US Examination Research Articles

Peripheral arterial pathology and osteoarthritis of the knee: US examination of arterial wall stiffness, thickness, and flow characteristics

BackgroundOsteoarthritis (OA) is a widespread chronic joint disorder characterized by the degeneration of articular cartilage, extensive bone remodeling, ligamentous fibrosis, and synovial inflammation impacting millions. Shared factors like phenotypic similarities, hypofibrinolysis, and inflammation constitute similarities in pathophysiology and clinical manifestations between OA and peripheral vascular disease (PVD). This study investigated peripheral arterial flow characteristics, vascular wall thickness, and stiffness in knee OA to clarify a potential association with early atherosclerosis. MethodsThe OA cohort consisted of 35 knees with a mean age of 69 years. The control cohort consisted of 58 knees with a mean age of 68 years. Subjects underwent arterial ultrasound scanning of the common femoral, superficial femoral, and popliteal arteries. Data measured included peak systolic volumetric flow, intima-media thickness, systolic and diastolic vessel diameter, and simultaneous EKG and flow curves. Structural and functional vascular data were quantified using the incremental Young's modulus, pulse wave velocity (PWV), and distensibility. ResultsSignificantly elevated arterial volumetric flow, measures of arterial stiffness, and intima-media wall thickness were observed in those with OA compared to those without. PWV as calculated by the Bramwell-Hill equation were found to be significantly greater in all three vessels of patients with OA. ConclusionsThis study supports the association between peripheral arterial pathology and knee OA, consistent with shared clinical and phenotypic traits. The observed characteristics of early vascular pathology suggest potential pathophysiologic linkages between OA and PVD. This foundational framework provides avenues for mechanistic studies exploring the relationship between these two disease processes.

Utility of ultrasound imaging in monitoring fracture healing in rat femur: Comparison with other imaging modalities

ObjectiveFractures are common injuries and various imaging modalities are employed to diagnose and monitor bone union. However, the follow-up of fracture healing using ultrasound imaging (US) remains a topic of debate. In this study, we analyzed of fracture healing process and compared US and radiological analyses with histological analyses to clarify the characteristics and limitations of each modality. MethodsAn osteotomy model was created using the femur of Wistar rats, and US, radiological (radiography and micro-computed tomography (micro-CT)), and histological analyses were performed. Radiological assessments were conducted for the evaluation of calcified tissue. The gap between the bony callus and cartilaginous callus was measured. ResultsUS effectively captured changes on the fracture surface, potentially reflecting the early healing processes. Both US and radiographic findings showed strong correlation in terms of the decrease in the bony callus gap. US was unable to distinguish cartilaginous callus from the surrounding soft tissue. During the remodeling stage, micro-CT offered a detailed assessment of the internal fracture surface, whereas US was limited to evaluating the outer bone surface and lacked accuracy in visualizing the entire fracture site. Radiography provided a general overview of the fractures. The decrease in the bony callus gap measured using US correlated with the reduction in cartilaginous callus observed histologically. ConclusionThis study demonstrated that US could be a valuable tool for evaluating fracture healing. Combining fracture management with US and radiological examinations may provide a more accurate assessment of healing progress.

Clinical Versus Ultrasound Assessment of Joint Activity in Patients with Asymptomatic Hyperuricemia

Background: In this study, we aimed to investigate subclinical ultrasonographic change suggestive of gouty arthritis in the hyaline cartilage, joints and tendons from asymptomatic hyperuricemia (AH) individuals with hyperuricemia. Methods: We conducted a cross-sectional, observational study including US examinations of the knees and first MTPJs as well as of the tendons and enthesis. The normal distribution of different parameters was tested by the Shapiro–Wilk normality test. Quantitative data were expressed in mean ± standard deviation and the difference between means of two groups was tested by Student’s t-test while qualitative data were expressed in frequency and the difference between proportions was tested by the chi-square test or Fisher exact test. Results: Fifty-nine AH individuals and 52 normouricemic subjects were included. A total of 118 knees, ankles and first MTPJs in patients with AH and 104 in the normouricemic subjects were studied. The most common abnormality found on USG was power Doppler signal in 1st MTPJ (37% vs. 0%; P < .001) followed by joint cavity widening (31% vs. 0%; P < .001). Double contour sign was found in 11% of the first MTPJs from AH individuals versus none in the control group ( P < .001). Posterior tibialis tenosynovitis (6% vs. 0%; P < .01) and Achilles tendon enthesopathy (8% vs. 0%; P < .001). Conclusions: These data demonstrate that subclinical changes detected in the US suggestive of gouty arthritis induced by chronic hyperuricemia frequently occur in both intra- and extra-articular structures of clinically AH individuals.

