Combination Of Ultrasonography Research Articles

Prognosis and diagnosis of fetal cardiac rhabdomyomas

Objective To improve the awareness of fetal cardiac rhabdomyomas (CRs) and investigate a better model for prenatal diagnosis and treatment through analyzing imaging findings and prognosis. Methods A retrospective study was conducted on 23 cases of CRs which were diagnosed by ultrasound in Obstetrics and Gynecology Hospital of Fudan University from January 2008 to November 2015. General conditions, imaging features, prognosis and follow-up data of the 23 cases were described. Results The average gestational age of the 23 fetuses at diagnosis was (29.8±4.1) (22.4-35.7) weeks. Seventeen out of the 23 gravidas received prenatal multidisciplinary consultation. Among all 23 gravidas, three (13%) were lost to follow-up, 12 (52%) decided to terminate the pregnancy, and the other eight (35%) continued to term pregnancy and their babies were followed up for three years. Of these eight cases, two cases received prenatal brain MRI and no tuberous sclerosis complex (TSC) was detected, no CRs was identified during the follow-up, and their physical and mental developments were both normal. One case was diagnosed with suspected subependymal nodules by prenatal brain MRI in our hospital, but the MRI images was normal when scanned in the other hospital, and follow-up data revealed neither CRs nor abnormal physical and mental developments. Four cases did not received prenatal brain MRI, but the MRI images of neonatal brains indicated TSC, besides, follow-up data showed that seizures were observed, physical developments were all normal, but three of the four cases had mental retardation; CRs disappeared in only two of the four cases. One case had neither prenatal nor neonatal MRI, but follow-up data showed that CRs had disappeared and physical and mental developments were both normal. Conclusions Prenatal diagnosis of fetal tuberous sclerosis is crucial to the prognosis of CRs. Prenatal ultrasonography in combination with cranial MRI improves the accuracy of prenatal diagnosis of CRs complicated with TSC and assists in clinical decision-making and prognosis analysis. Key words: Heart neoplasms; Rhabdomyoma; Tuberous sclerosis; Ultrasonography, prenatal; Physician's practice patterns; Prognosis

Assessment of Tongue Position and Laryngeal Height in Two Professional Voice Populations

Purpose To advance our current knowledge of singer physiology by using ultrasonography in combination with acoustic measures to compare physiological differences between musical theater (MT) and opera (OP) singers under controlled phonation conditions. Primary objectives addressed in this study were (a) to determine if differences in hyolaryngeal and vocal fold contact dynamics occur between two professional voice populations (MT and OP) during singing tasks and (b) to determine if differences occur between MT and OP singers in oral configuration and associated acoustic resonance during singing tasks. Method Twenty-one singers (10 MT and 11 OP) were included. All participants were currently enrolled in a music program. Experimental procedures consisted of sustained phonation on the vowels /i/ and /ɑ/ during both a low-pitch task and a high-pitch task. Measures of hyolaryngeal elevation, tongue height, and tongue advancement were assessed using ultrasonography. Vocal fold contact dynamics were measured using electroglottography. Simultaneous acoustic recordings were obtained during all ultrasonography procedures for analysis of the first two formant frequencies. Results Significant oral configuration differences, reflected by measures of tongue height and tongue advancement, were seen between groups. Measures of acoustic resonance also showed significant differences between groups during specific tasks. Both singer groups significantly raised their hyoid position when singing high-pitched vowels, but hyoid elevation was not statistically different between groups. Likewise, vocal fold contact dynamics did not significantly differentiate the two singer groups. Conclusions These findings suggest that, under controlled phonation conditions, MT singers alter their oral configuration and achieve differing resultant formants as compared with OP singers. Because singers are at a high risk of developing a voice disorder, understanding how these two groups of singers adjust their vocal tract configuration during their specific singing genre may help to identify risky vocal behavior and provide a basis for prevention of voice disorders.

