Sonographic Changes Research Articles

“Comparison of Placental Grading by Ultrasonographic Study in Normal and High Risk Pregnancy in North Indian Population”

The relationship of the placenta as seen after birth, to infant outcome is very important. By ultrasonography we visualize the placenta in-situ and describe progressive sonographic changes in the placenta. The placenta undergoes series of progressive changes that relate to gestational age and fetal maturity. The purpose of the present study was to relate the placental growth in normal and high-risk pregnancy for predicting neonatal outcome. This study was conducted on total number of 42 patients coming to antenatal clinic of obstetrics & gynecology and in the department of Radiodiagnosis, at Sardar Vallabh Bhai Patel Hospital, Meerut, Uttar Pradesh. Detailed personal and family history was taken; general examination of the patient was done to include the high risk cases. Morphology of placenta was studied under following heading a) chorionic plate b) echotexture of placental substance c) basal layer of placenta. The placental grading was done according to Grannum's classification. It was observed that between 32 to 37 week, grade II placenta were found more common as compared to grade I, whereas with >37 weeks grade III placenta was found in normal pregnancy. Acceleration and deceleration of placental growth were observed in high risk cases.

Tridimensional sonographic anatomical changes on pelvic floor muscle according to the type of delivery

The aim of the study was to evaluate the association of avulsion and postnatal hiatal dimensions with delivery mode. These anatomical changes on pelvic floor muscle may be assessed by 3-4D ultrasonography. This is a prospective observational study that included 164 women: 20 nulliparous, 20 primigravid, and 124 postpartum women (62 at 1 month, 62 at 9 months postpartum). We performed an introital 3-4D ultrasonography to assess levator ani muscle's integrity, levator hiatal area at rest, on Valsalva, and on contraction. Levator ani avulsion was diagnosed in 59.5% of forceps deliveries. There were no statistically significant differences in postnatal hiatal dimensions between normal vaginal deliveries at 9 months postpartum and nulligravid. Levator hiatal area was significantly higher after forceps delivery. Low incidence of levator avulsion takes place in normal vaginal deliveries. However, forceps delivery is the riskiest type of delivery for pelvic floor pathology and its recovery.

ABDOMINAL ULTRASONOGRAPHIC FINDINGS IN DOGS NATURALLY INFECTED WITH BABESIOSIS

Canine babesiosis is a tick-borne disease with a worldwide distribution that can involve multiple organs and result in a wide variety of clinical manifestations. Our goal was to describe the sonographic changes occurring in 72 dogs naturally infected with babesiosis. Seven healthy Beagle dogs were used as a control group. The most common finding in all dogs was splenomegaly with a diffuse heterogenic parenchyma and generally reduced echogenicity. Diffuse hypoechoic hepatomegaly and bilaterally increased cortical echogenicity of the renal parenchyma were found more frequently in severe uncomplicated and complicated babesiosis groups. Mean renal resistive index and pulsatility index (PI) values were 0.66/1.35, 0.73/1.91, and 0.71/1.73 for mild uncomplicated, severe uncomplicated, and complicated babesiosis groups, respectively. A markedly increased PI for complicated and severe uncomplicated groups correlated with anemia and severity of renal damage. Ultrasonography can be an adjunct for diagnosis and monitoring canine babesiosis and its systemic complications. The detection of diffuse heterogeneous splenomegaly can support the diagnosis of Babesia infection, because of the high prevalence of this lesion in these patients.

SAFETY AND CORRELATION OF TEST RESULTS OF COMBINED ULTRASOUND‐GUIDED FINE‐NEEDLE ASPIRATION AND NEEDLE CORE BIOPSY OF THE CANINE SPLEEN

