Real-time Gray Scale Research Articles

EVALUATION OF EPIDIDYMORCHITIS BY HIGH FREQUENCY GRAY SCALE AND COLOR DOPPLER ULTRASONOGRAPHY

INTRODUCTION: Ultrasonography is extremely well suited to study of scrotum and its contents. Ultrasound is simple to perform, quick, non-invasive, low cost effective, easily reproducible, widely available and does not involve irradiation of gonads.It is very helpful in differentiating intratesticular and extratesticular pathologies. Ultrasound is the modality to differentiate solid from cystic lesions of testes and with the introduction of color Doppler, it becomes easiear to assess the viability of testis in cases of torsion and guiding the treatment accordingly. USG is helpful in differentiating torsion/ischaemia of testis from the acute inammatory pathologies. Role of other Modalities: CT and MRI have dominated imaging of other regions of the body, they have certain restrictions in evaluation of scrotal diseases. Computed Tomography delivers radiation to gonads, On the contrary, MRI imaging is expensive and not readily obtainable. Radionuclide scan helps in equivocal presentations to assess vascularity within the testis in setting of torsion but its readily availability and cost is the main set back. AIM: To assess the role of high frequency gray scale and color doppler ultrasonography in evaluation of epididymorchitis. MATERIAL & METHODS: SAMPLE: 50 cases of scrotal pathology were taken using High-frequency real time gray scale ultrasonography and Color Doppler . Patients were referred to our department for scrotal ultrasonography and Doppler study by department of Urology and department of Surgery of SRMS IMS Bareilly. RESULTS: In the present study total evaluated cases of epididymoorchitis were 15,among them 11 cases were acute and 4 cases were of chronic epididymoorchitis.. Majority of cases were having unilateral involvement with 1 case of B/L involvement. USG gray scale found heterogenous echogenicity or reduced echogenicity in acute EPO while the echogenicity was reduced with calcication in chronic EPO. .Doppler study found increased vascularity in majority of cases of acute EPO with reactive hydrocele while vascularity was either normal or increased in chronic EPO without any reactive hydrocele. CONCLUSION: High-frequency gray scale USG helps in clear evaluation of anatomical structural alterations associated with acute scrotal inammatory diseases, and color Doppler USG is highly sensitive in diagnosing acute scrotal pathology. In addition, Color Doppler USG accurately differentiates between testicular ischemia and torsion from acute inammatory diseases in acute painful scrotal conditions.

Evaluation of color Doppler study of thyroid swellings: a prospective study at JSS hospital, India

Background: Color Doppler sonography of thyroid is an emerging and promising pre-operative investigatory modality for thyroid diseases at present. Because of superficial location and good vascularisation of thyroid gland high resolution real time grey scale and color Doppler sonography can delineate and demonstrate the normal thyroid anatomy and pathological conditions with remarkable clarity. Methods: Present study includes total number of 50 cases admitted in JSS Hospital, Mysore, India from September 2014 to September 2016. Color assisted duplex sonography was performed following a detailed history and physical examination. All routine investigations and specific investigations like thyroid function tests and FNAC were done. Later on patients were subjected to thyroid surgery as required, based on the diagnosis. The histopathological findings obtained for the resected thyroid specimens were compared with the previously scan findings. Results: Thyroid ultrasound was efficient in picking up all 50 cases in our study. The most common benign lesion determined in our study were adenomatous nodules which was the most common benign lesion, we were able to detect malignant nodules with a better specificity. According to several reports, for the differentiation of benign versus malignant thyroid nodules, sonography has sensitivity rates ranging from 63% to 94%, specificity from 61% to 95% and an overall accuracy from 80% to 94%. In our study we found sensitivity of 55.56%, specificity of 90.24%, positive predictive value of 55.56%, and negative predictive value of 90.24% and overall diagnostic efficiency of 84%. Conclusions: Ultrasound is valuable for identifying many malignant or potentially malignant thyroid nodules. Although there is some overlap between the ultrasound appearance of benign nodules and that of malignant nodules, certain features are helpful in differentiating between the two. The newly developed high resolution ultrasonography with color Doppler flow mapping function can reveal fine details of the thyroid gland and the haemodynamic features of thyroid neoplasms.

