Sonographic Changes Research Articles

New features in the treatment of patients with chronic pancreatitis on the background of obesity

s / Pancreatology 13 (2013) S2–S98 S37 artery disease than in patients only with CP. Famotidine therapy in this group of patients was significantly reduced lipid peroxidation indices (p <0.05) and significantly improved the indices of reduced glutathione (p 1⁄4 0.076), indicating drug normalizing effect on antioksidant protection system and improve quality of life of patients after 14 days of treatment. Conclusion: Famotidine reduces lipid peroxidation and restores glutathione antioxidant link, which can be an indication for use in treatment of CP and CHD. PI-61 Abstract id: 76. Chronic pancreatitis: psychophysiological features adaptation of the patient Tamara Khrystych, Dmitriy Gontsaryuk, Larisa Kushnir. Bukovynian State Medical University, Ukraine Introduction: The mental state of patients with chronic pancreatitis (CP) defines the rate of recovery, quality of life and adaptation to existing conditions. Aims: To study the psychophysiological adaptation of patients with chronic pancreatitis to determine the significance of psychogenic factors in recurrence disease and clinical prognosis. Patients & methods: Examined 35 patients with chronic pancreatitis, of which 10 patients CP combined with peptic ulcer, 12 with chronic cholecystitis men was 21, women 14. Psychophysiological adaptation strategies examined by the Minnesota multipersonality questionnaire (MMPI) S. R. Hathaway. Results: Thus, patients with decompensated course of CP mental changes were detected in 80.2% of patients, and besides in 44% they were pronounced. Of the patients with subcompensated CP mental disorders were observed in 69.5%, and only 19.5% were severe. In compensation stage of CP psychopathic symptoms were observed in 49.2% of cases, in 12.7% was pronounced. By the nature of psychiatric disorders were the most diverse, but all patients had hypochondriacal disorder. MMPI data confirmed the clinical observations. All groups showed a general rise in the profile of MMPI, and above all on the scales of the neurotic triad and with the highest peak by hypochondria scale, which indicates considerable fixing rate of attention on his health, the revaluation of the severity of the disease, inner tension, anxiety, depressed mood. Conclusion: In patients with CP psychiatric disorders depend on the severity of the disease and are accompanied by deep neuroticism, hypochondriasis and depressive triad. PI-62 Abstract id: 11. New features in the treatment of patients with chronic pancreatitis on the background of obesity Natalya Gubergrits , Olha Bondarenko . Donetsk National Medical University n. a. M. Gorky, Ukraine 2 Lviv National Medical University n. a. D. Galitsky, Ukraine Introduction: There is a considerable increase of the frequency of obesity around the world in the last decade. Pancreatitis has more severe course on the background of obesity. In addition, obesity increases the risk of pancreatic cancer. The efficiency of L-carnitine is proved in the treatment of non-alcoholic steatohepatitis (M. Malaquarnera et al., 2010). Lcarnitine wasn’t used in chronic steatopancreatitis. Aims: To examine the effectiveness of L-carnitine in the treatment of chronic non-alcoholic steatopancreatitis in patients with obesity. Patients & methods: We observed 68 patients with chronic steatopancreatitis on the background of obesity. Patients abusing alcohol were not included in the study. Patients were divided into 2 groups: main (conventional treatment of chronic pancreatitis þ L-carnitine, 450 mg 3 times daily for a month) and the comparison group (only traditional treatment of chronic pancreatitis). We also examined 30 healthy persons. The dynamics of clinical manifestations, the activity of pancreatic isoamilase of blood, sonographic changes of the pancreas were evaluated. Results: In patients of main group the abdominal pain decreased or disappeared in 2.3 times more frequent than in the comparison group (p<0.01). The activity of pancreatic blood isoamilase in the main group decreased significantly (p<0.01) and normalized. In the comparison group only non-significant trend to decreasing of pancreatic blood isoamilase was observed. According to the results of sonography, structural changes of the pancreas after treatment were less marked in the main group. Conclusion: L-carnitine is effective in the treatment of chronic nonalcoholic steatopancreatitis. PI-63 Abstract id: 79. Comprehensive assessment of quality of life in patients with chronic pancreatitis on the background of chronic obstructive pulmonary disease Jana Teleki, Tamara Khrystych, Olexander Fediv, Olga Olinyk, Vladimyr

