Use of ultrasonography methods in the diagnosis of neurogenic paraosteoarthropathy in spinal cord injury

To assess the role of the ultrasonic imaging evaluation of articular lesions suspected to be the initial presentation of heterotopic ossifications (HO), 59 consecutive injured patients were studied. 32 out of 59 patients showed clinical signs of local inflammation in one of the articular sites of the upper or lower limbs, sonographic scans proved to be diagnostic of HO in 7 out of those 32 patients before their radiographic findings. Serial sonographic examinations were performed utilizing a 7.5 MegaHertz transducer probe for 2 months. The imaging abnormalities were correlated with biochemical levels of serum alkaline phosphatase, modifications of radiographic features and bone 99nTC scintigraphy. Scintigraphy revealed to have a high sensitivity but a low specificity for the diagnosis of HO. Also the serum levels of alkaline phosphatase were not a sensitive indicator of early HO in our group of patients. Moreover serial sonographic scans confidently excluded the HO in the 25 patients with no initial signs of the disease without any false negative results. Thus, early sonographic assessment of patients, with spinal cord injury in which local signs of inflammation suggest initial HO formation, revealed to be superior to the other utilized technique for the diagnosis of HO and may be considered a valuable alternative in particular to evaluate the evolutive pattern of this disease.     

Acute heavy alcohol intake increases silent myocardial ischaemia in patients with stable angina pectoris

PURPOSE: The purpose was to determine tumor neovascularisation via colour-coded Doppler (duplex) sonography and the "power mode", both visually and quantitatively, by means of videodensitometry. MATERIAL AND METHODS: 6 VX2 tumours of 4 to 11 mm size were implanted in 4 rabbits at various sites. The colour-coded duplex sonography and the new sonographic power technique were tested before and after having injected a new contrast medium (SH U 616A). RESULTS: If no contrast medium was injected, tumour neovascularisation was identified in only 50% of the cases. Injection of contrast medium increased signal intensity three to fourfold with all examined tumors. Combined use of the sonographic method by the power technique with injection of contrast medium is outstandingly suitable for tumor vessel imaging even of small tumors, as these initial results seem to show. CONCLUSION: If these results are corroborated by further studies, contrast-medium supported sonographic technique may possibly become established as an alternative method to other imaging procedures.     

Crescent-shaped necrosis: a new imaging sign suggestive of stromal tumor of the small bowel

We report three cases of unsuspected stromal tumors of the small bowel (STSB). These cases were diagnosed preoperatively by sonography, the imaging was completed for some with barium studies, computed tomography, magnetic resonance imaging, or angiography. To our knowledge, the use of this noninvasive technique for detecting this type of tumor has not been described in the literature. Moreover, we believe that some sonographic findings such as crescentic tumoral necrosis may appear highly suggestive of STSB.     

Sonographic features of colon carcinoma seen with high-frequency transabdominal ultrasound

To assess the value of high-frequency ultrasonography as a diagnostic imaging procedure in patients with colon carcinoma, we first evaluated the sonograms of 37 patients who had been already diagnosed with contrast enema and/or colonoscopy as having colon carcinoma. As a result, the sonographic criteria for diagnosis of a possible colon carcinoma were (1) a localized and irregular thickening of the colonic wall with heterogenous low echogenicity, (2) an irregular contour, (3) a lack of demonstrable movement or change of configuration of the bowel on real-time scanning, and (4) absence of wall stratification. During the last 4 years, 41 consecutive patients had findings meeting our sonographic criteria. In 37 patients (90%), the presence of colon carcinoma was confirmed by contrast enema and/or colonoscopy. Our study suggests that high-frequency real-time ultrasonography may be a useful imaging technique in diagnosis of colon carcinoma.     