Real-time grey scale contrast-enhanced ultrasonography in diagnosis of gallbladder cancer

Purpose: To explore the clinical value and charateristics of contrast-enhanced ultrasound (CEUS) in diagnosis of gallbladder carcinoma.

Real-time grey scale contrast-enhanced ultrasonography in diagnosis of gallbladder cancer

Real-time grey scale contrast-enhanced ultrasonography in diagnosis of gallbladder cancer

Ultrasound evaluation of renal length of healthy adults in University of Port Harcourt Teaching Hospital, Nigeria

Context: Renal length which can be determined with ultrasonography is a reliable singular renal dimension for the assessment of the kidney size both in normal and pathologic conditions. Aim: This study aimed at determining renal size by evaluating length in healthy adult Nigerians in the University of Port Harcourt Teaching Hospital. It also aimed to correlate the renal length with age, sex and weight of this group and determine the variation in size in both kidneys. Materials and Methods: This study was carried out at the Radiology Department of University of Port Harcourt Teaching Hospital. Four hundred healthy adults comprising of two hundred and eighty four females (71%) and one hundred and sixteen males (29%) who fulfilled the inclusion criteria were recruited into the study. Biodata was obtained and the length of the kidneys was measured using real time gray scale ultrasound scanning via the transabdominal route. Data Anaysis: Data obtained was analysed using Statistical Package for Social Sciences (SPSS) version 17.0 (SPSS Inc. Chicago IL, USA). Results: The mean renal length in males (10.6cm) was slightly higher than in females (10.5cm). The left kidney (10.8cm) was longer than the right kidney (10.4cm) in both sexes. There was a positive correlation between the mean length of both kidneys and body weight, but no correlation between the mean length of the kidneys and the age of subjects. A decline of renal length after the age of sixty years was seen. Conclusion: Normal values for length and variations in size of the kidneys in healthy adults in south-south Nigeria have been established.

Fetal kardiyak anatominin değerlendirilmesinde 3 boyutlu ultrasonografinin yeri

Objective: We aimed in this study to compare two-dimensional ultrasonography with three-dimensional ultrasonography for obtaining standard anatomic cross-sections used during ultrasonographic fetal cardiac examination between 18 and 24 weeks of gestation. Methods: Four-chamber view, aorta, pulmonary arterial outlets and cross-section of three-vessel in real-time gray scale were obtained from totally 2839 patients between 18 and 24 weeks of gestation who referred to the Obstetrics and Gynecology Clinic of Mersin University’s Health Practices and Research Hospital between 16.01.2007 and 19.12.2009, and were admitted for fetal anatomic screening. Subsequently, they were evaluated according to the protocol defined by obtaining static three-dimensional volume data. Results: Totally 2839 pregnant women who were between 18 and 24 weeks of gestation with ages between 18 and 43 were included into the study. The median age was 27.3 (range: 17-46) years, mean pregnancy number was 1.9 (range: 1-7), and mean examination week was 21 weeks and 4 days. In the evaluation, congenital anomaly was found in 143 cases (5.03%), and among them, congenital cardiac anomaly was in 28 cases (0.9%). Four-chamber views were obtained in all cases whose volume data were taken by 3D ultrasonography. Seventy-eight percent of aortic outlet was observed, 75% of pulmonary outlet was observed and 90% of vessels and trachea crosssection was observed. Conclusion: It was observed that the standard cross-sections consulted during fetal cardiac examination by 3D ultrasonography were obtained with a rate between 75-90%. On the other hand, technical issues we faced during conventional ultrasonographic evaluation prevented also by this method to yield satisfactory results during the examination.