Sonographic and Mammographic Changes of Breasts in Women Receiving Estrogen Replacement Therapy

Sonographic and Mammographic Changes of Breasts in Women Receiving Estrogen Replacement Therapy

Correlation Between Subclinical Median Neuropathy and the Cross-Sectional Area of the Median Nerve at the Wrist

Although subclinical median neuropathy is not uncommon, its correlation with sonographic changes to the median nerve at the wrist has not been studied. We included 62 subjects (with 107 wrists) who reported experiencing no hand numbness. All subjects underwent nerve conduction studies (NCS) and sonography for median nerve at the pisiform level. The cross-sectional area (CSA), perimeter, long axis and short axis of median nerve were obtained off-line by manual tracing with a mouse and computed by one algorithm written in MatLab. Eighteen wrists met the inclusion criteria of subclinical median neuropathy. The CSA, perimeter and long axis of the median nerve were significantly different between normal and abnormal NCS wrists. Mixed model analysis showed that subclinical neuropathy was associated with enlarged CSA, but the other demographic variables (gender, age and body mass index and occupational categories) were not. Our findings support the use of both patient symptoms and NCS to define normal subjects during further studies. In addition, enlarged CSA within asymptomatic individuals should raise concern for subclinical median neuropathy.

Treatment of supraspinatus tendinopathy with ultrasound guided dry needling

The purpose of this case study is to describe the treatment of a patient with tendinopathy using sonographically guided dry needling. Tendinopathies are a highly prevalent problem in musculoskeletal medicine, and no one form of treatment has gained universal acceptance as being superior to another. A 30-year-old woman with a 4-month history of anterolateral right shoulder pain was diagnosed with supraspinatus tendinopathy upon physical examination, which was confirmed with diagnostic sonography. Sonography was used to guide an acupuncture needle into the pathologic tissue to induce a humoral healing response. Therapeutic exercise was also prescribed. At 10-day follow-up, increased echogenicity was found in the previously heterogenous hypoechoic areas. The patient also experienced a subjective resolution of her shoulder pain, which did not return with increased physical activity. Sonographically guided dry needling was shown to be beneficial for this patient as evident by sonographic changes pre- and postprocedure.

Comparison of sample adequacy, pain-scale ratings, and complications associated with ultrasound-guided fine-needle aspiration of thyroid nodules between two radiologists with different levels of experience

This study aimed to assess and compare the sample adequacy, patient pain ratings, and complications associated with ultrasound-guided fine-needle aspiration of thyroid nodules between two radiologists with different levels of experience. From March 2012 to May 2012, two radiologists performed ultrasound-guided fine-needle aspiration to diagnose thyroid nodules in consecutive patients using the same techniques. 157 patients were divided into two groups: group 1 consisted of 75 patients who underwent ultrasound-guided fine-needle aspiration by an experienced radiologist and group 2 consisted of 82 patients who underwent ultrasound-guided fine-needle aspiration by a less experienced radiologist. The sample adequacy, pain-scale ratings, and complications related to ultrasound-guided fine-needle aspiration were compared between the two groups. There was no statistical difference in sex, age, nodule size, or location between the two groups. There was no statistical difference (p = 0.710) in the prevalence of adequate cytology between group 1 (94.7 % [71/75]) and group 2 (96.3 % [79/82]). The mean ± standard deviation of pain-scale ratings was 1.99 ± 1.68 in group 1 and 2.30 ± 1.83 in group 2, but there was no statistical difference (p = 0.326). There were no significant complications related to the procedure and no sonographic changes on follow-up ultrasound for either group. The study results demonstrated good outcomes for ultrasound-guided fine-needle aspiration of thyroid nodules and no statistically significant differences in sample adequacy, pain-scale ratings, or complication rates between two radiologists with different levels of experience.

