Ultrasound Correlation Research Articles

Stratifying fibrinolytic dosing in pediatric parapneumonic effusion based on ultrasound grade correlation.

Complicated pleural effusion prolongs the hospital course of pneumonia. Chest tube placement with instillation of fibrinolytic medication allows efficient drain output and decreases hospital stay. To evaluate experience with lower fibrinolytic dose for parapneumonic effusions and to assess potential dose stratification based on a simple ultrasound grading system. We retrospectively reviewed the medical record to identify children and young adults who received fibrinolytic therapy for parapneumonic effusion and had chest tube placement by an interventional radiology service at a single children's hospital. We assessed tissue plasminogen activator (tPA) dosing and treatment duration, as well as the need for a second pleural procedure or surgical drainage. Diagnostic US images were classified as showing less than 50% pleural echogenicity (grade 1) or greater than 50% pleural echogenicity (grade 2) and were correlated with clinical parameters. Of 32 patients with parapneumonic effusion, all except one received at least some 1-mg tPA doses. Dosing was solely 1-mg tPA in 81% of subjects; 19% of subjects also received 2-mg tPA doses. Mean fibrinolytic duration was 3.1days for grade 1 effusions compared to 5.4days for grade 2 effusions. A second pleural procedure was required in 15.6% of children. Pleural drainage with fibrinolytic therapy was successful in 97%; only one child required surgical drainage. Grade 2 US differed significantly from grade 1 US, with grade 2 occurring in younger patients (P < 0.0001), smaller patients (P < 0.0001), those needing a second procedure (P = 0.001), those with positive pleural culture or polymerase chain reaction test (P = 0.006), and those with longer treatment duration (P = 0.03). A lower 1-mg dosing regimen of tissue plasminogen activator was effective in all children with less complex (grade 1 US imaging) parapneumonic effusions. Grade 2 US images correlated with younger and smaller children, presence of a pleural organism, and longer or more complicated chest tube duration.

Fetal Magnetic Resonance Imaging of Head and Neck Anomalies

Fetal head and neck (HN) anomalies represent complex diagnostic and management challenges, often requiring serial imaging and a multidisciplinary team approach. In this article, we will review the prenatal magnetic resonance imaging diagnosis of HN malformations, with ultrasound and postnatal imaging correlation. Key topics to be discussed include craniofacial abnormalities, posterior fossa malformations, neural tube defects, cervicofacial masses, and airway anomalies.

Subscapularis function after total shoulder arthroplasty: electromyography, ultrasound, and clinical correlation

The literature lacks electromyographic (EMG) examination of subscapularis function in the postoperative period after total shoulder arthroplasty (TSA). The primary purpose of this study was to document EMG activity of the subscapularis after TSA and to correlate it with clinical and ultrasound findings. The study included 30 patients who were at least 1 year (average, 2.1 years) from surgery, status post TSA approached through a standard subscapularis tenotomy. Patients returned for a physical examination, ultrasound evaluation, and EMG evaluation. Patients also completed postoperative surveys: the American Shoulder and Elbow Surgeons questionnaire, the Simple Shoulder Test, and the 12-Item Short Form Health Survey. The American Shoulder and Elbow Surgeons, Simple Shoulder Test, and physical 12-Item Short Form Health Survey scores improved from preoperatively to postoperatively, respectively, 45.3 to 76.8 (P = .0002), 3.9 to 9.0 (P < .0001), and 33.9 to 42.8 (P = .017). Six patients had a positive lift-off test result, and the belly-press test result was negative in all patients. Two patients had a subscapularis rupture on ultrasound. The postoperative EMG finding was normal in 15 patients; in the other 15 patients, there was evidence of chronic denervation with reinnervation changes: 30% subscapularis, 27% infraspinatus, 20% supraspinatus, 20% teres minor, and 13% rhomboids. This is the first study using a comparison EMG evaluation to document subscapularis function after TSA. EMG evaluation showed that active denervation of the subscapularis was not evident in any patient at least 1 year after TSA. However, in half of the patients, there was evidence of chronicdenervation and reinnervation changes across 5 muscle groups. We theorize that surgical exposure, traction, and the use of interscalene regional anesthesia may contribute to these unexpected EMG results.