Effects of oxygen and carbon dioxide on mean cell volume

PURPOSE: Renal sonography is an accepted primary imaging modality for evaluating the pediatric urinary tract. We report a new sonographic finding associated with vesicoureteral reflux (VUR). METHODS: Ten patients underwent sonographic evaluation of the kidneys and were noted to have intermittent renal collecting system dilatation that expanded and contracted during real-time scanning. These patients were further evaluated with voiding cystourethrography. RESULTS: All 10 patients were proven to have VUR on the side of the sonographic abnormality. Four patients had bilateral VUR for a total of 14 refluxing renal units. Of these 14 renal units, 1 was sonographically normal. Five of the 14 renal units had grade V VUR that required surgical reimplantation of the ureter. CONCLUSIONS: This new finding of intermittent renal collecting system dilatation may become an important predictor of VUR. The finding warrants further evaluation even when detected in patients not suspected of having VUR who are undergoing renal sonography for other reasons.     

Endo-neuro-sonography: principles of 3-D technique

To evaluate the usefulness of transendoscopic sonography we studied two new sono probes 6 F in diameter in 17 fresh specimens. We saw precise imaging of well-known anatomical structures and also gained an additional dimension in endoscopy, as the sono adds to the endo-view a transverse scan like a mini-CT at the tip of the probe. We also experienced the navigation characteristic of this imaging technique, both in real time and on line. Some 3-D reconstructions of the ventricular system were examined. The equipment has been used in clinical practice and must now be adapted for neurosurgery.     

Imperjalja. A view into the Oskar Panizza system based on his last writing. Instead of an obituary on the occasion of the 75th anniversary of his death]

High-frequency ultrasound can provide high-resolution imaging for diagnosing diseases of the head and neck. Over the last few years, a virtual technical evolution has led to the development of small and flexible ultrasound transducers with even greater anatomic resolution. The aim of the present study was to evaluate the efficacy of this new technique for imaging normal and altered anatomical structures of the endolarynx. Specially developed high-resolution, real-time ultrasound transducers (10 and 20 MHz) placed on the tip of endoluminal catheters were inserted into 20 autopsied larynges and five laryngectomy specimens. In a standardized examination process the endolarynx was analyzed in a real-time mode. Using this technique, exact 360 degrees cross sections of the larynx were obtained, demonstrating that it was possible to image the structures of the endolarynx with ultrasonography. Depending on the frequency used, all anatomical structures could be visualized up to a depth of 2 cm. In laryngeal cancer the depth of tumor as well as its relationship to the laryngeal framework could be clearly recognized. These findings suggest that this new endoluminal sonographic procedure represents a potentially important diagnostic tool in the assessment of laryngeal carcinoma.     

Clinical application of volume estimation based on three-dimensional ultrasonography

The development of three-dimensional sonography represents a milestone in the history of diagnostic ultrasound. It has become possible to evaluate a region of interest not only in the horizontal and vertical planes but also in a third, i.e. the frontal, plane. Among other possible applications, this technique greatly facilitates volume estimation. The objective of the present study was to evaluate the accuracy and precision of volumetry based on three-dimensional sonography. The results demonstrate a good correlation between estimated volumes and the volumes measured by transvaginal needle-guided follicle aspiration performed under sonographic visualization. Our findings confirm the conclusion of previous studies that three-dimensional sonography is making a valuable contribution to imaging techniques.     

Transumbilical use of the endovaginal probe

The endovaginal probe can be used in the umbilicus to improve fetal imaging. In 27 of 31 patients, an optimal ultrasound examination was achieved because of this added technique. The procedure is most useful in obese women and those with prior abdominal surgery.     

Multiphoton excitation provides optical sections from deeper within scattering specimens than confocal imaging

Multiphoton excitation fluorescence imaging generates an optical section of sample by restricting fluorophore excitation to the plane of focus. High photon densities, achieved only in the focal volume of the objective, are sufficient to excite the fluorescent probe molecules by density-dependent, multiphoton excitation processes. We present comparisons of confocal with multiphoton excitation imaging of identical optical sections within a sample. These side-by-side comparisons of imaging modes demonstrate a significant advantage of multiphoton imaging; data can be obtained from deeper within biological specimens. Observations on a variety of biological samples showed that in all cases there was at least a twofold improvement in the imaging penetration depth obtained with multiphoton excitation relative to confocal imaging. The more pronounced degradation in image contrast deep within a confocally imaged sample is primarily due to scattered emission photons, which reduce the signal and increase the local background as measurements of point spread functions indicated that resolution does not significantly change with increasing depth for either mode of microscopy. Multiphoton imaging does not suffer from degradation of signal-to-background to nearly the same extent as confocal imaging because this method is insensitive to scatter of the emitted signal. Direct detection of emitted photons using an external photodetector mounted close to the objective (possible only in a multiphoton imaging system) improves system sensitivity and the utilization of scattered emission photons for imaging. We demonstrate that this technique provides yet further improvements in the capability of multiphoton excitation imaging to produce good quality images from deeper within tissue relative to confocal imaging.     

Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography

We studied the value of dynamic sonography in adhesive capsulitis of the shoulder joint in patients with clinically suspected frozen shoulder. The sonographic criterion of adhesive capsulitis was continuous limitation of the sliding movement of the supraspinatus tendon against the acromion of the scapula. Arthrography was regarded as a gold standard in the diagnosis of adhesive capsulitis against which the sonographic results were compared. Among 23 patients with arthrographically documented adhesive capsulitis, sonographic examination showed limitation of movement of the supraspinatus tendon in 21. This sonographic sign therefore has a sensitivity of 91%, a specificity of 100%, and an accuracy of 92% for detecting adhesive capsulitis, making dynamic sonography a reliable technique for the diagnosis of this condition.     

Hepatic cavernous hemangioma: sonographic patterns and speed of contrast enhancement on multiphase dynamic MR imaging

OBJECTIVE: Our purpose was to investigate a correlation between the speed of contrast enhancement in patients with hepatic cavernous hemangioma revealed by dynamic MR imaging and the internal echo pattern revealed by sonography. MATERIALS AND METHODS: Forty-five patients underwent multiphase IV contrast-enhanced dynamic MR imaging that revealed 71 hepatic cavernous hemangiomas less than 4 cm in diameter; the MR findings were compared with the sonographic findings in these patients. On MR imaging, the hemangiomas were classified as rapid-, intermediate-, and slow-enhancing. We classified sonographic features as hypoechoic, iso- or mixed-echoic, and hyperechoic according to the relative echogenicity seen between lesions and the surrounding hepatic parenchyma. Sonographic patterns and MR imaging findings of individual lesions were then compared. RESULTS: Rapid-enhancing hemangiomas revealed on dynamic MR imaging tended to be hypoechoic on sonography (18/24, 75%; p = .0143), and lesions that were slow-enhancing on MR imaging tended to be hyperechoic (26/29, 90%; p < .0001). Hypoechoic lesions on sonography tended to be rapid-enhancing on dynamic MR imaging (18/18, 100%). Likewise, hyperechoic lesions on sonography tended to be slow-enhancing on MR imaging (26/33, 79%; p = .0009). CONCLUSION: In most patients with hepatic cavernous hemangiomas, we found that the speed of contrast enhancement on multiphase dynamic MR imaging enabled us to predict the echo pattern in sonography and vice versa.     

Comparison of ultrasound imaging in patients undergoing transperineal and transrectal prostate ultrasound

OBJECTIVES: Prostatic evaluation in men who have undergone prior abdominoperineal resection pose an unusual challenge for the urologist. Neither digital rectal examination nor transrectal ultrasound (TRUS) can be performed. Transperineal ultrasound (TPUS) has been suggested as an alternative means of imaging. This imaging modality was compared directly with the standard TRUS method. METHODS: TPUS was performed with a 4-MHz abdominal probe or biplane multiple frequency probe at a frequency of 5 to 7 MHz followed by TRUS at 7 MHz in 50 consecutive men referred for prostate ultrasound and biopsy who had not undergone prior abdominoperineal resection. Dimensions of the prostate and ultrasound findings such as hypoechoic, anechoic, or hyperechoic areas were noted for each sonographic approach. Volume calculation was performed by the prolate spheroid method. RESULTS: There was good TPUS visualization of the prostate in the transverse plane in 48 (96%) of 50 patients and in the sagittal plane in 45 (90%) of 50 patients. Prostate volume calculation by TPUS correlated well with the volume calculated by TRUS (r=0.876). Twenty-nine patients (58%) were found to have suspicious hypoechoic lesions by TRUS; none were seen by TPUS. Prostatic calcifications were present in 12 patients and were visualized by both TPUS and TRUS in all 12 patients. Six prostate glands demonstrated cystic lesions on TRUS imaging; three of these cystic lesions were also seen with TPUS imaging. CONCLUSIONS: TPUS allows visualization of the prostate with volume determination that is comparable to the volume determination by TRUS. Some intraprostatic findings such as calcifications and cysts can be identified; however, suspicious hypoechoic lesions were not identified by TPUS imaging of the prostate.     

