Ultrasound Changes Research Articles

Animal model of acute gout reproduces the inflammatory and ultrasonographic joint changes of human gout.

IntroductionGout is an inflammatory condition induced by the deposition of monosodium urate (MSU) crystals in the joints and soft tissues that can produce acute or chronic arthritis. Several animal models of crystal-induced inflammation have been proposed that involve direct injection of MSU-crystals into different anatomical structures; however, only a few of these models reflect a true diarthrodial joint microenvironment in which an acute gouty attack takes place. The aim of this study was to assess the inflammatory and structural joint changes in a rabbit model of acute gout attack by ultrasound (US), synovial fluid (SF) and histopathological analyses.MethodsUnder US guidance, 42 rabbit knees were randomly injected with a suspension of 50 mg/ml of either MSU or allopurinol synthetic crystals. The control group received intra-articular vehicle of phosphate-buffered saline (PBS). US evaluation, SF and histopathological analyses were performed at days 1, 3, and 7.ResultsA total of 21 rabbit knees were assigned to the control group, 12 to the MSU-crystals group, and 9 to the allopurinol crystals group. By US, the MSU crystals group displayed the double contour sign and bright stippled aggregates in 67% and 75% of joints, respectively. Neither control knees nor allopurinol crystals group displayed these US signs. Power Doppler (PD) signal was moderate to intense in the MSU-crystals group and greater than both the allopurinol crystal and control groups at day 1 (P <0.001) and 3 (P <0.05), with its practical disappearance by day 7. SF leukocyte count was 40,312 ± 6,369 cells/mm3 in the MSU-crystals group, higher than in controls (P = 0.004) and allopurinol crystal group (P = 0.006). At day 7, SF leukocyte count decreased in both MSU and allopurinol crystal groups reaching the non-inflammatory range. Histologically, at day 3 intense synovial polymorphonuclear cells infiltration and MSU aggregates were identified.ConclusionThe rabbit model of MSU crystal-induced acute arthritis efficiently reproduces the inflammatory, US, SF and histopathological changes of the human acute gouty attack.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0550-4) contains supplementary material, which is available to authorized users.

Abdominal ultrasonographic findings in acromegalic cats.

Acromegaly is increasingly recognized as a cause of insulin resistance in cats with diabetes mellitus (DM). The objective of this study was to determine if ultrasonographic changes in selected abdominal organs of acromegalic cats could be used to raise the index of suspicion for this condition. In this retrospective case-control study, medical records of cats presenting to North Carolina State University or Colorado State University from January 2002 to October 2012 were reviewed. Cats were included in the acromegaly group if they had insulin-resistant DM with increased serum insulin-like growth factor (IGF-1) concentrations and had an abdominal ultrasound examination performed with report available. A control group included age-matched cats that had abdominal ultrasound examination performed for investigation of disease unlikely to involve the kidneys, adrenal glands, pancreas or liver. Twenty-four cats were included in each group. IGF-1 concentrations in the acromegaly group ranged from >148 to 638 nmol/l. When compared with age-matched controls, cats with acromegaly demonstrated significantly increased median left and right kidney length, significantly increased median left and right adrenal gland thickness, and significantly increased median pancreatic thickness. Hepatomegaly and bilateral adrenomegaly were reported in 63% and 53% of acromegalic cats, respectively, and in none of the controls. Pancreatic abnormalities were described in 88% of the acromegalic cats and 8% of the controls. These findings indicate that compared with non-acromegalic cats, age-matched acromegalic patients have measurably larger kidneys, adrenal glands and pancreas. Diagnostic testing for acromegaly should be considered in poorly regulated diabetic cats exhibiting organomegaly on abdominal ultrasound examination.

Computed tomographic angiography under sedation in the diagnosis of suspected canine pancreatitis: a pilot study.

