Scale Ultrasonography Research Articles

The value of multimodal ultrasonography in the evaluation of late presenting testicular torsion in a rat experimental model.

To evaluate the value of multimodal ultrasonography (US) in a rat experimental torsion model after 6 h of torsion with different degrees. Twenty-one male rats were divided into three groups. Left testes of the rats were twisted around their vascular pedicle 360 degrees in group 1, 720 degrees in group 2, and 1080 degrees in group 3 and intact right testes of the rats were accepted as control group. Grey-scale US, superb microvascular imaging (SMI), colour Doppler ultrasonography (CDUS), strain elastography (SE), and two-dimensional (2-D) shear wave elastography (SWE) examinations were applied 6 h after torsion procedure and testes were removed for pathological evaluation. Short-axis dimensions and volumes of the torsion side were higher than control testes. Lengths of the testes in the 3rd torsion group were smaller than the testes in groups 1 and 2 (P < 0.002). SMI was better than CDUS in recognizing blood flow in testicular tissue. Strain ratios were higher in group 1 and decreased with the increasing torsion degree. Emean and standard deviation (SD) measurements increased in the torsion side. Pathologically the mean testicular damage scores were statistically significant between torsion and control testes in all groups. Our results showed that short-axis and volume measurements, SMI, 2D-SWE, and SE are effective in the evaluation and diagnosis of testicular torsion (TT). Evaluation of affected testis and intact testis with multiparametric US in late presenting TT cases is more reliable than being dependent on a single sonographic modality.

Usefulness of Grey Scale and Doppler transvaginal sonography in diagnosis of ovarian torsion

Background: Ovarian torsion diagnosis is a great challenge as delay in diagnosis can cause severe morbidity. Early accurate diagnosis is crucial to preserve ovarian function. Ultrasonography being the primary imaging modality plays a vital role in the evaluation of suspected ovarian torsion by helping surgeons reach the correct diagnosis, thus avoiding unnecessary intervention. This study aims to determine the diagnostic accuracy of isolated and combined sonographic features of ovarian torsion on grey scale and Doppler transvaginal ultrasonography.&#x0D; Patients and methods: From radiology database, from January 2016 till December 2019, sonographic signs of ovarian torsion in 113 women with suspected ovarian torsion on ultrasonography and subsequent surgical diagnosis were evaluated. Ultrasound findings were compared with surgical findings to determine the accuracy, sensitivity, specificity, and positive and negative predictive values of individual and combined ultrasound signs.&#x0D; Results: Diagnostic accuracy of ultrasound for ovarian torsion was 85.8%. Abnormal ovarian Doppler flow was the most accurate individual sonographic sign with accuracy, sensitivity, specificity and positive predictive value of 85.8%, 83.5%, 100% and 100% respectively followed by ovarian enlargement and ovarian edema. Combined ultrasound signs resulted in higher sensitivity and positive predictive values, and lower specificity and negative predictive values for ovarian torsion. Increasing the number of sonographic parameters increased the specificity but decreased sensitivity. High accuracy, sensitivity, positive predictive value, specificity and negative predictive value was seen when combination of three or two sonographic parameters was used as diagnostic criteria.&#x0D; Conclusion: Transvaginal sonography is a convenient, reliable and extremely useful imaging modality for preoperative diagnosis of ovarian torsion with high specificity, sensitivity, positive predictive value and diagnostic accuracy helping treating physicians to take prompt decisions regarding timely surgical intervention. However, due to low negative predictive values, absence of sonographic signs does not rule out ovarian torsion and high index of clinical suspicion remains of utmost importance.

The Diagnostic Value of Color Doppler Ultrasound and Grey Scale Sonography in Predicting the Malignancy of Thyroid Nodules

Retrospective study was done at KAUH to determine the sonographic characteristics in predicting the malignancy of thyroid nodules. The sample was 120 patients consisting of 70 benign nodules and 50 malignant nodules. Out of 120 patients, 106 (88.3%) female and 14 (11.7%) male patients. Out of 106 female patients, 64 (91.45) had benign and 42 had malignant thyroid nodules. Out of 14 (11.7) male patients, 6 had benign and 8 had malignant thyroid nodules. The youngest patient in our study was 31 years and the oldest patient was 76 years. The common range of patients age was ≥ 60 years and consisting of twenty (28.6%) benign thyroid nodules and fourteen (28%) malignant thyroid nodules. The majority of patients’ age group with malignant thyroid nodules were between 50 - 60 years and consisting of twenty (40%) malignant nodules. In our study, according to the result of gray scale and color Doppler ultrasonography, hypo-echogenicity, solid echo structure, micro-calcification and intra-nodular vascularity were the significant characteristics of malignancy in nodules with sensitivity (72%, 74%, 48% and 88% respectively), specificity (66%, 63%, 94% and 69% respectively), PPV (60%, 59%, 86% and 67% respectively) and NPV (77%, 77%, 72% and 89% respectively).

