Underwent Ultrasound Research Articles

Monorchism cryptorchidism: what should be the imaging evaluation protocol? - a case report

Background: Monorchism is having only one testis and cryptorchidism is undescended testis. This is usually congenital anomaly but can happen as a result of trauma or surgical procedure undertaken. There are great psychosocial factors related to this entity. The complete evaluation is of paramount importance. Radiological protocol for detailed search for the hidden testis is of utmost importance for future management procedure. Case presentation: We present 2-years old male child who was evaluated for having an empty scrotal sac. He underwent Ultrasound (US), and magnetic resonance imaging (MRI) for the evaluation. Diffusion weighting images (DWI) played a great role in the diagnosis. The child was having only left sided testis and that too was undescended. Conclusion: There is great value of cross-sectional imaging in diagnosing the hidden testis. The sonography remains the first investigation of choice. MRI should be undertaken to locate the testis but may fail also for the localization. Diffusion weighted imaging (DWI) plays an important role with great reliability in the diagnosis among pediatric cases being radiation-free modality.

Thermal Resistance Anastomosis Device for the Percutaneous Creation of Arteriovenous Fistulae for Hemodialysis

PurposeTo evaluate the safety and efficacy of arteriovenous fistula (AVF) creation with a thermal resistance anastomosis device (TRAD). Materials and MethodsFrom January 2014 to March 2015, 26 patients underwent ultrasound (US)-guided percutaneous creation of proximal radial artery–to–perforating vein AVFs with a TRAD that uses heat and pressure to create a fused anastomosis. Primary endpoints were fistula creation, patent fistula by Doppler US, two-needle dialysis at the prescribed rate, and device-related complications. ResultsTechnical success rate of fistula creation was 88% (23 of 26). Procedure time averaged 18.4 minutes (range, 5–34 min), and 96% of anastomoses (22 of 23) were fused. At 6 weeks, 87% of AVFs (20 of 23) were patent, 61% (14 of 23) had 400-mL/min brachial artery flow, 1 patient was receiving dialysis, 2 fistulae had thrombosed, and 1 patient had died unrelated to the procedure. Eighty percent (16 of 20), 70% (14 of 20), and 60% (12 of 20) of patients were receiving dialysis at 3, 6, and 12 months; 4 patients died, 3 fistulae failed, and one patient was lost to follow-up. Overall, 87% of AVFs (20 of 23) had an additional procedure at a mean of 56 days (range, 0–239 d), including balloon dilation in 43% (n = 10), brachial vein embolization in 26% (n = 6), basilic vein ligation in 17% (n = 4), venous transposition in 30% (n = 7), and valvulotomy in 4% (n = 1). There were no major complications related to the device. ConclusionsPercutaneous AVFs created with a TRAD met the safety endpoints of this study. Midterm follow-up demonstrated intact anastomoses and fistulae suitable for dialysis.

Computed tomography for the management ofexit-site and tunnel infections in peritoneal dialysis patients .

To evaluate the effectiveness of computed tomography (CT) for detection of exit-site and tunnel infections with a Tenckhoff catheter. The study enrolled patients with exit-site or tunnel infections who underwent ultrasonography (US), CT scans, and subsequent catheter removal or partial catheter reimplantation from 2010 to 2014. Control cases on peritoneal dialysis who underwent abdominal CT scans for other reasons were randomly selected. Attenuation of the soft tissue around the Tenckhoff catheter was measured in Hounsfield units (HU). 9 infected cases and 15 control cases were identified. CT showed increased attenuation around the catheter in all cases, while ultrasonography detected a hypoechoic area only in one case with abscess formation. Maximal attenuation of the inflamed soft tissue was high (median, 36 HU) compared with normal fatty tissue (median, -75 HU). In all cases, one or two sites with increased fat density were observed focally along the catheter, and these areas did not always extend directly from the exit site. In this retrospective study comprising a small number of cases, increased attenuation of fatty tissue around the Tenckhoff catheter correlated with exit-site or tunnel infections. CT might be an auxiliary tool for diagnosis, although CT costs much more than US and is not always available in general practice. Further prospective studies are needed. .