BackgroundComputed tomography (CT) is highly accurate for diagnosing pancreatitis in humans. The diagnosis of pancreatitis in dogs is based on clinical signs, laboratory findings, and ultrasonographic (US) changes. There are, however, inherent limitations in relying on laboratory and ultrasound findings for the clinical diagnosis of pancreatitis in dogs.Hypothesis/ObjectivesWe hypothesized that CT angiography would be a rapid and reliable method to confirm pancreatitis in dogs compared to ultrasonography. The aim was to describe the CT characteristics and compare them to ultrasound findings and correlate the CT appearance to the severity of the patients' clinical course.AnimalsA prospective pilot case series; 10 dogs with pancreatitis were enrolled if the history, clinical signs, laboratory, and ultrasonographic findings were indicative of pancreatitis.MethodsA 3‐phase angiographic CT was performed under sedation. Afterward, each dog had US‐guided aspirates of the pancreas collected and blood drawn for cPLi assay. Images were evaluated for portion of visible pancreas, pancreatic size and margin, pancreatic parenchyma, presence of peripancreatic changes and contrast enhancement pattern. The results were compared with outcome.ResultsAn enlarged, homogeneously to heterogeneously attenuating and contrast‐enhancing pancreas with ill‐defined borders was identified in all dogs. CT identified more features characterizing pancreatic abnormalities compared to US. Thrombi were found in 3/10 dogs. Three dogs with heterogeneous contrast enhancement had an overall poorer outcome than those with homogenous enhancement.Conclusions and Clinical Importance CT angiography under sedation was used in dogs to confirm clinically suspected pancreatitis and identified clinically relevant and potentially prognostic features of pancreatitis in dogs.

Association of Ultrasound and Anatomopathologic Findings of Equine Metacarpophalangeal Lesions

To determine the association between ultrasonographic (US) and anatomopathologic findings, an US examination was performed postmortem on the fetlock and associated structures of 37 equine forelimb specimens. All these specimens exhibited images suggestive of lesions on the ultrasound examination. Subsequently, these limbs were dissected and underwent an anatomopathologic study. Ultrasonographic changes in size, shape, architecture, and echogenicity of ligaments, tendons, joint capsule, articular cartilage, and bony surfaces of the metacarpophalangeal joint were associated with the anatomopathologic findings.

Ultrasonographic median nerve changes under tendon gliding exercise in patients with carpal tunnel syndrome and healthy controls

Study designCase control study. Purpose of the studyTo evaluate the ultrasonographic median nerve changes under tendon gliding exercise in patients with carpal tunnel syndrome (CTS) and healthy controls. MethodsSeventy-three patients with CTS and 53 healthy volunteers were consecutively recruited. Each subject underwent a physical examination, nerve conduction studies and ultrasonographic examinations of the median nerve during tendon gliding exercises. ResultsSignificant changes in the cross-sectional area of the median nerve were found while moving from the straight position to the hook position and from the hook position to the fist position. There were also significant changes in the flattening ratio when moving from the hook position to the fist position. ConclusionsUltrasonography revealed that the median nerve was compressed in the fist position in both CTS patients and healthy volunteers. Thus, forceful grasping should be avoided during tendon gliding exercises performed in the fist position. Level of evidence3b

Ultrasonographic changes in dogs naturally infected with tick borne intracellular diseases.

Tick-borne infectious diseases constitute an emerging problem in Veterinary Medicine. The study was undertaken to find out the ultrasonographic changes of liver and spleen in 101 positive cases of tick borne intracellular haemoparasitic diseases in dogs. Abdominal survey of ultrasonography revealed hypo echogenicity of liver, gall bladder distension, splenomegaly, hepato-splenomegaly and ascites in various tick born intracellular diseases viz. ehrlichiosis, babesiosis, anaplasmosis, hepatozoonosis and in mixed infection. Correlating these USG finding with other laboratory examination will be very much useful to spot the diseases condition and organ involvement in tick born intracellular diseases of dog.

SAT0277 Has Shoulder Ultrasonography Got A Predictive Value in Polymialgia Rheumatica?

