid serology was negative. The patient did not accept the surgical cure. She had been put on albendazole and diuretic treatment. Fatal outcome was reported after two-month follow-up.

Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective cohort study

BackgroundThere is much value in identifying non-invasive ways of measuring endometrial receptivity, as it has the potential to improve outcomes following in vitro fertilization (IVF). It has been suggested that endometrial echogenicity on the day of hCG administration was a good marker of endometrial receptivity. In the daily practice, we notice that patients with non-homogeneous hyperechoic endometrium on the embryo transfer day usually have lower pregnancy rates. We therefore extended the research onward transformation of echo pattern after hCG trigger to analyze the relationship between endometrial echogenicity transformation and IVF outcomes.MethodsA total of 146 infertile women undergoing their first IVF cycle were recruited in the prospective cohort study from August 2017 through August 2018. A series of endometrial echo pattern monitoring was carried out in these patients after hCG trigger: hCG day, from 1 through 3 days after ovum pick-up (OPU + 1, OPU + 2, OPU + 3).ResultsThe endometrial echogenicity value was calculated as the ratio of the hyperechogenic endometrial area over the whole endometrial area. Clinical pregnancy rate and embryo implantation rate had positive relationship with echogenicity value. The ROC curve analysis of endometrial echogenicity showed the area under curve was greatest on the second day after oocyte retrieval (OPU + 1, 2, 3 were 0.738, 0.765, 0.714 respectively) versus pregnancy. Endometrial echogenicity value on OPU + 2 had a higher predictive efficiency, and the cutoff value was 76.5%. The sensitivity was 61.3% and specificity was 82.0%. When putting the cut-off at <60%, the sensitivity was 93.8% and the specificity was 23.1%.ConclusionsThe endometrial echogenicity value on OPU + 2 was recommended to evaluate endometrial receptivity. It seemed appropriate for clinicians to provide a ‘freeze all’ IVF cycle and transfer in a subsequent frozen-thawed embryos cycle when echogenicity value <60% on OPU + 2.Trial registrationThe registration number was ChiCTR-OOC-17012214 and the registration date was August 1st, 2017.

Prodromal substantia nigra sonography undermines suggested association between substrate accumulation and the risk for GBA-related Parkinson's disease.

Individuals with GBA (glucocerebrosidase) mutations are at increased risk of Parkinson's disease (PD). It is still debated, however, whether this increased risk results from impaired glucocerebrosidase activity leading to substrate accumulation. Comparing the presence of prodromal PD marker in GBA mutation carriers and patients with Gaucher disease (GD) (in which substrate accumulation is extensive) can assist in clarifying this issue. In this cross-sectional study, we compared the hyperechogenic area of the substantia nigra, a prodromal PD marker, in large cohorts of GBA mutation carriers (n=71) and patients with GD (n=145). Our control populations were healthy, non-carriers (n=49) and patients with GBA -related PD (n=11). Substrate accumulation was assessed from dry blood spot levels of glucosylsphingosine. Our findings indicate no contribution of substrate accumulation, as the area of hyperechogenicity is similarly enlarged relative to healthy controls in both GBA mutation carriers and patients with GD. Moreover, this similarity between GBA carriers and patients with GD persists when comparing only carriers of the N370S (c.1226A>G) mutation (n=38) with untreated patients with GD who were homozygotes for the same mutation (n=47). In addition, measurements of hyperechogenic area did not correlate with levels of glucosylsphingosine in the untreated patients with GD. The presence of a marker of prodromal PD (substantia nigra hyperechogenicity) is independent of substrate accumulation in a population with mutated GBA . Although further longitudinal studies are needed to determine the precise predictive value of this marker for GBA -related PD, our findings raise doubts regarding the contribution of substance reduction strategies to PD prevention.