The safety and diagnostic value of combined splenic fine-needle aspiration (FNA) and needle core biopsy (NCB) is unknown. Forty-one dogs with splenic lesions were studied prospectively. Safety was assessed in 38 dogs and no complications were encountered. Initially, clinical and anatomic pathologists reviewed each FNA and NCB sample, respectively, without knowledge of the other's results. Diagnoses were categorized as neoplastic, benign, inflammatory, normal, or nondiagnostic. The level of agreement between sampling methods was categorized as complete, partial, disagreement, or not available. Test correlation was performed in 40 dogs. Nondiagnostic results occurred in 5/40 NCB (12.5%) and no FNA samples. Neoplasia was diagnosed in 17/40 dogs (42.5%), benign changes in 20/40 dogs (50%), inflammatory disorders in 0/40 dogs, and normal 2/40 dogs (5%). One of the 40 dogs (2.5%) had a diagnosis that was equivocal for neoplasia on both tests and therefore was not categorized. Of the 35 dogs that had diagnostic samples, cytopathologic and histopathologic diagnoses agreed completely in 18/35 dogs (51.4%), partially in 3/35 dogs (8.6%), and were in disagreement in 14/35 dogs (40.0%). Pathologists collaboratively reviewed diagnoses that were in disagreement or partial agreement and altered their individual diagnoses in 6/17 dogs (35.3%) to be within partial or complete agreement, respectively. Percutaneous FNA and NCB can be performed safely in dogs with sonographic splenic changes. Results suggest that adding NCB to FNA provides complementary information in dogs with suspected splenic neoplasia. This combined protocol may improve detection of splenic neoplasia and provide neoplastic subclassification.

Extraartikuläre Sonografie bei rheumatischen Erkrankungen

Die Sonografie ermöglicht eine gute Differenzierung von Weichteilraumforderungen wie Hämatomen, Ganglien, Rheumaknoten, Gichttophi und Erythema nodosum. Maligne Lymphknoten sind echoarm und kugelförmig. Mittels abdomineller Sonografie kann nach Tumoren gesucht werden, und es können begleitende Veränderungen an Leber, Milz und Nieren nachgewiesen werden. Beim Sjögren Syndrom finden sich charakteristische Veränderungen der Speicheldrüsen. Vaskulitiden großer Arterien sind durch eine homogene Wandschwellung charakterisiert. Phlebothrombosen, die bei vielen rheumatischen Erkrankungen gehäuft vorkommen, lassen sich von rupturierten Bakerzysten differenzieren. Die Fingerarteriensonografie hilft zwischen primärem und sekundärem Raynaud Phänomen zu unterscheiden. Die Echokardiografie hat ihre Bedeutung im Nachweis oder Ausschluss einer kardialen Beteiligung bei Vaskulitiden und Kollagenosen und insbesondere als Screening Verfahren und Verlaufskontrolluntersuchung der pulmonalen Hypertonie bei systemischer Sklerose.

Combined application of interference therapy and "dry" carbon dioxide baths for the treatment of hemodynamic disorders in patients with implantation failure due to inflammation

This work was designed to evaluate the influence of different physiotherapeutic modalities on the possibility of implantation, development and outcome of pregnancy in patients with chronic endometriosis and previous failures of implantation. The study confirmed initial sonographic changes and deficit of uterine blood supply as well as gradual improvement of these parameters under effect of adequate physiotherapy. Inclusion of dry carbon dioxide baths in the combined treatment of hemodynamic disorders made it possible to "prepare" endometrium for implantation and optimize blood circulation in the uterine vasculature in order to enhance the probability of implantation, development of pregnancy, and its success.

Sonographic basal ganglia alterations are related to non-motor symptoms in multiple sclerosis

The anatomical basis of cognitive dysfunction and other non-motor symptoms in multiple sclerosis (MS) is poorly understood. In MS patients, transcranial sonography (TCS) shows neurodegenerative disease-like lesions of the substantia nigra (SN) and basal ganglia, thought to reflect iron accumulation. The present study deals with the question of whether sonographic changes of SN, brainstem raphe, lenticular nucleus (LN) or caudate nucleus are related to non-motor symptoms of MS. We used TCS to investigate 54 MS patients and 54 age- and sex-matched healthy subjects. Degree of cognitive (executive) dysfunction, fatigue, depression, and urinary urge incontinence in MS patients was assessed using the Paced Auditory Serial Addition Test, the Faces Symbol Test, the Modified Fatigue Impact Scale, the Beck Depression Inventory, and the Urinary Distress Inventory. Abnormal TCS findings of SN, brainstem raphe, LN, and caudate nucleus were found in 13, 7, 11, and 6% of the healthy subjects, but in 54, 43, 62, and 41% (each, p<0.001) of the MS patients, with similar frequency in relapsing-remitting and primary or secondary progressive MS patients. Sonographic alteration of the LN correlated with cognitive dysfunction. Combined alteration of both, LN and SN, was clearly associated with cognitive dysfunction and cognitive fatigue. The combined sonographic alteration of SN and brainstem raphe indicated severe urinary urge incontinence irrespective of the presence of spinal MS lesions. No relation was found between depression and any of the TCS findings. These findings suggest that neurodegenerative processes affecting deep brain structures contribute to cognitive and autonomic dysfunction in MS.

