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Objectives: To assess the performance of elastography (ES) and ultrasound (US) in predicting the malignancy of breast lesions and to compare their combined diagnostic value with that of magnetic resonance imaging (MRI). Materials and Methods: The study prospectively enrolled 242 female patients with dense breasts treated in 35 heath care facilities in China between November 2018 and October 2019. Based on conventional US and elastography, radiologists classified the degree of suspicion of breast lesions according to the US Breast Imaging Reporting and Data System (BI-RADS) criteria. The diagnostic value was compared between US BI-RADS and MRI BI-RADS, with pathological results used as the reference standard. Results: The results demonstrated that irregular tumor shape, a nonparallel growth orientation, indistinct margins, angular contours, microcalcifications, color Doppler flow and ES score on US imaging were significantly related to breast cancer in dense breasts (P=0.001; P=0.001; P=0.008; P

Rectus sheath hematomas can occur due to nontraumatic increases in abdominal pressure from respiratory disease such as chronic obstructive pulmonary disease (COPD). This case study describes a 59-year-old male who was on dual antiplatelet therapy after a right coronary percutaneous intervention for acute coronary syndrome. He developed abdominal pain and ecchymosis on dual antiplatelets and was found to have a rectus sheath hematoma. The hematoma resolved with conservative care and did not require surgical intervention. The etiology of rectus sheath hematoma is thought to be due to coughing spells from chronic obstructive pulmonary disease exacerbation while taking dual antiplatelet therapy. Cases of rectus sheath hematomas continue to emerge in the literature with similar patient histories, and we should be cognizant of this possible complication in patients with chronic coughing.

The hemangioma is the most common solid lesion of the liver. Therefore, radiologists must know the typical and atypical imaging findings of this lesion in order to reach a correct diagnosis and avoid diagnostic errors. However, only few papers have comprehensively described the entire spectrum of atypical and uncommon imaging features. In this updated review, we provide the imaging features of hepatic hemangioma, in both typical and atypical forms, as well as its association with abnormalities in the adjacent hepatic parenchyma and other hepatic lesions, and its complications.

Purpose To develop and evaluate the accuracy of a three-dimensional (3D) US method for assessing unilateral breast reconstruction and discuss the feasibility of breast ultrasound 3D reconstruction of the unilateral breast compared with 3D MRI. Methods Sixty-four breast lesions were collected for surgical resection. (1) MRI and US imaging were used to reconstruct the 3D models of the breast neoplasm. The diameters for maximum length, width, and depth of the negative tumor margins were used as the primary standards for comparison. (2) The measurement direction was determined by the largest gravity change between the two body positions. (3) The vertical distance from the midpoint of breast neoplasm to the ipsilateral nipple was calculated via MRI and US reconstruction. Results (1) Comparison of the measured size and histopathology of the breast neoplasm showed that US, MRI, and histopathology were highly correlated (p 0.05). Conclusions We have presented a novel US 3D reconstruction method for evaluating tumor size, which can provide a basis for investigated advanced visualization techniques for assessing breast tissue such as holographic presentation of 3D image data. These methods can provide physicians with a novel approach for making accurate surgical plans, for better communication with patients, and for more effective navigating throughout the operation.

Purpose of Review To highlight the potential uses and applications of imaging in the assessment of the most common and relevant musculoskeletal (MSK) manifestations in systemic lupus erythematosus (SLE). Recent Findings Ultrasound (US) and magnetic resonance imaging (MRI) are accurate and sensitive in the assessment of inflammation and structural damage at the joint and soft tissue structures in patients with SLE. The US is particularly helpful for the detection of joint and/or tendon inflammation in patients with arthralgia but without clinical synovitis, and for the early identification of bone erosions. MRI plays a key role in the early diagnosis of osteonecrosis and in the assessment of muscle involvement (i.e., myositis and myopathy). Conventional radiography (CR) remains the traditional gold standard for the evaluation of structural damage in patients with joint involvement, and for the study of bone pathology. The diagnostic value of CR is affected by the poor sensitivity in demonstrating early structural changes at joint and soft tissue level. Computed tomography allows a detailed evaluation of bone damage. However, the inability to distinguish different soft tissues and the need for ionizing radiation limit its use to selected clinical circumstances. Nuclear imaging techniques are valuable resources in patients with suspected bone infection (i.e., osteomyelitis), especially when MRI is contraindicated. Finally, dual energy X-ray absorptiometry represents the imaging mainstay for the assessment and monitoring of bone status in patients with or at-risk of osteoporosis. Summary Imaging provides relevant and valuable information in the assessment of MSK involvement in SLE.