Acute Cholecystitis: Do Sonographic Findings and WBC Count Predict Gangrenous Changes?

The purpose of our study was to determine, first, if gallbladder wall striations in patients with sonographic findings suspicious for acute cholecystitis are associated with gangrenous changes and certain histologic features; and, second, if WBC count or other sonographic findings are associated with gangrenous cholecystitis. Sixty-eight patients who underwent cholecystectomies within 48 hours of sonography comprised the study group. Sonograms and reports were reviewed for wall thickness, striations, Murphy sign, pericholecystic fluid, wall irregularity, intraluminal membranes, and luminal short-axis diameter. Medical records were reviewed for WBC count and pathology reports for the diagnosis. Histologic specimens were reviewed for pathologic changes. Statistical analyses tested for associations between nongangrenous and gangrenous cholecystitis and sonographic findings and for associations between wall striations and histologic features. Ten patients had gangrenous cholecystitis and 57, nongangrenous cholecystitis. One had cholesterolosis. Thirty patients had wall striations: 60% had gangrenous and 42% nongangrenous cholecystitis. There was no association with the pathology diagnosis (p = 0.32). There was no association between any histologic feature and wall striations (p ≥ 0.19). A Murphy sign was reported in 70% of patients with gangrenous cholecystitis and in 82% with nongangrenous cholecystitis; there was no association with the pathology diagnosis (p = 0.39). Wall thickness and WBC count were greater in patients with gangrenous cholecystitis than in those with nongangrenous cholecystitis (p ≤ 0.04). Gallbladder wall thickening and increased WBC counts were associated with gangrenous cholecystitis; however, there was considerable overlap between the two groups. Wall striations and a negative Murphy sign were not associated with gangrenous cholecystitis.

Cruveilhier-Baugarten syndrome: sonographic aspects

Objective: The purpose of this paper is to analyze the sonographic changes that characterize the Cruveilhier-Baumgarten syndrome and its clinical charactheristics. CruveilhierBaumgartem syndrome is characterized by a prominent paraumbilical vein, with dilatated superficial veins of the abdominal wall radiating from the umbilicus of patients with chronic liver disease and portal hypertension. Patients and methods: In a sonographic evaluation of 60 patients diagnosed with chronic liver disease with portal hypertension we found 4 cases of Cruveilhier-Baumgarten syndrome, which we studied with color doppler sonography. Results: All patients were male, in their third decade of life, with a clinical history of splenomegaly and varicose abdominal wall veins. Patients had schistosomiasis and micronodular cirrhosis on hystopathological examination. We also evaluated two patients with esophageal varices without hemathemesis. All patients had ultrasound signs of splenomegaly and chronic liver disease, with hepatopetal flow in all segments of the portal vein and hepatofugal flow in the efferent veins of the liver (paraumbilical vein in the falciform ligament and the anterior abdominal wall surface veins). Conclusion: CBS is charactherized by the association of signs of chronic liver damage with splenomegaly, distention of paraumbilical veins (portal hypertension) and blood flow towards the superficial abdominal wall veins, which are Cruveilhier-Baugarten syndrome: sonographic aspects Joao Paulo Kawaoka Matushita1, Jose de Laurentys-Medeiros2, Julieta Sebastiao Matushita3, Cristina Sebastiao Matushita4, Joao Paulo Kawaoka Matushita Jr.5 1 Professor Associado da Faculdade de Medicina da Universidade Federal de Minas Gerais. Medico Radiologista, CDI Dr. Matsushita Ltda. Belo Horizonte, MG – Brasil. 2 Professor Titular de Semiologia Medica da Faculdade de Ciencias Medicas de Belo Horizonte. Belo Horizonte, MG – Brasil. 3 Medica Radiologista. CDI Dr. Matsushita Ltda. Belo Horizonte, MG – Brasil. 4 Medica Nuclear. CDI Dr. Matsushita Ltda. Belo Horizonte, MG – Brasil. 5 Medico. Mestrando em Radiologia e Diagnostico por Imagem da Faculdade de Medicina da Universidade Federal do Rio de Janeiro-FM-UFRJ. Rio de Janeiro, RJ – Brasil. Sindrome de Cruveilhier-Baumgarten: aspectos ultrassonograficos DOI: 10.5935/2238-3182.20130010