Sonomorphological, gray scale and color Doppler flow imaging evaluation of ovarian lesions

Background: Ultrasonography (USG) is considered the primary imaging modality for confirmation of the ovarian origin of the mass and characterization of the nature of the mass as benign or malignant. However, when morphologic features alone are applied to the prediction of ovarian malignancy, there is a tendency to over diagnose malignant tumors because of a substantial overlap between malignant and benign-appearing masses. Transvaginal color Doppler imaging with pulsed Doppler spectral analysis improves the characterization of ovarian masses by means of quantitative blood flow measurements obtained from tumor vessels. Color Doppler ultrasound helps identify solid, vascularized components in a mass. Objectives: To evaluate prospectively the relative usefulness of color Doppler, spectral Doppler, and gray scale sonography in differentiating benign from malignant adnexal masses. Materials and Methods: Patients with abdominal lump were screened for sonography. If on sonography patient having ovarian lesion then detailed study was carried out by gray scale, color, power Doppler and by spectral waveform analysis. Morphologic indexing of the adnexal masses was performed using the Sassone score. Flow results were recorded as being absent or present and further characterized as normal or increased, vessel location, and arrangement. Results: A total of 50 patients with 53 adnexal masses were enrolled into the study. Benign lesions were common in premenopausal age (30 [81%]) and malignant lesions (10 [77%]) were more common in the postmenopausal state. 23 out of 49 masses were considered suspicious of malignancy (Sassone score = 9), of which, 18 were malignant (including bilateral ovarian metastasis as a separate lesion) and 8 were benign. The sonomorphologic evaluation following Sassone scoring system had a sensitivity of 90%, specificity 75%, positive predictive value (PPV) 69% and negative predictive value (NPV) 92%. The sensitivity, specificity, PPV, and NPV of gray scale USG alone were 70%, 72.22%, 58.33%, and 81.25% respectively. While for gray scale with combined color and spectral Doppler USG the values were 90%, 91.66%, 85.71%, and 94.28%, respectively. Conclusion: Adding color Doppler to conventional sonography produced a specificity and PPV higher than those of conventional sonography alone and so gray scale USG in combination with Color Doppler and Spectral Doppler is proposed as the first and foremost diagnostic modality in patients with ovarian lesions.

Unilateral Exploration for Parathyroid Adenoma.

Between January 2012 to 2016, 20 patients with primary hyperparathyroidism underwent surgical exploration for presumed diagnosis of parathyroid adenoma. Nineteen patients underwent ultrasonography of neck and USG was found to be accurate in localizing the adenoma in 84.2%. Seventeen patients underwent sestamibi isotope scanning and imaging correlated with operative findings in 94.1%. Combined accuracy of ulrasound and sestamibi scan which was done in 17 patients was 95%. Seventeen patients underwent unilateral exploration and there was resolution of disease in 94.1%. Three patients underwent bilateral exploration and had a success rate of 100% in the removal of offending adenoma. Fifteen minutes post excision, rapid intraoperative intact parathormone assay was sent in 14 out of 17 unilateral explorations and was found to have true positive rate of 93% and false positive rate of 7%. There was a significant difference in the operating time between unilateral (17 patients, mean operating time 1h) and bilateral (3 patients, mean operating time 1¾hrs) explorations. It is clear from this study; the preoperative localization of adenoma with plan for unilateral exploration with a combination of ultrasonography and sestamibi scan is extremely useful if unilateral exploration is planned for excision of parathyroid adenoma. However, the number of patients who underwent 15min post excision intact parathormone assay, is a small number to comment on its usefulness in predicting the success of unilateral exploration.

Killian-Jamieson diverticulum mimicking a calcified thyroid nodule on ultrasonography: A case report and literature review.