Comparison of Gray Scale and Color Doppler Sonography with Cytopathology Findings in Cervical Lymphadenopathy in Tertiary Level Hospital

Introduction: Cervical region is the commonest area of lymphadenopathy which is easily accessible to ultrasound and Doppler study. The morphological and vascular-architectural differences among various nodal diseases aids in differentiating benign from malignant causes.&#x0D; Methods: The study was done on the 108 patients referred to Department of Radiology andImaging, TUTH for ultrasound of cervical lymphadenopathy who subsequently underwentFNAC examination. Gray scale evaluation for morphology of the nodes along with Doppler evaluation for resistive index (RI), pulsatility index (PI) and Peak systolic velocity (PSV) were done and correlated with FNAC findings.&#x0D; Results: Among the 108 lymph nodes, 24 were proven to be malignant on FNAC. Features such as S/L ratio &gt;0.5, absence of echogenic hilum, and abnormal vascular pattern demonstrated sensitivities of 96%, 92%, and 87%, specificities of 74%, 65% and 77% and positive predictive values (PPVs) of 51%, 43%, and 55% respectively. The cutoff values for RI, PI and PSV were found to be 0.705, 1.34 and 17.5 cm/s with sensitivities of 96%, 96% and 87%, specificities of 95%, 99% and 88% and positive predictive values (PPVs) of 85%, 95% and 70% respectively.&#x0D; Conclusion: Ultrasound findings of S/L ratio, absence of echogenic hilum, abnormal vascular pattern and Doppler indices revealed good sensitivity, specificity, and accuracy in differentiating benign and malignant lymph nodes.

Torsion of the Testicular Appendages in Adult Acute Scrotum

Adult patients with acute scrotum sometimes tend to be treated for epididymitis without undergoing ultrasonographic examination, although precise ultrasonography reveals that there are some patients with torsion of the testicular appendages. In this report, I investigate the incidence of patients with torsion of the testicular appendages among patients with adult acute scrotum, who mainly used to be treated for epididymitis. In the last 5 years, 46 patients (23~62, average age 43.5 years) with scrotal pain and swelling visited our clinic for diagnosis and treatment. On an outpatient basis, their symptoms were evaluated, and blood tests, urinalysis, and grey scale and color Doppler ultrasonography with a 5-12 MHz linear scan were performed. Five (10.9%) of the 46 patients were diagnosed as having torsion of the testicular appendages. Although none of them had a high fever, 4 of the 5 (80%) had nausea and abdominal pain. Leukocytosis and pyuria were not found in any case. Typical ultrasound appearances were reactive hydrocele and a hyperechoic swollen mass or enlarged hyperechoic, spherical mass of the appendage. On color Doppler ultrasonography, there was no blood flow within the torsed appendage testis, and an increase in periappendiceal blood flow was seen in all of the cases. They were treated conservatively with anti-inflammatory agents and cooling, and their symptoms disappeared within 2 weeks. It is suggested that as many as 10.9% of adult patients with scrotal pain and swelling may suffer from torsion of the testicular appendages. We should conduct ultrasonography for adult patients with acute scrotum.

Myomectomies of 65 Fibroids with Preservation of Uterus in a Nulligravida with Minimally Invasive Incision - A Rare Case with Review of Literature

Uterine fibroids are benign neoplastic growth arising from the myometrium, with estimated incidence being 20 - 40%. They are a major cause of morbidity in women of reproductive age group. The gold standard diagnostic modality for uterine fibroids appears to be gray - scale ultraso nography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medi cally, surgically, and even by minimal access techniques. Here we are reporting a case of myo mectomy with removal of 65 fibroids and conserving the uterus for future fertility.

Non invasive assessment of malignancy in solitary non palpable thyroid nodules: A comparative and complimentary evaluation of grey scale ultrasound and color doppler parameters –Way towards a new scoring system?

