Hyperechoic Dots Research Articles

Differentiating Peripheral Pulmonary Lesions Based on Images of Endobronchial Ultrasonography

To attempt to develop a simple method to discriminate between neoplasm and nonneoplasm peripheral pulmonary lesions based on images of endobronchial ultrasonography (EBUS). Between June 2004 and June 2005, 151 patients with bronchoscopic peripheral lesions that could not be detected via a conventional bronchoscope underwent EBUS for advanced localization with a 20-MHz miniature radial probe in a tertiary-referral teaching hospital. The image characteristics were applied subsequently to correlate definite histopathologic results in studied patients. Based on an initial 20 consecutive patients with a definite diagnosis, four image characteristics were issued: (1) continuous hyperechoic margin outside the lesion, (2) homogeneous, or heterogeneous internal echoes, (3) hyperechoic dots in the lesion, and (4) concentric circles along the echo probe. In the following 131 patients, excluding five cases due to inconsistent typing, 93 patients (73.8%) established a diagnosis later. Most cases involving the image characteristics of homogenous internal echoes and concentric circles had nonneoplasm lesions (18 of 19 cases, 94.7%, and 14 of 16 cases, 87.5%, respectively). The difference shown in these two respects with neoplasm lesions was significant by univariate analysis (p < 0.001), although only concentric circles had a significant p value after multivariate analysis. Another two image patterns (continuous hyperechoic margins and hyperechoic dots) did not yield a significant difference (p = 0.090 and p = 0.079, respectively). The average additional time for EBUS was 3.94 min (1.5 to 10 min). EBUS can provide characteristic information to differentiate the nature of a peripheral pulmonary lesion from the image characteristics of concentric circles.

An outbreak of subacute fasciolosis in Soay sheep: Ultrasonographic biochemical and histological studies

A naturally occurring outbreak of subacute fasciolosis in a group of 17 seven-month-old Soay ram lambs was studied following the sudden death of two sheep. In addition to standard biochemical investigations, ultrasound examination of the liver and cranial abdominal cavity was undertaken. There was a significant positive linear correlation between liver weight and ultrasonographic determination of liver size ( R = 0.72, P < 0.05). Ultrasonographic examination of the liver revealed multiple hyperechoic dots in the parenchyma giving a granular appearance to the hepatic texture in three sheep corresponding to the most advanced histopathological changes as determined by the size of the abscesses and their relatively mature fibrous capsules, and areas of hepatic necrosis. No distension of the bile duct system was noted nor was the gall bladder imaged. While serum concentrations of albumin, globulin and certain liver enzymes assisted in the diagnosis of subacute fasciolosis in sheep, only glutamate dehydrogenase, and gammaglutamyl transferase remained elevated four weeks after triclabendazole treatment.

Analysis of the Internal Structure of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography

To correlate the internal structure of peripheral pulmonary lesions, as visualized by endobronchial ultrasonography (EBUS), and the histology of the surgical specimen to develop a classification system for distinguishing benign from malignant lesions by EBUS. Retrospective review. A national hospital. One hundred twenty-four patients with peripheral pulmonary lesions who had undergone EBUS in whom a definitive histologic diagnosis was made. In 69 patients, EBUS findings were correlated with the histology of a surgical specimen. EBUS was performed by a miniature probe (20-MHz) introduced up to the lesion through a channel in a bronchoscope. Three classes and six subclasses of lesions were identified by EBUS based on the internal structure of the lesion, focusing on internal echoes, vascular and bronchial patency, and the morphology of the hyperechoic areas, reflecting air in the alveoli and bronchioles. The classes of lesions are as follows: type I, homogeneous pattern (type Ia, with patent vessels and patent bronchioles; type Ib, without vessels and bronchioles); type II, hyperechoic dots and linear arcs pattern (type IIa, without vessels; type IIb, with patent vessels); and type III, heterogeneous pattern (type IIIa, with hyperechoic dots and short lines; type IIIb, without hyperechoic dots and short lines). Twenty-three of 25 type I lesions (92.0%) were benign, while 98 of 99 type II and III lesions (99.0%) were malignant. Twenty-one of 24 type II lesions (87.5%) were well-differentiated adenocarcinomas, and all type IIIb lesions were malignant, including 18 poorly differentiated adenocarcinomas (81.8%). EBUS permits the visualization of the internal structure of peripheral pulmonary lesions, and this information suggests the histology of the lesion.

