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Archive for the ‘Ultrasonography’ Category

It is all about HEART that matters, here!

 

We already know that heart pumps blood through circulatory system by rhythmic contraction and dilation; cardiology is a medical specialty that deals with syndromes and disorders of the heart; medical practitioners specialized in function, structure and diseases of the heart are known as Cardiologists; patients with following conditions are treated by cardiologists: valvular heart disease, congenital heart disease/defects, coronary artery disease/atherosclerosis, congestive heart failure, to name a few.

In case of angiography, after instilling the patient with radio-opaque substance (instilled in) through a catheter, blood vessels are portrayed through an x-ray device for irregularities; about cardiac tumors, primary tumors of heart and membrane enclosing (pericardium) it are uncommon – most are benign; metastatic tumors rise from other nearby organ locality, in the body; in case of intravascular ultrasound, catheter with tiny ultrasound probe/equipment is used for visualization of lipid plaques, and related in coronary arteries.

On the other, electrocardiography (ECG/EKG) is extensively used for to graphically record cardiac cycle, of patients; here, the electrical activities of the heart is captured through electrodes positioned on the skin, of the patient, viz. legs, arms, chest etc., for ECG readings and interpretation. The process facilitates the care provider to measure how regular and frequent, the heart beats in a person.

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Have an understanding, how high frequency ultrasonic waves have transfigured the tomographic imaging approach!

 

Ultrasound is a type of imaging/tomography, where high frequency ultrasonic waves are used for diagnostic medical imaging and therapy; in ultrasonography – reverberations of ultrasonic wave pulses are used to picture/delineate regions and objects of varied density in the body.

Widely used in to image fetus in the human womb, so as to date pregnancy, and for other fetal viabilities, diagnostic ultrasound imaging is even put in use to conceive hypodermic body structures, viz. muscles, internal organs, joints, tendons for likely health problems or lesions. Unlike X-ray and other, ultrasound machines do not utilize ionized radiations, for to construe medical conditions; ultrasound technology has wide applications in urology, interventional radiology practices, to name a few.

In dental practice, through with ultrasonic scaling – calculus/tartar is removed, above the gums; under anesthesia, the dental cleaning process is carried on, making use of dental scaling tip that reverberates at high frequency, and is cooled by water.

The flexible and light weight, high frequency acoustic ultrasound transducers with state of the art design offer for specific detail of subtle lesions and intricate pathological masses, on examination. During ultrasound scan, coupling gels facilitate for sound transmission from ultrasound probe/transducer to the skin, and inner tissues in the body; on the other, ultrasound phantoms simulate the feel and look of body organ, and are used to test the overall functioning and performance of the imaging equipment.

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The peril of bleeding after ultrasound-guided thoracentesis executed by radiologists is low, irrespective of irregularities of platelet count and pre-procedural international normalized ratio.

The method in which no rectification or coagulation testing is executed prior thoracentesis can be established.

The medical research study was conducted by Maitray D. Patel and Sahil D. Joshi from Department of Radiology, Mayo Clinic, Phoenix, AZ.

The study is available in American Journal of Roentgenology, and the research objective was to recognize alterations in complications of hemorrhage, after ultrasound-guided thoracentesis, on grounds of coagulation parameters in patients.

The data of subjects that passed through ultrasound-guided thoracentesis from January 2008-April 2010 were evaluated, to register the platelet count and international normalized ratio (INR) gathered in 72 hours prior thoracentesis, and to establish bleeding complications that came about after the process. The remarked rate of complication and 95% confidence interval for variance in rates of complication were estimated.

About the results, no hemorrhagic complications could be figured out through execution of 1076 procedures, during the phase of study. Of 822 procedures with INR value prior thoracentesis showed subsequent figures: in 139 cases – it exceeded 2.0; for 59 cases – 2.5, while for 32 cases – it was 3.0, in the order given.

The 95% confidence interval for no deviation in complications remarked amongst two patients’ groups established by particular INR values was analyzed through. Platelet values prior thoracentesis were obtainable for 953 procedures, and the platelet counts were equated for various procedures.

Conclusion: Irrespective of irregularities of platelet count and pre-procedural international normalized ratio, the peril of bleeding after ultrasound-guided thoracentesis executed by radiologists is low. The approach in which no rectification or coagulation testing is executed prior thoracentesis can be rationalized.

Fetal heart rate less than 100 beats/min discovered at 6.1 weeks or less is not inevitably a poor predictive indicator.

The feasibility of successive first-trimester survival is notably higher if there is agreement/concordance between gestation age, as calculated by last menstrual period and biometrics than if there is discordance.