進行肝細胞癌に対するソラフェニブ治療前後の超音波検査所見（非造影/造影）の検討

To evaluate the sonographic changes observed in hepatocellular carcinoma (HCC) post sorafenib. Sixteen advanced HCC patients received sorafenib and were studied with unenhanced ultrasonography (US) and contrast-enhanced ultrasonography (CEUS) using Sonazoid at before and less than 4 weeks after treatment. Changes in US findings and Micro Flow Imaging (MFI) findings by CEUS were evaluated. MFI findings were classified Fine, Vascular, and Irregular. Response was as follows D (at least a 30%decrease in the major axis of diameters of intratumoral arterial enhancing target lesion) (n=8), I (at least a 20%increase in the minor axis of diameters of intratumoral arterial enhancing target lesion) (n=6), S (other case; stable) (n=2). MFI findings changed Vascular to Fine 3 on D, Fine to Vascular 2, and Vascular to Irregular 2 on I. MFI findings by CEUS are suggested to be useful for evaluating early responses to sorafenib.

Long-term androgen priming by use of dehydroepiandrosterone (DHEA) improves IVF outcome in poor-responder patients. A randomized controlled study

Abstract Introduction Success with COH depends on the ability to recruit adequate numbers of follicles. Unfortunately, some patients produce too few follicles with COH and are classified as poor responders. Over the years, numerous techniques and therapies have been developed in an effort to help the poor responder, but few have met with success. Recently attempts of ovarian androgen priming have been developed on the basis that temporary exposure of follicles to increased levels of androgens may augment their responsiveness to FSH. Long-term DHEA exposure can induce histological and sonographic changes in normal ovaries similar to PCOS. This effect is cumulative as more of the antral follicles become exposed to treatment. Objective The aim of this study was to compare the effect of DHEA supplementation on IVF treatment outcomes among a cohort of women with known decreased ovarian reserve using a short protocol. Design It is a randomized controlled study. Materials and methods Between July 2008 and April 2012, 133 patients with a prior poor response to ovarian stimulation in IVF were selected to undergo an IVF cycle. The cases were divided without prejudice into 2 groups; (1) study group (DHEA group); in which the patient began taking 25 mg of DHEA orally, three times a day, for at least 12 weeks before starting COH, (2) control group; in which the patient started COH without DHEA priming. Results The study group had statistically significant higher numbers of retrieved oocytes (5.9 ± 3.6) compared to the control group (3.5 ± 2.9) – P P P Conclusion According to our findings, long-term androgen priming by use of DHEA improves IVF outcome in poor responder patients. Additional, larger studies, using different protocols are needed to reinforce our findings.

Anti-TNF-alpha treatments and obstructive symptoms in Crohn's Disease: A prospective study

The development of symptomatic strictures in Crohn's Disease after anti-Tumour Necrosis Factor-α antibodies is undefined. To assess, in a prospective longitudinal study, the frequency of sub/obstructions in Crohn's Disease patients after treatment with Infliximab or Adalimumab. Changes of small bowel lesions after these biological therapies were searched by ultrasonography. From January 2007 to October 2008, 36 Crohn's Disease patients with no previous sub/obstructions were treated with either Infliximab (n=13) or Adalimumab (n=23) for ≥12months (mean follow-up duration after the first treatment 23.2±6.8months). Small Intestine Contrast Ultrasonography was performed before and after treatment in 19/36 patients. Sonographic parameters included: bowel wall thickness, lumen diameter, bowel dilation and lesion extent. Sub/obstructions developed in 3/36 patients treated with Infliximab (n=1) or Adalimumab (n=2), all with fibrostricturing Crohn's Disease. Sonographic parameters did not significantly change after treatment. Sub/obstructive symptoms may develop in one tenth of Crohn's Disease patients treated with anti-Tumour Necrosis Factor-α antibodies, with no significant sonographic changes of the small bowel lesions.