Transcranial sonography in carriers of Gaucher disease

Background: Glucocerebrosidase (GBA) mutation is the most common genetic risk factor in Parkinson's disease (PD). Transcranial sonography (TCS) shows increased substantia nigra (SN) echogenicity in both idiopathic and genetic forms of PD. The goal of this study was to compare maximal area of SN hyperechogenicity (aSNmax) and diameter of third ventricle (DTV) between GBA mutation carriers and healthy controls. Methods: Twenty-six carriers of GBA mutation and twenty-six healthy controls underwent TCS. The aSNmax and the DTV were measured. Mini-mental status examination (MMSE) and demographic data of the subjects were recorded, too. Results: Mean aSNmax in GBA mutation carriers was significantly higher (0.31 ± 0.06 cm2) than controls (0.16 ± 0.04 cm2). Moreover, DTV was significantly higher in GBA mutation carriers group (3.98 ± 0.90 vs 3.29 ± 0.56 cm). Conclusion: Increased SN echogenicity and increased third ventricle diameter in GBA mutation carriers may be caused by alterations in iron metabolism with reference to their genetic status.

Ultrasonographic study of the temporomandibular joint in individuals with and without temporomandibular disorder.

The present study's aim was to compare temporomandibular joint (TMJ) images for individuals with and without temporomandibular disorder (TMD) using high-resolution ultrasonography (HRUS). The distance between the lateral-most point of the articular capsule and the lateral-most point of the mandibular condyle (lateral capsule-mandibular condyle distance) was determined to confirm the clinical diagnosis according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The sample group comprised 17 women and 15 men, aged 19-39 years, distributed into TMD (n = 20) and Asymptomatic (n = 12) groups. The evaluations were in closed- and open-mouth positions. The lateral capsule-mandibular condyle distance was measured in both positions. The articular surface of the condyle and the articular capsule were visualized as hyperechoic structures, and the articular disk was visualized as a central, hyperechogenic area surrounded by a hypoechoic linear image. Morphological changes were observed in some TMD group participants, including joint effusion (hypoechogenic area), condylar erosions (increased hyperechoic area), and condylar surface irregularities. The lateral capsule-mandibular condyle distance did not differ between sides or groups among participants with intra-articular disorders with or without pain (P > 0.05). In conclusion, HRUS allowed visualization of the TMJ structures, but did not allow confirmation of clinical diagnosis by DC/TMD.

An interesting case of subdiagphragmatic cold abscess: a case report

Subdiaphragmatic abscess is rather common itself but a tubercular subdiaphragmatic abscess in the absence of coexisting tuberculous abdomen presenting as thoracic complication is extremely rare. A cold abscess is an abscess that commonly accompanies tuberculosis. It develops so slowly that there is little inflammation and it becomes painful only when there is pressure on the surrounding area. Here we report a case of isolated subdiagphragmatic tuberculous cold abscess in a 38-year-old female whose imaging of the abdomen revealed a hyperechogenic area involving segment 7 of liver adherent to rib cage and diaphragm, S/O ruptured liver abscess, subdiagphragmatic abscess. The pus drained from the abscess cavity at diagnostic laparoscopy proved Multidrug Resistant Tuberculosis. This case has been reported for the rarity of isolated subdiaphragmatic tuberculous abscess and the importance of microscopic or culture diagnosis in a suspected case of tuberculous abscess.

Iron accumulation and microglia activation contribute to substantia nigra hyperechogenicity in the 6-OHDA-induced rat model of Parkinson's disease

IntroductionThis study aims to explain the mechanisms for the formation of sonographic features of Parkinson's disease (PD) using a 6-hydroxydopamine (6-OHDA) rat model of PD. The iron chelator deferiprone (DFP) was used in the PD model rat to examine the relationship between iron and the echo signal. MethodsRat models were created using stereotactic injections of 6-OHDA. DFP was administered intragastrically. Transcranial sonography (TCS) was performed to observe the substantia nigra (SN) echo signal of the brain. Immunofluorescence and iron staining were performed to observe the histological characteristics of the hyperechogenic area. The imaging findings were compared with the histopathological findings. ResultsThe PD model rat presented a large area of hyperechogenicity in the SN. Ferric ion accumulation and microglia proliferation occurred in the hyperechogenic area. DFP inhibited dopaminergic (DA) neuron necrosis, ferric ion accumulation and microglia proliferation and reduced the hyperechogenic area of the SN. ConclusionsBoth iron aggregation and gliosis contribute to the formation of substantia nigra hyperechogenicity (SNH) in PD. DFP exhibits a neuroprotective effect by inhibiting SNH. Iron deposit and the SNH are correlated with DA neuron necrosis.

Hemodynamic characteristics and the occurrence of renal biopsy-related arteriovenous fistulas in native kidneys.