Clinical and ultrasound correlation in first trimester abortion

Aims and Objectives of Study: To compare the diagnostic accuracy of clinical and ultrasound evaluation in first trimester abortions and assess the impact of ultrasound on patient management. Study Design: Non-interventional comparative study conducted o n 100 patients, selected o n simple random basis from Gynae Outpatient Department. Study place: Department of Obstetrics &amp; Gynaecology, Allama Iqbal Medical College and Jinnah Hospital, Lahore Materials and Methods: All the patients with symptoms of first trimester abortion were evaluated clinically and by ultrasound to formulate a diagnostic and management plan. Main Outcome Measures: Both Modalities were compared for diagnostic accuracy, positive and negative correlation in different types of abortions. Results: 34% of the patients were at l0 weeks of gestation, 28% were unsure of dates, 17% were at 11 weeks of gestation, 13% of the patients were at 9 weeks of gestation, 5% were at 6 weeks while 3% were at 7 weeks of gestation. Clinical diagnosis was made in 42% of cases; in 39% definite diagnosis was possible with combined clinical and ultrasound evaluation while in 19% no diagnosis was established with either modality In 89% of the cases the diagnosis was made on single ultrasound scan, while 11% required a repeat scan. Correlation between two modalities was present in 81% of the cases. Positive correlation was obtained in 59% and negative correlation was seen in 22% . The correlation was not possible in 19% of cases. Conclusion: Ultrasonography is an essential tool in diagnosis of early pregnancy failures especially where clinical evaluation is inconclusive.

Abstract P4-02-12: Breast MRI: Enhancing pre-operative planning in women with newly diagnosed breast cancer

Abstract Hypothesis: Preoperative breast MRIs in newly diagnosed breast cancer patients may lead to additional findings, including larger disease involvement, thus leading to a change in the operative plan. This information can led to better surgical planning and decreased rates of surgical re-excisions. Methods: This was a single surgeon, single institution, retrospective analysis of women with newly-diagnosed breast cancer who had surgery between December 2013 and December 2014. A total of ninety-six patients underwent preoperative breast MRI. Exclusion criteria were patient's refusal of MRI or surgery, contraindication to MRI based on implants or body habitus, and male patients. Results: Overall, breast MRI most closely correlated to pathological tumor size (gold standard). MRI had a 64% correlation with pathology size, whereas mammography and ultrasound correlation were 44% and 43% respectively. As breast density increased, MRI correlation to pathologic tumor size improved. For breast density between 25-50%, tumor size by MRI correlated with pathology size in 27% of patients, mammogram correlation was 33% and ultrasound was 12%. When breast density increased to 51-75%, MRI correlation improved to 92%, whereas mammogram correlation was 56% and ultrasound was 68%. The majority of patients fell within these two density categories; correlation for breast density &amp;lt;25% and &amp;gt;75% were not statistically significant. Of the breast biopsies preformed for MRI abnormalities not otherwise identified by mammography or ultrasound, 42% were positive for invasive cancer or DCIS. Thirty-eight percent of patients had a change in operative plan based on their MRI findings. Of the ninety-six patients, nine were changed from breast conserving surgery to mastectomy, and 29 underwent a larger area of resection than planned prior to MRI, due to findings of more extensive disease on MRI not otherwise appreciated by mammography or ultrasound. Conclusion: Pre-operative MRI played a significant role in the pre-surgical evaluation of patients with newly diagnosed breast cancer. In our series, breast MRI demonstrated better correlation with extent of disease compared to other imaging modalities. This is turn enhanced patient and surgeon decision making and led to more precise pre-operative surgical planning. Citation Format: Carr B, Lamb LC, Zarfos K, Weigert J, Singh R. Breast MRI: Enhancing pre-operative planning in women with newly diagnosed breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-12.