Noninvasive anatomical and functional imaging has become an essential tool to evaluate tissue oxygen saturation dynamics in preclinical or clinical studies of hypoxia. Our dual-wavelength technique for photoacoustic (PA) imaging based on the differential absorbance spectrum of oxyhemoglobin (oxy-Hb) and deoxyhemoglobin (deoxy-Hb) can quantify tissue oxygen saturation using the intrinsic contrast property. PA imaging of tissue oxygen saturation can be used to monitor tumor-related hypoxia, which is a particularly relevant functional parameter of the tumor microenvironment that has a strong influence on tumor aggressiveness. The simultaneous acquisition of anatomical and functional information using dual-modality ultrasound (US) and PA imaging technology enhances the preclinical applicability of the method. Here, the developed dual-modality US/PA system was used to measure relative tissue oxygenation using the dual-wavelength technique. Tissue oxygen saturation was quantified in a pancreatic tumor mouse model. The differences in tissue oxygenation were detected by comparing pancreatic samples from normal and tumor-bearing mice at various time points after implantation. The use of an in vivo pancreatic tumor model revealed changes in hypoxia at various stages of tumor growth. The US/PA imaging data positively correlated with the results of immunohistochemical staining for hypoxia. Thus, our dual-modality US/PA imaging system can be used to reliably assess and monitor hypoxia in pancreatic tumor mouse models. These findings enable the use of a combination of US and PA imaging to acquire anatomical and functional information on tumor growth and to evaluate treatment responses in longitudinal preclinical studies.

The most important role of ultrasound (US) in the management of gallbladder (GB) lesions is to detect lesions earlier and differentiate them from GB carcinoma (GBC). To avoid overlooking lesions, postural changes and high-frequency transducers with magnified images should be employed. GB lesions are divided into polypoid lesions (GPLs) and wall thickening (GWT). For GPLs, classification into pedunculated and sessile types should be done first. This classification is useful not only for the differential diagnosis but also for the depth diagnosis, as pedunculated carcinomas are confined to the mucosa. Both rapid GB wall blood flow (GWBF) and the irregularity of color signal patterns on Doppler imaging, and heterogeneous enhancement in the venous phase on contrast-enhanced ultrasound (CEUS) suggest GBC. Since GWT occurs in various conditions, subdividing into diffuse and focal forms is important. Unlike diffuse GWT, focal GWT is specific for GB and has a higher incidence of GBC. The discontinuity and irregularity of the innermost hyperechoic layer and irregular or disrupted GB wall layer structure suggest GBC. Rapid GWBF is also useful for the diagnosis of wall-thickened type GBC and pancreaticobiliary maljunction. Detailed B-mode evaluation using high-frequency transducers, combined with Doppler imaging and CEUS, enables a more accurate diagnosis.

