Ultrasonography Group Research Articles

Low Levels of Serum Vitamin D3 Are Associated with Autoimmune Thyroid Disease in Pre-Menopausal Women

Low serum vitamin D levels have been associated with several autoimmune diseases, but their association with thyroid autoimmunity is unclear. We evaluated the association of serum vitamin D levels with the prevalence of autoimmune thyroid disease (AITD). Our cross-sectional study included subjects who underwent routine health checkups, which included assays of serum 25-hydroxy vitamin D3 [25(OH)D3] and anti-thyroid peroxidase antibody (TPO-Ab), as well as thyroid ultrasonography (US) between 2008 and 2012 at the Asan Medical Center. We defined AITD according to the levels of TPO-Ab and US findings. A total of 6685 subjects (58% male; 42% female) were enrolled for this study. Overall prevalence of TPO-Ab positivity and both TPO-Ab/US positivity were 10.1% (6.3% male; 15.3% female) and 5.4% (2.3% male; 9.7% female) respectively. In female subjects, mean serum 25(OH)D3 levels were significantly lower in the TPO-Ab(+) (22.0 vs. 23.5 ng/mL, p=0.030) and TPO-Ab(+)/US(+) groups (21.6 vs. 23.4 ng/mL, p=0.027) compared with the control group, respectively. According to the levels of serum 25(OH)D3, the prevalence of TPO-Ab positivity (21.2%, 15.5%, and 12.6% in deficient, insufficient, and sufficient group, respectively; p=0.001) and both TPO-Ab and US positivity (14.7%, 9.9%, and 7.1% in deficient, insufficient, and sufficient group, respectively; p<0.001) decreased in female subjects. Interestingly, this pattern was significant only in pre-menopausal women (p=0.003 and p<0.001; respectively), but not in postmenopausal women. Multivariate analysis indicated that the adjusted odds ratios (OR) for AITD among those in the 25(OH)D3-deficient [TPO-Ab(+): OR 1.95, p=0.001; TPO-Ab(+)/US(+): OR 2.36, p<0.001] and -insufficient groups [TPO-Ab(+): OR 1.31, p=0.043; TPO-Ab(+)/US(+): OR 1.50, p=0.017] were significantly increased when compared with the sufficient group. The levels of serum vitamin D were significantly lower in pre-menopausal women with AITD. Vitamin D deficiency and insufficiency were significantly associated with AITD in pre-menopausal women.

Meta-analysis of the diagnostic value of three imaging techniques in Crohn's disease

Objective To evaluate the diagnostic value of computed tomography enteroclysis/enterography (CTE),magnetic resorance enteroclysis/enterography (MRE) and ultrasonography (US) in Crohn's disease (CD) by Meta-analysis.Methods Segmental intestinal wall thickening and strengthening was taken as image diagnostic indicators in CD.Endoscopic and histopathologic findings and follow-up results were set as diagnostic standard.Retrieve and literature inclusion criteria were developed.The papers of CD diagnosed by CTE,MRE and US which met the criteria were searched and screened.The quality of the papers was evaluated by quality assessment of diagnostic accuracy studies (QUADAS).The diagnostic efficacy of CTE,MRE and US was compared,which included sensitivity,specificity,positive likelihood ratio and negative likelihood ratio,positive predictive value (PPV) and negative predictive value (NPV).Results Among the 2197 retrieved literature,a total of 12 papers met the criteria and nine of which were blinded study.The papers were grouped by three different imaging techniques and underwent QUADAS scale scoring.One paper was about CTE and MRE comparative study,so there were six papers in CTE group,the scores of all the six papers were over 10 and all of them were blinded study.There were four papers in MRE group,the scores of three papers were over 10 and all of them were blinded study.There were three papers in US group,the score of one paper was over 10 and two of these three papers were blinded study and one with unclear evaluation.The sensitivity of CTE group was the highest (89 ％),while the specificity (90 ％) was lower than that of US group (95％).The PPV (93％),NPV (95％),positive likelihood ratio (15.16) and negative likelihood ratio (0.17) of US group were the highest,those of CTE were secondary (PPV 91％,NPV 82％,positive likelihood ratio 6.25 and negative likelihood ratio 0.15).The sensitivity (74％),specificity (84％),PPV (80％),NPV (80％),positive likelihood ratio (4.18) and negative likelihood ratio (0.33) of MRE group were lower than both US group and CTE group.Conclusions The sensitivity of CTE in CD diagnosis is better than that of MRE and US,while other diagnostic indicators are poorer than US.Even though US has high diagnostic value in CD,more well designed large sample study were still needed for further evaluation. Key words: Crohn disease; Tomography, X-ray computed; Magnetic resonance imaging; Ultrasonography; Meta-analysis