As a rare hypopharyngeal diverticulum, Killian-Jamieson diverticulum (KJD) is usually incidentally detected, small, asymptomatic and likely to be misdiagnosed as a thyroid nodule. In order to avoid unnecessary treatments resulting from misdiagnosis, principles to distinguish between esophageal diverticula and thyroid nodules should be noted clearly. The current study presents a case of an asymptomatic unilateral KJD that mimicked a calcified thyroid nodule. In the current case, a 40-year-old man presented with a 'suspected malignant thyroid nodule' in the left thyroid gland, and underwent left thyroid lobectomy and a neck exploration. However, no visible 'suspected tumor', but a sac protruding from the left anterolateral wall of the cervical esophagus, was observed during the surgery. A swallow test on ultrasonography (US) in combination with pharyngoesophagography was then performed, which confirmed the diagnosis. The patient recovered well during the 3-month follow-up after the operation. The present study indicates that real-time US and pharyngoesophagography are important techniques to distinguish a KJD from a thyroid nodule so that unnecessary surgical intervention can be avoided.

Sonography and Transthoracic Echocardiography for Diagnosis of Systemic Cardiovascular Metastatic Tumor Thrombi.

Sonography and transthoracic echocardiography (TTE) are seldom used for assessment of metastatic tumor thrombi in the cardiovascular system in routine clinical practice. We performed this retrospective study to evaluate the combination of sonography with TTE for diagnosis of metastatic tumor thrombi in heart and systemic vessels. Vascular, abdominal, pelvic, and small-part sonography was applied in 18 patients, and TTE was conducted simultaneously in 14 patients. Tumor thrombi invaded into the inferior vena cava system in 12 patients, superior vena cava system in 5 patients, and aorta in 1 patient; they extended to the right cardiac chambers in 11 patients. Six patients had diagnoses by pathologic examination. The primary neoplasms were identified by conventional imaging in 17 patients. The morphologic and echogenic characteristics of the tumor thrombi were diverse and depended on their original tumors. The thrombi were either contiguous or discrete from the original tumors. The neoplastic vascularity of the thrombi and the invasive extension were the primary characteristics that distinguished them from bland thrombi. Simultaneous application of sonography and TTE is a feasible way to comprehensively evaluate cardiovascular metastatic tumor thrombi in most patients.

Single-centre experience of extending indications for percutaneous intraportal islet autotransplantation (PIPIAT) after pancreatic surgery to prevent diabetes: feasibility, radiological aspects, complications and clinical outcome.

Islet allotransplantation is a less invasive alternative to surgical pancreas transplantation for Type 1 diabetes, while percutaneous intraportal islet autotransplantation (PIPIAT) is usually performed after pancreatic surgery to prevent diabetes. Our aim was to assess the feasibility, radiological aspects, complications and clinical outcome of PIPIAT following pancreatic surgery for not only chronic pancreatitis but also benign and malignant nodules. From 2008 to 2012, 41 patients were enrolled for PIPIAT 12-48 h after pancreatic surgery (extended pancreatic surgery for chronic pancreatitis and benign/malignant neoplasms). PIPIAT was performed using a combined ultrasonography and fluoroscopy-guided technique (4-F catheter). PIPIAT feasibility, median follow-up and metabolic (insulin independence rate, graft function based on C-peptide levels) and oncologic outcomes were recorded. PIPIAT was not performed in 7/41 patients (4 cases for an inadequate islet mass, 2 cases for haemodynamic instability and 1 case for islet culture contamination), while it was successfully performed in 34/34 patients. Procedure-related major complications occurred in four patients: two bleedings requiring transfusions, one patient with left portal vein thrombosis and one patient with sepsis. Median follow-up duration was 546 days. Insulin independence was achieved in 15/34 (44%) patients, partial graft function in 16/34 (47%) patients and no function in 3/34 (9%) patients. None of the 17 patients with malignant nodules developed liver metastases during follow-up. PIPIAT, performed under ultrasound and fluoroscopy combined guidance and not requiring immunosuppression, is feasible, with a relatively low complication rate and a better metabolic outcome than allotransplantation. PIPIAT can prevent pancreatogenic diabetes. Ultrasound is a useful tool for the guidance and monitoring of PIPIAT.

The Combination of Sonography and Physical Examination Improves the Patency and Suitability of Hemodialysis Arteriovenous Fistula in Vascular Access.