Powerdopplersonografische Befunde der Achillessehnen von 953 Langstreckenläufern – eine Querschnittsstudie

The aim of this cross-sectional study was to assess the frequency of tendinopathy-typical Doppler sonographic changes in the Achilles tendons of long distance runners and to correlate these findings with anamnestic and anthropometric data of the subjects. 1906 Achilles tendons of 953 long distance runners were examined by ultrasound and power Doppler (Toshiba Aplio SSA-770A/ 80 12 MHz). Ultrasound images (spindle-shaped thickening, hypoechoic/hyperechoic lesions, neovascularizations) were analyzed in relation to the runners' anthropometrical data and history of Achilles tendon complaints. In asymptomatic runners as well as in the overall group, there was a statistically significant correlation between tendon thickness and age, height and weight (CC 0.24 - 0.38, p < 0.001). Runners with current or healed Achilles tendon complaints displayed a statistically significant thickening of the tendons, as well as an increase in hypoechoic lesions and neovascularizations (p < 0.001). While grayscale abnormalities were rarely found in asymptomatic runners (< 10 %), neovascularization was detected in 35 % of healthy test persons using the high-resolution power Doppler "Advanced Dynamic Flow". Contrary to frequent assumption, neovascularization is often found in tendons of asymptomatic runners, using modern power Doppler equipment. The pathological relevance of single microvessels in asymptomatic tendons must, therefore, be critically discussed.

Outcome of induction of labour using maternal characteristics, ultrasound assessment and biochemical state of the cervix

Objective. To assess pre-induction sonographic, digital examination and biochemical changes in the cervix to predict induction outcome.Methods. Transvaginal and abdominal scans were performed in 460 women at 37–41 weeks of gestation to determine cervical length (CL), posterior cervical angle (PCA) and foetal occipital position. The Bishop Score (BS) and the absence/presence of phosphorylated form of insulin-like growth factor-binding protein-1 (phIGFBP-1) in cervical secretions were assessed. Independent parameters significantly associated with a vaginal delivery were identified.Results. A total of 340 (73.9%) women achieved a vaginal delivery following induction. Multivariate analysis indicated that significant independent predictors of vaginal delivery were CL (adjusted odds ratio [AOR]: 0.59, 95% confidence interval [CI]: 0.45–0.79), PCA (AOR: 1.89, 95% CI: 1.09–3.28) and multiparae (AOR: 10.02, 95% CI: 5.10–19.69). For a specificity of 75%, the sensitivity for prediction of vaginal delivery using the BS, the CL and the multivariate model using the identified significant independent predictors were 37.1, 46.8 and 68%, respectively.Conclusion. The combination of sonographic assessment of the cervix and maternal characteristics was superior to the either BS or CL alone in the prediction of the induction outcome. Inclusion of the absence/presence of phIGFBP-1 did not further improve induction outcome.

Sonographic changes after laparoscopic cystectomy compared with three-stage management in patients with ovarian endometriomas: a prospective randomized study

Laparoscopic surgery is the gold standard treatment for ovarian endometriomas. The aim of this study was to evaluate the impact of two different laparoscopic methods on sonographic indicators of ovarian reserve in the treated ovary. In this prospective randomized clinical trial, 20 patients with endometriomas were randomly assigned to undergo either laparoscopic cystectomy (Group 1) or the 'three-stage procedure' (Group 2). All patients underwent ultrasound examination preoperatively and 6 months after laparoscopy. Another ultrasound examination was performed 12 months after intervention in order to detect any recurrence. We investigated the alterations in the residual ovarian volume, ovarian vascular supply and antral follicle count (AFC) on the ovary with the endometriotic cyst by transvaginal color Doppler ultrasonography. The residual ovarian volume and the lowest pulsatility and resistance indexes were found to be similar between the two groups before and 6 months after laparoscopic intervention. The AFC of the operated ovary was increased significantly (P = 0.002) in Group 2 compared with Group 1 after 6 months. One year after laparoscopy, two recurrences of endometriomas were detected in Group 2, although none were detected in Group 1 (P = 0.47). Ovarian volumes and vascularization were comparable among the two laparoscopic methods. On the contrary, functional ovarian tissue as determined by AFC was higher after the 'three-stage' procedure.