English

AIMS & OBJECTIVES: To find out prevalence of gallbladder mass among the patients of gallbladder pathology & define morphological feature of gall bladder masses using real time gray scale ultrasonography and color Doppler flow imaging & power Doppler imaging to find out prevalence of gall stones among the patients of gall bladder mass. MATERIAL AND METHOD: 10424 patients were evaluated for gall bladder pathology with grey scale ultrasonography in between 1.10.12 to 30.09.2013 in Radiodiagnosis department of G.R.M.C. RESULT: 54 patients out of 10424 i.e. 0.5% were found to have gall bladder mass lesion. Among these 79.5% (43) of patients had gall bladder carcinoma, 9.3% (5) had gall bladder polyp, 87.4% (4) had mucocele of gall bladder 1.9% (1) had porcelain gall bladder and 1.9% (1) had gall bladder metastasis. The youngest patient in our study was 12 years old male presented with mucocele. Oldest patient in our study was 68 years old female presented with gallbladder carcinoma.7% of overall gall bladder mass lesion were encountered in females showing clear female preponderance. Gall Stone embedded in 70% of gall bladder mass. CONCLUSION: J.A. group of hospital and G.R. Medical College, Gwalior serve a good proportion of population of M.P. and adjoining area of U.P. and Rajasthan which is endemic for gall bladder pathology. The present study concludes that ultrasonography is a powerful readily available and cost effective tool in the diagnosis of gall bladder pathology.

Abstract P4-01-13: Fusion imaging using opto-acoustics and ultrasound to differentiate breast mass histopathology

Abstract Introduction: Opto-acoustics (OA) is a true fusion imaging technology that combines dual energy laser optic functional imaging with real time gray scale ultrasound morphologic imaging. The laser optic component uses two wavelengths that have been chosen to optimally demonstrate oxygenated and deoxygenated hemoglobin. The color-coded laser optic images are co-registered and temporally interleaved with real time gray scale images. OA fusion imaging benefits from the combination of the high contrast resolution of dual wavelength laser optics and the higher spatial resolution and penetration of gray scale ultrasound. OA can demonstrate both tumor neovascularity and the relative degrees of oxygenation-deoxygenation within breast mass and within the surrounding tissues. Methodology: A series of 68 prospective patients with undiagnosed breast masses going to biopsy were evaluated before biopsy with a handheld device combining ultrasound co-registered with OA for the visualization of pre-defined internal and external features. The internal features included vascularity (V), blush (BU), and blood (BL) accumulation while external features included boundary zone vascularity and blush (BZ) and peri-tumoral radiating vessels (RV); each were scored on a 0-5 ordinal scale and were summed to get a total internal score, total external score, and a total score. A two-sided exact Jonckheere-Terpstra test was used to test the relationship between increasing scores and higher cancer grade. Results: The study population consisted of 29 fibroadenomas (FAs) as well as 10 invasive ductal carcinoma (IDC), grade 1, 11 IDC grade 2, and 18 IDC grade 3 cases. OA Total (two-sided p = 3×10−8) and OA Total Internal (two-sided p = 6×10−9) were highly significant but OA Total External was not statistically significant; OA Total and OA Total Internal Features were highly related to histology with lower scores for FAs increasing progressively to highest scores for IDC 3. Moreover, all three internal OA features were highly significant: (1) V (two-sided p = 10−7), BU (two-sided p = 3×10−8), and BL (two-sided p = 5×10−6). Cumulative contribution of each internal feature to the total internal score was also assessed for each histopathology subgroup to confirm independent contribution to the OA Total Internal Score. Pairwise correlations explained no more than 56% of the total variance. Conclusions: We have established the prognostic value of OA Total and OA Internal Features as well as the validation of the contributions of each OA Internal Feature. Using the combination of individual internal and external OA features not only helps distinguish benign from malignant masses, but helps stratify malignant lesions by histologic grade. These abilities could be useful both for diagnosis and for monitoring non-surgical treatment of malignant masses. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-13.