BackgroundPolymyalgia rheumatica (PMR) is an inflammatory condition characterized by aching and morning stiffness in the shoulders, hip girdle, and neck. The initial goal of therapy is to rapidly achieve symptomatic...

FRI0238 Changes in Ultrasonographic Vascularity upon Initiation of Adalimumab Combination Therapy in Rheumatoid Arthritis Patients with Inadequate Response to Methotrexate

BackgroundControl of disease activity in patients with rheumatoid arthritis (RA) has become achievable using synthetic and biologic disease modifying anti-rheumatic drugs, both as monotherapy or in combination. However, residual inflammatory...

THU0353 The Accordance of Changes between Ultrasound and MRI in Patients with Shoulder Pain

BackgroundUltrasound (US) and magnetic resonance imaging (MRI) are valid diagnostic modalities in detecting, characterizing and discriminating the rotator cuff disorders, with no significant comparable difference [1]. MRI is the procedure...

Symptomatic and Asymptomatic Interphalangeal Osteoarthritis: An Ultrasonographic Study

ObjectiveTo date few studies have examined whether ultrasonography can depict morphologic differences in painful and painless osteoarthritis (OA). This study describes and compares the clinical, radiographic and ultrasonographic findings of patients with both painful and painless proximal interphalangeal (PIP) and/or distal interphalangeal (DIP) OA. MethodsPatients with PIP and/or DIP OA (ACR criteria) were prospectively recruited. The clinical rheumatologist chose up to 3 painful joints and up to 3 painless symmetric joints in each patient to define 2 cohorts of OA: symptomatic (SG) and asymptomatic (ASG). A conventional postero-anterior hand X-ray was performed and read by one rheumatologist following the OARSI atlas, blinded to clinical and sonographic data. Ultrasound (US) was performed by an experienced rheumatologist, blinded to both clinical and radiographic data in joints previously selected by the clinical rheumatologist. US-pathology was assessed as present or absent as defined in previous reports: osteophytes, joint space narrowing, synovitis, intra-articular power Doppler signal, intra-articular bony erosion, and visualization of cartilage. Radiographic and ultrasonographic intrareader reliability test was performed. ResultsA total of 50 joints in the SG and ASG were included from 20 right-handed women aged 61.85 (46–73) years with PIP and DIP OA diagnosed 6.8 (1–17) years ago. In all, 70% SG and ASG joints were right and left sided respectively. The SG showed significantly more osteophytes, synovitis and non-visualization of joint cartilage. Intrareader radiographic and ultrasonographic agreement was excellent. ConclusionThis study demonstrates that painful PIP and/or DIP OA has more ultrasonographic structural changes and synovitis.

Artrosis interfalángica sintomática y asintomática: un estudio ecográfico

ObjectiveTo date few studies have examined whether ultrasonography can depict morphologic differences in painful and painless osteoarthritis (OA). This study describes and compares the clinical, radiographic and ultrasonographic findings of patients with both painful and painless proximal interphalgeal (PIP) and/or distal interphalgeal (DIP) OA. MethodsPatients with PIP and/or DIP OA (ACR criteria) were prospectively recruited. The clinical rheumatologist chose up to 3 painful joints and up to 3 painless symmetric joints in each patient to define 2 cohorts of OA: symptomatic (SG) and asymptomatic (ASG). A conventional postero-anterior hand x ray was performed and read by one rheumatologist following the OARSI atlas, blinded to clinical and sonographic data. Ultrasound (US) was performed by an experienced rheumatologist, blinded to both clinical and radiographic data in joints previously selected by the clinical rheumatologist. US-pathology was assessed as present or absent as defined in previous reports: osteophytes, joint space narrowing, synovitis, intra-articular power doppler signal, intra-articular bony erosion, and visualization of cartilage. Radiographic and ultrasonographic intrareader reliability test was performed. ResultsA total of 50 joints in the SG and ASG were included from 20 right handed women aged 61.85 (46-73) years with PIP and DIP OA diagnosed 6.8 (1-17) years ago. 70% SG joints and ASG were right and left sided respectively. The SG showed significantly more osteophytes, synovitis and non-visualization of joint cartilage. Intrareader radiographic and ultrasonographic agreement was excellent. ConclusionThis study demonstrates that painful PIP and/or DIP OA have more ultrasonographic structural changes and synovitis.