We compared the patency and the suitability of arteriovenous fistula (AVF) created for vascular access by two approaches: (a) physical examination with preoperative vascular mapping and (b) physical examination alone. We compared the patency and the suitability of AVF created in patients for dialysis. There were two cohorts of patients of 79 patients each: (a) patients with AVF created based on the combination of physical examination and preoperative vascular mapping (PE+VM) and (b) patients with AVF created based on physical examination (PE) alone. Fistula patency is defined as clinical detection of thrill (or auscultation) of murmur over the fistula and coded as having thrills (patent) versus not having thrills (not patent). Suitability of fistula is defined as functioning AVF (AVF can be adequately used via 2-needle cannulation for dialysis) and coded as suitable versus not suitable. AVF created after the preoperative vascular mapping (PE+VM) has 5.70 (at six weeks) and 3.76 (at three months) times higher chance for patency, and 3.08 times higher chance for suitable AVF for dialysis than AVF created after the physical examination (PE) alone. Physical examination with preoperative ultrasound mapping (PE+VM) significantly improves the short term patency and the suitability of AVF for dialysis.

Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention?

A non-invasive and widely available method for pre-operative evaluation of the axilla is axillary ultrasonography (US). The purpose of this study was to evaluate the diagnostic accuracy of axillary US and fine-needle aspiration cytology in a large cohort of breast cancer patients. The sensitivity and specificity of US and fine-needle aspiration cytology in our cohort of 1124 patients were 42.2% and 97.1%, respectively. As the number of axillary nodes increased, sensitivity increased. The percentage of false-negative US results was 18.9%; patients in this subgroup were significantly younger, had larger tumors, more often had lymph vascular invasion and were more likely to have estrogen receptor-positive tumors. Ultrasonography in combination with fine-needle aspiration cytology is useful in the pre-operative workup of breast cancer patients, especially patients with three or more nodal metastases. Special attention should be paid to younger women with larger tumors in whom a larger percentage of false-negative results are obtained.

Combined Tc-99m sesta MIBI scintigraphy and Ultrasonography in preoperative detection and localization of parathyroid adenoma

PurposeTo evaluate the role of combined high resolution ultrasonography and technetium Tc-99m methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy in preoperative detection and localization of parathyroid adenoma, for better operative outcome. Patients and methods40 patients were included in this study, 25 of them were females and 15 were males, with age ranging between 31 and 75 (mean 46±15). All patients presented with some of symptoms of hyperparathyroidism with venous blood sampling showed elevated parathyroid hormone (PTH). Parathyroid imaging was evaluated by ultrasonography, double phase Tc-99m MIBI parathyroid scintigraphy with surgical findings and results of clinical follow-up as a reference standard. ResultsAmong the 40 patients, Ultrasonography correctly identified 35 adenomas (87.5%) and MIBI scintigraphy identified 34 adenomas (85%), but when both modalities were applied together, 37 adenomas were correctly detected (92.5%).Minimally invasive parathyroidectomy under local anesthesia with unilateral incision was successfully performed in 34 (85%) patients. ConclusionsAccurate localization of adenomas should be obtained prior to surgery for minimal invasive surgical procedure. In this study, combined ultrasonography and Tc-99m MIBI improved localization of parathyroid adenomas.

Screening and surveillance for occupational cholangiocarcinoma in workers exposed to organic solvents.

