US In Detection Research Articles

Added Value of Contrast-enhanced US for Evaluation of Female Pelvic Disease.

Since the first application of contrast-enhanced US (CEUS) in the late 1960s, the use of US contrast agents has grown tremendously, and this examination has proved to be a valuable adjunct to diagnostic US for detection and characterization of disease. Also, CEUS has emerged as an excellent option for evaluation of indeterminate lesions that require additional imaging, given its excellent safety profile, including that in patients with end-stage renal disease or allergies to contrast material who are unable to undergo contrast-enhanced CT or MRI. US traditionally has been considered the imaging modality of choice for evaluation of the female pelvis, followed by MRI and rarely fluoroscopy, CT, PET, or angiography. CEUS has the potential to add significant value in imaging gynecologic disease, and indications for its use in the female pelvis are expected to continue evolving. It can aid in evaluation of nonvascular structures, such as assessment of tubal patency, uterine cavity morphology, and pelvic fistulas. CEUS can help characterize poorly vascularized gynecologic tumors or tissues with slow flow by using qualitative and quantitative parameters and aid in image-guided interventions or biopsies by facilitating visualization of lesions that are difficult to see with other imaging modalities. The authors provide an overview of current applications of US contrast agents in the female pelvis and discuss associated factors such as technique, interpretation, and image optimization. They also discuss the limitations of CEUS and describe its utility in the evaluation of female pelvic disease by using an organ system case-based approach. © RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Limited Chest Ultrasound to Replace CXR in Diagnosis of Pneumothorax Post Image-Guided Transthoracic Interventions.

To assess the diagnostic accuracy of limited chest ultrasound in detecting pneumothorax following percutaneous transthoracic needle interventions using chest X-ray (CXR) as the reference standard. With IRB approval, after providing consent, asymptomatic patients after percutaneous transthoracic needle interventions were enrolled to undergo limited chest ultrasound in addition to CXR. A chest Radiologist blinded to the patient's prior imaging performed a bedside ultrasound, scanning only the first 3 anterior intercostal spaces. Pneumothorax diagnosed on CXR was categorized as small or large and on ultrasound as grades 1, 2, or 3 when detected in 1, 2, or 3 intercostal spaces, respectively. 38 patients underwent 36 biopsies (34 lungs, 1 pleura, and 1 mediastinum) and 2 coil localizations. CXR showed pneumothorax in 13 patients. Ultrasound was positive in 10 patients, with 9 true-positives, 1 false-positive, 4 false-negatives, and 24 true-negatives. The false positive results were due to apical subpleural bullae. The false-negative results occurred in 2 small apical and 2 focal pneumothoraces at the needle entry sites. Four pneumothoraces were categorized as large on CXR, all of which were categorized as grade 3 on ultrasound. Sensitivity and specificity of US for detection of pneumothorax of any size were 69.23% (95%CI 38.6%, 90.1%) and 96.0% (95%CI 79.6%, 99.9%), and for detection of large pneumothorax were 100% (95%CI 39.8%, 100%) and 100% (95%CI 89.7%, 100%). Results of this prospective study is promising. Limited chest ultrasound could potentially replace CXR in the management of postpercutaneous transthoracic needle intervention patients.

Non-invasive staging of liver fibrosis by two-dimensional shear wave elastography (2D-SWE) in patients with chronic hepatitis C and B

BackgroundNon-invasive shear wave-based techniques have been developed for estimating liver fibrosis in patients with chronic liver diseases. Two-dimensional shear wave elastography provides in real-time, a tow dimensional quantitative map of tissue stiffness and enables measuring the stiffness by adjustment of a region of interest of tissue. The aim of this study was to highlight the role of tow dimensional shear wave elastography (2D-SWE) in detecting the degree of liver fibrosis in patients with chronic hepatitis C and B, in correlation with liver enzymes level and fibrotest.ResultsThis study included 50 patients with chronic hepatitis C and B whose ages were (range, 30-65 years; mean, 48 years). Shear wave elastography cutoff values were 1.35 m/s, 5.48 KPa for (F>0); 1.66 m/s, 8.29 kPa for (F>1); 1.77 m/s, 9.40 kPa for (F>2); and 1.99 m/s, 11.9 kPa for (F>3). An excellent agreement was found between shear wave elastography and Fibrotest in staging of liver fibrosis in 88% of patients (κw=0.943, 95% CI, 0.88 to 1.00) achieving a highly statistical significance (P<0.001). There was a significant moderate positive concordance between US scoring and staging by 2D-SWE and staging by Fibrotest (rs, 0.49; P<0.01) and (rs, 0.48; P<0.01) respectively. However, no significant concordances were noticed between staging by AST and ALT and 2D-SWE and staging by Fibrotest (P>0.05).Conclusions2D shear wave elastography showed better diagnostic performance than visual assessment by conventional US for detection of chronic liver diseases, as well as for evaluation of their severity and prognosis. Elastograhy—Fibrotest combination gives best diagnostic performance in detecting the degree of fibrosis non-invasively and can be used reliably as a first-line pre-therapeutic evaluation of fibrosis in HCV and HBV-infected patients.