Erratum to: Radiographic and ultrasonographic changes of the patellar ligament following tibial tuberosity advancement in 25 dogs by R. Pettitt et al. (Vet Comp Orthop Traumatol 2014; 27: 216-221)

In the original article by R. Pettitt et al., “Radiographic and ultrasonographic changes of the patellar ligament following tibial tuberosity advancement in 25 dogs” (Vet Comp Orthop Traumatol 2014; 27: 216-221) two values were reported incorrectly in the text on page 219: 1st column, 2nd paragraph, last sentence. The last sentence in this paragraph should have read as follows: “Following treatment, the mean width increased by between 0.32 and 0.60 mm (p <0.001).” The values of 0.32 and 0.60 had been incorrectly reported as 0.31 and 0.58 in the original text. This has now been updated in the PDF file which is available online. The authors apologise for this oversight.

Radiographic and ultrasonographic changes of the patellar ligament following tibial tuberosity advancement in 25 dogs

Patellar ligament thickening is a recognized response following osteotomy of the proximal tibia as a treatment for cranial cruciate disease. In humans this is seen as a response to increased loading, but the reason for this thickening in dogs is unclear. A prospective study was undertaken to assess the degree and frequency of patellar ligament desmopathy in 25 consecutive cases undergoing tibial tuberosity advancement (TTA). To determine the incidence of patellar ligament thickening following TTA. Consecutive cases undergoing TTA had ultrasonographic and radiographic measurements performed of the patellar ligament, at multiple positions on the ligament. This was performed at the time of surgery, and at six weeks and six months (ultrasound only) following surgery. The radiographic measurements were performed by two reviewers who were blinded to the timeframe of each image. There was great variation in both the incidence and degree of thickening of the ligament. Fifty percent of the cases showed no changes in the thickness of the patellar ligament. A clinical pain response was not associated with patellar ligament thickening. No statistically significant variables which predicted the development of patellar ligament thickening were identified . The presence of signs of patellar ligament thickening is of questionable clinical significance and is probably an incidental finding.

Ultrasonographic measurement of amniochorionic membrane in asymptomatic pregnant women is not a useful tool for preterm birth prediction

The objective of this study was to determine the accuracy of ultrasonographic measurement of amniochorionic membrane thickness (AMT) in the prediction of preterm birth among an asymptomatic pregnant population. One hundred and ninety consecutive singleton pregnant women presenting for prenatal care between May 2010 and August 2011 were recruited for the study. AMT of the patients was measured once between 18 and 22 weeks of gestation and then again between 28 and 32 weeks of gestation with transabdominal ultrasound. The results of measurements were recorded and compared with the perinatal outcome related to prematurity. Thirteen of the 190 births were preterm. The mean AMT of the pregnant women who delivered at term were 0.79 ± 0.23 mm in the second trimester and 0.88 ± 0.27 mm in the third trimester. The mean AMT of pregnant women who delivered preterm were 0.77 ± 0.27 mm in the second trimester and 0.91 ± 0.20 mm in the third trimester. There were no statistically significant differences between the second and third trimester AMT of the preterm delivery group and term delivery group (P = 0.542 and P = 0.448, respectively). In this study, ultrasonographic measurement of fetal membranes was not found to be a useful marker for prediction of preterm birth. The findings of our study may help in understanding ultrasonographic changes in fetal membranes in normal pregnancies.