Combined Sonography

We report the results of a joint thyroid clinic with a consultant surgeon and consultant radiologist to offer “triple assessment” for patients on a single visit. All new referrals from September 2011 to December 2013 were reviewed. Among 228 patients referred, 163 patients underwent ultrasonography (US) on the same visit and 66 fine needle aspiration cytology (FNAC) studies (57 under US guidance) were done. One hundred ninety-eight (87%) patients made a single visit to the clinic for diagnosis. One hundred twenty-five were discharged or referred elsewhere after the visit and 21 underwent surgery; the remaining 52 patients were followed up. There were 7 thyroid cancers and 2 lymphomas diagnosed. We have concluded that the joint ultrasound-surgery clinic provided an effective outpatient thyroid service with fewer hospital visits.

Evaluation of Diagnostic Efficiency of Ultrasound Features on Malignant Thyroid Nodules in Chinese Patients.

Background:The aim of this study was to evaluate the efficacy of ultrasonic features in predicting the malignancy of thyroid nodules in a group of Chinese patients.Methods:In all, 762 patients with thyroid nodules (424 malignant and 338 benign) underwent ultrasound (US) check and surgery between March 2011 and July 2014 at Peking University First Hospital were identified. Univariate and receiver operating characteristic (ROC) analyses were performed to calculate the sensitivity, specificity, negative and positive predictive values of each US feature, and the accuracy of their combinations for prediction of malignancy.Results:Patients with malignant nodules were younger and without obvious risk history than those in the benign group (P < 0.001, P = 0.93). No individual US sign was fully predictive of a malignant lesion. The Youden indexes of irregular margins and hypoechogenicity were the first and second highest in all US features, which were 51.9% and 45.2%, respectively. The sensitivity of solid components (89.7%) and hypoechogenicity (89.2%) and the specificity of taller-than-wide shape (98.5%) and microcalcifications (90.6%) were the first and second highest in all US features. Intranodular flow on a color Doppler examination was a weak predictor of malignancy. Under ROC analysis excepting intranodular flow, the 95% confidence interval (CI) of areas under the curves of hypoechogenicity and irregular margins with any one of the US features were overlapped that of five-feature combinations (95% CI: 0.850–0.901).Conclusions:We should be alert with taller-than-wide shape and microcalcifications. Intranodular flow was a weak predictor of malignancy. According to Youden indexes and ROC analysis, irregular margins and hypoechogenicity combined with solid component or taller-than-wide shapes or microcalcifications have a high predicative value for malignant thyroid nodules in Chinese patients.

Laryngeal myofascial pain syndrome as a new diagnostic entity of dysphonia.

To consider the feasibility of diagnosing intrinsic laryngeal muscle myofascial pain syndrome (MPS) in dysphonic patients who demonstrated immediate symptom and stroboscopic finding improvement after laryngeal electromyography (LEMG) without further treatment. A chart review of patients who showed subtle vocal fold movement abnormalities on a stroboscopic examination and underwent ultrasonography (US)-guided LEMG was performed. Patients with vocal fold paralysis, mucosal lesions, spasmodic dysphonia, and vocal tremor on stroboscopic examination were excluded. Among them, patients with normal EMG findings were included in this study. The patients who reported voice symptom improvement after LEMG without further treatment were placed in laryngeal MPS (LMPS) group and the other patients were placed in non-laryngeal MPS (non-MPS) group. Predisposing factors, voice symptom, symptom-duration, and stroboscopic findings of these patients were reviewed. Among the 16 patients, LEMG findings were normal, five (31%) were included in the LMPS group and the other 11 patients (69%) were included in the non-MPS group. All LMPS group patients had a history of voice abuse and reported odynophonia. The Korean Voice Handicap Index-10 score decreased significantly after US-guided LEMG without additional treatment in the LMPS group. The stroboscopic findings revealed that vocal fold hypomobility was the most common finding in the LMPS group, and two patients showed a muscle tension dysphonia pattern. The LMPS groups showed improvement of vocal fold mobility on 1-week stroboscopic evaluation. LMPS is a potential diagnosis for patients with vocal fold hypomobility finding on stroboscopic findings but with normal EMG results. Diagnosis of LMPS could be considered in patients who showed symptom and vocal fold movement improvement after LEMG.