Does Static Intra Access Pressure Monitoring of Arteriovenous Fistulas Predicts Intra Access Stenosis?

The initiation of hemodialysis in patients with chronic kidney disease (CKD) requires vascular access formation. The choice of vascular access for individual patient depends on various factors however arteriovenous fistula (AVF) is conventionally considered to be the vascular access of choice. Once hemodialysis is initiated through a mature AVF, there is an ongoing need for surveillance of the AVF to ensure adequate function and prevent vascular access issues among which flow obstruction (both inflow and outflow) remains the most important. AVF stenosis can potentially lead to inadequate dialysis delivery and thrombosis thus leading to access loss. Physical examination and AVF Doppler ultrasonography (DUS) are useful for evaluation of stenosis in the arteriovenous connection and the outflow tract. Periodic assessment of the AVF with Static Intra access Pressure (SIAPR) determination may be a reliable means of predicting vascular access stenosis.&#x0D; Material &amp; Methods A cross sectional study carried out at Department of Nephrology, Fatima Memorial Hospital, Lahore from July 2018 to December 2018. In total 113 patients were included, and all patients underwent SIAPR assessment and Doppler Ultrasound of AVF.&#x0D; Results Mean age of the patients was 56.81±9.38 years, male to female ratio of the patients was 1.8:1. In this study the SIAPR was suggestive of stenosis in 87(76.99%) patients. The sensitivity, specificity and diagnostic accuracy of SIAPR against Doppler US of the AVF for detection of stenosis was 75.86%, 22.62% &amp; 36.28% respectively&#x0D; Conclusion SIAPR has low specificity and diagnostic accuracy compared to Doppler US for detection of AVF stenosis.

Abbreviated MRI for Hepatocellular Carcinoma Screening and Surveillance.

To detect potentially curable hepatocellular carcinoma (HCC), clinical practice guidelines recommend semiannual surveillance US of the liver in adult patients at risk for developing this malignancy, such as those with cirrhosis and some patients with chronic hepatitis B infection. However, cirrhosis and a large body habitus, both of which are increasingly prevalent in the United States and the rest of the world, may impair US visualization of liver lesions and reduce the sensitivity of surveillance with this modality. The low sensitivity of US for detection of early-stage HCC contributes to delayed diagnosis and increased mortality. Abbreviated MRI, a shortened MRI protocol tailored for early-stage detection of HCC, has been proposed as an alternative surveillance option that provides high sensitivity and specificity. Abbreviated MRI protocols include fewer sequences than a complete multiphase MRI examination and are specifically designed to identify small potentially curable HCCs that may be missed at US. Three abbreviated MRI strategies have been studied: (a) nonenhanced, (b) dynamic contrast material-enhanced, and (c) hepatobiliary phase contrast-enhanced abbreviated MRI. Retrospective studies have shown that simulated abbreviated MRI provides high sensitivity and specificity for early-stage HCC, mostly in nonsurveillance cohorts. If it is supported by scientific evidence in surveillance populations, adoption of abbreviated MRI could advance clinical practice by increasing early detection of HCC, allowing effective treatment and potentially prolonging life in the growing number of individuals with this cancer. Online supplemental material is available for this article. ©RSNA, 2020.

Diagnostic Accuracy of Transabdominal Ultrasound in Detecting Intestinal Inflammation in Paediatric IBD Patients-a Systematic Review.