Doppler ultrasonographic assessment of uterine arteries during normal canine puerperium

The aim of this study was to describe Doppler ultrasonographic changes of uterine arteries during normal canine puerperium. Eight healthy, pure-bred bitches, were ultrasonographically assessed during the postpartum period on Days −3, 3, 10, 17, 24, 38, 52 and 80 (Day 0 defined as the day of parturition). Total horn diameters (TD) and endometrium thickness (E) were evaluated. Color Doppler was used to localize uterine arteries at both sides of the body and pulsed-wave Doppler was performed to obtain the waveforms. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured. Resistance index [(PSV−EDV)/PSV] was automatically calculated.Values of TD, E, PSV, EDV and RI were analyzed by repeated measures ANOVA followed by LSD test (SPSS 18.0; SPSS, Chicago, IL, USA). A correlation analysis was also carried out between RI and TD. A progressive decrease of TD (P<0.01) and E (P<0.01) was found in the course of the study. A gradual diminution of PSV (P<0.01) and EDV (P<0.01) and an increase of RI (P<0.01) were also found throughout the study period. The resistance index negatively correlated with TD (r=−0.46; P<0.01) and E (r=−0.44; P<0.01) while the ultrasonographic and vascular changes in this period are concurrent with regenerative changes in the glandular and epithelial structures of the uterus. It is concluded that uterine artery RI progressively increased during normal canine puerperium, associated to the two-dimensional ultrasonographic regression of the organ.

Ultrasonographic Findings of the Pancreas in Cats with Elevated Serum Pancreatic Lipase Immunoreactivity

Pancreatitis is a common disease in cats that is difficult to diagnose. To determine the sensitivity and specificity of ultrasonographic changes of the pancreas with serum feline pancreatic lipase immunoreactivity (fPLI) as the standard for diagnosis of pancreatitis. 35 cats with clinical signs consistent with pancreatitis with an abdominal ultrasound examination and serum fPLI concentration measured within 3 days of the ultrasound. Retrospective study: Pancreatic thickness, pancreatic margination, pancreatic echogenicity, and peripancreatic fat echogenicity were evaluated. Sensitivity and specificity were calculated with an elevated serum fPLI concentration indicative of pancreatitis as the standard for diagnosis. Serum fPLI was elevated and diagnostic for pancreatitis in 19 of 35 cats. The single ultrasound characteristic with the highest sensitivity was hyperechoic peripancreatic fat at 68% (95% confidence interval = 44-87%), indicating a moderate probability that cats with pancreatitis will have this abnormality on ultrasonographic examination. Specificity was >90% for each of increased pancreatic thickness, abnormal pancreatic margin, and hyperechoic peripancreatic fat. The sensitivity and specificity of ultrasound were 84% (95% confidence interval = 60-97%) and 75% (95% confidence interval = 48-93%), respectively, in cats with elevated serum fPLI indicative of pancreatitis. The presence of a thick left limb of the pancreas, severely irregular pancreatic margins, and hyperechoic peripancreatic fat in cats with appropriate clinical signs and elevated serum fPLI are highly supportive of pancreatitis.

AB0665 Relationship between clinical and ultrasonographic changes in patients with shoulder pain

BackgroundThe shoulder is one of the most common application of musculoskeletal ultrasound due to the high incidence of rotator cuff disorders related to increasing aging and sporting activities (1) Muskuloskeletal...

THU0454 Thyroid Involvement in Patients with Spondyloarthritis

BackgroundThe association between chronic inflammatory diseases and thyroid dysfunction is well recognized. This fact can be attributed to hormonal factors and the presence of a facilitator genetic terrain. Increased prevalence...

THU0316 Salivary Gland Ultrasonography in Primary SjöGren’s Syndrome. Association with Lymphoma Risk Markers and Longitudinal Follow-Up.

BackgroundPreviously we reported that salivary gland ultrasonography (SGUS) using a simplified score1,2 is a specific but not a sensitive diagnostic method in primary Sjögren’s syndrome (pSS). The purpose of the...

OP0236 Ultrasonography of major salivary glands in primary sjÖgren’s syndrome – correlation with glandular function and minor gland inflammation

BackgroundUltrasound (US) represents a non-invasive imaging method of the major salivary glands that may serve as a supplement to minor salivary gland biopsy. Minor salivary gland biopsy is part of...