ThP8.6 - A real-world diagnostic algorithm for identifying carotid artery stenosis

Abstract Aim Eighty-five percent of ischaemic strokes are caused by extracranial atheromatous lesions involving a narrowing of the Internal Carotid Artery so accurate and timely diagnosis is vital for management. The aim of this study was to correlate CT angiogram (CTA) and ultrasound doppler (US) derived measurements of carotid artery stenosis (CAS), with a view to identify those cases where second modality is required to reduce potential errors. Methods All consecutive carotid US and CTA examinations performed in 2021 and 2022 were included for comparison in this retrospective cohort study. Collected data was then reviewed and evaluated by a multidisciplinary team. North American Symptomatic Carotid Endarterectomy Trial (NASCET) and St Mary’s criteria were used to narrow down the percentage stenosis. Result There were fifty-one patients (102 carotid arteries) over this period who had both studies performed. Twenty-nine males and twenty-three females with a median age of seventy-three. Initial data analysis showed no discrepancy in ninety-one (90%) carotid arteries between both modalities. After MDT review, there were eight (7.1%) false positive results and three (2.9%) true positive (2 symptomatic & 1 asymptomatic). In three (2.9%) cases quantification was significantly inaccurate in the initial imaging modality because of heavily calcified vessels. Conclusion This study supports the use of US or CTA as a single modality in grading CAS. Heavily calcified vessels on the first test should be a ‘red flag’ for triggering further alternative imaging to reduce the risk of error. Persistent discrepancies even after the second modality will require a further modality e.g. enhanced magnetic resonance angiography.

Neurofibroma in Unusual Localisation: Rare Case

Neurofibroma is a rare entity, with only few cases reported in the literature so far. Magnetic resonance imaging (MRI) is the key to the diagnosis. We report a 23 year-old women with an antero medial thigh mass diagnosed as neurofibroma on the basis of the imaging findings on US and MRI examinations. The differential diagnosis can be excluded by the fine imaging analysis always associated with the clinical context.

Surgical treatment of small-sized S3 arterio-venous malformations with neo-adjuvant and adjuvant bleomycin

Arteriovenous Malformations are complex and challenging entities, and their treatment is often tailored on the patient. Interstitial sclerosing treatment with bleomycin is promising especially in cases where the aesthetical and/or functional burden of surgical intervention would be impactful as in the S3 AVM according to the SECg classification.We treated 15 patients presenting small (<10cm3) S3 arterio-venous malformations with 3 + 3 sessions of 15.000 IU of interstitial bleomycin. 9 patients presented moderate to good response to the first 3 sessions and thus surgical re-shaping was performed between the two cycles. US examination was done pre-treatment, before each session and every 3 months after the end of the protocol to assess the arterio-venous malformations.Fifteen of the seventeen patients concluded the protocol. 9 patients underwent surgical re-shaping while 6 skipped it because of their excellent response to the first 3 bleomycin injections. Major improvement in terms of appearance and symptoms (pulsations, ulcerations, bleeding or pain) were always achieved. There was a 20% of minor complications.The presented data are encouraging and seem to suggest that this may be a promising protocol to extend the use of bleomycin in arterio-venous malformations and reduce the impact of surgery.

Ultrasound Imaging of Ankle Retinacula: A Comprehensive Review.