This study aimed to establish an efficient strategy for screening and surveillance for occupational cholangiocarcinoma. We evaluated the consecutive changes in laboratory findings during regular health examinations and in abdominal ultrasonography findings before the diagnosis of occupational cholangiocarcinoma in nine patients. The results of laboratory tests and abdominal ultrasonography at the time of diagnosis were also examined. In all patients, the serum γ-glutamyl transpeptidase (γ-GTP) activity increased several years before the diagnosis of cholangiocarcinoma. The serum alanine aminotransferase (ALT) activity also increased several years before the diagnosis, following an increase in the serum aspartate aminotransferase (AST) activity in most patients. Abdominal ultrasonography before the diagnosis revealed regional dilatation of the bile ducts, which continued to enlarge. At the time of diagnosis, the γ-GTP, AST, and ALT activities were increased in nine, seven, and seven patients, respectively. The regional dilatation of bile ducts without tumor-induced stenosis, dilated bile ducts due to tumor-induced stenosis, space-occupying lesions, and/or lymph node swelling were observed. The serum concentrations of carbohydrate antigen 19-9 (CA 19-9) and/or carcinoembryonic antigen (CEA) were increased in all patients. Regular health examinations with a combination of ultrasonography and laboratory tests including the γ-GTP, AST, ALT, CA 19-9, and CEA levels are useful for screening and surveillance for occupational cholangiocarcinoma.

Echinococcus multilocularis Detection in Live Eurasian Beavers (Castor fiber) Using a Combination of Laparoscopy and Abdominal Ultrasound under Field Conditions.

Echinococcus multilocularis is an important pathogenic zoonotic parasite of health concern, though absent in the United Kingdom. Eurasian beavers (Castor fiber) may act as a rare intermediate host, and so unscreened wild caught individuals may pose a potential risk of introducing this parasite to disease-free countries through translocation programs. There is currently no single definitive ante-mortem diagnostic test in intermediate hosts. An effective non-lethal diagnostic, feasible under field condition would be helpful to minimise parasite establishment risk, where indiscriminate culling is to be avoided. This study screened live beavers (captive, n = 18 or wild-trapped in Scotland, n = 12) and beaver cadavers (wild Scotland, n = 4 or Bavaria, n = 11), for the presence of E. multilocularis. Ultrasonography in combination with minimally invasive surgical examination of the abdomen by laparoscopy was viable under field conditions for real-time evaluation in beavers. Laparoscopy alone does not allow the operator to visualize the parenchyma of organs such as the liver, or inside the lumen of the gastrointestinal tract, hence the advantage of its combination with abdominal ultrasonography. All live beavers and Scottish cadavers were largely unremarkable in their haematology and serum biochemistry with no values suspicious for liver pathology or potentially indicative of E. multilocularis infection. This correlated well with ultrasound, laparoscopy, and immunoblotting, which were unremarkable in these individuals. Two wild Bavarian individuals were suspected E. multilocularis positive at post-mortem, through the presence of hepatic cysts. Sensitivity and specificity of a combination of laparoscopy and abdominal ultrasonography in the detection of parasitic liver cyst lesions was 100% in the subset of cadavers (95%Confidence Intervals 34.24–100%, and 86.7–100% respectively). For abdominal ultrasonography alone sensitivity was only 50% (95%CI 9.5–90.6%), with specificity being 100% (95%CI 79.2–100%). For laparoscopy alone sensitivity was 100% (95% CI 34.2–100%), with specificity also being 100% (95% CI 77.2–100%). Further immunoblotting, PCR and histopathological examination revealed one individual positive for E. multilocularis, whilst the other individual was positive for Taenia martis.

Ureteroscopic management of asymptomatic and symptomatic simple parapelvic renal cysts.

BackgroundTo investigate feasibility and safety of treating simple parapelvic renal cysts using flexible ureteroscopy with the Holmium laser.MethodsBetween February 2010 and July 2013, a total of 21 patients, aging from 29 to 71 (49.00 ± 13.23), were diagnosed with parapelvic renal cysts by ultrasonography in combination with contrast-enhanced computer tomography (CT) and intravenous urography (IVU) in the Department of Urology Surgery, People’s Hospital of the Zhejiang province. Fifteen patients were asymptomatic and 6 patients were symptomatic with flank pain. All patients underwent drainage of the cysts using flexible ureteroscopy with Holmium laser. Patients were followed up 1, 3 and 12 months after the operation.ResultsThe intervention was successful in 20 patients and failed in 1 patient who, subsequently successfully underwent a laparoscopic cyst removal. There were no intra-operative and post-operative complications reported. The mean operation time was 27 min (range: 15 to 45 min). The mean hospital stay was 2.6 days (range: 1 to 5 days). Twenty patients were followed up until 15 months after surgery. After such ureteroscopic management, there were no renal cysts detected in 7 patients (35 %) and a reduction in size of the renal cysts was found in 13 patients (65 %). Flank pain subsided in all 6 (100 %) previously symptomatic patients.ConclusionsFlexible ureteroscopy with the Holmium laser may be a feasible and effective treatment option in selected patients with simple parapelvic renal cysts. Further prospective randomized studies that compare the procedure to laparoscopic treatments are needed.