Background and AimsCurrently used non-invasive tools for monitoring children with inflammatory bowel disease [IBD], such as faecal calprotectin, do not accurately reflect the degree of intestinal inflammation and do not provide information on disease location. Ultrasound [US] might be of added value. This systematic review aimed to assess the diagnostic test accuracy of transabdominal US in detecting intestinal inflammation in children with IBD in both diagnostic and follow-up settings.MethodsWe systematically searched PubMed, Embase [Ovid], Cochrane Library, and CINAHL [EBSCO] databases for studies assessing diagnostic accuracy of transabdominal US for detection of intestinal inflammation in patients diagnosed or suspected of IBD, aged 0–18 years, with ileo-colonoscopy and/or magnetic resonance enterography [MRE] as reference standards. Studies using US contrast were excluded. Risk of bias was assessed with QUADAS-2.ResultsThe search yielded 276 records of which 14 were included. No meta-analysis was performed, because of heterogeneity in study design and methodological quality. Only four studies gave a clear description of their definition for an abnormal US result. The sensitivity and specificity of US ranged from 39-93% and 90–100% for diagnosing de novo IBD, and 48–93% and 83–93% for detecting active disease during follow-up, respectively.ConclusionsThe diagnostic accuracy of US in detecting intestinal inflammation as seen on MRE and/or ileo-colonoscopy in paediatric IBD patients remains inconclusive, and there is currently no consensus on defining an US result as abnormal. Prospective studies with adequate sample size and methodology are needed before US can be used in the diagnostics and monitoring of paediatric IBD.

Pancreas Graftectomy Predicting Markers

Background Over last 13 years 193 pancreas transplantations were performed at the Department of Gastroenterological Surgery and Transplantation at the Central Clinical Hospital of the Ministry of the Interior in Warsaw. The 5-years survival of the patients in our cohort is 84%, for the pancreas grafts 65% and for kidney graft 83%. The aim of the study was to verify which laboratory parameters and imaging markers in ultrasound and computed tomography of pancreas graft may have most specific role for transplantectomy prediction. A retrospective analysis of clinical data was performed. The parameters included in the study were: sex, type of transplantation (simultaneous pancreas and kidney- SPK, pancreas alone PTA, pancreas after kidney PAK), glycemic profile and selected laboratory results (amylase, lipase, CRP, PCT, C-peptide, INR). US and CT images were revived for following findings: abnormal graft echogenicity or density, venous thrombosis (full and partial), arterial thrombosis, anastomotic stenosis and aneurysms, peripancreatic fluid collections, abdominal fluid collection, increased echogenicity of peripancreatic fat or peripancreatic fat infiltration, lymph nodes, increased RI, low arterial flow. Data from two end-points were taken into statistical analysis. For patients without complications the data was collected 3 months after transplantation, while for others on the day preceding transplantectomy. 68% of the analyzed group underwent SPK, 29%-PTA and 2%- PAK. Total mortality for the cohort was 7%. In 67% of the cohort the function of the pancreas graft during observation was satisfying, without demand for insulin and positive C-peptide. 22% patients had severe complications that lead to transplantectomy, while 10% were diagnosed with temporary graft pancreatitis without need for surgical intervention. The most specific markers that predicted transplantectomy or pancreatitis were full or partial portal vein thrombosis and abnormal echogenicity in US (p<0.005), as well as abnormal density and venous thrombosis in CT (p<0.005). Results of laboratory test occurred statistically insignificant for risk of complications in our cohort. Abnormal graft density or echogenicity and presence of venous thrombosis are the best imaging markers for graft dysfunction. Even partial thrombosis is a risk factor for pancreas graft transplantectomy. Although CT is superior to US for detection of graft dysfunction, the use of ionized radiation and administration of intravenous contrast agent hampers its application, especially in patients with simultaneous pancreas-kidney transplantation. Imaging examination occurred prior to laboratory tests in our study and marked an important role of radiologists in a treatment process. Further studies should be done to establish imaging guidelines in ultrasound and computed tomography of pancreas graft malfunction, rejection and failure.

P3.02-052 Stability of EGFR Mutations in Whole Blood and Plasma in Patients with NSCLC

The cobas® EGFR Mutation Test v2 (Roche Molecular Systems Inc.) has recently been IVD approved in the US for detection of epidermal growth factor receptor (EGFR) mutations in blood samples. Knowledge of the EGFR mutation status in non-small cell lung cancer (NSCLC) patients is essential to designing optimal, individualized treatment. However, implementing blood-based analyzes to detect cancer-specific mutations demands standardized pre analytical conditions, but research in this field is rare and inadequate.