The medical research study was conducted by Elizabeth Kagan Arleo and Robert N. Troiano from Weill Cornell Imaging, New York Presbyterian Hospital, New York, NY.

The study is available in American Journal of Roentgenology, and the research objective was to prospectively evaluate concordant and discordant gestational age (GA) calculations in forecasting fetal demise in embryos with a slow heart rate, as decided on early first-trimester ultrasound.

36 successive singleton pregnancies with slow fetal heart rate gauged on a 5.0-6.1 week ultrasound were prospectively recognized. Pregnancies were termed discordant, if there was deviation of more than 5 days amongst gestational age decided by biometrics equated with the same by last menstrual period; while, it were termed as concordant on deviation of less than 5 days amongst gestational age measurements.

20 survived, and 16 died, of 36 embryos with heart rate less than 100 beats/minute, at 5-6.1 weeks’ gestational age. 14 were discordant and 2 were concordant – of 16 that went on to demise; on the other, of 20 that survived – 4 were discordant, while 16 were concordant. The ratio of discordant pregnancies that went on to demise was 14 of total 18, while, the ratio of survival with concordant pregnancies was 16 of 18. The frequency of demise in discordant group was comparatively higher than that of concordant group.

Conclusion: Fetal heart rate less than 100 beats/min discovered at 6.1 weeks or less is not inevitably a poor predictive indicator. The feasibility of successive first-trimester survival is notably higher if there is agreement/concordance between gestation age, as calculated by last menstrual period and biometrics than if there is discordance.

Plateau curve enhancement and non-mass lesions are prevalent MRI findings of pure ductal carcinoma in situ.

The lesions with mass visibility on MRI findings have more suspicious kinetic features, than non-mass lesions.

 

The medical research study was conducted by Jeong-Ah Kim, Eun Ju Son, Ji Hyun Youk, Eun-Kyung Kim, Min Jung Kim, Jin Young Kwak and Joon Jeong from Department of Radiology and Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.

The study is available in online journal of American Roentgen Ray Society, and the research objective were to examine the kinetic and morphologic features of pure ductal carcinoma in situ, and MR images, and to equate the kinetic characteristics in relation to mammographic/sonographic findings, MRI lesion type and histopathologic factors.

About 67 patients presented with histologically demonstrated pure ductal carcinoma in situ were picked up for the study. Breast Imaging-Reporting and Data System (BIRADS) was utilized to analyze MRI findings, without pathological data. Quantitative variables of enhancement pattern were calculated for lesions, along with assessment of histological factors of hormone receptor and c-erbB-2 expression status, nuclear grade etc.

Independent assessments were made for sonographic and mammographic findings, without facts about MRI, and kinetic features were equated, in relation to MRI lesion type, mammographic/sonographic finding and histopathologic factors.

About the results, the prevalent morphological appearance was a non mass lesion with diverse enhancement, where the pure ductal carcinoma in situ lesions displayed inconsistent enhancement patterns composed of plateau, persistent and washout curves. Other than correlation of MRI lesion type with mean enhancement slope, time to peak enhancement and same of sonographic findings with time to peak enhancement, there was were no statistically significant relationship amid histopathologic factors/mammographic finding and kinetic features.

Conclusion: Plateau curve enhancement and non-mass lesions were prevalent MRI findings of pure ductal carcinoma in situ. In contrast to non-mass lesions, the lesions with mass appearance at MRI findings had more leery kinetic features.

The levonorgestrel-releasing intrauterine system/mirena is considerably less perceptible than copper intrauterine devices on 2D imaging.

3D ultrasound improves the discernibility of both the types of intrauterine devices.

 

The medical research study was conducted by Elysia Moschos and Diane M. Twickler from Department of Obstetrics and Gynecology, Division of Gynecology, and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.

The study is available in online journal of American Roentgen Ray Society, and the research objective was to estimate discernibility and position evaluation of intrauterine devices (IUD) on 2D ultrasound and 3D ultrasound in patients that are not pregnant.

Previous ultrasound database from July 2008-2009 were assessed for identification of patients with intrauterine devices, and for position and type of it, with current symptoms. Depending on 7 point grading scale, the discernibility of intrauterine device on transverse and 2D sagittal planes, and 3D coronal reconstructed view was recorded, and then the data was analyzed through Pearson’s chi-square and Student’s t test.

Out of 269 patients with intrauterine device that had undergone ultrasound at the study period – 180 patients showed up with copper IUD, 59 with levonorgestrel intrauterine system (Mirena), and 3 with Lippes loop. 27 IUDs could not be established, and were to be barred out.