Applications of health risk adjustment: what can be learned from experience to date?

BACKGROUND: Despite having appropriate sonographic equipment available many radiologists remain unfamiliar with B mode sonography of the eye. OBJECTIVE: This article reviews the advantages and disadvantages of B mode sonography of the paediatric eye. We illustrate the spectrum of eye abnormalities occurring in paediatric practice and the sonographic appearance of clinical entities for which sonography is appropriate. MATERIALS AND METHOD: We reviewed our experience of eye sonography within a paediatric radiology department over 8 years. A total of 212 sonographic examinations were performed on 206 eyes in 103 children, aged from 3 days to 16 years (mean 4.6 years). RESULTS: Sonography was well tolerated by the children, was a very useful imaging modality and was the only diagnostic imaging modality required in 94%. Supplementary computed tomography (CT) was performed in ten of 206 eyes (5%) and magnetic resonance imaging (MR) was performed in two of 206 eyes (1%). CONCLUSIONS: B mode sonography is a very useful imaging modality for suspected ocular or orbital pathology in children and is often the appropriate first line investigation following clinical evaluation. Radiologists familiar with sonography of the eye can provide valuable support to their ophthalmology colleagues.     

Three-dimensional echocardiographic evaluation of fetal heart anatomy and function: acquisition, analysis, and display

The purpose of this work was to assess the functional dynamics and anatomy of the cardiac chambers and great vessels in the fetus (18 to 36 weeks) using in utero three-dimensional ultrasonographic imaging. Fifteen patients were studied using conventional two-dimensional sonographic equipment incorporating a position sensor attached to the transducer and a graphics workstation. Sonographic image data were acquired at 30 images per second and required less than 30 seconds per data set. Fetal heart rate and time in the cardiac cycle were determined and used to synchronize image data for reprojection into a volume at the appropriate part of the cardiac cycle. Volume data were analyzed, rendered, and displayed interactively. Three-dimensional sonographic volume data demonstrated fetal cardiac anatomy from multiple orientations and showed the myocardium, valves, ventricles, and atria clearly. The images showed good correlation with currently available embryologic-anatomic-pathologic data. Dynamic and spatial relationships among chambers, valves, and great vessels were readily appreciated. Three-dimensional sonographic imaging of the fetal heart provides both anatomic and functional information regarding the valves, myocardium, great vessels, and chamber dynamics. Interactive three-dimensional cinegraphic display enhances visualization of cardiac anatomy, which can be difficult to appreciate with two-dimensional methods. The methods presented in this work demonstrate the feasibility of three-dimensional fetal echocardiography.     

Ultrasonographic diagnosis of ectopic pregnancy: importance of transabdominal imaging

Endovaginal sonography has greatly improved the diagnostic evaluation of suspected ectopic pregnancy. Some authors suggest imaging solely by endovaginal technique for diagnosis. We perform both a transabdominal scan for a global view of the pelvic and abdominal contents and an endovaginal sonographic examination for a higher resolution and focused view of the gynecologic structures. We report three patients with negative endovaginal examinations who had obvious ectopic pregnancies on our subsequent transabdominal examination. These cases remind us of the valuable information that can be obtained with the transabdominal approach and the complementary role it plays with endovaginal sonography.     