Role of bedside sonography in the assessment of patients with chest trauma in the emergency department of Suez Canal University Hospital

Background: Chest trauma is responsible for more than 20 to 25% of all traumatic death. Chest trauma is the second leading cause of traumatic death in each year. In order to keep the prognosis of patients with chest trauma relatively good, the patient should be diagnosed rapidly &amp; managed adequately. Chest ultrasound is a safe, rapid and accurate method in diagnosing chest trauma.Methods: A total of 50 patients were enrolled in this study. Objectives were to assess the accuracy of bedside chest US in detection of either haemothorax, pneumothorax or lung contusion in chest trauma patients. All the patients underwent chest US, CXR, and chest CT. The data from ultrasound and CXR were compared with the gold standard CT. Then the accuracy of which were calculated.Results: Showed that Motorcar accidents are the most common cause for chest trauma and most patients were presented by chest pain and dyspnea. Chest ultrasound specificity in diagnosing pneumothorax was higher than sensitivity, 100% and 81% respectively, with over all accuracy 88%. Supine CXR showed sensitivity (75%), specificity (88.9%) and accuracy (80%) which are good numbers but still lower than chest US. Chest US Detection of haemothorax by chest had showed 100% sensitivity, 90% specificity and 96% accuracy.Conclusions: Chest ultrasound is highly accurate tool for detection of pneumothorax, haemothorax and less lung contusion in chest trauma. Chest ultrasound is a useful tool for the emergency physician for bedside rapid and accurate diagnosis without interruption of the resuscitation and without transferring the patient for the radiology unit.

US in Detection and Differentiation of Ileus

Ultrasonography has become increasingly important in the routine diagnostics of gastrointestinal diseases. It is not only assessing the lumen but more important the wall and the surrounding structures of the stomach and bowel. Furthermore, functional processes (peristalsis, blood flow) can be visualized and provide important information about passage and perfusion. With modern high resolution (compressive) sonography the gastroenterologist has an ideal method available complementary to endoscopy. Ultrasonography is an effective diagnostic tool in situation of emergency (ileus, perforation). In emergency indications sonography is the method of first choice achieving a high sensitivity. The same applies to the ileus, which can be diagnosed significantly earlier by sonography than with conservative X-ray. Meanwhile sonography can contribute considerable information to clarify genesis (e.g. invagination, intusception). Signs of mechanical small bowel ileus are dilatated and round bowel loops. In the late phase, the bowel wall is thicker, oedematous and a peristaltic. Hyper peristaltic, pendula peristalsis und atony depend on the stadium. Distal of the stenosis the bowel is empty (“hunger bowel”). Frequent causes are adhesive bands and adhesions (not visible), incarcerated hernias, invaginations (in children) or tumours (seldom foreign bodies or gall stones). Differential diagnostic peritoneal carcinosis has to be excluded as cause of the obstruction. Often the cause for he ileus can be found by detailed examination in conjunction with medical history and clinical symptoms. Differential diagnostic wide, exudate-filled, intestinal loops with hyper-motility in case of endemic sprue, but also other forms of secretory diarrhoea. Most frequently the cause of large bowel ileus is colon cancer. Typical is a lot of gas in the dilated colon. Other reasons are coprostasis, volvulus, peri-diverticulitis and IBD. In paralytic ileus, small bowel loops are enlarged and a peristaltic and also the colon is enlarged. Typical examples are postoperative bowel atony or paralytic situations in pancreatitis, peritonitis and mesenteric ischemia. The published sensitivity of sonography (89 – 97 %) is significant higher than that of X-ray (77 - 85 %). In mechanical small bowel ileus diagnosis with possible US is 6 h earlier then with X-ray. Radiological signs are considerably later apparent as the passage obstruction, detectable by sonography. In large bowel ileus, heavy flatulence of single bowel segments is the main sign, in some cases this can be demonstrated more clearly with a X-ray abdomen overview. But gas filling is usually a late sign of Ileus. Free intraabdominal fluid (interenteric ascites) is also a (late) sign of Ileus.

Metacarpophalangeal (MCP) and Interphalangeal (IP) Joints of the Hand: The Role of Ultrasound and SW Elastography in Detection and Monitoring of Rheumatoid Arthitis (RA)

To display the spectrum of pathologic alterations of MCP and IP joints in RA including gray-scale images, flow assessment and SWE characteristics and establish the role of US in detection and monitoring of the disease. The MCP and the proximal and distal IP joints of the hand were studied in 22 patients with RA in early and advanced stages of the disease, in acute and subacute phases and pre- and post-treatment. The high-resolution US examination comprised gray-scale imaging, flow assessment with colour Doppler in acute and subacute presentation of RA and SWE of the pannus. Different characteristics and a whole spectrum of altering pathology during RA will be shown. An initial estimation of the SWE characteristics of the pannus in acute and subacute stages was made and a statistically significant difference (p < 0.01) was found between the mean values of the two entities. US examination and SWE of the small joints of the hand in patients with rheumatoid arthritis is a quick, cost-effective examination, which is comfortable to the patient and is important in 1. Detecting the early changes, thus monitoring the medical therapy. 2.Follow-up, and 3. guiding interventional procedures.