Primary Sjogren’s syndrome (SS) is a systemic autoimmune chronic inflammatory disease with predominant involvement of the exocrine glands, particularly the salivary glands (SGs). The role of salivary glands ultrasound (SGUS) in the work-up of patients with primary Sjogren syndrome (SS) is progressively increasing due to its useful support in diagnosis and follow-up as a widely available, repeatable, non-invasive and safe technique. Although SGUS is not yet included in the dominant primary SS classification, several studies supported its inclusion in the American College of Rheumatology/European League Against Rheumatism criteria. In this context, a novel imaging technique, ultra-high frequency ultrasound (UHFUS), is being explored. Compared to the frequencies used in conventional ultrasound (US) (up to 22 MHz), UHFUS operates with higher frequencies (30–100 MHz) allowing for outstanding image resolution, up to 30 µm. UHFUS permits the scan of both major and minor SGs, opening new avenues for the integration of tissue and imaging biomarkers. Although further studies are needed to confirm its role, this novel imaging technique might lead to several potential improvements, including earlier diagnosis, reduction of unnecessary and inadequate biopsies and better management and follow-up of patients with primary SS.

Lipoblastoma is a rare and benign tumour arising from embryonal fat cells, predominantly diagnosed in children younger than 3 years old. The most frequent locations are the extremities and trunk, while the head and neck areas are more rarely affected (10–15% of total cases). Clinically, the most common presentation is a fast-growing painless mass. Ultrasound is the first-line imaging examination, but Magnetic Resonance Imaging (MRI) allows for better definition of the relationships with the adjacent vascular and muscular structures. It can help to identify the lipomatous components, and it is useful for preoperative planning. However, the definitive diagnosis is provided by histopathological examination. Complete surgical excision is the first-line treatment, with a good prognosis in case of total eradication. We report the case of a 7-month-old male child with a rapidly growing mass that had typical radiological features of lipoblastoma.

Background and Objective: In the first trimester of pregnancy, fetal growth, and abnormalities can be assessed using the exact middle sagittal plane (MSP) of the fetus. However, the ultrasound (US) image quality and operator experience affect the accuracy. We present an automatic system that enables precise fetal MSP detection from three-dimensional (3D) US and provides an evaluation of its performance using a generative adversarial network (GAN) framework. Method: The neural network is designed as a filter and generates masks to obtain the MSP, learning the features and MSP location in 3D space. Using the proposed image analysis system, a seed point was obtained from 218 first-trimester fetal 3D US volumes using deep learning and the MSP was automatically extracted. Results: The experimental results reveal the feasibility and excellent performance of the proposed approach between the automatically and manually detected MSPs. There was no significant difference between the semi-automatic and automatic systems. Further, the inference time in the automatic system was up to two times faster than the semi-automatic approach. Conclusion: The proposed system offers precise fetal MSP measurements. Therefore, this automatic fetal MSP detection and measurement approach is anticipated to be useful clinically. The proposed system can also be applied to other relevant clinical fields in the future.

Kidney cysts are quite common in adults. Though small simple renal cysts in an adult over 30-40 years of age are not too unusual, however, if the same cysts are seen in a child, and especially if there are additional findings, then several diagnostic possibilities may come to mind. The role of ultrasound, together with the help of intravenous contrast agents and Doppler mode, are very critical in describing the morphologic features and follow-up of the complex or multiple and bilateral renal cysts. These sonographic signs are occasionally specific for diagnosis, but in many cases sonographic clues should be evalu-ated together with the other genetic and clinical data to reach diagnosis. The first part of this pictorial essay included the introduction into the subject and the classification of non-genetic cystic renal diseases. The key features for the non-genetic cystic renal diseases are illustrated. In the second part, eye-catching fea-tures of genetic cystic renal diseases are demonstrated., NA