Treatment of Ovarian Cysts in Buffaloes with Emphasis to Echotexture Analysis

The present study was conducted on 31 buffalo-cows aged 3-10 years and diagnosed rectally as they had follicular cyst. The previous diagnosis of the follicular cyst was confirmed by ultrasonography and serum progesterone assay. Ultrasound images of the ovarian follicles, both mature and cystic follicles, were individually identified and monitored and were subsequently digitized for computer analysis of echotexture [mean pixel value (MPV) and pixel heterogeneity (PH)] of the follicle antrum and wall. Animals were classified into two groups (Treated, n=20 and control, n=11). The treated buffalo-cows injected i.m with 100mg progesterone oily in nature followed by i.m injection of 5000 IU HCG at days 5. Out of the twenty treated animals 14 buffaloes responded and diagnosed as they had luteinized cyst. Out of the 14 animals that had luteinized cyst 9 buffaloes injected with 25 mg of PGF2α at day 14 and the other 5 buffaloes left as control. The 6 non responded buffaloes were classified into two subgroups each (n=3), one of them injected with HCG and the other left as control without any treatment. The time elapsed till luteinization of the follicular treated group was significantly different (32.67 ± 1.45 days and 15.71 ± 0.75 days respectively). The recovery rate was 27.27 % in control animals and 70% in treated ones. Days elapsed till appearance of estrus was significantly shorter in treated buffaloes (22.20 ± 1.19 days) in comparison to the control ones (56.33 ± 2.03 days). The conception rates were 33.33% and 66.67% in control and treated group respectively. Days elapsed from the treated animals (36.50 ± 1.47 days) compared to the control ones (64 days). Serum progesterone level was significantly different in treated animals comparing to the control ones. Changes in echotexture of bovine ovarian follicles assessed by computer analysis of ultrasound images has revealed a significant increase in echotexture parameters (MPV & PH) in cystic follicles compared with preovulatory follicles. PH of the antrum and wall of luteinized cystic follicles increased significantly compared to preovulatory and cystic follicles. Ultrasonography examination and echotexture analysis has revealed a presence of positive correlation between the cyst wall thickness and progesterone level which consequently aids in the treatment protocol. From the present study, it could be recommended that accurate diagnosis of the ovarian cyst was done by ultrasonography in combination with echotexture characteristics of ultrasound images together with progesterone profile 2 weeks postpartum early as soon as possible; and the animals should be re-examined with 7-10 days if possible for re-treatment of non responded cases if necessary.

Diagnose and treatment of post-cesarean section scar diverticulum by hysteroscopy combined ultrasonography and laparoscopy