The retinacula of the ankle are specialized anatomical structures characterized by localized thickenings of the crural fascia that envelop the deep components of the lower leg, ankle and foot. The ankle retinacula include the extensor retinacula, the peroneal retinacula and flexor retinaculum. Despite their potential to explain persistent and unexplained pain following an injury, these structures are often overlooked or incorrectly diagnosed. Hence, this comprehensive review was performed aiming to investigate the use and the methodology of US imaging to assess ankle retinacula. The search was performed on PubMed and Web of Science databases from inception to May 2024. The MeSH keywords used were as follows: "Ankle Retinacula", "Foot Retinacula", "Superior extensor retinaculum", "Inferior extensor retinaculum", "peroneal retinaculum", "superior peroneal retinaculum", "inferior peroneal retinaculum", "flexor retinaculum", "Ultrasound Imaging", "Ultrasound", "Ultrasonography" and "Ultrasound examination". In total, 257 records underwent screening, resulting in 22 studies meeting the criteria for inclusion after the process of revision. Data heterogeneity prevents synthesis and consistent conclusions. The results showed that advanced US imaging holds promise as a crucial tool to perform an US examination of ankle retinacula, offering static and dynamic insights into ankle retinacula pathology. Understanding normal anatomy and US imaging is essential for accurately identifying injuries. Future research should focus on clinical trials to validate parameters and ensure their reliability in clinical practice.

3Dimensional sonography for the diagnosis of congenital uterine anomalies in women with eccentric pregnancy implantation: a novel approach.

The eccentric implantation of pregnancies in the upper lateral aspect of the uterine cavity is poorly defined clinically. The aim of the current study was to investigate whether differentiating between uterine anomalies that can lead to cavitary distortion has implications for the management of these pregnancies. Eight cases of first-trimester eccentric pregnancy implantation within the endometrial cavity (study group) were retrospectively identified. For each woman in the study group, 10 women identified as having a first-trimester concentric pregnancy implantation during the first-trimester US examination were retrieved from our database (control group). After delivery or pregnancy demise, the presence of uterine anomalies was assessed by a 3D-US examination in all patients. In the study group patients, an increased incidence of uterine anomalies (50.0% vs. 8.8%, p = 0.007) was found, compared to the controls. In the study group, the eccentric location persisted in half of the pregnancies (n = 4; 50%), whereas the other half migrated to a more centric location within the endometrial cavity (n = 4; 50%). The follow-up examination showed that all the early pregnancy demises occurred in cases where the pregnancy persisted at the eccentric location. Uterine malformations were also detected in all these cases. The data point to a significantly higher incidence of uterine anomalies in patients diagnosed with eccentric pregnancy implantation within the endometrial cavity. These results advocate for the value of differentiating between eccentric pregnancies in non-anomalous versus anomalous uteri.

Diagnostic Accuracy of Ultrasound in Evaluation of Obstructive Jaundice with MRCP as a Gold Standard

Abstract Background MRCP has high sensitivity for CBD stones, strictures and malignancies in cases of obstructive jaundice especially cases with suspicion (clinical/CBD-IHBR dilatation on USG). As MRCP has more diagnostic accuracy compared to ultrasound in detecting the cause of obstruction in cases of obstructive jaundice, USG may be considered as an initial screening test and MRCP for definitive treatment planning. The limitation of the study is the small sample size. Objective To evaluate cross sectional retrospective study was done From June 2021 to June 2022 on 31 patients (17 females and 14 males) presenting with obstructive jaundice were referred from Internal Medicine, General Surgery and Clinical Oncology Department to Diagnostic Radiology Department in Ain Shams University hospitals, MRCP were done for all the patients and then Abdominal US examination were performed and then comparison between US &amp; MRCP result were done. Results The US has sensitivity of 100.0%, specificity of 100.0% and accuracy of 100.0 % in detection of level of obstruction and also has sensitivity of 71.0% and accuracy of 71.0% in detecting cause of obstruction taking MRCP as a gold standard. Conclusion MRCP is an excellent tool for detecting the cause of obstructive jaundice, Use of MRCP could therefore spare the patients from invasive preoperative endoscopic procedures and it can also most likely reduce overall surgical costs. We propose MRCP as the method of choice for the diagnostic imaging of obstructive jaundice.