Sonographic changes after removing all benign breast masses with sonographically guided vacuum-assisted biopsy

Total removal of benign breast masses by vacuum-assisted biopsy (VAB) is now increasingly accepted as a treatment option. However, little is known about whether this procedure produces early changes on follow-up sonography and, if so, how often and what factors might influence them. To evaluate sonographic changes after total removal of benign breast masses using sonographically guided VAB and to determine the influencing factors. We evaluated sonographic changes prospectively 1 week, 1 month, and 6 months after biopsying 32 benign masses from which all sonographic evidence had been removed during sonographically guided directional VAB performed with 8- or 11-gauge needles. Procedural factors were documented and compared with sonographic findings. At 1-week follow-up, hematomas were observed in 84% (27/32) of the lesions. After 1 month, while the hematomas had resolved in all but five lesions, focal new architectural distortion had developed in 26 (90%) lesions; 11 lesions were graded as severe, mimicking malignancy. After 6 months, 23 lesions with various degrees of architectural distortion were observed. Six of the 32 lesions (19%) contained a residual lesion. No statistically significant association between sonographic findings and procedural variables was identified, except between the degree of hematoma and lesion size. The total removal of benign breast masses using sonographically guided VAB frequently produces changes on follow-up sonography after 6 months. Although these changes failed to show statistical significance with procedural factors, a larger dedicated study is needed.

1427: Sonographic Features of Vasectomy Related Abnormality in the Scrotum: Revisited

Vasectomy is one of the most effective methods of male fertility control. In general, it is a safe procedure, but, acute and chronic complications can be developed. The aim of this exhibit was to present the sonographic changes in the epididymis after vasectomy and illustrate various vasectomy related abnormal conditions. The medical records and sonographic findings of patients with history of vasectomy were reviewed. We collected vasectomy related abnormalities. Chief complaints of patients with vasectomy were scrotal mass, scrotal pain and scrotal enlargement. In patients with scrotal pain after vasectomy, the sonographic findings included enlargement of epididymis with ill-defined border. Hematoma and hematocele can be associated. The typical sonographic changes in the epididymis after long-term vasectomy were mainly epididymis thickening and epididymal tubular ectasia, mostly with no or diminished blood flow in the epididymis. The spermatoceles and sperm granulomas were typically associated with vasectomy. Spermatoceles have various sonographic findings from multilocular cyst, cystic lesions with low-echo levels to solid mass. Sperm granulomas showed well-circumsecribed heterogeneous mass in the epididymis. Epididymal tumor could not be excluded in those masses. The Hydroceles, varicocele and epididymal cysts can be also associated, however, these are nonspecific. When radiologists encounter such changes of epididymis, it would be useful to get history of vasectomy for correct diagnosis. To avoid an incorrect diagnosis, it is important to be aware of the typical and atypical sonographic features of vasectomy related abnormalities.

0432: Ultrasound of Salivary Glands - Anatomy and Benign Conditions

Due to their superficial position the parotid, the submandibular and the sublingual glands can be imaged with high-resolution transducers. In acute inflammatory diseases sonography can differentiate between obstructive or non-obstructive sialoadenitis. Abscess formations may be detected and the maturation of the colliquation may be controlled. Abscesses may be punctured under US guidance. In Sjögren's Syndrome the sonographic changes correlate with the histological destruction, in acute forms hypervascularisation is found in color Doppler. In fibrotic cases the stimulation-induced hyperemia is impaired. In siaIoadenosis inflammatory and tumorous lesions can be ruled out by sonography. Tumors of the salivary glands can be visualized with high sensitivity. Like other imaging methods the specificity in assessment of the histology of a tumor is low. Multilocular lesions as sarcoidosis, lymphoma, metastases or cystadenolymphoma are discussed. In deep located, malignant tumors or when the tumor cannot be delineated completely, MR or CT are obligatory to delineate the tumor. Sonography enables the diagnosis of cysts or ranulae. The accuracy of sonography in assessment of sialolithiasis is about 90 %. Non-opaque stones can be visualized too. However small stones of less than 2mm are difficult to detect since the posterior shadow may be missing. The concrements can be differentiated into intraductal or intraglandular stones. Indirect signs like ductal dilatations or inflammatory changes may be found. Pseudotumorous lesions as hypertrophy of the masseter muscle, tuberculosis, sarcoidosis or lymphoepithelial lesions in AIDS are discussed. In children the main differential diagnosis of salivary gland pathologies are addressed.