Discrimination between pleural thickening and minimal pleural effusion using color Doppler chest ultrasonography

BackgroundThe discrimination of pleural thickening from minimal pleural effusion may be difficult as both lesions appear as anechoic on grayscale ultrasound, hence, free of “echoes” does not confirm the presence of pleural fluid. Aim of this studyTo evaluate the value of color Doppler ultrasound in differentiating minimal pleural effusion that could be aspirated from pleural thickening and to compare it with grayscale ultrasound. Patients and methodsThis analytic cross-sectional study was done prospectively on 40 patients who presented with pleural based opacity in their chest radiographs compatible with minimal pleural effusion. Gray scale ultrasound was done for all patients then color Doppler ultrasound examination was applied to detect the presence or absence of fluid color sign. The presence or absence of pleural effusion was confirmed by aspiration of pleural fluid. ResultsThe sensitivity of real time gray scale ultrasound in detecting minimal pleural effusion and differentiating it from pleural thickening was 95.5% while, specificity was 33%, and accuracy was 67%. The ability of ultrasound in discrimination of minimal pleural effusion from pleural thickening improved greatly by application of the color Doppler examination where the specificity of the method reached 100% while the sensitivity was 91% and accuracy was 95%. ConclusionsApplication of color Doppler examination increases the accuracy of real time chest ultrasound to discriminate pleural thickening from minimal pleural effusion and hence color Doppler examination proved to be a useful diagnostic tool to real-time gray-scale ultrasound for diagnosis of minimal pleural effusion.

Real-Time Grey Scale Contrast-Enhanced Ultrasonography in Diagnosis of Gallbladder Cancer

Real-Time Grey Scale Contrast-Enhanced Ultrasonography in Diagnosis of Gallbladder Cancer

Advanced Obstetrical and Gynecological Ultrasound: Imaging with New Technologies

ABSTRACT Since, ultrasound was introduced as diagnostic tool in obstetrics and gynecology by Professor Ian Donald 6 decades ago, realtime imaging has become the most common sonographic technique used in obstetrics and gynecology. When uncertain findings on real-time gray scale during two-dimensional sonography require further evaluation, advanced techniques are often necessary. Such advanced techniques include color and power Doppler, three- and four-dimensional ultrasound and techniques of volume manipulation (rendering), such as surface and maximum mode, magic cut, volume calculation (VOCAL), NICHE mode, and -as latest innovation, HD flow (Doppler) and HD life surface rendering. The authors would like to illustrate by means of a series of images and case presentations, how these new diagnostic tools find their clinical application in the daily routine of care in obstetrics and gynecology. How to cite this article Honemeyer U, Kurjak A. Advanced Obstetrical and Gynecological Ultrasound: Imaging with New Technologies. Donald School J Ultrasound Obstet Gynecol 2013;7(1):51-65.

Detecting Metastasis of Lymph Nodes and Predicting Aggressiveness in Patients With Breast Carcinomas

The purpose of this study was to evaluate the contrast-enhanced ultrasonographic (CEUS) characteristics of metastatic lymph nodes (LNs) and to determine the correlation of CEUS parameters with the tumor aggressiveness in patients with breast cancer. Real-time gray scale CEUS of axillary LNs was preoperatively performed in 51 consecutive patients with breast carcinoma who were scheduled for axillary lymph node dissection. The CEUS characteristics assessed by a direct visualization method and quantification software were compared with pathologic findings. Expression of human epidermal growth factor receptor 2 (HER-2/neu) in the primary tumor was detected by immunohistochemical analysis. Correlation analysis of CEUS parameters with HER-2/neu expression and the LN stage was performed. Of the LNs examined, 27 were metastatic, and 25 were diagnosed as reactive hyperplasia. Lymph nodes with metastasis were characterized by centripetal progress (66.7%) and a heterogeneous pattern (55.6%) or no or scarce perfusion (25.9%). However, LNs with nonmetastases were characterized by with centrifugal enhancement (56.0%) and a homogeneous pattern (80.0%). The difference between the hyperintense and hypointense regions was higher in metastatic LNs than nonmetastatic ones (P < .001). No significant differences were found in the arrival time, time to peak intensity, and peak intensity between the two groups. A histopathologic diagnosis could be predicted with sensitivity, specificity, and accuracy of 92.6%, 76.0%, and 84.6% respectively, by a standardized difference between maximum and minimum signal intensity (SI(max)-SI(min)) value of 28. Human epidermal growth factor receptor 2 expression and the LN histopathologic stage were significantly associated with the SI(max)-SI(min). In metastatic LNs, the relationship between the diagnostic sensitivity of CEUS and the transverse diameter of LNs remained statistically significant (P < .05). Noninvasive CEUS can play a role in discriminating metastatic from nonmetastatic LNs and predicting the aggressiveness in patients with breast cancer.