Cost‐effectiveness analysis on the surveillance for hepatocellular carcinoma in liver cirrhosis patients using contrast‐enhanced ultrasonography

Sonazoid is a new contrast agent for ultrasonography (US). Contrast-enhanced ultrasonography (CEUS) using Sonazoid enables Kupffer imaging, which improves the sensitivity of hepatocellular carcinoma (HCC) detection. However, there are no studies on the cost-effectiveness of HCC surveillance using Sonazoid. We constructed a Markov model simulating the natural history of HCV-related liver cirrhosis (LC) patients, and compared three strategies (no surveillance, US surveillance and CEUS surveillance). The transition probability and cost data were obtained from published data. The simulation and analysis were performed using TreeAge pro 2009 software. When compared to the no surveillance group, the US and CEUS surveillance groups increased the life expectancy by 1.67 and 1.99 quality-adjusted life-years (QALY), respectively, and the incremental cost effectiveness ratio (ICER) were 17 296 $US/QALY and 18 384 $US/QALY, respectively. These results were both less than the commonly-accepted threshold of $US 50 000/QALY. Even if the CEUS surveillance group was compared with the US surveillance group, the ICER was $US 24 250 and thus cost-effective. Sensitivity analysis showed that the annual incidence of HCC and CEUS sensitivity were two critical parameters. However, when the annual incidence of HCC is more than 2% and/or the CEUS sensitivity is more than 80%, the ICER was also cost-effective. Contrast-enhanced ultrasonography surveillance for HCC is a cost-effective strategy for LC patients and gains their longest additional life years, with similar degree of ICER in the US surveillance group. CEUS surveillance using Sonazoid is expected to be used not only in Japan, but also world-wide.

In de Quervain’s with a separate EPB compartment, ultrasound-guided steroid injection is more effective than a clinical injection technique: a prospective open-label study

We compared ultrasonography (US)-guided injection, targeting the extensor pollicis brevis (EPB) in de Quervain's disease (dQD) with septation, to clinical injection. Forty-four wrists were randomly allocated to US-guided or manual (non-US-guided) injection. At 4 weeks, pain was significantly reduced in both groups. Pain on the 100 mm visual analogue scale (VAS) for the US group was 80.3 (SD 19.6) mm at baseline and 25.6 (SD 15.1) mm at 4 weeks after injection (p = 0.004). Values for the manual group were 78.0 (SD 18.5) mm at baseline and 58.2 (SD 21.9) mm at 4 weeks after injection (p = 0.04). Pain on the VAS showed a more significant decrease in the US-guided than in the manual injection group (p = 0.0007) from baseline to 4 weeks after injection. The results of this study suggest US-guided injection targeting the EPB in dQD patients with septation is more effective than manual injection.

Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography

Background Elderly patients diagnosed with acute cholecystitis (AC) may undergo both ultrasonography (US) and computed tomography (CT). Methods A total of 475 patients (age, >64 y) with AC were included. Results Groups included US alone (n = 240), CT alone (n = 60), and CT + US (n = 168). Sixty patients (35.7%) in the US + CT group had inflammation in both studies, 34 (20.2%) had inflammation only on US, and 32 (19.0%) had inflammation only on CT. In the US + CT group, detection of cholelithiasis was not different, but mean common bile duct size did not correlate. There was no difference among the groups in age, sex, medical service admission, nonambulatory status, dementia, diabetes, or coronary artery disease. Peritonitis, leukocytosis, and acidosis were more frequent in the 2 groups undergoing CT. The cholecystectomy rate was lowest (and the complication rate was highest) in the CT + US group. Conclusions CT often is used in the diagnosis of AC in the elderly, especially those with more acute presentations. CT and US findings may be complementary in AC.

A Comparison of the Effectiveness of Landmark-guided Injections and Ultrasonography Guided Injections for Shoulder Pain

To compare the effectiveness of landmark-guided local injections and ultrasonography (USG) guided injections for shoulder pain. A total 60 consecutive patients with shoulder pain due to soft tissue disorders was enrolled, and randomly assigned to receive triamcinolone (40 mg) either by landmark-guided (LMG, n=30) or USG guided (n=30) injection. The patients were evaluated on admission and 6 weeks after the injection. Clinical assessment included demographic and clinical data, a visual analoge scale (VAS) for pain (0 to 10 cm), the Constant scale (0 to 100) for function, passive and active shoulder range of motion (ROM) with goniometric evaluation, and postinjection adverse effects. Initial demographic, clinical and USG findings in the groups exhibited no significant differences. Six weeks after injection, the VAS and the Constant score showed a significantly better improvement in USG group compared with LMG group (mean VAS score decrease: 4.0+/-1.7 for USG vs. 2.2+/-0.9 for LMG, P<0.05; mean Constant score change: 32.2 for USG vs. 12.2 for LMG, P<0.05). Significant improvements were observed in active and passive ROM values in both groups, USG group values being better. Initially 18 patients in LMG and 24 patients in USG had limited shoulder ROM, of which 6 was returned to normal values in LMG group and 12 in USG group at 6 week after injection (P<0.05). Our results indicate that the injection of corticosteroids to patients with shoulder pain due to soft tissue disorders under the USG-guidance may improve therapeutic effectiveness and reduce adverse effects.

Significance of sonographic characterization for managing subcentimeter thyroid nodules

Ultrasonography (US) is increasingly able to detect thyroid nodules, and the differentiation between malignant and benign nodules has been raising issues among both clinicians and patients, especially patients with non-palpable small nodules. It is important to diagnose thyroid cancer at an early stage, because it may reduce the risk of disease recurrence and possible mortality. To evaluate the diagnostic accuracy of malignant sonographic features of subcentimeter thyroid nodules. This study examined 815 subcentimeter thyroid nodules in 815 patients. A final diagnosis was determined using fine-needle aspiration biopsy (FNAB) or postoperative pathologic findings. Logistic regression tests were used to evaluate statistical relationships between US findings and thyroid carcinoma. Of 534 lesions that showed suspicious US findings, 472 (88.4%) revealed malignancy upon cytopathology. Two hundred eighty-one lesions showed probably benign findings on US, and only 23 (8.2%) were malignant. Sensitivity, specificity, positive predictive value, and negative predictive value of US were 95.4%, 80.6%, 88.4%, and 91.8%, respectively. There was a significant difference between the two US groups in the percentages of malignancy, according to logistic regression analysis. Our results demonstrate that this system of US classification can efficiently differentiate malignant subcentimeter nodules from benign nodules. Suspicious sonographic features can be useful criteria to decide whether a nodule should receive FNAB.

