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Despite the lack of fluid in the muscular system, the tool can be useful even for musculoskeletal imaging, affirms Dr Carlo Martinoli, Associate Professor of Radiology at the University of Genoa. Volume ultrasonography has become an established modality in some specialties during the last years. The 'state-of-the-art' high frequency volume ultrasound (HFVU), presently performed using electromechanical transducers, is based on the quick acquisition of a volume data set which can then reviewed and re-processed using various display formats.

Despite the lack of fluid in the muscular system, the tool can be useful even for musculoskeletal imaging, affirms Dr Carlo Martinoli, Associate Professor of Radiology at the University of Genoa, who presented the findings of his initial experience with 3D-volume ultrasound during the European Congress of Radiology (ECR) on 10 March.

"HFVU offers better anatomical rendering of superficial structures", Dr. Martinoli said. "Multiplanar imagining not only improves the presentation of the US information but can also be used as a problem-solving technique for diagnostic benefit."

In particular, structures oriented in the z-place are those that could benefit more from additional planes: the sternum, the pectoralis major tendon and the subscapularis tendon are some of them. De Quervain disease (baby wrist) and clubfoot are examples of the pathologies affecting tendons, muscles, nerves, joints and bone that are amenable to HFVU imaging.

In the first case, HFVU enables the radiologist to visualize tenosynovitis and retinacula (by image of the wrist extension tendons) and partial tendon tears (through the longitudinal split of the tendon for the index finger). For the latter, the main advantage of volume ultrasound over plain films is the non-inasive imaging of the unossified bones.

With 2D ultrasound, it is not possible to estimate the angle between the long-axis of the calcaneus and the talus. With HFVU, the true bone axis can be estimated, helping to classify the disease severity despite the paucity of water-containing structures.

"Volume technology integrated in a conventional 'small-parts' probe would lead to a more flexible use as a complement to 2D ultrasound", Dr. Martinoli said. "It's a complement, better depicted than 2D imaging. With the other measurements, it can definitely contribute to better diagnosis."

Fast and simple breast imaging procedure

Volume ultrasound has also an impact in breast imaging, as shown by another presentation during the ECR. "3D and 4D ultrasound provide additional aspects to conventional 2D sonography", said Dr Christian Weismann, breast radiologist, Assistant Medical Director of the Department of Diagnostic Radiology of the General Hospital in Salzburg, Austria.

"It offers completely new superior diagnostic information such as the ability to study a breast mass and the surrounding tissue in three orthogonal planes, or to obtain new information about the blood flow intensity in a volume of interest (VOI) or three-dimensional vasculature of breast lesions," he added.

4D ultrasound offers almost real-time 3D rendered image information and is taken as a basis of multidimensional imaging of the breast. "It makes it easier to determine the benignancy or malignancy of a solid breast lesion", Dr. Weismann explained, "as you can cross several data. The pattern - star-like or compression -, the volume and several other measurements."

The radiologist defended that tomographic ultrasound imaging has the potential to reduce redundant ultrasound investigations. "It's a fast and simple procedure, completely suitable for daily diagnosis", he affirmed.

Virtual cystocopy for children

A third speciality benefiting from 3D ultrasound is pediatrics. "Based on own experiences and literature reports, 3DUS appears to be a useful ultrasound technique for the neonatal brain and in the pediatric genitourinary tract", said Dr. Michael Riccabona, from the Division of Pediatric Radiology of the University Hospital Graz, Austria, who also made a presentation at the ECR during the Satellite Symposium organized by GE Healthcare. He affirmed that 3DUS can reduce the number of cystoscopies in children.

"Some soft tissue and musculoskeletal queries as well as tumor volume assessment also hold promising perspectives. Volume ultrasound has great potential for future applications", Dr. Riccabona said. He listed some of the 3DUS benefits that apply to its use in infants and children as well:

• To reduce the imaging time at the patient
  
• To improve the demonstration of complex anatomy
  
• To improve volume assessment
  
• Potential to improve standardization and documentation, as well as comparison with other sectional imaging
  
• To allow visualizing structures otherwise inaccessible to US such as surfaces (e.g., virtual cystoscopy) or complicated and tortuous arrangements (vessels, ducts)
  
• To be an ideal modality for counseling, training and education, as the volume data can be virtually rescanned at the workstation without the patient's presence.

"Volume ultrasound definitely improves diagnosis and documentation. It is clearly a useful tool", the radiologist concluded.