The discernibility score for copper IUDs varied considerably from mirena/levonorgestrel-releasing intrauterine system on 2D ultrasound, of 239 IUDs that were being recognized out.

The deviation in the discernibility score for copper IUDs in contrast to mirena on 3D ultrasound was to a limited extent substantial. Other than 74% cases of IUDs within endometrial cavity, other IUDs were malpositioned, where 3 IUDs could not be established with. Many cases were being reported of pain, missing strings, bleeding (due to malposition) etc.

Conclusion: The levonorgestrel-releasing intrauterine system/mirena is considerably less perceptible than copper intrauterine devices on 2D imaging. 3D ultrasound improves the discernibility of both the types of intrauterine devices.

Ultrasound spleen volume does not reflect function, but increased volume shows mutual relationship with glomerular filtration rate.

Sonographic biliary defects can form early in life, though staying clinically silent.

 

The medical research study was conducted by M. Beth McCarville, Zhaoyu Luo, Xiangke Huang, Renee C. Rees, Zora R. Rogers, Scott T. Miller, Bruce Thompson, Ram Kalpatthi, Winfred C. Wang from Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis TN; Clinical Trials & Surveys Corporation, Baltimore, MD; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Department of Hematology, State University of New York–Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY; Children’s Mercy Hospitals and Clinics, Kansas City, MO; Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN.

The study is available in online journal of American Roentgen Ray Society, and the research objective was to carry out and assess baseline abdominal ultrasonography in infant babies with sickle cell anemia (a grave hereditary form of anemia) that took part in BABY HUG multi-institutional randomized controlled trial (RCT), for to measure the capacity and effectiveness of hydroxyurea therapy, and to evaluate the potential association amid results of ultrasound and clinical/laboratory data.

Approved by institutional review board, and written consent from kins of patients, about 87 boys and 116 girls presented with sickle cell anemia experienced abdominal sonography at varied medical institutions. Centralized examination review from a radiologist was carried through for measurement and evaluation of kidneys, ductus choledochus/common bile duct, spleen and gallbladder. Baseline physical assessment of spleen size, serum alanine aminotransferase (ALT), bilirubin levels, 99mTc-sulfurcolloid scan (liver/spleen), and glomerular filtration rate (GFR) were acquired by.

To equate sonographic findings and issued results in clinical/lab findings and controlled group – variance analysis and student examinations were carried out.

Of the result, the mean spleen volume was found considerably larger than issued control values. No mutual relationship could be established amid spleen volume and activity evaluated by liver-spleen scan. The mean glomerular filtration rate increased, in comparison to that of control glomerular filtration rate. The renal volumes were considerably larger than control volumes, and had positive mutual relationship with glomerular filtration rate. About 5% of patients showed up with gallbladder/biliary tract abnormalities, though there was no mutual relationship amid laboratory results and biliary sonographic discoveries.

Conclusion: In infant babies with sickle cell anemia, ultrasound spleen volume does not bring about activity, but increased volume shows mutual relationship with glomerular filtration rate, and is coherent with hyperfiltration. Sonographic biliary defects can form early in life, though staying clinically silent.

Contrast-enhanced ultrasound with sonazoid is viable for histologic grade estimation of hepatocellular carcinomas.

 

The medical research study was conducted by Junichi Arita, Kiyoshi Hasegawa, Michiro Takahashi, Shojiro Hata, Junichi Shindoh, Yasuhiko Sugawara and Norihiro Kokudo from Divisions of Hepato-Biliary-Pancreatic Surgery and Artificial Organ and Transplantation, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo,Japan.

The study is available in online journal of American Roentgen Ray Society, and the research objective was to precisely evaluate the combined relationship amid findings of contrast-enhanced ultrasound with sonazoid and hepatocellular carcinoma (HCC) histological grade.

About 239 patients that were going through surgery for hepatocellular carcinoma selected by for the study. Due to exclusion of 33 patients with necrosis of hepatocellular carcinoma, about 374 histologically proved cases were picked up for the detailed study that had well, moderately and poorly-differentiated hepatocellular carcinomas, in varied proportions.

Following-up after liver mobilization and laparotomy procedure, contrast-enhanced ultrasound with sonazoid was performed, in the harmonic mode, and HCC vascularity was assessed by in the vascular phase, and after a time lag – liver was explored during late kupffer phase. Findings of routine execution of dynamic CT in the preoperative stage were evaluated over.

In the vascular phase, the proportion of hypervascular tumors showed the tendency to be higher amid moderately and poorly-differentiated hepatocellular carcinomas than well-differentiated hepatocellular carcinomas. The proportion of hypoechoic lesions on kupffer phase was considerably lower amid well-differentiated hepatocellular carcinomas, in comparison to moderately and poorly differentiated HCCs.