Impact of ultrasonography on central venous catheter insertion in intensive care

Background and Aims:The insertion of central venous catheters (CVCs) is an integral part of the management of critically ill patients. We aimed to study the impact of ultrasonography (USG) on CVC insertion in intensive care.Setting and Design:A prospective study of 450 patients requiring CVC in the intensive care unit (ICU) of a tertiary care hospital.Methods and Materials:The patients were randomized into two groups: to have CVC insertion with USG-guidance or with the anatomic landmark technique (ALT). Data were collected on patient demographics; operator experience; and method, site and side of insertion. Outcome measures included successful insertion of CVC, number of attempts needed and complications.Results:Internal jugular vein (IJV) cannulation was successful in 177/194 patients (91.2%) using ALT and in 200/205 patients (97.6%) using USG guidance, a significant difference of 6.4% (P = 0.006). Using ALT, 72.7% of cannulations could be accomplished in the first attempt as compared with 84.4% with USG guidance (P = 0.004). The overall complication rate was 28/399 (7%), with 19 (9.8%) complications in the ALT group and 9 (4.4%) in the USG group (age-, sex-, and operator-adjusted OR = 0.35, 95% CI: 0.13–0.96; P = 0.03). For subclavian vein catheterization, the success rate was 26/28 (92.9%) in the ALT group and 17/17 (100%) in the USG group (P = 0.52). Using ALT, 71.4% cannulation could be accomplished in the first attempt as compared with 82.4% under USG guidance (P = 0.49). The overall complication rate was 6/45 (13.3%), with 4 (14.3%) complications in the ALT group and 2 (11.8%) in the USG group (P > 0.99).Conclusions:Real-time USG guidance improves success rates, reduces the number of attempts and decreases the complications associated with CVC insertion, especially for the IJV, and should become the standard of care in intensive care.

The characteristics of concomitant thyroid nodules cause false-positive ultrasonography results in primary hyperparathyroidism

Background Concomitant thyroid nodules are the most common reason for false-positive ultrasonography (US) results in primary hyperparathyroidism. The aims of this prospective clinical study were to evaluate false-positive US results according to the characteristics of concomitant thyroid nodules and to determine which characteristics of thyroid nodules are important. Study design This prospective study included 120 consecutive patients with primary hyperparathyroidism. The patients were divided into 2 groups according to preoperative US results. Group 1 consisted of 32 patients with false-positive US results and group 2 consisted of 88 patients with true-positive US results. Results The risk for false-positive US result was increased 25-fold for patients with parathyroid adenoma weight of more than 500 mg (odds ratio [OR], 25; 95% confidence interval [CI], 8.6–74.5), 75-fold for more than 1 posteriorly located thyroid (OR, 75; 95% CI, 19.3–293.4), 358-fold for the presence of exophytic thyroid nodules (OR, 358; 95% CI, 42.3–3036), and 423-fold for the presence of posteriorly located thyroid nodules (OR, 423; 95% CI, 49–3662). Conclusion Although there was no particular characteristic of concomitant thyroid nodules that contributes to false-positive US results, the posteriorly located thyroid nodules were the strongest correlate for the false-positive US results to other features.

Prospective Outcomes of Selective Lymph Node Dissection for Papillary Thyroid Carcinoma Based on Preoperative Ultrasonography