PurposeRenal biopsy-related arteriovenous fistula (RB-AVF), although usually asymptomatic, may sometimes result in serious clinical implications. The aim of the study was to prospectively evaluate the incidence of RB-AVF in native kidneys, together with the assessment of hemodynamic characteristics and the impact of the histopathological results of biopsy.Methods The study included 138 patients (age 46.2 ± 15.2; 70 F, 68 M), who underwent percutaneous renal biopsy (PRB) of the native kidney. In all patients, 2D and color Doppler ultrasound was performed 24 h after PRB in order to exclude RB-AVF.ResultsBleeding complications in the form of hematomas were found in 136 patients (98.55 %), and 23 cases of RB-AVF were observed (16.67 %). RB-AVF group had an increased maximal hematoma diameter and reduced number of glomeruli in PRB. The segmental arteries supplying the fistulas are characterized by higher maximum flow velocity (FV) and a lower resistance index (RI) compared to the normal segmental arteries (difference 45.9 ± 20.0 cm/s and 0.252 ± 0.104, respectively). In the ROC analysis, RI ≤ 0.524 allowed to detect RB-AVF with a sensitivity of 91 % and specificity of 100 % (AUC 0.998, p < 0.001). In approximately 39 % of RB-AVF cases, 2D ultrasound detected a hyperechogenic ischemic area between the fistula and the renal capsule.ConclusionsArteriovenous fistula is a quite frequent complication of native renal biopsy and can cause ischemia in the renal parenchyma detected by ultrasound. The arteries supplying the fistula are characterized by an increased flow velocity and reduced resistance index.

Substantia nigra hyperechogenicity does not correlate with motor features in Parkinson's disease

IntroductionThe evaluation of hyperechogenicity of the substantia nigra (SN) by transcranial sonography (TCS) is validated for the diagnosis of Parkinson's disease (PD). However, its correlation with the severity of motor involvement is still uncertain. MethodsWe included patients with clinical diagnosis of idiopathic PD in a cross-sectional study. All patients were evaluated with Unified Parkinson's Disease Rating Scale-motor score (UPDRS-III) and TCS at the same day with measurement of the area of SN hyperechogenicity for each side. We analysed the association between the area of SN hyperechogenicity and the contralateral motor scores of UPDRS-III, adjusting for age and dominance of the patient (statistical significance set to p<0.05). Results35 patients were analysed, 3 (8.6%) were excluded due to poor temporal acoustic bone window.From a total of 32 patients, the mean age was 58.4 (±11.2)years. The mean area of SN hyperechogenicity was: right 0.26 (±0.12)cm2 and left 0.27 (±0.07)cm2. The mean score of UPDRS-III was 18.9 (±6.1). There were no statistically significant association between the scores of the UPDRS-III (rigidity, tremor and bradykinesia) and the contralateral area of SN hyperechogenicity. ConclusionThe area of SN hyperechogenicity did not correlate with motor deterioration in Parkinson's disease.

The diagnostic value of midbrain hyperechogenicity in ALS is limited for discriminating key ALS differential diagnoses.

BackgroundHyperechogenicity of the substantia nigra was recently reported in patients with sporadic ALS with a frequency similar to PD. Data on the diagnostic utility compared to key differential diagnoses of ALS do not exist yet.MethodsWe prospectively enrolled 43 patients with ALS, 29 with myasthenia gravis, 25 patients with inflammatory neuropathy, and 13 with cervical canal stenosis. All patients were examined by a blinded investigator using transcranial B-mode sonography planimetrically measuring hyperechogenic areas of the midbrain representing the substantia nigra.ResultsMean midbrain hyperechogenic area was increased in ALS compared to non-ALS differentials. ROC analysis revealed only small area under the curve for detecting ALS (AUC: 0.669 [95%CI: 0.56-0.78]; p = 0.006). Highest Youden index was observed for area size of <0.14 cm2 (Youden index: 0.28). Using this cut-off score and that generated from normative data of healthy controls, area size measurements provided a sensitivity of only 46-58% and specificity of 69-83% for detecting ALS. No correlations of hyperechogenic area sizes in ALS patients were found to age, gender, ALS subtype (bulbar versus spinal form), disease duration or ALS-FRS-R score.ConclusionsMidbrain hyperechogenicity is reproducibly found in ALS patients, but its diagnostic value for discriminating ALS from its key differentials is limited.