Pancreatic cysts in general population on ultrasonography: Prevalence and development of risk score.

Pancreatic cysts are related to the presence of ductal adenocarcinomas elsewhere in the pancreas, and are also associated with an increased risk of pancreatic adenocarcinoma in the future. Most of the previous studies that investigated the prevalence of pancreatic cysts focused on patients within a hospital or out-patient setting, which may not be representative of the general population. We investigated the prevalence and predictive factors for the presence of pancreatic cysts within a large number of subjects via general health examination. Between December 2007 and December 2013, a total of 5198 subjects were enrolled that underwent ultrasonography (US) on general health examination. We established a scoring system for predicting the presence of one or more pancreatic cysts using a split-sample method. Among the enrolled subjects, the prevalence of a pancreatic cyst was 3.5%. In multivariate analysis, the prevalence was significantly increased with older age, female sex, and the presence of gall bladder adenomyomatosis (GB-ADM). Based on multivariate analysis in the training sample (n=2,599), we established the scoring system consisting of age, sex, and the presence of GB-ADM to predict the presence of pancreatic cysts. This scoring system was validated in the testing sample (n=2,599) and produced an area under the curve of 0.711. The prevalence of pancreatic cyst detected by US was 3.5% in the general population, and increased with age, female sex, and the presence of GB-ADM. A new scoring system developed in the present study may help to identify better candidates for further examination when the pancreas is not visible by US.

Meta-analysis of radiofrequency ablation for treating the local recurrence of thyroid cancers.

Our aim was to evaluate the efficacy of ultrasound-guided radiofrequency ablation (RFA) for localized recurrent thyroid cancers. We did a systematic review and meta-analysis of the scientific literature by searching the PubMed, Embase, Web of Science,Scopus and the Cochrane Library up to November 26, 2015. We assessed the pooled standard mean difference (SMD) of nodule volume, largest diameter and serum thyroglobulin (Tg) level by comparing pre-RFA with post-RFA using fixed or random-effects model. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the included studies, risk of bias in the selective populations, comparability of groups and exposure. We finally identified nine articles including 189 patients (male: 54 and female: 135) with 255 tumor lesions, who underwent ultrasound (US)-guided RFA beyond the mean 6months of follow-up. The results showed that tumor volume (SWD: 0.77, 95% CI: 0.57-0.97, I (2)=25.9%, p=0.231), largest diameter (SWD: 1.56, 95% CI: 0.94-2.17, I (2)=82.6%, p<0.001) and Tg level (SWD: 0.52, 95% CI: 0.30-0.73, I (2)=0%, p=0.493) were decreased and no significant publication bias was detectable. The pooled data indicated that the prognosis improved for patients with localized recurrent thyroid cancers and RFA is a promising treatment for these patients with infeasible surgery.

Ultrasonography Role in Evaluation of Achilles Tendon Enthesis in Reactive Arthritis Patients.