Ultrasound and magnetic resonance imaging correlation of the wrist and metacarpophalangeal joints in fifty consecutive patients of rheumatoid arthritis

Background: Gray-scale ultrasound and Power Doppler ultrasound (GSUS, PDUS) and contrast Magnetic Resonance Imaging (MRI) are the imaging modalities to detect the disease in this early stage of rheumatoid arthritis (RA). This study was conducted to observe the advantages and disadvantages of USG and MRI of wrist and metacarpophalangeal joints in patients with rheumatoid arthritis. Methods: Clinically diagnosed cases of RA were included. GSUS-PDUS and high field (1.5T) MRI with contrast were used by two assessors. The evaluation and scoring was done using the RAMRIS score. Other assessed parameters included Joint space narrowing, GSUS bone erosions, Gray scale USG synovial hypertrophy, MRI tenosynovitis and tenosynovitis on GSUS. Results: Total 50 patients (44 female, 6 male; age 18-76 years) with 100 joints and 400 Metacarpophalangeal joints (2nd to 5th) including 2300 bone areas were evaluated. GSUS, PDUS evaluation was equal to contrast MRI evaluation in detecting joint space narrowing, effusion, flexor tenosynovitis (except for FPL tendon), extensor tenosynovitis. Whereas synovial thickening was better picked up in GSUS, PDUS than on contrast MRI. Contrast MRI picked up more cases of bone erosions, triangular fibro cartilage lesions and active synovitis as compared to GSUS, PDUS. Bone marrow edema which indicates active ostitis could only be directly detected on contrast MRI. Conclusions: GSUS, PDUS can be used as radiological investigative modality for the diagnosis of cases of early rheumatoid arthritis specially for synovial thickening, joint effusion, flexor and extensor tenosynovitis.

Subcutaneous intravascular papillary endothelial hyperplasia: ultrasound features and pathological correlation.

To describe grayscale and color Doppler ultrasound features of subcutaneous intravascular papillary endothelial hyperplasia (IPEH). The ultrasound appearances of ten histologically proven subcutaneous IPEH in ten patients (age range, 15-69 years; mean age, 38.2years; six females, four males) were reviewed retrospectively by two musculoskeletal radiologists. Color Doppler examination and surgical excision were performed in all cases. The correlations between the ultrasound and pathological features of the lesions were done. All ten cases were pathologically diagnosed as pure forms of IPEH. The mean size of the lesions was 1.3cm. The margins of the lesions were circumscribed in seven of ten patients. Three had lobular margins. The distinct internal septum-like structures were seen in seven of ten cases (70%). The vascularity was rich in three (30%), moderate in four (40%), and little in three (30%) of the ten cases. The most common vascular pattern was one or more vessels peripherally or both peripherally and centrally located in the lesion. The detectable origin vessel was noted in four of ten cases (40%). Although sonographic features of subcutaneous IPEH are non-specific, they should be included in the differential diagnosis of a small, well-defined, oval or elliptical, heterogeneous, hypoechoic soft tissue mass, showing a vascular pattern of one or more vessels in the lesion and variable vascularity. The presence of the internal septum-like structures and detectable origin vessel may be help to distinguish the lesion from the other soft tissue masses.

Identification of hyperelastic properties of passive thigh muscle under compression with an inverse method from a displacement field measurement

The mechanical behavior of muscle tissue is an important field of investigation with different applications in medicine, car crash and sport, for example. Currently, few in vivo imaging techniques are able to characterize the mechanical properties of muscle. Thus, this study presents an in vivo method to identify a hyperelatic behavior from a displacement field measured with ultrasound and Digital Image Correlation (DIC) techniques. This identification approach was composed of 3 inter-dependent steps.The first step was to perform a 2D MRI acquisition of the thigh in order to obtain a manual segmentation of muscles (quadriceps, ischio, gracilis and sartorius) and fat tissue, and then develop a Finite Element model. In addition, a Neo-Hookean model was chosen to characterize the hyperelastic behavior (C10, D) in order to simulate a displacement field. Secondly, an experimental compression device was developed in order to measure the in vivo displacement fields in several areas of the thigh. Finally, an inverse method was performed to identify the C10 and D parameters of each soft tissue.The identification procedure was validated with a comparison with the literature. The relevance of this study was to identify the mechanical properties of each investigated soft tissues.