To investigate the application of hysteroscopy combined ultrasonography and laparoscopy in the diagnose and treatment of post-cesarean section scar diverticulum (PCSD). From March 2011 to February 2013, 27 patients with PCSD were diagnosed and treated in Beijing Obstetrics and Gynecology Hospital. All patients were diagnosed by hysteroscopy and ultrasonography. Treatment protocols were decided by the thickness of the diverticulum. The clinical data of all patients were analysed fully. (1) All patients were diagnosed by hysteroscopy combined ultrasound, of which only 17 cases were diagnosed by preoperative ultrasound, the coincidence rate was 63% (17/27). (2) The thickness of diverticulum was measured by hysteroscopy combined ultrasound. Thickness of less than 3 mm in 19 cases, were treated by hysteroscopy combined with laparoscopy diverticulectomy repair; no less than 3 mm in 8 cases, were used hysteroscopy diverticulum incision. (3) The effective rate was 7/8 after hysteroscopy, and which was 16/19 after laparoscopy combined with hysteroscopy surgery. There was no difference in the treatment effect (P=0.663). The ineffective rate was 1/8 after hysteroscopy, and which was 3/19 after laparoscopy combined with hysteroscopy surgery. The size of the PCSD was smaller and the thickness of diverticulum was thicker than preoperation in the later one, which has no difference in the former one. (1) Hysteroscopy combined ultrasound is an accurate method for the diagnose of PCSD. (2) According to the thickness of the diverticulum operation method is choosed, which is beneficial to reduce the trauma, and relieve symptoms. (3) Diverticulum poor positioning and incomplete resection are the main causes of postoperative recurrence of the diverticulum.

MIBI SPECT Scan and Ultrasonography in Preoperative Imaging of Primary Hyperparathyroidism

Objectives: In patients who have parathyroid adenoma, combination of ultrasonography and technetium Tc 99m sestamethoxyisobutylisonitrile scan (also called sestamibi or MIBI scan), which allows anatomic and functional information about parathyroid adenomas, is used commonly to maximize operative cure. The sensitivity of MIBI scan may be increased by adding single photon emission computed tomography (SPECT) and computed tomography (CT) as a combined MIBI-SPECT CT scan. We assessed the accuracy of ultrasonography and parathyroid MIBISPECT scan in detecting parathyroid adenoma and evaluated the potential benefit of the combined protocol of ultrasonography and MIBI-SPECT parathyroid scan. Methods: In 58 patients who had biochemical evidence of primary hyperparathyroidism, we retrospectively reviewed the preoperative ultrasonography and MIBI-SPECT scans. The results of these studies were correlated with surgical findings. Results: In the 58 patients, surgery showed that 43 patients (74%) had solitary parathyroid adenoma. The sensitivity, specificity and accuracy of MIBI-SPECT for parathyroid adenoma was (72%,80%,74%) and for ultrasonography (53%,60%,55%) respectively. The highest sensitivity is noted with the combination of MIBI-SPECT and ultrasonography (79%), . 9 adenomas (21%) were missed by both modalities. In the 20 adenomas that were missed by ultrasound 11 were detected by MIBI SPECT. Conclusion: The MIBI-SPECT had better performance than ultrasonography for parathyroid adenoma localization. The combined MIBI SPECT and ultrasonography has the highest sensitivity for parathyroid adenoma detection (79%). An alternative strategy may be to use MIBI-SPECT initially, and to proceed to ultrasonography only in patients with negative MIBI- SPECT. This may avoid many ultrasonography procedures.

A Clinical Study of a Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of Salivary Glands

Malignant lymphoma involving the salivary glands is a rare entity that accounts for only 1 to 4% of all salivary gland tumors. We have analyzed the clinical features of MALT lymphoma of the salivary glands in 7 patients whom we have treated in the past 10 years, including data from 43 patients in the literature. The most common symptom was persistent or progressive swelling of the salivary glands without pain or facial palsy. The affected glands were the unilateral parotid in 62%, the unilateral submandibular gland in 6.8%, and the bilateral parotid or submandibular gland in 6.8%. The salivary gland swelling as evaluated by MRI or ultrasonography consisted of a localized solitary tumor in 68.9%, multiple tumors in 10.3%, and diffuse swelling of the gland in 26.1%. In 24 out of 50 patients, MALT lymphoma developed on the basis of Sjögren's syndrome. As for diagnosis, malignant lymphoma was suspected only in 4 cases out of 11 (36.7%) based on the fine needle aspiration cytology. In all patients, a definitive diagnosis was obtained based on histopathological study of the localized tumor or the biopsy specimens. When patients with Sjögren's syndrome have developed persistent swelling of the salivary glands, it is necessary to rule out malignant lymphomas, especially MALT lymphoma, by combination of ultrasonography, MRI, FNA, and biopsy or open surgery depending on image findings. The treatment of MALT lymphoma has not yet been standardized because MALT lymphoma is a rare entity. The choice of initial treatment is important because it is related to its prognosis. If MALT lymphoma remains in a local site, we should undertake an operation or radiotherapy. If MALT lymphoma has dissemineated systemically, we should choose chemotherapy.