Plaque Characteristics of Asymptomatic Carotid Stenosis and Risk of Stroke

Background: The optimal treatment of asymptomatic carotid stenosis (ACS) is controversial. To optimize the risk-benefit ratio of carotid artery revascularization, it is crucial to identify ACS patients who are at increased stroke risk. Recent data suggest that plaque vulnerability depends on its composition. Therefore, we assessed plaque composition in ACS to determine predictors for ipsilateral cerebrovascular events. Methods: 62 patients with 65 ACS ≥50% underwent 3-T MRI of the carotid bifurcation (TOF, special dark-blood weighted noncontrast and contrast-enhanced T₁ and T₂ images) and of the brain. The different plaque components (lipid core, intraplaque hemorrhage, calcification and the status of the fibrous cap) were assessed. Furthermore, the plaque volume and the volume of clinically silent cortical and subcortical infarcts in the territory of the stenosed carotid artery as seen on FLAIR images were determined by using a semi-automated software. Carotid stenosis was considered asymptomatic if there had not been any clinically apparent ischemic events in the corresponding vascular territory within the previous 6 months. During follow-up, information on the occurrence of cerebrovascular events, medical treatment and sonographic changes of the stenosis was collected. Results: At baseline, 24 ACS (37%) were classified as high grade. A lipid-rich necrotic core was the dominant plaque component in 16 ACS (25%). The plaque volume was higher in ACS with a lipid-rich necrotic core as dominant plaque component (p = 0.002) and in patients with prior stroke/TIA (p = 0.010). After a median follow-up of 18.9 months (interquartile range 3.5–30.1) there were 2 ipsilateral strokes and 3 ipsilateral TIAs. The average annual event rate was 7.7%. A lipid-rich necrotic core (HR 7.21; 95% CI 1.12–46.28; p = 0.037), sonographic progression of the stenosis (HR 7.00; 95% CI 1.13–41.34; p = 0.036), history of stroke (HR 11.03; 95% CI 1.23–99.36; p = 0.032), and the volume of clinically asymptomatic ischemic brain lesions (HR 1.14/cm³; 95% CI 1.03–1.25; p = 0.008) predicted cerebrovascular events. Patients on statin therapy at follow-up were at lower risk of events (HR 0.17; 95% CI 0.03–1.00; p = 0.05). Conclusions: In addition to medical history and sonographic findings, a lipid-rich necrotic core within the plaque turned out as a predictor of cerebrovascular events. Therefore, MR imaging of carotid plaques deserves further attention and might be helpful to improve risk stratification of asymptomatic carotid disease. The identified predictors could be combined in a risk model and tested in larger prospective studies.

The prevalence and clinical significance of sonographic tendon abnormalities in asymptomatic ballet dancers: a 24-month longitudinal study

IntroductionSonographic abnormalities of the achilles and patellar tendons are common findings in athletes, and tendinopathy is a common cause of pain and disability in athletes. However, it is unclear whether...