Clinical and ultrasound correlation in the diagnosis of acute appendicitis: a retrospective study

Introduction Ultrasonography (USG) has been increasingly used to help in the diagnosis of acute appendicitis with the aim of minimizing both underdiagnosis and overdiagnosis of acute appendicitis. The aim of this study is to ascertain whether USG could change the decision making in the management of acute appendicitis. Methods This is a retrospective analysis of prospective data on 100 patients who underwent appendicectomy either open or laparoscopic. These 100 patients were divided into two groups; those with equivocal appendicitis and those with strongly suspected appendicitis based on clinical assessment. Modified Alvarado Score (MAS) was used for clinical assessment. All of them had USG as the sole mode of imaging. The accuracy of each mode of assessment was confirmed by macroscopic and/or microscopic appearance of the appendix. Based on the findings it was judged whether performing USG has made any changes to the clinical decision. Results There were 61 males and 39 females with a mean age of 25 (7-86) years. Total number of patients admitted with modified Alvarado score (MAS) of 2-6 was 39 and those with MAS of 7-9 was 61. True positive cases of acute appendicitis in the former group were 33. While ultrasonography detected acute appendicitis correctly in 30 patients, only 3 patients were correctly diagnosed clinically. Out of 59 true positive cases of acute appendicitis in the latter group, USG detected only 41 cases whereas all 59 patients were correctly identified clinically. While USG has helped change the clinical decision in the equivocal appendicitis, clinical decision takes precedence over USG in patients with typical appendicitis. Conclusion While USG has definite place in the evaluation of suspected appendicitis with low clinical probability, it has little value in changing the clinical decision to undertake appendicectomy in patients getting admitted with typical history of appendicitis. The Sri Lanka Journal of Surgery 2015; 33(2): 8-13

Hyperhomocysteinemia as an Early Predictor of Erectile Dysfunction: International Index of Erectile Function (IIEF) and Penile Doppler Ultrasound Correlation With Plasma Levels of Homocysteine.

Erectile dysfunction (ED) is inability to achieve and maintain an erection to permit satisfactory sexual activity. Homocysteine (Hcys) is a sulfur-containing amino acid synthesized from the essential amino acid methionine. Experimental models have elucidated the role of hyperhomocysteinemia (HHcys) as a strong and independent predictor for atherosclerosis progression and impaired cavernosal perfusion.The aim of this study is to investigate the serum levels of Hcys in our cohort of patients with ED, to compare these values with these of control population and to examine Hcys as a predictive marker for those patients who are beginning to complain mild–moderate ED.A total of 431 patients were enrolled in the study. The whole cohort was asked to complete the International Index of Erectile Function (IIEF) questionnaire. The study population was divided in 3 main groups: Group A: 145 patients with no ED serving as a control group; Group B: 145 patients with mild or mild–moderate ED; Group C: 141 patients with moderate or severe ED. Each participant underwent blood analysis. All patients underwent baseline and dynamic penile Doppler ultrasonography.We found in our cohort mean Hcys plasma concentrations significantly higher than the cut-off point in both groups B and C (18.6 ± 4.7 and 28.38 ± 7.8, respectively). Mean IIEF score was 27.9 ± 1.39, 19.5 ± 2.6, and 11.1 ± 2.5 for groups A, B, and C, respectively (P < 0.0001). In the penile Doppler ultrasonography studies, a high significant inverse correlation was detected between the mean values of the 10th minute's peak-systolic velocity (PSV) and Hcys levels for the groups B and C.This establishes a dose-dependent association between Hcys and ED. Furthermore, we showed that Hcys was an earlier predictor of ED than Doppler studies, as the Hcys increase was present in patients with mild ED even before abnormal Doppler values.

Use of digital image correlation and ultrasound: analysis of thigh muscle displacement fields.

The understanding of the mechanical behavior of the muscle tissue is an important field of investigation with different applications in medicine, car crash and sport. Currently, few in vivo imaging techniques are able to characterize the mechanical properties of muscle. Thus, the development of an in vivo identification method is a current thematic where the displacement field measurements could be used for further interpretations. This study aims at presenting the displacement fields measured in the anterior, posterior, lateral and medial parts of the thigh muscles using ultrasound and Digital Image Correlation (DIC) techniques. The results of the displacement field measurements confirmed and are correlated with the ultrasound observations.