1126: The Application of Real-time Gray Scale Contrast Ultrasonography in Diagnosis of Focal Liver Lesions

1126: The Application of Real-time Gray Scale Contrast Ultrasonography in Diagnosis of Focal Liver Lesions

Correlation of Real-time Gray Scale Contrast-Enhanced Ultrasonography With Microvessel Density and Vascular Endothelial Growth Factor Expression for Assessment of Angiogenesis in Breast Lesions

The purpose of this study was to determine the correlation of real-time gray scale contrast-enhanced ultrasonographic (CEUS) patterns and parameters with microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression for assessment of angiogenesis in breast lesions. Real-time gray scale CEUS was performed in 53 women with breast lesions. Contrast-enhanced ultrasonographic patterns and quantitative parameters were analyzed. Mean MVD and VEGF expression in breast lesions were measured by immunohistochemical analysis. Surgical pathologic analysis showed 25 benign and 28 malignant lesions. Different CEUS patterns were observed in the high- and low-MVD and -VEGF groups. Microvessel density and VEGF expression were significantly associated with heterogeneous enhancement with or without perfusion defects and radial or penetrating vessels surrounding the lesions (P< .05). The enhancement order and degree were significantly related to MVD (P< .01) but not correlated with VEGF expression (P> .05). Malignant and benign lesions did not differ significantly in time-intensity parameters (P> .05). The peak intensity, rise in intensity, maximum rise slope of the curve, wash-out slope of the curve, and area under the time-intensity curve (area) were statistically correlated with MVD (P< .05). The highest correlation (r=0.56; P< .001), however, was between the area and MVD. No significant association was found between any CEUS parameters and VEGF expression (P> .05). Contrast-enhanced ultrasonographic patterns and parameters of breast lesions are more closely correlated with MVD than VEGF expression. Real-time gray scale CEUS has a potential role in evaluating angiogenesis in breast lesions, but CEUS parameters are not correlated with the malignancy or benignity of breast tumors.

Benign and Malignant Breast Lesions: Efficacy of Real Time Contrast-Enhanced Ultrasound vs. Magnetic Resonance Imaging

To assess the efficacy of low mechanical index (MI) real time grey scale contrast-enhanced US (CEUS) in the differentiation of breast lesions in comparison to Magnetic Resonance Imaging (MRI). 50 lesions previously detected at mammography or conventional US were evaluated by means of CEUS and MRI. Contrast-enhanced examinations were performed with a dedicated equipment (Esatune, Esaote, Genoa, Italy), before and after injection of 4.8 ml of Sonovue (Bracco, Milan, Italy). MRI was conducted with a 1.5 T equipment (Siemens Vision Plus, Erlangen, Germany) with bilateral dedicated superficial coil, on T2w STIR and 3D Flash T1w before and 1, 2, 3, 4, 5 minutes after the administration of contrast agent (Gd-DTPA, 1.5 ml/kg). Wash-in and wash-out curves were assessed for both procedures. A specific sonographic quantification software (Qontrast, Bracco, Milan, Italy), based on pixel by pixel signal intensity over time, was used to obtain contrast-enhanced sonographic perfusion maps for each lesion. Mc Nemar test was then calculated. 24 invasive ductal carcinomas, 18 fibroadenomas, 4 fibro-cystic dysplasias, 1 mucinous carcinoma, 1 invasive ducto-lobular carcinoma, 1 intraductal florid papillomatosis and 1 phylloides tumour were diagnosed. Contrast-enhanced sonographic patterns correlated well with those provided by MRI. Sensitivity, specificity, and accuracy of US were: 69.2 %, 66.7 %, and 68 %, respectively. According to the different contrast enhancement patterns and the resulting perfusion maps, all the malignant lesions and 9 out of 12 benign lesions were correctly diagnosed, thus resulting in 87.5 % of specificity and 100 % of sensitivity. Regarding the specificity, there is no difference between US and CEUS with McNemar (p = 0.18). Regarding sensitivity, the difference between contrast-enhanced US and US is significant as calculated with McNemar test (p = 0.013). The three lesions which were incorrectly classified as malignant were two hypervascularised fibroadenomas in young women and a phylloides tumour. CEUS seems to be a reliable method to differentiate breast lesions, since it provides typical enhancement patterns. Contrast sonographic perfusion curves correlate well with MRI wash in--wash out curves.