Usefulness of pelvic ultrasonography for the diagnosis of central precocious puberty in girls.

PurposeIt is difficult to differentiate between central precocious puberty (CPP) and premature thelarche (PT) in girls. The aim of this study was to investigate the diagnostic usefulness of pelvic ultrasonography to distinguish between CPP and PT in girls with early breast development.MethodsThis study included girls with early breast development who visited the clinic between January 2012 and December 2013. Clinical, laboratory, and pelvic ultrasonographic data were evaluated. CPP and PT were confirmed using the gonadotropin-releasing hormone stimulation test.ResultsA total of 248 girls aged 7-8 years were included, among whom 186 (75.0%) had CPP and 62 (25.0%) had PT. The uterine length, transverse diameter, fundus, volume, and cross-sectional area were significantly larger in the CPP group (uterine length, 2.45±0.50 cm vs. 2.63±0.49 cm, P=0.015; uterine volume, 0.95±0.62 cm3 vs. 1.35±0.76 cm3, P<0.001). However, there were no differences in the fundus/cervix ratio and ovarian measurements. In receiver operating characteristic analysis, a uterine volume of at least 1.07 cm3 was the most predictive parameter for CPP with an area under the curve of 0.670 (95% confidence interval, 0.593-0.747).ConclusionUterine measurements by pelvic ultrasonography in girls with early pubertal development were significantly larger in the CPP group. However, the diagnostic value of ultrasonographic parameters was not high because of a considerable overlap of values between the two groups. Therefore, pelvic ultrasonography in combination with clinical and laboratory tests may be useful to distinguish between CPP and PT in girls.

The role of preoperative ultrasonography, computed tomography, and sestamibi scintigraphy localization in secondary hyperparathyroidism.

PurposeThe role of preoperative localization studies is controversial in surgery of secondary hyperparathyroidism (sHPT). The aim of study was to evaluate the accuracy of preoperative ultrasonography (USG), CT, and 99mTc sestamibi scintigraphy (MIBI) in localizing enlarged parathyroid glands and to find the impact of correct localization in successful parathyroidectomy.MethodsWe compared operative findings with the preoperative localization of ultrasonography, computerized tomography and sestamibi scintigraphy in 109 patients with sHPT and identified well-visualized locations of abnormal parathyroid glands by evaluating the sensitivity of each imaging study with regard to typical locations of glands. We investigated the effect of preoperative imaging localization on the surgical outcomes by measuring the intraoperative parathyroid hormone (ioPTH) decrement for positive or negative imaging localization.ResultsUSG (91.5%) had the highest sensitivity and MIBI (56.1%) had the lowest among 3 modalities. The sensitivity of combined USG and CT (95.0%) was the highest among combined 2 modalities. The combination of all 3 modalities (95.4%) had the highest sensitivity among the combinations of modalities. The reduction of ioPTH in patients with positive imaging localization (86.6%) was greater than negative imaging localization (84.2%), with no significant difference (P = 0.586). The recurrence or persistence of sHPT was not correlated with preoperative imaging localization (19 patients in negative, 16 in positive; P = 0.14).ConclusionPreoperative imaging localization contributed to surgical success but not to surgical outcomes. The combination of ioPTH measurement with imaging localization might be valuable for better surgical results in sHPT.

PB.3. Detection of lymph node metastases in newly diagnosed breast cancer patients with axillary ultrasonography in combination with the Memorial Sloan Kettering Cancer Centre normogram as a prediction tool

Current axillary lymph node assessment criteria by ultrasonography (US) depends on cortical thickness >3 mm, focal eccentric cortical thickness and lobulated cortex. Combination with a prediction tool may define better patient management strategies.