Relationship between perfusion defect and contrast-enhanced ultrasound features,clinical pathological parameters of breast cancers

Objective To study the ultrasonic imaging of breast cancer with or without filling defect with contrast-enhanced ultrasound and clinical pathologic correlation. Methods The suspicious breast lesions underwent contrast-enhanced ultrasound examination, the imaging of 119 breast cancer with pathological results were retrospectively analyzed, and the contrast enhanced ultrasound effect, distribution of contrast agent, sequence of contrast agent into the tumor, contrast enhanced ultrasound mode, perforator vessel, filling defect and flow classification were observed. Then clinical and pathological data were collected including the tumor size, clinical stage, pathological grade and the situation of micro calcification. The perfusion defect as the grouping factor, there were 37 cases of perfusion defect and 82 cases without perfusion defect. A mono-pactor and multi factor analysis was performed by the logistic regression models to the relationship between perfusion defect and contrast-enhanced ultrasonography, clinical pathological parameters. Results Both mono factor and multifactor analysis displayed that whether to display the filling defect in contrast enhanced ultrasound was associated with ultrasound contrast distribution, the sequence of contrast agent into the tumor and histological grade(χ2=19.5050, 21.1210, 10.3640, OR=6.977, 0.261, 2.509, all P<0.05). Multivariate analysis showed that tumor size and whether to display the filling defect in contrast enhanced ultrasound were close(OR=1.692, P<0.05) .Clinical stage, whether the blood flow signal penetrates was meaningful in univariate analysis but excluded in multivariate analysis. Both mono factor and multifactor analysis displayed that contrast enhanced ultrasound mode, contrast enhanced ultrasound effect, flow classification and pathological micro calcification were not associated with whether to display the filling defect. Conclusions Whether to display the filling defect and the related factors of contrast-enhanced ultrasound in diagnosis of benign and malignant were not completely consistent. Breast cancers with filling defects of contrast-enhanced ultrasound tend to present large masses, contrast agent distribution of peripheral enhancement, centripetal filling of ultrasound contrast agents and the higer histological grading. Key words: Ultrasonography; Microbubbles; Breast neoplasms; Filling defect

Does Transparency Really Help?

INTRODUCTION: To assess whether visualizing a fluid pocket during amniocentesis training helps improve skills required for the procedure, including needle placement and aspiration. METHODS: We performed an observational study using two models; one allowed trainees to visualize a fluid-filled area in a “uterus,” whereas the other required an ultrasonogram for localization. We randomly divided 16 obstetrics–gynecology residents into two groups. After a brief didactic, one group practiced their technique with the clear model (“clear” group), whereas the other group practiced with the opaque model (“opaque” group). Residents were compared with regard to time to aspiration, number of attempts (removal of entire needle), needle reorientations (movement of needle within space), and movement of the needle while aspirating. RESULTS: Pretest knowledge and skills were similar in both groups. Understanding of key amniocentesis concepts improved greatly after simulation (55% compared with 85%, P<.001) as did confidence in performing such procedures (P<.001). There was no significant difference in the aspiration time between the clear and opaque group (76.9 compared with 81.6 seconds, P=.8). The numbers of needle attempts and reorientations were not different between clear and opaque groups (P=.6 and P=1, respectively). Interestingly, the opaque group showed more needle tip movements during aspiration, although this was not significant (P=.2). CONCLUSION: In trying to teach a complex skill such as amniocentesis, “visualizing” a uterus does not appear to improve skills. Likely, “seeing” the uterus minimizes the need for ultrasound correlation, yet simulation didactics are effective at teaching rare skills to residents and help boost confidence in procedures.

Ultrasound and anatomical correlation of the radial nerve at the arcade of Frohse.

In this anatomical study we evaluated the feasibility of ultrasound (US) guided perineural injection of the deep branch of the radial nerve (DBRN) at the arcade of Frohse as potential therapy for nerve entrapment at this site. We examined 21 arms from 11 nonembalmed cadavers with US. Under US guidance, we injected ink into the DBRN perineural sheath beneath the arcade of Frohse. In subsequent anatomical dissection we evaluated the distribution of the ink. It was possible to apply ink at the DBRN in 95%. In 80% the ink remained within the supinator and did not reach the DBRN segment proximal to the arcade. With US guidance, it is possible to apply injection fluid safely around the DBRN inside the supinator tunnel. Due to the limited extent of the fluid, a second injection proximal to the arcade should be considered in the clinical setting.