Dysplastic kidneys in children – Do they grow?

Dysplastic kidneys (DK) are a common cause of chronic kidney disease (CKD). Little is known about their growth or how their sonographic appearance changes. This study aimed to test the hypothesis that DK gain little length, and to identify radiologic trends predictive of CKD. Ultrasound scans of children with DK born in 1980-2005 and referred to a single tertiary centre were analysed by a pediatric radiologist. Renal lengths were plotted on standard nomograms and the degree of dysplastic appearance noted. Factors related to DK - bladder outlet obstruction, vesico-ureteric reflux and renal impairment - were noted. Fifty-three children were studied (83 kidneys), of whom 41 were boys; 289 scans were analysed. In 33 children there was associated bladder outlet obstruction or vesico-ureteric reflux. Forty-four DK were noted to fall off their renal length 'centile'. This correlated well with the development of CKD and is statistically significant. Deterioration occurred in 53% of DK; primarily progressive reduction in corticomedullary differentiation. This also correlated well with development of CKD. More than half of the DK showed poor growth velocity. This, together with the degree of sonographic abnormality, carries a high predictive value for development of CKD. We recommend diligent serial sonography to follow renal growth and dysplastic appearance in children with DK.

Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved

This study aimed at determining whether lowering serum urate (SU) to less than 6 mg/dl in patients with gout affects ultrasonographic findings. Seven joints in five patients with monosodium urate (MSU) crystal proven gout and hyperuricemia were examined over time with serial ultrasonography. Four of the five patients were treated with urate lowering drugs (ULDs) (allopurinol, n = 3; probenecid, n = 1). One patient was treated with colchicine alone. Attention was given to changes in a hyperechoic, irregular coating of the hyaline cartilage in the examined joints (double contour sign or "urate icing"). This coating was considered to represent precipitate of MSU crystals. Index joints included metacarpophalangeal (MCP) joints (n = 2), knee joints (n = 3), and first metatarsophalangeal (MTP) joints (n = 2). The interval between baseline and follow-up images ranged from 7 to 18 months. Serial SU levels were obtained during the follow-up period. During the follow-up period, three patients treated with ULD (allopurinol, n = 2; probenecid, n = 1) achieved a SU level of <6 mg/dl. In two patients, SU levels remained above 6 mg/dl (treated with allopurinol, n = 1; treated with colchicine, n = 1). At baseline, the double contour sign was seen in all patients. In those patients who achieved SU levels of <6 ml/dl, this sign had disappeared at follow-up. Disappearance of the double contour sign was seen in two knee joints, two first MTP joints, and one MCP joint. In contrast, disappearance of the double contour sign was not seen in patients who maintained a SU level > or =7 mg/dl. In one patient treated with allopurinol, SU levels improved from 13 to 7 mg/dl during the follow-up period. Decrease, but not resolution of the hyperechoic coating was seen in this patient. In the patient treated with colchicine alone, SU levels remained >8 mg/dl, and no sonographic change was observed. In our patients, sonographic signs of deposition of MSU crystals on the surface of hyaline cartilage disappeared completely if sustained normouricemia was achieved. This is the first report showing that characteristic sonographic changes are influenced by ULDs once SU levels remain < or =6 mg/dl for 7 months or more. Sonographic changes of gout correlate with SU levels and may be a non-invasive means to track changes in the uric acid pool. Larger prospective studies are needed to further assess these potentially important findings.

Malarial hepatopathy in falciparum malaria.

To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. A case series. This study was conducted at Medical Unit-I (Ward 5), Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease (e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice) was excluded on the basis of history, relevant clinical examination and investigations. Age of the patients ranged from 13-48 years (mean 26.04+/-8.33). All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two (51.6%) had serum bilirubin 3-6 mg%, 20 (32.2%) had 6-10 mg% and 10 (16.1%) had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients (45%) had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 (35.4%), splenomegaly in 48 (77.4%) and both hepatomegaly and splenomegaly in 16 (25.8%). Gallbladder wall thickness was increased in 5 (8.06%) patients. There was no evidence of biliary dilatation. A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given.