Background To compare the differences in the diagnosis of retroperitoneal tumors among multi-slice spiral computed tomography (MSCT), magnetic resonance imaging (MRI), and ultrasound (US). Methods Sixty cases of retroperitoneal tumors admitted in our hospital from January 2016 to January 2019 were collected and related data were analyzed. After admission, patients were examined by MSCT, MRI, and US, and the pathological results of the patients were used as the controls. The differences in the diagnosis of retroperitoneal tumors were compared with the results of MSCT, MRI, and US. Results Thirteen cases of benign tumors were diagnosed by MSCT, 47 cases were malignant, and 1 case was false benign, with diagnosis accuracy, sensitivity and specificity of 98.33%, 97.92% and 92.30%, respectively. Thirteen cases of benign tumors were diagnosed by MRI, 47 cases of malignant tumors, and 1 case was false benign, with diagnosis accuracy, sensitivity and specificity of 98.33%, 97.92%, and 92.30%, respectively. Fourteen cases of benign tumor were diagnosed by US, 46 cases were malignant, and 2 cases was false benign, with diagnosis accuracy, sensitivity and specificity of 96.67%, 97.92%, and 85.71%, respectively. There were no statistically significant differences in the accuracy, sensitivity, and specificity of MSCT, MRI, and US in the diagnosis of retroperitoneal tumors (P>0.05). Conclusions MSCT, MRI, and US tests are highly accurate, sensitive, and specific in the diagnosis of retroperitoneal tumors.

Background This article discusses the importance of high frequency ultrasonography in detection of different types of thyroid nodules considering only the histopathological examination of the surgical specimens as the final diagnosis. We studied 50 patients referred to ENT clinic with a thyroid nodule. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy were done to all the patients. Thyroid surgery was done according to FNAB results. Result From 50 thyroid specimens, the US could predict the malignancy in 18 specimens. By histopathology, only 16 specimens were malignant, and 34 were benign thyroid disease. The sensitivity, specificity, and accuracy of US were 100%, 94.12%, and 96% respectively. The most suspicious ultrasongraphic feature was microcalcification followed by taller than wider (T ˃ W). Conclusion High frequency ultrasound is a very important tool to predict the malignant possibility during thyroid nodule evaluation.

The seminal vesicles are paired organs of the male reproductive tract, which produce and secrete seminal fluid. Although congenital anomalies of seminal vesicles are usually asymptomatic, they may lead to various urogenital symptoms, including infertility. Due to their embryologic relationship with other urogenital organs, congenital anomalies of seminal vesicles may accompany other urinary or genital anomalies. Congenital anomalies of seminal vesicles include agenesis, hypoplasia, duplication, fusion, and cyst. These anomalies can be diagnosed with various imaging techniques. The main purpose of this article is to summarise imaging findings and clinical importance of congenital anomalies of seminal vesicles with images of some rare and previously unreported anomalies.

Skopowska Agnieszka, Biernacki Maciej, Dekowska Monika, Łukowicz Małgorzata, Sielski Łukasz, Filarecka Agnieszka. Therapeutic procedures in shoulder impingement syndrome (SIS) for professionally active people: randomized research..Journal of Education, Health and Sport. 2018;8(02):26-42. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1164269 http://ojs.ukw.edu.pl/index.php/johs/article/view/5246 https://pbn.nauka.gov.pl/sedno-webapp/works/852438 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26.01.2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2018; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.12.2017. Revised: 15.12.2017. Accepted: 01.02.2018. Therapeutic procedures in shoulder impingement syndrome (SIS) for professionally active people: randomized research Agnieszka Skopowska1, Maciej Biernacki2, Monika Dekowska3, MałgorzataŁukowicz4, Łukasz Sielski5, Agnieszka Filarecka6 1 Collegium Medicum, UMK Bydgoszcz, Department of Laser Therapy and Physiotherapy 2 Collegium Medicum, UMK Bydgoszcz, Department of Anatomy 3 UKW Bydgoszcz , The Institute of Psychology 4 AWF Warsaw, Department of Rehabilitation 5 Collegium Medicum, UMK Bydgoszcz, Department of Midwifery 6 Collegium Medicum, UMK Bydgoszcz, Department of Oncological Surgery ABSTRACT Objectives. Pain and limitation of motions in the glenohumeral joint are frequently the consequence of the shoulder impingement syndrome (SIS). Misdiagnosis or improper treatment of the illness may effect in a serious functional impairment of the upper limb. The treatment, dependent on the medical condition, involves: rest, NSAID therapy, physiotherapy as well as kinesitherapeutic procedures. The aim of the research was to conduct a detailed diagnosis of the shoulder impingement syndrome and the efficacy assessment of the matched rehabilitating procedures considering the symptoms. Material and methods. The research was conducted in 39 people aged 30 to 81 treated for SIS. 85% of the respondents were professionally active. In order to assess the efficacy of the therapy the following were carried out: the pain assessment test, functional tests (Neer’s, Ludington’s, Hawkins’, Apley’s, Job’s and the active painful arc test) as well as measurements of the active range of motion of the joint. The patients were subjected to two kinds of physiotherapy – ultrasound therapy (US) procedures and the short wave diathermy (SWD), both connected with procedures aiming at mobilization of the shoulder complex and off-load exercises. The outcome was submitted to statistical analysis. Results. The results obtained in both groups of patients were compared via the Mann-Whitney U test. No significant differences between the SWD and the US groups in the efficacy of the conducted procedures were observed. The data analysis within therapeutic groups revealed the existence of significant differences (p Conclusions. The outcome of both conducted therapies in both research groups included: decrease in pain, increase in the range of motions of the glenohumeral joint and improved function of the upper limb. Both procedures may be successfully employed in the treatment of SIS in professionally active people. Key words: Shoulder Impingement Syndrome (SIS), Ultrasound (US), Manual Therapy, Short Wave Diathermy (SWD), VAS