Pelvic Floor Structure and Function in Women with Vesicovaginal Fistula

Vesicovaginal fistula is a catastrophic event, especially in areas with poor peripartum care, where most occur. It is usually due to severely obstructed and protracted labor. We assumed that such patients would show evidence of abnormal levator function, eg due to denervation. In an external audit at Hamlin Fistula Hospital in Addis Ababa, Ethiopia, 95 women were seen for clinical examination and 4-dimensional translabial ultrasound. Patients were examined supine and after voiding. Volume data sets were obtained upon coughing, Valsalva maneuver and pelvic floor muscle contraction. Women were seen before (22) or after (73) vesicovaginal fistula repair. Mean age was 29.5 years (range 16 to 65) and mean parity was 2.7 (range 1 to 11). Only 2 patients had a significant cystocele (stage 2), 3 had stage 2 uterine prolapse and 13 had a stage 2 rectocele. Levator biometry was done in 92 of 95 women, which showed no evidence of muscle atrophy. Mean hiatal area on Valsalva was 18.8 cm(2) (range 7.7 to 45.9) and only 6 of the 92 women (7%) fulfilled the criteria for ballooning (hiatal distention 25 cm(2) or greater). Levator avulsion was diagnosed in 27 cases (28%), of which 11 were bilateral. Reflex contraction of the levator ani was observed upon coughing in all except 2 patients. Levator contraction upon request could be performed by all except 6 women. Abnormal levator function and anatomy in patients with vesicovaginal fistula is not uncommon but no more than in unselected urogynecologic patients in the developed world. There was no evidence of permanent denervation of the levator ani.

Ultrasound guided percutaneous treatment and follow-up of Baker's cyst in knee osteoarthritis

Purpose of this study is to assess sonographic changes and clinical response in different subgroups of Baker's cyst patients with knee osteoarthritis after a single session of ultrasound-guided percutaneous aspiration and corticosteroid injection. Thirty-two knee osteoarthritis patients (46-85 years, mean 58.97±9.88) with symptomatic Baker's cyst diagnosed at ultrasonography were included in the study. To determine the grade of the symptoms, Visual Analogue Scale was applied. The patients were grouped in two, as simple (n=24) and complex (n=8) Baker's cyst. Thirty-two ultrasound-guided cyst aspirations concomitant 1 ml betamethasone injection (24 simple, 8 complex subgroups) were performed. Patients were followed clinically as well as via ultrasonography for 6 months after procedures. A significant decrease in volume of the Baker's cysts after percutaneous treatment was accompanied by a significant clinical improvement. Moreover, the volume reduction of Baker's cyst after the treatment was significantly correlated with the clinical improvement (Pearson correlation coefficient=0.542, p=0.001). All 6 Baker's cysts relapsed at ultrasonography were complex type. Furthermore, a comparison of patients with simple Baker's cysts and those with complex Baker's cysts demonstrated no significant change in Visual Analogue Scale scores between two groups (p=0.061, Mann-Whitney U). No complications (minor or major) occurred secondary to percutaneous treatment. Baker's cysts can be grouped as simple and complex groups via ultrasonography prior to the treatment. Cyst aspiration with ultrasound-guided corticosteroid injection yields clinical improvement and cyst volume reduction in all subgroups of patients with Baker's cyst secondary to knee osteoarthritis.

Potpartum uterine involution: sonographic changes in the endometrium between 2 and 6 weeks postpartum related to delivery mode and gestational age at delivery

Potpartum uterine involution: sonographic changes in the endometrium between 2 and 6 weeks postpartum related to delivery mode and gestational age at delivery

Abdominal ultrasonographic findings at diagnosis of osteosarcoma in dogs and association with treatment outcome

The purpose of this study was to describe abdominal ultrasonographic findings present at diagnosis of osteosarcoma (OSA) in dogs and to investigate for associations with treatment outcome. Medical records from 118 dogs diagnosed with OSA that had abdominal ultrasonography performed as part of their initial evaluation were reviewed. Fifty-seven percent had ultrasonographic abnormalities identified. The organ with the highest frequency of ultrasonographic changes was the spleen. While most sonographic changes were considered to be either benign or of unknown clinical consequences, metastases were identified in three dogs (2.5%), two of which (1.7%) did not have other evidence of metastasis. Dogs with any ultrasonographic abnormality were less likely to receive definitive therapy (P = 0.005) and exhibited shorter survival, although the latter observation was not statistically significant (P = 0.071). However, the identification of lesions in either the liver (P = 0.021) or the kidney (P = 0.003) was statistically associated with shorter survival.