Gray-scale and doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis

To describe the gray-scale and color Doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis. Vascular canals in the femoral condylar epiphysis were examined using gray-scale and Doppler US. The study was performed in 45 volunteers (aged <1 month-72 years) who comprised 1 subject with short stature, 1 subject with Klippel-Trenaunay-Weber syndrome and 43 subjects with normal growth. In the 8-year-old and younger group (n=34), vascular canals were observed in 32 subjects (94%), whereas vascular canals were not observed in the 9-year-old and older group (n=11). Vascular canals were visualized as hyperechoic lines and dots. With Doppler US, blood flow in the vascular canals was observed in 20 of the 32 subjects (62.5%). Spectral Doppler analysis was possible in 15 subjects, in all of whom only arterial waveforms were observed. US was helpful to delineate the vascular canals and flow therein. The detection and evaluation of vascular canals and blood flow therein may prove useful in understanding growth.

Gray-scale and Doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis.

To describe the gray-scale and color Doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis. Vascular canals in the femoral condylar epiphysis were examined using gray-scale and Doppler US. The study was performed in 45 volunteers (aged <1 month-72 years) who comprised 1 subject with short stature, 1 subject with Klippel-Trenaunay-Weber syndrome and 43 subjects with normal growth. In the 8-year-old and younger group (n=34), vascular canals were observed in 32 subjects (94%), whereas vascular canals were not observed in the 9-year-old and older group (n=11). Vascular canals were visualized as hyperechoic lines and dots. With Doppler US, blood flow in the vascular canals was observed in 20 of the 32 subjects (62.5%). Spectral Doppler analysis was possible in 15 subjects, in all of whom only arterial waveforms were observed. US was helpful to delineate the vascular canals and flow therein. The detection and evaluation of vascular canals and blood flow therein may prove useful in understanding growth.

Hepatobiliary and pancreatic: Commentary

Journal of Gastroenterology and HepatologyVolume 16, Issue 3 p. 348-348 Free Access Hepatobiliary and pancreatic: Commentary First published: 21 December 2001 https://doi.org/10.1046/j.1440-1746.2001.2449b.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat INTERPRETATION OF FIG. 1 (SEE PAGE 345) Figure 1 shows many hyperechoic dots and short lines, most of which are parallel (arrows), and they are collectively (S) and individually casting acoustic shadows. In the liver, calcification or air causes acoustic shadowing. Linear calcification that occurs within the liver are either arteries, portal veins or bile ducts. Calcification of large portal veins has been described in advanced schistosomiasis, but intrahepatic portal tract calcification is more pronounced than vascular calcification.1 The biliary tract in the liver may contain calculi, but calcification is within the duct lumen, not the wall itself. Hyperechoic lesions with acoustic shadowing may also represent pneumobilia, but they do not show parallel lines. Thus, these hyperechoic lines and dots seem to represent arterial wall calcification. In fact, this patient had hyperparathyroidism secondary to chronic renal failure, with a parathormone level of 110 ng/mL (normal being less than 0.8) at the time of examination. The hepatic artery at the hepatic hilum is also calcified (Fig. 2) and abdominal CT similarly demonstrated a markedly calcified hepatic artery arising from the calcific aorta (Fig. 3). Figure 2Open in figure viewerPowerPoint Sonogram of the hepatic artery at the hepatic hilum (arrow). Figure 3Open in figure viewerPowerPoint Abdominal CT showing marked calcification of the abdominal aorta, splenic and hepatic (arrow) arteries. DIAGNOSIS: CALCIFIED HEPATIC ARTERIES This patient had hyperparathyroidism secondary to chronic renal failure for which he has been hemodialyzed for 16 years. Extraskeletal calcification occurs in hyperparathyroidism, particularly of the abdominal aorta, femoral and digital arteries, but calcification of the hepatic artery is uncommon. In our study of 216 patients with chronic renal failure on chronic hemodialysis, hepatic artery calcification was recognized by CT in only 6.5%, while abdominal aorta calcification was seen in 77.3% and calcification of the splenic artery in 77.8%. For some unclear reason, the hepatic artery is not as readily calcified as other arteries. Calcified intrahepatic arteries mimicking pneumobilia seen by ultrasound was first reported by Desai et al.2 in 1989, but there have been few similar observations thereafter.3 REFERENCES 1 Okuda K, Jinnouchi S, Arakawa M, Nitta A & Nakashima T. Generalized calcification of the liver in advanced schistosomiasis. Acta Hepatol-Gastroenterol. 1975; 23: 98– 102. Google Scholar 2 Desai RK, Paushter DM & Armistead J. Intrahepatic arterial calcification mimicking pneumobilia. A potential pitfall in the ultrasound evaluation of biliary tract disease. J. Ultrasound. Med. 1989; 8: 333– 5.Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 3 White LM & Wilson SR. Hepatic arterial calcification: A potential pitfall in the sonographic diagnosis of biliary calculi. J. Ultrasound. Med. 1994; 13: 141– 4.Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Volume16, Issue3March 2001Pages 348-348 FiguresReferencesRelatedInformation