Catheter-tracking FOV MR fluoroscopy

Recent improvements in intravascular magnetic resonance imaging techniques mandate an accurate method of monitoring the introduction of MR catheter probes into the vessel of interest. For this purpose, a novel imaging protocol and a display method have been designed. First, a roadmap 3D image data set with standard pulse sequences is obtained using an external imaging coil. Subsequently, using very narrow rectangular-FOV fast-spoiled gradient recalled (SPGR), a movie of the percutaneous placement procedure of an MR catheter probe is acquired at a rate of 7.3 frames/second. In this protocol, the probe is used to transmit RF pulses and receive MR signal. A computer program was written for image unwrapping and for displaying the unwrapped movie frames on the roadmap image. In an alternative protocol, the movie frames in two projection angles were acquired in an interleaved fashion. Frames were unwrapped and combined with a 3D roadmap and displayed on a Silicon Graphics workstation equipped with stereovision goggles. Using these methods, percutaneous catheter placement in a phantom and a dog was examined. In conclusion, a new visualization technique for MR catheter placement is proposed. Combining this technique with high resolution intravascular MRI techniques may result in a very useful diagnostic tool for the evaluation of atherosclerosis and other vessel diseases.     

Scintimammography using Tc-99m tetrofosmin

TIM (Zeppelin Chirurgische Instrumente GmbH, 82 049 Pullach, Germany) is a tomographic imaging system which enables surgeons to visualize the pathologic lesions three dimensionally in relationship to the surrounding structures. The distance and the angle between the pathologic lesion and the anatomical and/or bony landmarks as well as the volume of the mass lesion can be measured. Therefore an accurate localization of the lesion is possible with this technique. It is very applicable for planning of surgery on skull base tumors. The surgical procedure for small and well-defined, intrinsic pathologic deep-seated brain lesions, however, becomes much easier by using the stereotactic techniques of this system. The target point and the direction brain-surface-to-lesion can be determined within seconds. Before the aiming probe is inserted to the target, the cortical motor area is mapped by direct electrical stimulation. The approach can be varied depending on the results of these neurophysiologic investigations of the brain surface. The dissection is made along the aiming probe up to the target point. Because of the fixation of the brain with the needle, a brain shifting due to the dissection as well as to CSF release is diminished. Forty patients with deep-seated intracerebral lesions were operated on during a 13 months period by these combined techniques in our service. Using this technique, we never made a negative exploration. In all but three patients, total removal of the mass lesion was achieved. Permanent neurological deficits were observed in two patients only. In our opinion, this combined imaging and neurophysiological technique is easy to perform, and of major benefit for the patients due to its accuracy and is preferable in comparison with other single computer localizer techniques without neurophysiological monitoring.     

Rapid calibration for 3-D freehand ultrasound

3-D freehand ultrasound is a new imaging technique that is rapidly finding clinical applications. A position-sensing device is attached to a conventional ultrasound probe so that, as B-scans are acquired, they can be labelled with their relative positions and orientations. This allows a 3-D data set to be constructed from the B-scans. A key requirement of all freehand imaging systems is calibration; that is, determining the position and orientation of the B-scan with respect to the position sensor. This is typically a lengthy and tedious process that may need repeating every time a sensor is mounted on a probe. This paper describes a new calibration technique that takes only a few minutes to perform and produces results that compare favourably (in terms of both accuracy and precision) with previously published alternatives.     

Hepatic hydatid cysts: sonographic follow-up after percutaneous sonographically guided aspiration

PURPOSE: We studied the sonographic appearances of hepatic hydatid cysts and used sonography to follow up these cysts after sonographically guided aspiration using the PAIR technique. METHODS: Included in this study were 362 patients with 558 hepatic hydatid cysts. Initial sonographic examination revealed 510 noncomposite cysts and 48 composite cysts (18 rosette and 30 honeycomb pattern). Noncomposite hydatid cysts (510 cysts) were aspirated and treated with scolicidal agents using the PAIR technique. Sonographic follow-up was done for up to 5 years after aspiration. RESULTS: There was immediate detachment of the germinal layer in all cysts during aspiration. There were no serious complications. Sonographic follow-up after 1 month and 1 year revealed complete cyst collapse in 326 cysts (64%) and 449 cysts (88%), respectively. Repeat ultrasound scanning showed a continued decrease in the sizes of all remaining cysts. Organized lesions (pseudosolid pattern) were detected in only 26 cases after up to 5 years of follow-up. CONCLUSIONS: The most common sonographic appearance of hepatic hydatid cysts among Egyptians is noncomposite, anechoic cysts. The PAIR technique is a safe, effective, and inexpensive therapeutic modality.