Screening Outcomes of Mammography with AI in Dense Breasts: A Comparative Study with Supplemental Screening US.

Background Comparative performance between artificial intelligence (AI) and breast US for women with dense breasts undergoing screening mammography remains unclear. Purpose To compare the performance of mammography alone, mammography with AI, and mammography plus supplemental US for screening women with dense breasts, and to investigate the characteristics of the detected cancers. Materials and Methods A retrospective database search identified consecutive asymptomatic women (≥40 years of age) with dense breasts who underwent mammography plus supplemental whole-breast handheld US from January 2017 to December 2018 at a primary health care center. Sequential reading for mammography alone and mammography with the aid of an AI system was conducted by five breast radiologists, and their recall decisions were recorded. Results of the combined mammography and US examinations were collected from the database. A dedicated breast radiologist reviewed marks for mammography alone or with AI to confirm lesion identification. The reference standard was histologic examination and 1-year follow-up data. The cancer detection rate (CDR) per 1000 screening examinations, sensitivity, specificity, and abnormal interpretation rate (AIR) of mammography alone, mammography with AI, and mammography plus US were compared. Results Among 5707 asymptomatic women (mean age, 52.4 years ± 7.9 [SD]), 33 (0.6%) had cancer (median lesion size, 0.7 cm). Mammography with AI had a higher specificity (95.3% [95% CI: 94.7, 95.8], P = .003) and lower AIR (5.0% [95% CI: 4.5, 5.6], P = .004) than mammography alone (94.3% [95% CI: 93.6, 94.8] and 6.0% [95% CI: 5.4, 6.7], respectively). Mammography plus US had a higher CDR (5.6 vs 3.5 per 1000 examinations, P = .002) and sensitivity (97.0% vs 60.6%, P = .002) but lower specificity (77.6% vs 95.3%, P < .001) and higher AIR (22.9% vs 5.0%, P < .001) than mammography with AI. Supplemental US alone helped detect 12 cancers, mostly stage 0 and I (92%, 11 of 12). Conclusion Although AI improved the specificity of mammography interpretation, mammography plus supplemental US helped detect more node-negative early breast cancers that were undetected using mammography with AI. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Whitman and Destounis in this issue.

Significant functional impairment and disability in individuals with psoriatic arthritis and Achilles tendon pain: a cross-sectional observational study

The Achilles tendon (AT) insertion is the most common site of enthesitis in psoriatic arthritis (PsA). The structure and function of the AT in PsA, and the prevalence of mid-portion pathology, is unknown. To compare the structure and function of the AT in people with PsA with self-reported AT pain (PsA + AT), PsA without self-reported AT pain (PsA-AT) and healthy controls. A cross-sectional, observational study was conducted. The ATs were assessed by clinical and US examination (B-mode and Power Doppler), performance-based testing (bilateral heel raise test (HRT) and 10 m walk test), and patient-reported outcome measures (PROMs) (including the Victorian Institute of Sport Assessment-Achilles [VISA-A]). Between-group differences were described using descriptive statistics, Chi-squared testing, parametric (1-way ANOVA) and non-parametric (Mann-Whitney or Kruskal-Wallis) testing. 22 PsA (11 per group) and 11 healthy control participants who were comparable in terms of sex, age, and BMI (PsA-AT = longer PsA disease duration) were recruited. VISA-A scores were significantly worse in the PsA + AT group compared to the PsA-AT group and healthy controls (p < 0.001). Inflammatory US features were significantly more prevalent in the PsA + AT group (p < 0.001). Mid-portion AT pathology was observed in the PsA + AT group, irrespective of entheseal disease. Clinical examination alone missed 5/7 cases of ‘active’ US-confirmed AT enthesitis. AT functional deficits were significant in the PsA + AT group and both PsA groups had lower HRT repetition rates and walked slower compared to healthy controls. Less than 1/3 of the PsA + AT group had received podiatry or physiotherapy care. Significant differences in the structure and function of the AT in PsA were noted. Despite management in line with current guidance, AT pain appears to persist and can result in severe functional impairment.