Contrast‐enhanced gray‐scale and color doppler voiding urosonography versus voiding cystourethrography in the diagnosis and grading of vesicoureteral reflux

Purpose The purpose of this study was to compare contrast-enhanced gray-scale voiding urosonography (CE-VUS) and contrast-enhanced color Doppler voiding urosonography (CE-CDVUS) with voiding cystourethrography (VCUG) to verify whether the use of color Doppler imaging improves the diagnosis and grading of vesicoureteral reflux (VUR). Methods In 74 patients, CE-VUS and CE-CDVUS were compared with VCUG, which was used as the gold standard. SHU 508 A (Levovist) was used as the echo-enhancing contrast agent. VUR was diagnosed if hyperechoic dots or color signals were visualized in the ureter on sonograms. VUR grading was based on morphologic and dynamic findings on CE-VUS and morphologic and color findings on CE-CDVUS. VCUG was performed conventionally, and grading by VCUG was in accordance with the international system of radiographic VUR grading. Patients who voided during 1 examination only (either CE-VUS and CE-CDVUS or VCUG) were excluded from the study. Agreement between the results of CE-VUS and VCUG and between those of CE-CDVUS and VCUG in diagnosing VUR was calculated by κ statistics. CE-VUS and CE-CDVUS were compared for diagnostic accuracy by the McNemar test. Results The agreement between CE-VUS and VCUG in predicting VUR was 90% (κ score, 0.77; p < 0.001). The agreement between CE-CDVUS and VCUG was 96% (κ score, 0.91; p < 0.001). CE-CDVUS showed a significantly higher diagnostic accuracy than did CE-VUS (96% versus 90% of cases correctly classified; McNemar χ2 = 4; p < 0.05). This was mainly related to the lower number of false-negative results for grade I and grade II VUR when CE-CDVUS was used. Conclusions The use of color Doppler imaging significantly improves the accuracy of contrast voiding urosonography in the detection and grading of VUR. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:65–71, 2001.

Cystic teratomas of the ovary: diagnostic value of sonography.

This study was undertaken to determine if the diagnosis of cystic teratomas of the ovary can be made by experienced sonologists using only specific associated sonographic features. Two sonologists independently reviewed the sonograms of 252 adnexal masses. For each mass, each sonologist recorded sonographic features using a standardized checklist, which included four descriptions associated with cystic teratomas. From a list of diagnostic possibilities, each reviewer chose one specific conclusion, with emphasis on achieving the highest combination of sensitivity and positive predictive value for any particular diagnosis. The sensitivity, positive predictive value, and positive likelihood ratio for the diagnosis of cystic teratoma were evaluated for each sonographic finding and for each sonologist's interpretation. Of the 252 masses, 74 cystic teratomas were found, 55 of which showed two or more associated sonographic features. Each reviewer had a 98% positive predictive value with 85% sensitivity for the diagnosis and identification of cystic teratomas (positive likelihood ratio = 152). The positive predictive value was 100% when an adnexal mass had two or more sonographic features associated with dermoid masses. The positive predictive value for individual sonographic features associated with dermoid masses was 80% for a shadowing echodensity, 75% for regionally bright echoes, 50% for hyperechoic lines and dots, and 20% for a fluid-fluid level. An adnexal mass showing two or more of the sonographic features associated with cystic teratomas can be confidently diagnosed as a cystic teratoma.