Objectives: To assess the comparative as well as collective role of various grey scale (GS) ultrasonography (USG) and color doppler (CD) parameters in distinguishing benign from malignant thyroid nodules. To suggest a scoring system for predicting malignancy in thyroid nodules using this array of parameters. Methods: 140 patients with non palpable thyroid nodules were examined by five GS USG and three CD parameters. The results were compared with histopathological examination and evaluated statistically. Each GS and CD parameter was evaluated individually as well as collectively, comparatively. Total score was calculated by assigning each of these eight parameters a score of 0 to 2. Results: Scoring used in this study showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy of 87.5%, 90.6%, 70%, 96.7% and 80% respectively. These parameters were 85.4%, 86.2%, 60%, 96%, 80% for CD and 69.2%, 71.9%, 50%, 85.2% and 64% for GS. Two GS USG features showing p value < 0.05 were poorly defined margins and thick incomplete halo while on CD Resistivity index (RI) was found to be very highly significant (p < 0.0001) and Pulsatility index (PI) was highly significant (p < 0.001). Conclusion: Scoring system proposed in this study proved better than GS or CD individually for predicting malignancy in thyroid nodules. Amongst various GS and CD parameters RI showed highest statistical significance. Overall CD showed better accuracy, sensitivity, specificity than GS USG.

Post Renal Transplant Surgical Complications; MRI Standard Applications and Diagnostic Outcomes

Objective: Fast MR imaging sequences together with paramagnetic contrast agents, offer multiple advantages in the assessment of renal function. It provides cross sectional and vascular information without the risk of ionizing radiation, iodinated contrast or arterial catheterization. Post transplantation complications can be grouped as surgical or medical. Immediate surgical complications include renal artery thrombosis or stenosis, urinary leak or lymphocele. Renal allograft frequently require repeated imaging studies during the immediate post-operative period and various times thereafter, when renal function is compromised. Background: End stage renal disease is common and can result from a variety of diseases. Kidney transplantation from living-related donors offered the best prognosis. Imaging modalities that are currently used to evaluate transplanted kidneys are ultrasound (US), computed tomography (CT), scintigraphy, intravenous urography (IVU), contrast angiography, and magnetic resonance imaging (MRI). Methods: This study was conducted on 181 renal transplant recipients. Recipients were 139 males and 42 females. Their age ranged from 20 to 58 years (mean age 39 years). The patients underwent clinical assessment, Laboratory investigations, and different Radiological imaging procedures as: I- Gray scale and color Doppler ultrasonography. II- Magnetic Resonance Imaging. 3D Gd-enhanced MRA. MR Urography. Selective IA-DSA of the graft artery. III- Percutaneous catheter nephrostomy (PCN) and antegrade pyelography. IV- Radio-isotope diuretic renogram using 99m Tc-MAG3. Results: 30 renal transplants were examined by MRI in the 1st 2 weeks after renal transplantation. At the end of 1st 2 weeks, MR examinations were carried out, as basal studies (including MRI, MRA and MRU) for 98 transplants. From this group, 64 transplants were subjected to other MR examinations. After the 1st 2 weeks, 53 transplants were subjected to MR examinations for the 1st time at variable post-transplant duration. Among the studied 181 renal transplants, MR examinations detected 3 cases with graft arteries thrombosis (1.6%), 10 with graft arteries stenosis (5.5%), 6 with segmental infarctions (3.3%), 3 cases with graft intrarenal arteries pseudo-aneurysms (1.6%) and 2 cases with arterio- venous fistulae (1.1%) after graft biopsies. Conclusion: MRI is highly recommended to evaluate intra-/extra-renal graft vascular lesions, urinary obstructive syndrome, compressive collections (urinoma, lymphocele), inflammatory and tumoral lesions of the renal graft.