Reactive arthritis is an inflammatory joint disease which develops after 1-4 weeks following an enteral, genital or ORL infection, with a higher frequency in HLA-B27 positive patients. As a group feature, enthesitis is defined as inflammation in bone insertions of tendons, ligaments and muscular fascia. Aims: the main object of this study was to demonstrate the importance of musculoskeletal ultrasonography in Achilles tendon evaluation in patients with reactive arthritis. Patients and methods: we designed a transversal, retrospective study which included 15 patients diagnosed, based on ESSG criteria, with reactive arthritis (ReA), in Rheumatology Department, Emergency County Hospital. From those 15 patients, 9 were positive for a genital infection with Chlamydia trachomatis and 6 patients with enteral infection, 2 with Shigella, respectively 4 with Yersinia. Healthy control group included 15 patients, with no inflammatory joint diseases. After clinical examination, all patients and controls underwent ultrasound (US) evaluation for Achilles tendon changes, using an Esaote MyLab 25 machine, with a linear high frequency probe (10-18 MHz), using EULAR recommendations and OMERACT definitions for enthesitis, tendinitis and erosions. The cutoff value for the Achilles tendon thickness was 5.29mm, as described by Balint et al. Results: We examined 30 Achilles tendons in 15 patients, with a mean age of 35,2years±10,19 standard deviation (SD) and 30 tendons in 15 controls with a mean age of 35,8 years ±12,00 SD. In both groups sex prevalence showed more males than females (66,66% males in controls vs. 60,00% in patients group). We found a statistic significant higher ESR and CRP in patients group, compared to controls (24,86mm/h vs. 11,8mm/h; 18.90mg/dl vs. 6.22mg/dl). Most frequent finding in patients group was retrocalcaneal bursitis (56.66%), followed by tendon thickening (46.66%), compared to control group in which we found more frequently osteophytes (36.66%) and calcifications (23.33%). Tendon thickness was significantly higher in the patients group compared to control group 5.30mm±1.39SD vs. 4.42mm±0.77SD, p=0.008). When compared to clinical examination, US found at least one change in all patients (100% vs. 40.0%). Conclusions: A higher prevalence of retrocalcaneal bursitis and tendon thickening were found in reactive arthritis patients compared to control group. The US found more changes compared to clinical examination and manage to discriminate between the types of changes found more frequently in inflammatory conditions.

A second branchial cyst, masquerading as lipoma, a mistaken diagnosis supported by radiology and fine needle aspiration cytology: case report

At the fourth week of embryonic life, the development of four branchial clefts result in five branchial arches, which contribute to the formation of various structures in the head and neck. We report a case of second branchial cleft cyst in a 50 years old lady for last 30 years. The cyst did not develop any complication in spite of long duration. The mass had been evaluated in past and she underwent ultrasonography (USG) and fine needle aspiration cytology (FNAC). Again, we evaluated the patient with USG, contrast enhanced computer tomography (CECT) and FNAC. The final diagnosis on both the occasions was lipoma neck. The mass was found to be second branchial cyst on exploration under local anaesthesia and same was confirmed by histopathology. We wish to highlight the limitation of radiology and cytology the diagnosis of branchial cleft cysts. The magnetic resonance imaging (MRI) may have clinched the exact diagnosis, which was not done in this case. The operating surgeons should always keep in mind these limitation and be prepared for surprises in dealing with the neck masses .

Paediatric abdominal tuberculosis in developed countries: case series and literature review

ObjectiveTo provide an insight into the presentation, diagnosis and management of paediatric abdominal tuberculosis (TB) in developed countries.MethodsThe records of all children at the Montreal Children's Hospital (MCH) admitted with...

Ultrasound-guided thyroid nodule fine-needle biopsies--comparison of sample adequacy with different sampling techniques, different needle sizes, and with/without onsite cytological analysis.

The aim of this study was to compare the diagnostic adequacy of thyroid samples obtained by aspiration or capillary biopsy techniques, with 22 or 27 gauge needles, and with or without on-site cytological analysis (OCA). Four hundred patients with thyroid nodules underwent ultrasound (US)-guided fine-needle biopsies. Patients were divided into eight groups according to needle size (22 vs. 27 gauge), biopsy technique (aspiration vs. capillary), and whether or not OCA was performed. Sample adequacy rates were calculated for each group and subgroups and compared using chi-square tests. When all nodes were evaluated (n = 400), the adequacy rate was significantly greater with the capillary than with the aspiration technique (97% vs. 91.5%, p = 0.032) and when OCA was than was not performed (97% vs. 91.5%, p = 0.032). When only solid nodules were evaluated (n = 205) the adequacy rate was also significantly greater with the capillary than with the aspiration technique (98.9% vs. 89.7%, p = 0.008) and when OCA was than was not performed (97.9% vs. 89.6%, p = 0.014). In contrast, the adequacy rate was similar for 22 and 27 gauge needles (94.2% vs. 93.1%, p = 0.733). Optimal results were obtained with the capillary technique and OCA. The capillary technique and OCA should be the preferred approach in thyroid nodule biopsy, optimising adequacy rates and patient comfort.