Detection and diagnosis of automated breast ultrasound in patients with BI-RADS category 4 microcalcifications: a retrospective study

BackgroundAutomated Breast Ultrasound (AB US) has shown good application value and prospects in breast disease screening and diagnosis. The aim of the study was to explore the ability of AB US to detect and diagnose mammographically Breast Imaging Reporting and Data System (BI-RADS) category 4 microcalcifications.Methods575 pathologically confirmed mammographically BI-RADS category 4 microcalcifications from January 2017 to June 2021 were included. All patients also completed AB US examinations. Based on the final pathological results, analyzed and summarized the AB US image features, and compared the evaluation results with mammography, to explore the detection and diagnostic ability of AB US for these suspicious microcalcifications.Results250 were finally confirmed as malignant and 325 were benign. Mammographic findings including microcalcifications morphology (61/80 with amorphous, coarse heterogeneous and fine pleomorphic, 13/14 with fine-linear or branching), calcification distribution (189/346 with grouped, 40/67 with linear and segmental), associated features (70/96 with asymmetric shadow), higher BI-RADS category with 4B (88/120) and 4 C (73/38) showed higher incidence in malignant lesions, and were the independent factors associated with malignant microcalcifications. 477 (477/575, 83.0%) microcalcifications were detected by AB US, including 223 malignant and 254 benign, with a significantly higher detection rate for malignant lesions (x2 = 12.20, P < 0.001). Logistic regression analysis showed microcalcifications with architectural distortion (odds ratio [OR] = 0.30, P = 0.014), with amorphous, coarse heterogeneous and fine pleomorphic morphology (OR = 3.15, P = 0.037), grouped (OR = 1.90, P = 0.017), liner and segmental distribution (OR = 8.93, P = 0.004) were the independent factors which could affect the detectability of AB US for microcalcifications. In AB US, malignant calcification was more frequent in a mass (104/154) or intraductal (20/32), and with ductal changes (30/41) or architectural distortion (58/68), especially with the both (12/12). BI-RADS category results also showed that AB US had higher sensitivity to malignant calcification than mammography (64.8% vs. 46.8%).ConclusionsAB US has good detectability for mammographically BI-RADS category 4 microcalcifications, especially for malignant lesions. Malignant calcification is more common in a mass and intraductal in AB US, and tend to associated with architectural distortion or duct changes. Also, AB US has higher sensitivity than mammography to malignant microcalcification, which is expected to become an effective supplementary examination method for breast microcalcifications, especially in dense breasts.

Assessment of quantitative microflow Vascular Index in testicular cancer

PurposeUltrasound (US) is the primary imaging modality when a testicular tumor is suspected. Superb microvascular imaging (SMI) is a novel, highly sensitive Doppler technique that allows quantification of flow signals by determination of the Vascular Index (VI).The aim of the present study is to investigate the diagnostic significance of the SMI-derived VI in normal testicular tissue and testicular cancer. MethodsThis retrospective analysis included patients who underwent testicular US in our department from 2018 to 2022. Inclusion criteria were: i) sufficient image quality of the stored images, ii) US with standardized SMI-default setting (colour gain of 44 ± 5), iii) patient age ≥ 18 years, and iv) normal testicular findings or testicular tumor with histopathological workup. US examinations were performed as part of clinical routine using a high-end ultrasound system (Aplio i800/i900, Canon Medical Systems Corporation, Tochigi, Japan). Statistical analysis included Chi-square test and Mann-Whitney U tests and receiver operating characteristic (ROC) curve analysis. ResultsA total of 62 patients (31 each with normal findings and testicular tumors) were included. The VI differed statistically significantly (p < 0.001) between normal testis (median 2.5 %) and testicular tumors (median 17.4 %). Like vascular patterns (p < 0.001), the VI (p = 0.030) was shown to distinguish seminomas (median 14.8 %), non-seminomas (median 17.6 %) and lymphomas (median 34.5 %). ConclusionsIn conclusion, our study has shown the VI to be a quantitative tool that can add information for differentiating testicular tumor entities. While further confirmation in larger study populations is desirable, our results suggest that the VI may be a useful quantitative parameter.