The proportions of hypervascular tumors on primary phase and hypodense tumors on late phase in dynamic computed tomography imaging were considerably lower amongst well-differentiated hepatocellular carcinomas, than moderately and poorly differentiated ones.

Conclusion: Contrast-enhanced ultrasound with sonazoid is feasible for histologic grade estimation of hepatocellular carcinomas.

BIRADS score can be utilized for mucocele-like lesions related with Atypical Ductal Hyperplasia.

Intermediate concern calcifications of breast malignancy were detected more often in mucocele like breast lesions related with ADH.

 

The medical research study was conducted by Sun Mi Kim, Hak Hee Kim, Doo Kyung Kang, Hee Jung Shin, Nariya Cho, Jeong Mi Park and Joo Hee Cha from Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, South Korea; Department of Radiology, Division of Breast Imaging and Intervention, University of Iowa Hospitals, Iowa City, IA; Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, South Korea; Department of Diagnostic Radiology (Ajou University, College of Medicine, Suwon and Department of Diagnostic Radiology, Seoul National University, Seoul, South Korea.)

The study is available in online journal of American Roentgen Ray Society, and the research objective was to assess varied radiological findings of mucocele-like tumors of the breast and tumors related with Atypical Ductal Hyperplasia (ADH) as per Breast Imaging Reporting and Data System (BIRADS) and sonographic cystic mass classification (Note: though the condition is not cancerous, but women with ADH have greater tendency for cancer.)

In a period of ten years, about 68 women with 72 mucocele like breast lesions were evaluated in a microscopic study at three medical institutions.

Through contemplative study – ultrasound and mammographic findings of 72 mucocele like breast lesions were analyzed by, in accordance with BIRADS scale, and radiological study results were associated with pathological results.

Mammography demonstrated 53 breast lesions with calcifications, with and without a mass: 39 were calcifications without a mass. Intermediate concern calcifications of breast malignancy were detected more often in mucocele like breast lesions related with atypical ductal hyperplasia, in comparison to pure mucocele-like tumors. About 69 of mucocele-like tumors showed as cystic lesions on sonography.

Septated/clustered cysts in breast and complex cystic breast masses were often visible in mucocele-like tumors related with atypical ductal hyperplasia. Positive value for breast imaging reporting and data system 4 calcifications was 13.3%, whereas that for BIRAD score of 5 it was 50%, respectively.

Conclusion: Mucocele-like lesions related with atypical ductal hyperplasia (ADH) were often visible as septated/clustered cysts in breast and complex cystic breast masses, associated with intermediate concern calcifications of breast malignancy, and BIRADS score can be utilized for management of mucocele-like tumors.

Compared to traditional 2d ultrasound technology, 4-d ultrasound guided punctures for liver tumors can considerably enhance puncture accuracy for both inexperienced and well-versed physicians.

 

The medical research study was conducted by Katsutoshi Sugimoto, Fuminori Moriyasu, Junji Shiraishi, Masahiko Yamada and Yasuharu Imai from Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, and School of Health Sciences, Kumamoto University, Kumamoto, Japan.

The medical research study is available online in American Journal of Roentgenology. The research objective was to equate the preciseness of ultrasound guided puncture through contemporary 3d/4d ultrasound and 2d ultrasound for focal hepatic mass utilizing a liver phantom. 4 dimensional ultrasound system furnished with 5 MHz 4D probe showed both orthogonal and axial images synchronous to puncture line.

Liver phantom, comprised of 4 artificial spherical masses in an acrylic box with two different positions and sizes (diameter of 15 and 30 mm) was utilized for the study. Well versed and experience physicians and other unskilled, 4-each differently tried punctures on simulated mass through 2d and 4d ultrasound guidance protocol, in a total of about 128 punctures. The error distance calculated by, manually on grounds of 3d volume dataset, on offline analysis tool.

The mean error distance with 4d ultrasound was considerably smaller, in comparison to 2d ultrasound, on simulation model of tumors, other than one that was 30 mm in depth and 15 mm in diameter.

Group with experienced people, the mean error distance was smaller in comparison to that of inexperienced group, on each tumor model with both methods. There was statistical significant deviation amidst both the groups for a tumor model of 30 mm in diameter and 80 mm in depth on 4d ultrasound.

Conclusion: 4-d ultrasound guided punctures for liver tumors can considerably enhance puncture accuracy for both inexperienced and well-versed physicians, in comparison with the traditional 2d ultrasound.