Ultrasound-guided percutaneous microwave ablation for adenomyosis: efficacy of treatment and effect on ovarian function.

A total of 142 premenopausal women with symptomatic adenomyosis underwent ultrasound (US)-guided percutaneous microwave ablation (PMWA) at the Chinese PLA General Hospital. This study aimed to evaluate changes in serum pituitary, gonadal hormone and cancer antigen 125 (CA125) levels after US-guided PMWA. Therefore, estradiol (E2), follicle-stimulating hormone (FSH), prolactin (PRL) and CA125 levels were evaluated before ablation and at 3, 6, 9 and 12 months after ablation. No significant differences were observed in the E2 and FSH levels pre-ablation and during follow-up (E2: p = 0.933, p = 0.987, p = 0.106, p = 0.936; FSH: p = 0.552, p = 0.295, p = 0.414, p = 0.760). The mean absolute values of serum CA125 and PRL were significantly decreased at 3, 6, 9 and 12 months after ablation (CA125: p < 0.001, p < 0.001, p < 0.001, p = 0.003; PRL: p < 0.001, p < 0.001, p < 0.001, p < 0.001). A significant correlation between changes in CA125 levels and uterine volume was found (p < 0.001). No evidence of a decline in ovarian function was observed after US-guided PMWA.

64-Year-Old Woman With Diarrhea and Increased Abdominal Girth

64-year-old woman presented to our institution for evaluation of diarrhea and increasing abdominal girth. She had a 1-month history of postprandial diarrhea unrelated to the type of foods she consumed. Her stool was watery, with no evidence of gastrointestinal bleeding. Concurrently, she also noted increasing abdominal girth requiring new pants with a larger waist size. She had no abdominal pain, nausea/vomiting, flushing, light-headedness, or constitutional symptoms. Her medical history was notable for a previous stroke with a mild residual right hand tremor. She was a lifetime nonsmoker, had no history of illicit drug use, and drank alcohol rarely. She had no history of recent travel, infectious exposures, new medications, or herbal supplement intake. Her blood pressure was 136/83 mm Hg, and herheart rate was 98beats/min.Heroxygensaturation was 95% while she breathed room air, and her respiratory rate was 18 breaths/min. Her temperature was 36.9C. Her mental status was normal. Her abdomen was soft, nontender, and mildly distended with hyperactive bowel sounds. Shifting dullness with a fluid wave was present. 1. Which one of the following is the most appropriate diagnostic approach to evaluate the patient’s abdominal symptoms? a. Paracentesis b. Colonoscopy c. Clostridium difficile toxicology screen or polymerase chain reaction d. Serology testing for transglutaminase antibody e. Abdominal radiography

Normative MRI, ultrasound and muscle functional MRI findings in the forearms of asymptomatic elite rowers.

Forearm injuries are common and debilitating to elite rowers. Chronic exertional compartment syndrome, intersection syndrome and proximal radial bone stress injuries have been documented in this population. This paper explores the imaging findings related to these conditions in asymptomatic elite rowers. Observational study. 19 asymptomatic senior elite and under-23 rowers currently competing at National level or above underwent ultrasound (US), Magnetic Resonance Imaging (MRI) and muscle functional MRI evaluation of their forearms. A comprehensive evaluation sheet identifying characteristics of bone stress, intersection syndrome and chronic exertional compartment syndrome was utilised based on a literature search and review by senior clinicians working with this population. Peritendinous fluid of Extensor Carpi Radialis Longus (n=10, 53%) or Extensor Carpi Radialis Brevis (n=6, 32%) was a common finding on US. MRI had a higher rate of identification than US. Extensor Digitorum (Coeff=-1.76, 95%CI -3.04 to -0.49), Flexor Carpi Radialis (Coeff=-2.86, 95%CI -5.35 to -0.38) and Flexor Carpi Ulnaris (Coeff=-3.31, 95%CI -5.30 to -1.32), Pronator Teres (Coeff=-3.94, 95%CI -6.89 to -0.99), and Supinator (Coeff=-168, 95%CI -3.28 to -0.02) showed statistically significant changes immediately post-exercise. Mild proximal radial marrow hyperintensity was present (n=15, 78.9%) with three participants (15.8%) also having mild periosteal oedema of the radius. Imaging findings commonly seen in symptomatic populations are observed in elite, asymptomatic rowers. Care should be taken when diagnosing bone stress injuries, intersection syndrome and compartment syndrome on imaging findings alone. Data presented can be utilised as a normative dataset for future case studies.