High-Resolution Ultrasound of Odontogenic Cutaneous Sinus Tract: An International Multicentric Experience and a Review of the Literature.

To investigate the role of high-resolution ultrasound (HR-US) in the initial and differential diagnosis of the Odontogenic Cutaneous Sinus Tract (OCST) in a multicentric setting. Skin HR-US examinations of OCSTs performed between January 2019 and June 2023 at different Institutions were retrospectively reviewed. Epidemiological and clinical data (age, gender, location of the skin lesion, causative tooth, and the clinical suspicion) as well as HR-US imaging findings (morphology and length of the sinus tract, Doppler signal, and cortical bone interruption of maxilla or mandible) were collected. US examinations were performed by expert radiologists using a high-performance US scanner, employing a high-frequency linear probe (15 MHz or higher frequencies). In only one patient the HR-US exam was integrated with strain elastography (SE). Sixteen patients were enrolled with a median age of 37.6 years (range 16-70 years). The most frequent clinical suspicion was epidermal cyst, while OCST was suspected in only two cases. In all cases, HR-US depicted the sinus tract as a nodular, triangular or "champignon-shaped" lesion in the subcutaneous layer, which continued with a slightly tortuous band structure, up to the focally interrupted cortical bone plate. Furthermore, color Doppler evaluation showed color signals around and/or within the lesion, expression of inflammation. On SE, the sinus tract showed a hard pattern, due to fibrous and granulomatous tissue. HR-US, thanks to its high spatial resolution, allows the evaluation of OCST, and play a crucial diagnostic role, mainly when the clinical suspicious is different.

P190 Protocolised ultrasonography led pathway has a high sensitivity for diagnosis of primary large vessel vasculitis

Abstract Background/Aims Ultrasonography (US) for diagnosis of large vessel vasculitis (LVV) is a recommended first line diagnostic procedure. Our county has an annual incidence of 57.5/million for primary LVV (giant cell arteritis (GCA) 48.3/million; Takayasu 2.5/million; unclassified LVV 6.4/million). Our protocolised fast-track US pathway has reduced visual loss from 18.7% to 11.5%. We present the results of our first 1000 unique referrals. Methods Unique requests for US from January 2017 were analysed. Protocolised US examination of the arteries includes superficial temporal artery (STA) and its rami, followed by the entire axillary artery, followed by other arteries as necessary. Halo sign in at least two different arteries was needed for diagnosis of LVV. A temporal artery biopsy (TAB) or positron emission tomography (PET) were requested if the US was negative AND CRP was ≥20mg/L (or missing) AND an alternate explanation for the raised CRP was not immediately apparent. For those where a second test was not requested OR if it was negative, prednisolone was tapered rapidly, and a patient-initiated follow-up allowed rapid re-assessment. If referring physician or patient did not want a second test, GCA was diagnosed on clinical grounds alone and the pathway was considered to have failed. Results Median age was 73 (IQR 13); 11/1000 referrals were for people &amp;lt;50 years of age. The median delay for the procedure was 4 (IQR 4) days. Prednisolone had been started a median of 4 (IQR 5) days previously. 279/1000 (28%) US scans demonstrated vasculitis. Pre-steroid CRP was ≥20mg/L in 283 cases and unavailable in 7. An alternate explanation for the raised CRP was found in 102 cases, 181 were referred for a second test, and 7 received a clinical diagnosis of GCA without a second test. The second test was diagnostic in 31/181 (17%) - 24/139 (17%) TAB, 7/42 (17%) PET. 3/150 cases with a negative second test and 4/431 cases with CRP &amp;lt;20mg/L were diagnosed with GCA on patient-initiated follow-up. The delayed diagnosis did not result in visual loss. 202/279 (72%) US positive cases had bilateral STA involvement. The addition of axillary artery imaging picked up a further 53 (19%) cases; 24/279 (9%) cases needed imaging of other arteries. The sensitivity and negative predictive value of the pathway are 96% (310/324) and 98% (683/690) respectively. Conclusion Our protocolised US led pathway for diagnosis of LVV is highly sensitive and allows disease exclusion with high certainty. Routine US of the superficial temporal artery and its rami, and the entire axillary artery provide diagnosis in 91% of cases but ability to scan more arteries improves yield in a further 9% of cases. Composite testing with US plus second test, stratified by CRP levels, can be recommended as a gold standard diagnostic tool for LVV. Disclosure C.B. Mukhtyar: None. G. Ducker: None. C. Beadsmoore: None. K. Sisson: None. C. Jones: None.