Although many patients with papillary thyroid carcinoma (PTC) display associated cervical lymph node metastases (LNM), the optimal extent of lymph node dissection (LND) remains a matter of debate. Since 1993, we have performed cervical LND based on the preoperative suspicion of LNM by ultrasonography (US). We prospectively analyzed the outcomes of our "selective" LND to determine when prophylactic lateral neck dissection is advisable. Prospective analysis was conducted for 361 consecutive patients with PTC who received initial surgery between 1993 and 2001. Mean duration of follow-up was 8.1 years. Dissection of the central compartment only was performed for patients with LNM in the central zone only and for patients with no LNM detected by US (Group A). Modified radical lateral neck dissection (MND; combined with central compartment dissection) was performed for patients diagnosed with lateral neck LNM (Group B). Pathological LNM was found in 136 of 231 patients in Group A (59%). As for the accuracy of US diagnosis, positive predictive value was 82%. Nodal recurrences, occurring all in the lateral cervical region associated with one case of contralateral paratracheal region, was seen in 18 patients (8%) and 10-year nodal disease-free survival was 91%. Univariate analysis revealed true positive diagnosis by US, large primary tumor (> or = 4 cm), primary tumor located in the upper part of the thyroid lobe, presence of distant metastasis, extrathyroidal invasion of the primary tumor, and a poorly differentiated component of the primary tumor as significant risk factors for nodal recurrence. Among the risk factors that could be diagnosed preoperatively, distant metastasis (risk ratio, 46; p = 0.01) and large primary tumor (risk ratio, 3.6; p = 0.03) were the most important factors under multivariate analysis. Of the other 130 patients in Group B, only 3 patients had no pathological LNM (positive predictive value, 98%). Twenty-six patients (20%) developed nodal recurrence, with a 10-year nodal disease-free survival of 76%. Age (50 years or older), large nodal metastasis (> or = 3 cm), extrathyroidal invasion, and higher serum thyroglobulin level (> or =320 ng/ml) represented significant factors for nodal recurrence. When preoperative US shows no LNM or indicates only LNM in the central compartment, dissection of the central compartment alone offers a sufficient alternative to routine prophylactic MND. However, patients with PTC demonstrating large primary tumor and/or distant metastasis were high-risk for recurrence in the lateral cervical compartment. We recommend prophylactic MND to reduce nodal recurrence for those patients.

Long-term Follow-up Sonography of Benign Cystic Thyroid Nodules after a Percutaneous Ethanol Injection: The Incidence of Malignancy-mimicking Nodules

Purpose: To evaluate the incidence of malignancy-mimicking sclerosed thyroid nodules, from long-term follow-up ultrasonography (US) after an US-guided percutaneous ethanol injection (PEI). Materials and Methods: We examined 86 benign cystic thyroid nodules from 80 patients. The nodules were classified into two groups based on whether an aspiration (Group A, n=26) or non-aspiration (Group B, n=60) of infused ethanol was performed. The final follow-up US over 12 months was performed in all patients. Results: Of the 86 nodules, the cystic portion of 82 (95.3%) cases, from 76 patients, completely disappeared subsequent to the first follow-up US (Group A, n=24, Group B, n=58) (Chi-square test, p>0.05). Moreover, 46 sclerosed thyroid nodules showed two or more of the 'five sonographic criteria' upon a follow-up US (Group A, n=13, 50.0%, Group B, n=32, 53.3%). A higher ratio of the cystic portion of the nodules was associated with a higher incidence of the 'five sonographic criteria' for malignancies detected via a follow-up US (p

Caregiver and Health Care Provider Satisfaction with Volumetric Bladder Ultrasound

Conventional (nonimaged) bladder catheterization has lower first-attempt success rates (67%-72%) when compared with catheterization aided by volumetric bladder ultrasonography (US) (92%-100%), yet the total time to urine sample collection with US can be quite lengthy. Given the advantage and disadvantages, the authors assessed caregiver and health care provider satisfaction with these two methods. Caregivers and health care providers of children enrolled in a prospective, randomized, controlled trial examining the first-attempt urine collection success rates with these two methods completed standardized questionnaires. Each child's caregiver, nurse, and physician noted their perceptions, satisfaction, and future preferences using Likert-scale assessments. Of 93 caregivers, 45 had children randomized to the conventional arm and 48 to the US arm. Nine physicians and three nurses participated. Both caregiver groups had similar previous catheterization experience; none had children undergo volumetric bladder sonography. Caregivers in the conventional group rated their children's discomfort higher (4.4 vs. 3.4; p = 0.02) and were less satisfied (4.5 vs. 6.4; p < 0.0001) than those in the US group. Nurses' satisfaction with catheterization in the conventional group was lower than in the US group (3.0 vs. 5.5), as was physicians' satisfaction (4.3 vs. 5.7; p < 0.0001). Both nurses and physicians indicated that they would be less likely to use conventional catheterization in future attempts. Caregivers in the conventional group rated their children's discomfort higher than did caregivers in the US group. Both caregivers and health care providers expressed greater satisfaction with US and were more likely to prefer this imaging modality with future catheterization attempts.