THU0325 Lack of Relation between Inflammation on Joint Level and Fibromyalgia Symptoms in Patients with Rheumatoid Arthritis

BackgroundFibromyalgia (FM) exists in a substantial number of patients with rheumatoid arthritis (RA) (approx. 15%), who have higher disease activity as measured by DAS-28, than RA patients without concomitant FM....

The Massachusetts abscess rule: a clinical decision rule using ultrasound to identify methicillin-resistant Staphylococcus aureus in skin abscesses.

Treatment failure rates for incision and drainage (I&D) of skin abscesses have increased in recent years and may be attributable to an increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Previous authors have described sonographic features of abscesses, such as the presence of interstitial fluid, characteristics of abscess debris, and depth of abscess cavity. It is possible that the sonographic features are associated with MRSA and can be used to predict the presence of MRSA. The authors describe a potential clinical decision rule (CDR) using sonographic images to predict the presence of CA-MRSA. This was a pilot CDR derivation study using databases from two emergency departments (EDs) of patients presenting to the ED with uncomplicated skin abscesses who underwent I&D and culture of the abscess contents. Patients underwent ultrasound (US) imaging of the abscesses prior to I&D. Abscess contents were sent for culture and sensitivity. Two independent physicians experienced in soft tissue US blinded to the culture results and clinical data reviewed the images in a standardized fashion for the presence or absence of the predetermined image characteristics. In the instance of a disagreement between the initial two investigators, a third reviewer adjudicated the findings prior to analysis. The association between the primary outcome (presence of MRSA) and each sonographic feature was assessed using univariate and multivariate analysis. The reliability of each sonographic feature was measured by calculating the kappa (κ) coefficient of interobserver agreement. The decision tree model for the CDR was created with recursive partitioning using variables that were both reliable and strongly associated with MRSA. Of the total of 2,167 patients who presented with skin and soft tissue infections during the study period, 605 patients met inclusion criteria with US imaging and culture and sensitivity of purulence. Among the pathogenic organisms, MRSA was the most frequently isolated, representing 50.1% of all patients. Six of the sonographic features were associated with the presence of MRSA, but only four of these features were reliable using the kappa analysis. Recursive partitioning identified three independent variables that were both associated with MRSA and reliable: 1) the lack of a well-defined edge, 2) small volume, and 3) irregular or indistinct shape. This decision rule demonstrates a sensitivity of 89.2% (95% confidence interval [CI] = 84.7% to 92.7%), a specificity of 44.7% (95% CI = 40.9% to 47.8%), a positive predictive value of 57.9 (95% CI = 55.0 to 60.2), a negative predictive value of 82.9 (95% CI = 75.9 to 88.5), and an odds ratio (OR) of 7.0 (95% CI = 4.0 to 12.2). According to our putative CDR, patients with skin abscesses that are small, irregularly shaped, or indistinct, with ill-defined edges, are seven times more likely to demonstrate MRSA on culture.