P191 Giant cell arteritis relapses occur in a different arterial territory as compared to diagnosis

Abstract Background/Aims Ultrasonography (US) for diagnosis of large vessel vasculitis (LVV) is a recommended first line diagnostic procedure. We have been running an US led diagnostic pathway in our centre since January 2017. This pathway is also used to diagnose relapsing disease. We present US defined anatomical distribution of relapses in consecutive patients. Methods Patients in whom new and relapsing disease was diagnosed using US were included. Protocolised US examination of the common carotid system (segments of common carotid, external carotid and branches) and those of the subclavian system (segments from origin of subclavian to end of axillary artery and branches) were carried out at diagnosis and relapse. Halo sign in at least two different arteries was needed for establishing new or relapsing disease. Disease characterisation was classified as being in the carotid system, subclavian system, or both. The nature of the disease at relapse was compared to that at diagnosis. Results 279 patients were diagnosed with LVV using US since Jan 2017. 57 (20%) were diagnosed as having a relapse using US. 43/57 (75%) and 28/57 (49%) had involvement of the carotid system at baseline and relapse respectively. 22/57 (39%) and 44/57 (77%) had involvement of the subclavian system at baseline and relapse respectively. A comparison of the disease involvement is as in Figure 1. Conclusion The branches of the common carotid artery (external carotid artery) are commonly involved at diagnosis, but relapse occurs more frequently in the subclavian artery branches. This is especially true when disease affects the carotid system at baseline. The presentation of patients with subclavian system disease is often with only constitutional symptoms and with shoulder girdle pain and stiffness. This may be mistaken for being a polymyalgia rheumatica relapse. It is essential to examine the subclavian system of arteries in patients with LVV before diagnosing polymyalgia rheumatic relapse. Disclosure S. Alanoor: None. G. Ducker: None. C.B. Mukhtyar: None.

Simplified vs modified (reduced) ultrasound 6 joint score in assessing disease activity in rheumatoid arthritis patients

Introduction and aim. With increasing ultrasound US assessment opportunities for tight rheumatoid arthritis (RA) management, more simplified accurate US-assessment is desired in clinical practice. Aim of the work is assessing modified vs simplified ultrasound 6-joint scores relevance in assessing rheumatoid arthritis disease activity. Material and methods. Fifty-five RA patients were subjected to detailed history, clinical, and musculoskeletal examination with disease activity assessment by clinical disease activity index, simple disease activity index and disease activity score in 28 joints. Com plete blood count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, anti-cyclic citrullinated peptide antibodies were done. Patients underwent US examination (gray-scale and power Doppler) for wrist, 2nd and 3rd metacarpophalangeal and knee joints bilaterally. Synovitis composite score was added. Two US indices were constructed: simplified S6 and modified M6 joint scores. Results. Statistical significant positive correlations were high between S6/M6 score parameters (total, grey-scale (GS), power doppler (PD), Composite) and disease activity markers. Both M6 and S6 scores differentiated mild-moderate and moderate-severe disease activity patients. However, only S6 score differentiated remission from mild disease activity patients. Conclusion. Ultrasound 6-joint scores (especially simplified S6) were rapid, easy and sensitive ultrasound tools assessing rheu matoid arthritis disease activity in clinical practice.

Breast ultrasound: An opportunity to detect unsuspected pleural and pulmonary abnormalities.