The Role of Ultrasonography for Differentiating and Management of Malignant Cervical Lymph Nodes

Objective:To investigate the value of grey scale and Doppler ultrasonography in the assessment of metastatic and lymphomatous cervical lymph nodes.Methods:One hundred and nineteen malignant cervical lymph nodes in 119 patients diagnosed as malignant according to grey scale, color Doppler and spectral Doppler ultrasonography features were included in this study. The sizes, shape, echo pattern, echogenic hilus, nodal border, cystic necrosis and coagulation necrosis, vascular distribution pattern, resistivity and pulsatility index values of lymph nodes were noted. All patients had histopathological diagnosis.Results:The final diagnosis of the 42 lymph nodes was lymphoma, and of the 77 lymph nodes was carcinoma metastasis (33 thyroid carcinoma metastasis and 44 squamous cell carcinoma metastasis). While a hyperechoic pattern and calcification were detected in the lymph nodes originating from thyroid carcinoma as 39% and 33%, respectively, a reticular pattern (26%) and low resistive and pulsatility indices were detected in lymph nodes originating from lymphoma. These criteria were statistically significant for the differential diagnosis (p<0.05). Size, shape, hypoechoic echo pattern, absence of echogenic hilus, nodal border, cystic necrosis, coagulation necrosis and vascular distribution pattern were not found to be significant for the detection of a primary tumour.Conclusion:Hyperechoic echo pattern, reticular pattern, calcification, low resistivity and pulsatility indices are useful parameters for the differential diagnosis of malignant cervical lymph nodes. These ultrasonography critaria can be used for assesment and management of unknown primary malign neck nodes.

Characterisation of Flowmetric Changes and Haemodynamics in Portal Venous Hypertension with Duplex (Grey Scale and Colour Doppler) Ultrasonography: A Prospective Analysis and Etiological Stratification

Characterisation of Flowmetric Changes and Haemodynamics in Portal Venous Hypertension with Duplex (Grey Scale and Colour Doppler) Ultrasonography: A Prospective Analysis and Etiological Stratification

Sonographic Diagnosis of a Subclinical Wandering Spleen

A wandering spleen is a rare condition. It is usually diagnosed when abdominal pain develops secondary to splenic torsion. Although splenic hypermobility is the pathognomonic feature of a wandering spleen, it is rarely revealed by imaging in the subclinical stage. We report 3 patients with a subclinical wandering spleen who had incidental sonographic findings of splenomegaly. Gray scale and color Doppler sonography in the right decubitus position can easily show the migratory nature and perfusion status of a wandering spleen in real time.

Blood flow of the achilles tendon during military training

BackgroundThe link between the hypervascularisation and the pain symptoms in a tendinopathy is still obscure. It can be hypothesised that it is important to take the stage of the tendinopathy...

The importance of gray scale and color Doppler ultrasonography in the diagnosis of spontaneous renal pelvis rupture: case report

Peripelvic extravasation associated with spontaneous rupture of renal pelvis is a rare occurrence, caused mostly by the obstruction due to calculus. However, the presence of renal anomalies increases the risk of rupture. Urinary extravasation leads to flank pain and may cause acute abdominal symptoms. Especially, the displacement of viscera by extravasated urine and the presence of gastrointestinal symptoms arising through intestinal reflex stimulation renders diagnosis more difficult. Ultrasonography, intravenous urography and computed tomography are the most efficient diagnostic tools in the diagnosis of pelvic renal rupture. In the present study, pre- and post-treatment radiological imaging findings of a case with renal pelvis rupture due to right ureter stone and the use of gray scale and color Doppler ultrasonography in the diagnosis has been discussed.

Temporal Artery Pseudoaneurysm With Temporal Arteritis

We report a case of a temporal artery pseudoaneurysm in a patient with a history of human immunodeficiency virus (HIV) infection, hepatitis C infection, cocaine dependence, neurosyphilis, and remote head trauma. The diagnosis was made on gray scale and color Doppler sonography, and subsequent resection was performed. Histologic analysis showed temporal arteritis with no giant cells. Although most reported cases of temporal artery pseudoaneurysms are attributed to prior trauma, we discuss additional potential etiologies for temporal artery pseudoaneurysm in the setting of temporal arteritis.

Contrast-Enhanced Sonographic Findings of Gangrenous Meckel Diverticulitis

Meckel diverticulum is occasionally associated with several complications, including hemorrhage, inflammation, perforation, and bowel obstruction.1 However, the preoperative diagnosis of Meckel diverticulum is difficult because of the lack of specific physical and laboratory findings. Technetium Tc 99m pertechnetate scintigraphy is useful for identifying patients with a bleeding Meckel diverticulum 2 ; however, this technique is not suitable for patients with an acute abdomen in whom the treatment protocol has to be decided as early as possible. In recent years, several reports have described the usefulness of sonography in detecting a complicated Meckel diverticulum. 3-7 Here, we report a case of gangrenous Meckel diverticulitis with perforation; this condition was detected preoperatively by gray scale and contrast-enhanced sonography. The latter, in particular, was useful for evaluating the viability of the wall of the Meckel diverticulum in our case. To our knowledge, contrast-enhanced sonographic findings of this condition have not been reported in the literature to date. We present the sonographic findings, including those of contrast-enhanced sonographic images, of gangrenous Meckel diverticulitis and correlate these findings with its surgical and pathologic findings.