Changes of parotid and submandibular glands caused by radiotherapy—an ultrasound evaluation

Radiotherapy may alter the normal morphology of salivary glands located in the radiation field. These changes could be evaluated safely by sonography; however, there have been few studies in this regard. This study is aimed at evaluating the sonographic changes of the parotid and submandibular glands in patients undergoing radiotherapy for head and neck malignancies. 20 patients (16 males and 4 females) with head and neck malignancies who had been referred for radiotherapy to the Qaem Hospital in Mashhad, Iran, entered the study. Length, height, depth, echotexture, echogenicity and margins of parotid and submandibular glands were evaluated in three stages (I, before radiotherapy; II, 2 weeks after radiotherapy; and III, 6-7 weeks after radiotherapy) using sonography. Peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) were also evaluated by Doppler sonography. Significant differences in length, height and depth (p = 0.000, p = 0.000, and p = 0.39, respectively) and also echotexture, echogenicity and gland margins (p = 0.000) were observed before and after radiotherapy. Doppler sonography results showed no significant differences regarding PSV, EDV and RI between sonographic stages. Echotexture and echogenicity were the only independent parameters that showed significant differences in sonographic stages I and II (p = 0.000). Length in stage I and II (p = 0.000) and echogenicity in stage III (p = 0.038) were the only parameters that showed significant differences between the two glands. Radiotherapy may change the echotexture, echogenicity and margins of the salivary glands from homogenic to heterogenic, hyperechoic to hypoechoic and regular to irregular, respectively, and may reduce their size.

Ultrasonographic Findings of Feline Cholangitis

Cholangitis is a common inflammatory disorder of the biliary system in cats. There are two major forms based on the predominate type of inflammatory cell infiltrates: lymphocytic or neutrophilic. Ultrasound is a common imaging modality used in these patients. This retrospective study evaluated the ultrasound examinations of 26 cats with a histologic diagnosis of cholangitis. Most cats with cholangitis had sonographically normal liver size, echogenicity, and normal biliary systems. Statistically significant sonographic changes for cats with cholangitis included hyperechoic liver parenchyma, hyperechoic gallbladder contents, and increased pancreatic size. No statistically significant changes were noted to distinguish lymphocytic and neutrophilic forms of cholangitis. Cats with the sonographic features of diffuse liver hyperechogenicity, gallbladder contents and enlarged pancreas may suggest cholangitis.

Low residual proliferation after short-term letrozole therapy is an early predictive marker of response in high proliferative ER-positive breast cancer

The gene expression grade index (GGI) is a 97-gene algorithm that measures proliferation and divides intermediate histological grade tumors into two distinct groups. We investigated the association between early changes in GGI and clinical response to neoadjuvant letrozole and compared this to Ki67 values. The paired gene expression data at the beginning and after 10-14 days of neoadjuvant letrozole treatment were available for 52 post-menopausal patients with estrogen receptor (ER)-positive breast cancer. Baseline values and changes in GGI, Ki67, and RNA expression modules representing oncogenic signaling pathways were compared to sonographic tumor volume changes after 3 months of treatment in the subsets of patients defined by high and low baseline GGI. The clinical response was observed in 80% genomic low-grade (24/30) and 59% genomic high-grade (13/22) tumors (P=0.10). Low residual proliferation after 10-14 days of neoadjuvant letrozole therapy, measured by either GGI or Ki67, was associated with sonographic response in genomic high-grade (GGI, P=0.003; Ki67, P=0.017) but not genomic low-grade (GGI, P=0.25; Ki67, P=1.0) tumors. The analysis of expression modules suggested that sonographic response to letrozole in genomic high-grade tumors was associated with an early reduction in IGF1 signaling (unadjusted P=0.018). The major conclusion of this study is that the early assessment of proliferation after short-term endocrine therapy may be useful to evaluate endocrine responsiveness, particularly in genomic high-grade ER-positive breast cancer.

UP-02.119 Sonographic Changes of the Prostate: An Update

UP-02.119 Sonographic Changes of the Prostate: An Update