While scanning women for breast US, is possible to observe changes in the appearance of the pleural line or in the most superficial portion of the lung. The objective of this single-center, prospective study was to determine the prevalence of a variety of pleural and pulmonary US findings during routine breast US. In this study, there were 200 women undergoing standard breast US examination. The presence of pleural and pulmonary abnormalities in these cases was recorded. Two off-site reviewers confirmed the presence of pleura and lung changes. There was no abnormal finding in 168 out of 200 cases (84%) while there were one or more abnormal findings in 32 cases (16%). Pleural effusion was observed in 0.5% of cases, thickening of the pleural line 5% of cases, irregularity of the pleural line in 6% of cases, increased number of vertical artifacts in 9% of cases, subpleural nodulations in 2% of cases, and lung consolidation in 0.5%. Pleural and lung changes are not uncommon during breast US. Operators performing breast US examinations should be aware of the possibility to identify unsuspected pleuro-pulmonary abnormalities.

Diagnostic efficacy of abdominal US compared to contrast enhanced CT in the evaluation of the left hepatic lobe volume for morbidly obese patients before bariatric surgery

BackgroundBariatric surgery has been widely distributed as an effective treatment method for morbid obesity. An increased volume of the left hepatic lobe may affect the ergonomics of bariatric surgery, which could complicate the surgical techniques and require special instruments. CT of the abdomen is considered the gold standard imaging modality in the assessment of the left hepatic lobe volume; nevertheless, it has some drawbacks, such as exposure to ionizing radiation, besides the contrast and gantry limitations. The objective of this study is to investigate the diagnostic accuracy of abdominal US in comparison to CT in measuring the left hepatic lobe volume in morbidly obese patients as part of their preoperative evaluation. Seventy-two morbidly obese patients of different ages (between 22 and 55 years) and genders were included in this study who were scheduled for bariatric surgery.ResultsThe intraclass coefficient and Cronbach's alpha reliability coefficient with their 95% CI were used. There was a strong positive correlation between left hepatic lobe volumes as measured by US and CT (r = 0.999, p value < 0.001), indicating a significant linear relationship between them. The mean of the two variables was very close (474.2 ± 164.9 cm3) by US and (475.1 ± 164.5 cm3) by CT.ConclusionsAbdominal US examination for assessment of the left hepatic lobe volume is considered a valid diagnostic method compared to CT (with a clinically accepted slight difference between values) in preoperative assessment of morbidly obese patients. It provides an accurate, simple, and inexpensive diagnostic tool that avoids the drawbacks of CT.

Role of conventional ultrasound and shear wave elastography of median nerve in diagnosis and differentiation of carpal tunnel syndrome severity in correlation with electrodiagnostic studies

BackgroundThe gold standard for CTS diagnosis is abnormalities on electrophysiologic testing in conjunction with specified symptoms. Electrophysiologic testing can also identify the severity of nerve injury.Aim of workAimed to investigate how effective various ultrasonography and elastography parameters at diagnosing and grading the severity of carpal tunnel syndrome in correlation with the electrophysiological evaluation of the median nerve.MethodsThe study included 62 wrists, 31 CTS cases and 25 females. Thirty-one healthy adults served as control group. Eleven males (35.5%) and 20 females (64.5%) were included. All US examinations were done with the subjects sitting with their upper limbs relaxed on a pillow with forearm in supine position, and the fingers are semi-flexed. Ultrasound and elastography parameters were recorded. NCS was done by recording median nerve motor and sensory functions and then comparing median nerve versus radial and ulnar nerves if the previous recordings were normal to detect early starting cases.ResultsUS and elastography can significantly diagnose CTS and detecting its severity (mild/moderate versus severe CTS).ConclusionsIt is noninvasive to examine the median nerve using ultrasound and shear wave elastography, highly sensitive diagnostic modality. It can significantly diagnose CTS and severity of CTS (in contrast to mild, moderate, and severe instances). Mixing high-resolution conventional B-mode US with shear wave ultrasound elastography of the median nerve may increase the diagnostic precision of CTS.