Prenatal imaging of fetal hepatoblastoma

A detailed sonographic at 37 weeks of gestation performed due to non-reassuring fetal monitor of a breech presentation fetus detected a solid right lobe hepatic tumor. Prenatal gray scale and Doppler sonography suggested a diagnosis of hepatoblastoma which was confirmed postnatally. Differential ultrasonographic diagnosis of fetal hepatic tumors is discussed.

Prenatal imaging of fetal hepatoblastoma

A detailed sonographic at 37 weeks of gestation performed due to non-reassuring fetal monitor of a breech presentation fetus detected a solid right lobe hepatic tumor. Prenatal gray scale and Doppler sonography suggested a diagnosis of hepatoblastoma which was confirmed postnatally. Differential ultrasonographic diagnosis of fetal hepatic tumors is discussed.

Uterine artery embolization for the treatment of symptomatic fibroids

Uterine artery embolization (UAE) as the primary treatment modality for fibroids was first described by Ravina et al. in 1995. Since then reports from developed countries have indicated that UAE appears to be effective in controlling symptoms in 81—97% of cases. However there has been no published long-term data regarding the efficacy of UAE in the treatment of symptomatic fibroids in the Indian population. This prospective study was undertaken to evaluate the long-term safety and efficacy of the procedure and the efficacy of the use of grey scale and color Doppler sonography in the follow-up of women who underwent UAE. Uterine artery embolization was performed as an alternative to surgery in 30 women (age range: 21—52 years mean age: 33.8 years) with 1 or more symptomatic uterine fibroids. Exclusion criteria included active pelvic infection/inflammatory disease gynecological malignancy prior pelvic radiation connective tissue disorders associated pelvic conditions that might be corrected at the time of combined surgery such as stress incontinence or uterine prolapse and contraindications to angiography due to contrast allergy renal failure or uncorrectable bleeding diathesis. (excerpt)

Reliability of Venous Diameter in the Diagnosis of Subclinical Varicocele

Objective: The diameters of the veins in the pampiniform plexus have been used to diagnose subclinical varicocele. But there are many cutoff points and some controversies about the diagnosis. These cause difficulty in the evaluation of the results of epidemiological and clinical studies. Our aim is to establish the reliability of vein diameters in the pampiniform plexus in the diagnosis of subclinical varicocele. Methods: Physical examination, scrotal gray scale ultrasonography (SU) and color Doppler ultrasonography (CDU) were performed to assess varicocele in 100 infertile patients without clinical varicocele (group I), 100 infertile patients with clinical left varicocele (group II), and 50 fertile men without clinical varicocele (group III) as a control group. The diameter of the veins in the pampiniform plexus was measured with SU. According to various cutoff points of venous diameter and CDU criteria, the diagnosis of varicocele was made. The highest mean venous diameters were calculated with and without varicocele in men whose diagnoses had been made with CDU. The results were correlated with each other and the control group. Results: According to venous diameter cutoff points, the varicocele ratio did not correlate with the CDU results (p < 0.05) except for the left side of patients with clinical left-sided varicocele. The highest mean diameters of the veins in group III (control group) did not show a significant difference to the other groups (p > 0.05) except for the left side of group II patients. We did not find an exact relation between the highest venous diameter in the men who have and those who do not have subclinical varicocele with CDU. The highest mean diameter was 2.17 ± 0.34 (SD) mm for men who have subclinical varicocele and 2.00 ± 0.31 mm for men who do not have subclinical varicocele by CDU (p < 0.05). Conclusion: Our results indicate that venous diameters should not be used as diagnostic criteria for subclinical varicocele. Only the evaluation of venous diameter in varicocele should be used to document and quantify pathology, but it should not be used to establish the diagnosis.

OC153: Grey scale and Color Doppler sonography in the abnormal third stage of labour

OC153: Grey scale and Color Doppler sonography in the abnormal third stage of labour