Measurement of the quadriceps muscle displacement and strain fields with ultrasound and Digital Image Correlation (DIC) techniques

Objectives – In vivo characterization of muscle tissues is necessary to increase the understanding of musculoskeletal pathologies. Currently, few imaging techniques are able to characterize the in vivo mechanical properties of muscle. Thus, the purpose was to couple experimental and numerical tools to characterize the displacement and strain fields. This approach was validated on a phantom and then applied in vivo on thigh muscles.Materials and methods – An experimental compression device was developed in order to measure the displacement field from a phantom with inclusions, and from quadriceps muscle, using compressed and uncompressed ultrasound acquisitions (9 MHz). A diffuse approximation method was used to determine the optimal ZOI (Zone Of Interest) size (4, 8, 16 pixels) allowing for the realization of the DIC with a low noise and a high spatial resolution (about 100 μm). Then, the strain field was represented with a diffuse approximation radius, optimized from the theoretical noise.Results – The in vitro and in vivo displacement fields confirmed the qualitative ultrasound observations. The ZOI size was found optimal at 8 pixels. Then, the diffuse approximation radii were determined at 9 and 13 data points for the phantom and the quadriceps, respectively, providing the strain field cartographies. These cartographies validated the experimental protocol and the displacement field measurement.Conclusion – The present study revealed the feasibility of the Digital Image Correlation technique to assess the in vivo muscle mechanical behavior, and could be extended to different soft tissues.

Subscapularis Function after Total Shoulder Arthroplasty: Electromyelography, Ultrasound, and Clinical Correlation

Subscapularis Function after Total Shoulder Arthroplasty: Electromyelography, Ultrasound, and Clinical Correlation

Ultrasound vs MRI for stroke shoulder: Apples and pears or simply N/A?

To the Editor,We have taken interest in the recently published article entitled ‘Ultrasound and magnetic resonance findings and correlation in hemiplegic patients with shoulder pain’ in your journa...

Ultrasound and magnetic resonance cholangio-pancreatography correlation in biliary disorders

Ultrasound and magnetic resonance cholangio-pancreatography correlation in biliary disorders

Lesion morphology on breast MRI affects targeted ultrasound correlation rate.

Suspicious lesions on breast MRI are often initially evaluated using targeted ultrasound. However, workup varies. Data on the rate of correlate detection by morphology [mass, non-mass enhancement (NME), or focus] would be useful for developing practice guidelines. Breast MRI examinations from 1 January 2008 to 31 December 2010 were reviewed. BI-RADS 4 or 5 lesions on MRI evaluated with targeted ultrasound where definitive diagnosis was obtained were included. Statistical analysis was performed on aggregate data and at the lesion level. A total of 204 lesions were included in the study. A statistically significant difference in ultrasound correlate identification by morphology was found; a correlate was found in 49.3 % of masses, 15 % of NME, and 42.3 % of foci (p = 0.0006). Additional analysis within each morphology demonstrated significantly greater rate of malignancy in masses with an ultrasound correlate than masses without a correlate (p = 0.0062), while the rate of malignancy in NME and foci did not differ with ultrasound correlation. Morphology of a suspicious lesion on breast MRI affects the probability of identifying an ultrasound correlate. As sonographic correlates are found in nearly half of masses and foci, targeted ultrasound should be the initial step in their workup. • Lesion morphology on breast MRI affects the probability of ultrasound correlate identification. • An ultrasound correlate is significantly more likely for masses and foci. • Mass or focus should undergo targeted ultrasound before MRI-guided biopsy.

English

Placental mesenchymal dysplasia (PMD) is a rare, incompletely understood placental vascular lesion. Ultrasound and gross placental examination reveal placentomegaly and grape like vesicles that mimic molar pregnancy. PMD is often associated with normal foetus, diploid karyotyping and needs to be differentiated from its mimickers as the prognosis and management varies. Here in, we describe a case of PMD with ultrasound and histopathological correlation.