0217: 3D US in Detection and Differentiation of Bladder Tumors and Tumor-Like Lesions with Cystoscopical and Pathomorphological Correlations

0217: 3D US in Detection and Differentiation of Bladder Tumors and Tumor-Like Lesions with Cystoscopical and Pathomorphological Correlations

Hexyl Aminolevulinate

Hexyl aminolevulinate [aminolevulinic acid hexyl ester, hexyl 5-aminolevulinate, 5-ALA hexylester, hexaminolevulinate, Hexvix, Hexvix PD, Hexvix PDT, P 1206] is being developed by PhotoCure, a Norwegian company, for the diagnosis and treatment of bladder cancer. The current standard diagnosis of bladder cancer involves cystoscopic examination of urine and bladder washings and is combined with biopsy for better detection of low-grade malignancies. However, the method largely relies on the experience of the surgeon and often results in false negatives especially for low-grade malignancies and pre-cancerous tissues. Photocure believes that imaging with hexyl aminolevulinate (Hexvix) offers significant advantages over standard diagnostic methods for detection of bladder cancer and also can be used in combination with those to ensure the optimal diagnostic accuracy. PhotoCure's procedure for diagnosis of bladder cancer involves filling of the patient's bladder with hexyl aminolevulinate solution and allowing the active agent to accumulate in the cancerous tissue. Following bladder emptying, blue light illumination is applied to the bladder causing red fluorescence that is clearly visible, thus identifying the cancerous tissue. Imaging with hexyl aminolevulinate improves detection of bladder tumours and also can be used together with transurethral resection to check the completeness of tumour removal. PhotoCure is looking for the opportunity to out-license hexaminolevulinate for all regions except the Nordic regions. PhotoCure has proprietary rights for hexyl aminolevulinate from the Norwegian Radium Hospital. Under the terms of the agreement with the Norwegian Radium Hospital, PhotoCure gains an access to, and an option to acquire, all of the new photodynamic therapy technologies developed by the Norwegian Radium Hospital. For its part, PhotoCure provides research and development funding to the Norwegian Radium Hospital. This 3-year agreement was extended in February 2003 until December 2006. PhotoCure and Karl Storz GmbH of Germany have signed a formal collaboration for the development and marketing of hexyl aminolevulinate (Hexvix) and Karl Storz's D-light system. The two systems will be used in the diagnosis of bladder cancer. PhotoCure and Karl Storz GmbH will jointly apply for a marketing approval of hexyl aminolevulinate (Hexvix) and Karl Storz' D-light system in the US for detection of bladder cancer. The D-light system is already approved in Europe. PhotoCure has also formed a collaborative agreement with the Swiss Federal Institute of Lausanne and the Municipal University Hospital in Lausanne. These institutions have conducted preclinical studies and some exploratory clinical research on the active ingredient of Hexvix in approximately 100 patients. The first MAA for hexyl aminolevulinate fluorescence was filed in Sweden, the reference member state, in December 2002, and was approved in September 2004. PhotoCure plans to launch hexyl aminolevulinate in Sweden in June 2005. Phase II clinical trials were conducted in 52 patients with known or suspected bladder cancer at the university clinics in Switzerland, Germany, Sweden and Norway. Clinical data suggests that hexyl aminolevulinate (Hexvix) is useful in the early diagnosis of bladder cancers allowing treatment to be performed at an earlier stage and, thus, improve the chance of a successful clinical outcome. The company believes that the data from the US phase III programme at 19 leading urology clinics and two multicentre European trials at 28 leading hospitals across nine countries, will sufficiently support an NDA with the US FDA. The US phase III programme with hexyl aminolevulinate was initiated in December 2001. The results from the first European multicentre study conducted in 19 centres in 286 patients confirmed the advantages of hexaminolevulinate fluorescence cystoscopy over standard white light cystoscopy in the detection of bladder cancer. The second multicentre phase III study at ten centres in Germany and the Netherlands in 146 patients with known or suspected bladder cancer was sucessfully completed in March 2003. The independent blind reviewer acknowledged that imaging with hexyl aminolevulinate would result in better treatment options in every fifth patient compared with standard cystoscopy. Hexaminolevulinate is also undergoing early feasibility studies for the diagnosis and treatment of gynaecological and gastrointestinal conditions. PhotoCure was granted a European patent No. 0820432 covering hexyl aminolevulinate, an active ingredient used in Hexvix for the diagnosis and treatment of bladder cancer. The company was also granted patents in Australia, China, the Czech Republic, New Zealand, Russia, Singapore, South Korea and the US.