Comparison of various breast cancer detection methods with survival rates

17033 Background: The role of mammography (MG) but not of breast self-exam (BSE) and clinical breast exam (CBE) in breast cancer detection and survival is well documented. This study compares the different methods of breast cancer detection and subsequent survival rates, analyzing the differences even within the same stage of the disease. Methods: Retrospective review of 1,259 patients was done using the hospital Tumor Registry data. Only patients with stage I, IIA and IIB are included and were diagnosed between April 1992 to December 2005 with follow up ranging from June 1993 to August 2006. The detection methods studied include BSE, CBE, MG and ultrasonography (USG). Parametric tests were conducted. Results: Mean age of the sample was 62 years (range 24–96). There were 293 BSE, 64 CBE, 885 MG, 17 USG detected breast cancer patients. Mean size of mass at presentation was 19 mm (range 1–110). Mean survival time for patients detected with breast cancer till August 2001 was 76 months (range 1–163). 67% patients survived 5 years or more and 12% survived more than 10 years. Mean survival for BSE/CBE and MG/USG group was 43 and 57 months respectively. This difference in survival is significant p&lt; .05; The average survival time by stages I, IIA, IIB for BSE was 47, 45, 38 months, for CBE it was 43, 39, 51 months, for MG it was 57, 59, 50 months and for USG group it was 52, 47, 95 months respectively. Even within the same stage, the method of detection affected survival with the BSE and CBE group having less survival rates (Tukey Test mean difference 0.54, 95% C.I 42–66 and 0.38, 95% C.I 15–61) respectively than the MG group. Survival time also positively correlated with cancer recurrence (r =.7), family history (r = .06) and negatively correlated with age (r = -.09), size of tumor (r = -.09), estrogen receptor positivity status (r = -.06) all with (p &lt; 0.05). We believe this study underestimates overall survival rate as the last follow up date was taken as an end point and also the survival rates are not disease specific survival. Conclusions: MG/USG group show higher survival rates compared to BSE/CBE across the early stages of breast cancer. Even within the same stage, the method of detection affects survival with MG/USG detected cases having more favorable outcomes. May be our current staging system for breast cancer is inadequate and needs revision. No significant financial relationships to disclose.

Does the use of ultrasonography improve the outcome of children with appendicitis?

To determine whether the use of ultrasonography (US) improves the outcome of children with appendicitis. All cases of patients (<17 years old) with pathologically confirmed appendicitis treated in the ED between July 1992 and December 1995 were retrospectively reviewed. 231 charts met criteria for analysis. 100 (43%) patients had US prior to surgery. Age, race, and insurance status were similar for children in the US and non-US groups; there were no differences between the groups at presentation in mean temperature, mean WBC count, or percentage of children with vomiting, diarrhea, abdominal tenderness, or guarding. Those in the non-US group were more often male (71%, p=0.002) and more frequently had right lower quadrant pain (65%, p=0.003). Time from ED triage to the OR was 17.1 hours (US group) vs 10.4 hours (non-US group) (p=0.002). The perforation rates and the complication (abscess, wound infection, wound dehiscence) rates were similar for children in the two groups. Hospital charges were higher in the US group than in the non-US group ($14,123 vs $13,021, p=0.007). The use of US did not result in early diagnosis of appendicitis, nor was it associated with a reduction in perforation or complication rates. Among children with clinical evidence of appendicitis, US was associated with a delay in surgery and an increase in hospital charges.