Abdominal adiposity by ultrasonography: A “pocket” database for reference standard in Italian people

AimsTo provide a reference standard database of ultrasonographic parameters of abdominal adiposity in healthy people. MethodsItalian non-obese volunteers among blood donors were enrolled in 5 age bands (from 18 to 70 year-old) to reach the threshold of 25 males and 25 females per single band (total: 250). All subjects were measured for weight, height and waist circumference and underwent ultrasonography (US) by an expert radiologist for the assessment of several abdominal fat thicknesses (minimum and maximum subcutaneous fat thickness, maximum preperitoneal fat thickness, intrabdominal fat thickness, aorto-mesenteric thickness, and mesenteric fat thickness). In addition, US data were normalized per waist circumference. ResultsFrom 30s to 50s no statistically significant differences were achieved between males and females for the adiposity markers of visceral fat, while a relevant divergence was proved from 60s to 70s. During ageing a marked increase of the visceral fat compartment was observed in males, while only the preperitoneal circumference was significantly modified in females. ConclusionsThis paper reports on US parameters of abdominal adiposity of healthy Italian adults, to be used as a reference for daily clinical practice. Data could be also considered as control group for future investigations on physiology, pathological conditions, and differences between countries.

Hemodynamic analysis of renal artery stenosis using computational fluid dynamics technology based on unenhanced steady-state free precession magnetic resonance angiography: preliminary results

This study aims to evaluate the feasibility of computational fluid dynamics (CFD) technology in analysis of renal artery stenosis (RAS) based on unenhanced MR angiography (MRA). Thirty hypertensive patients with unilateral RAS, and 10 normal volunteers, underwent unenhanced MRA on a 1.5 T MR scanner. 12 of 30 patients also underwent ultrasound (US) to detect peak systolic velocity. The patient-specific CFD based on MRA was carried out thereafter. Stenosis grades and hemodynamic variables at the stenosis of main renal artery, including pressure difference (PD), velocity and mass flow rate (MFR), were analysed. And the hemodynamic indices of stenoses were compared with the parameters of normal renal arteries and available US velocity profile. High intraclass correlation coefficient (value 0.995) and no significant difference (p > 0.05) was shown between maximum velocity of CFD and peak systolic velocity of US in 12 patients. For normal renal arteries, the average PD, velocity and MFR were all in the reported normal physiological range. However, for stenotic arteries, the translesional PD and velocity of main renal arteries increased with the severity of stenotic degrees, while the MFR decreased. 50 % diameter stenosis was the threshold at which all three hemodynamic parameters experienced significant changes (p < 0.01). This preliminary study shows that unenhanced-MRA-based CFD can be utilized to noninvasively analyse hemodynamic parameters of RAS. The acquired variables may provide meaningful information regarding stratification of the stenosis and further therapeutic treatment.

Rapid on‐site assessment of specimens by biomedical scientists improves the quality of head and neck fine needle aspiration cytology

Immediate rapid on-site assessment (ROSA) of fine needle aspiration cytology (FNAC) specimens by biomedical scientists (BMS), the UK equivalent of cytotechnologists, or by pathologists may improve specimen quality and cellular adequacy rates for lymph node, head and neck and thyroid FNAC. The aim of this study was to evaluate the effect of introducing ROSA by BMS in an outpatient clinic setting. The adequacy rate and sensitivity of histological diagnosis for lymph node, thyroid and salivary gland FNAC samples were determined before and after the introduction of BMS ROSA. The additional financial costs and time required to perform this service were also estimated. Thirty-one patients underwent ultrasound (US)-guided FNAC with ROSA and 151 without. ROSA reduced the number of FNAC insufficient in quality for diagnosis from 43% to 19% (P=0.0194). The estimated additional cost for pathology per patient for ROSA was between £52.05 and £70.74, equivalent to €65.40/US $83.90 and €88.89/US $114.0, respectively, an increase of between 28% and 49% from the original cost. ROSA necessitated an additional 6minutes clinic time per patient, reducing the number of patients that could be seen in an average clinic from 13 to 10 as well as requiring increased laboratory time for FNAC slide assessment. ROSA by suitably trained biomedical scientists and with appropriate consultant pathologist support can improve the quality of FNAC sampling for head and neck lesions. Although ROSA resulted in both additional financial and time costs, these are more than likely to be offset by a reduction in patients returning to clinic for repeat FNAC or undergoing unnecessary surgery.