Sonographic findings following appendectomy for uncomplicated appendicitis in children

Little is known about 'normal' local sonographic changes occurring in the postoperative period after an uneventful appendectomy. To analyse the local changes on US examination occurring after uneventful open (OA) or laparoscopic (LA) appendectomy in children with normal histology and with nonperforated acute appendicitis. US was prospectively performed in 82 children (54 boys and 28 girls) aged 1-16 years (mean 11.6+/-3.2 years), 3 days following LA (n=51, 62%) or OA (n=31, 38%) for nonperforated appendicitis. Multivariate analysis was performed using stepwise logistic regression, with the following starting variables: surgical technique, gender, pathological finding, appendix location, and histology. Of the 82 patients, 35 (42.7%) had postoperative pathological US findings such as peritoneal fluid, oedematous mesenteric fat and thickening of the bowel wall. While the overall incidence of pathological US findings between OA and LA groups was not significantly different, multivariate logistic regression analysis showed that OA is associated with a reduction by a factor of 0.35 in the odds ratio of postoperative pathological US findings (P=0.007). Pathological US findings are common in children after appendectomy, particularly after LA. Awareness of these pathological findings might prevent unnecessary postoperative treatment.

Sonographic study of the decidua basalis in the first trimester of pregnancy

To describe the sonographic appearance of the decidua basalis and its changes in the first trimester of pregnancy. We reviewed images from 159 first-trimester ultrasound examinations in 105 women with uncomplicated pregnancies who later delivered at term. The appearance of the decidua basalis layer and the sonographic changes that it underwent, including in echogenicity and thickness, were analyzed with respect to gestational age. A distinct decidual layer could be identified consistently at 5-6 weeks' gestation and its thickness peaked at 6-7 weeks. It was seen inconsistently at 8-9 weeks and was not identifiable by 10 weeks. Its appearance changed over time, from a uniformly echogenic layer at 5-6 weeks to a heterogeneous echogenic layer at 7 weeks, corresponding to the histological evidence of trophoblast penetration. The layer then became less echogenic with time until it became unidentifiable. There is a window of opportunity in the first trimester for sonographic examination of the decidua. This may allow screening, at an early stage, for conditions that affect the decidua during pregnancy.

Abdominal Sonographic Changes After Antibody to Tumor Necrosis Factor (Anti-TNF) Alpha Therapy in Crohn’s Disease

Prospective study carried out on 24 consecutive patients with Crohn's Disease, using sonography to assess changes caused by biological therapy and its relationship with the clinical-biological response. The Crohn's Disease Activity Index, the plasma concentration of C-reactive protein and abdominal sonograms (to assess the thickness and Doppler flow grade of the bowel wall and to detect the presence of any complications) were carried out one week prior to the induction treatment and two weeks after. The biological therapy induced remission or a partial response in 46% and 25% of the patients, respectively. It also caused a significant reduction in the thickness of the bowel wall (P = 0.005) and Doppler flow (P = 0.02), leading to the disappearance of complications in 50% of the patients. Sonographic changes were significantly more marked in patients who achieved some type of clinical-biological response, in such a way that sonograms were improved in 65% (P = 0.001) and complications disappeared in 100% of patients (P = 0.005) compared to those patients who did not respond to treatment. However, sonographic normality was only achieved in five out of 17 (29%) reactive patients (P = 0.27). This fact may support the use of sonography as a technique for optimizing the biological treatment of Crohn's Disease.

Postmyomectomy sonographic imaging: uterus remodeling and scar repair

Description and evaluation of the sonographic changes at the site of the myomectomy and follow-up of the healing process. Twelve patients with intramural fibroids underwent myomectomy. Pre- and postoperative ultrasound examinations included measurements of uterine volume and the largest diameters of the largest fibroid and the myomectomy scar. The mean uterine preoperative volume was 773 cm(3) (range 271-1,343) (SD 285). It decreased postoperatively to 318 cm(3) (range 98-756) (SD 192) and 185 cm(3) (range 78-420) (SD 96) in the immediate and late scans, respectively. The mean size of the largest diameter of the largest fibroid was 10 cm (range 7-15) (SD 2.3). The largest diameter of the immediate postoperative myomectomy site was 4.5 cm (range 2.2-8) (SD 1.8) decreasing later to 2.4 cm (range 0-6) (SD 1.6). The postoperative sonographic findings following myomectomy demonstrates a solid finding that may mistakenly be interpreted as the remaining fibroid that shrinks gradually. The finding is probably the result of changes in hyperplastic myometrial tissue, focal small hematomata and suture material.