40 years of Ultrasound Real-time Grayscale Diagnostics

40 years of Ultrasound Real-time Grayscale Diagnostics

3522: Preliminary study of SonoVue in contrast-enhanced sonography

Objectives: To observe perfusion characteristic of contrast agent SonoVue, and investigate the role of SonoVue in differentiating benign and malignant tumors. Methods: Thirty-three ovary tumors (16 benign, 17 malignant) were examined with contrast agent SonoVue and contrast tuned imaging (CnTI) real time gray scale ultrasound technique. Perfusion patterns of tumors, arrival time, peak time and the duration of contrast agent effect were recorded and analyzed. Results: After contrast agent administration, for benign tumors, two cases with no enhancement, 13 cases with slight enhancement in capsule, septum or interior parts. Solid parts in all malignant tumors and one benign tumor enhanced obviously. The enhancement peak intensity was higher (36.8 versus18.4, p < 0.001), the arrival time was shorter (13.5 seconds versus 17.5 seconds, p = 0.023), and the duration of contrast agent effect was longer (254.7 seconds versus 208.5 seconds, p = 0.04 in malignant tumors than they were in benign tumors. There was no significant difference in peak time between malignant and benign tumors. Conclusions: SonoVue can assess precisely vascular pattern of ovary tumors. There are significant differences in the arrival time, enhancement peak intensity, and the duration of contrast agent effect.

Biliary Lithiasis: Prevalence and Ultrasound Profile in a Service Hospital.

Real time gray scale ultrasonography of upper abdomen was carried out in 1237 cases for varied indications. Overall prevalence of biliary lithiasis was 11.56% with female to male ratio of 4:1. Fifty years and below, female to male ratio was 6.5:1. 88.8% cases of biliary lithiasis were 60 years and below. Gall bladder dyspepsia (61.5%) and right upper quadrant pain (41%) were the main presenting features of biliary lithiasis. 26 patients (18%) presented with acute abdomen. Asymptomatic gallstones were found in 25 (17.5%) cases. Solitary calculus was less common than multiple calculi with a ratio of 1:4. Amongst cases of multiple calculi the small sized (2-4 mm) variety was the maximum (49%) followed by medium sized (5-10mm) and large sized (>10mm) calculi respectively.

Sonography in primary hyperparathyroidism: review with emphasis on scanning technique.

To review the sonographic features and focused sonographic scanning techniques that may assist in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism. The sonographic findings were reviewed in 54 of 58 consecutive patients with pathologically proven parathyroid adenomas. A systematic scanning approach including real-time gray scale, color and power Doppler, and graded compression gray scale imaging was used in all patients. Fifty-four (93%) of 58 proven adenomas were correctly identified by sonography. Gray scale imaging alone was sufficient for identifying 26 (100%) of 26 large (> or =1-cm) and 3 (11%) of 25 small (<1-cm) parathyroid adenomas. However, for 25 (89%) of 28 small adenomas, a combination of color and power Doppler and graded compression real-time gray scale imaging was required for sonographic localization and identification. Knowledge of typical locations and characteristic imaging features, as well as a systematic scanning approach, can result in accurate preoperative sonographic localization of parathyroid adenomas.

Diagnosis of pulmonary arteriovenous malformations by colour Doppler ultrasound and amplitude ultrasound angiography

BACKGROUNDThe clinical value of colour Doppler ultrasound and amplitude ultrasound angiography in the diagnosis and follow up of pulmonary arteriovenous malformations (PAVM) was investigated.METHODSSix consecutive patients suspected by clinical appearance...