Intensity-modulated radiotherapy (IMRT) has become the standard radiotherapy technology utilized for the treatment of prostate cancer, as it permits the delivery of highly conformal radiation dose distributions. Image-guided radiotherapy (IGRT) is an essential companion to IMRT that allows the treatment team to account for daily changes in target anatomy and positioning. In the present review, we will discuss the different sources of geometric uncertainty and review the rationale behind using IGRT in the treatment of prostate cancer. We will then describe commonly employed IGRT techniques and review their benefits and drawbacks. Additionally, we will review the evidence suggesting a potential clinical benefit to utilizing IGRT.

Purpose To investigate the imaging features of emerging COVID-19 pneumonia on chest ultrasound (US), radiographs (CXR) and computed tomography (CT) examinations performed at admission and to provide a comprehensive radiological literature review on ongoing radiological data from recent publications. Materials and methods In this retrospective single-center study, we enrolled consecutive patients from February 15, 2020, to March 15, 2020, with laboratory-confirmed SARS-CoV-2 hospitalized in Valduce Hospital (Como, Italy). Multi-modality imaging findings were evaluated and compared. Literature research was conducted through a methodical search on Pubmed and Embase databases. Results Fifty-eight patients (36 men, 22 women; age range, 18–98 years) were included in the study. Among these, chest US, CXR, and CT were performed respectively in twenty-two, thirty-two and forty-two patients. Lung US findings were consistent with diffuse B lines (100%) and subpleural consolidations (27.3%). CXR showed prevalent manifestations of consolidations (46.9%) and hazy increased opacities (37.5%). Typical CT features included bilateral and multilobar ground-glass opacities (GGO) with (59.5%) and without (35.7%) consolidations having a predominantly peripheral distribution (64.3%). Other imaging features included crazy paving pattern (57.1%), fibrous stripes (50%), subpleural lines (35.7%), architectural distortion (28.6%), air bronchogram sign (26.2%), vascular thickening (23.8%) and nodules (2.4%). Also, enlarged lymph nodes (14.3 %) and pleural effusion (7.1%) were observed. The literature review identified twenty-six original studies supporting our imaging chest findings. Conclusion The spectrum of chest imaging manifestations of COVID-19 pneumonia upon admission includes B-lines and consolidations on US, consolidations and hazy increased opacities on CXR, and multifocal GGO with consolidations on CT.

Purpose Acute epiploic appendagitis (EA) is a relatively rare, benign and local inflammatory disease involving the epiploic appendices. Unlike its mimics, EA is generally a self-limiting inflammatory disease and can be treated conservatively. Case presentation A 33-year-old Caucasian man presented to our emergency department with a sever and sharp left iliac fossa pain. He underwent abdominal X-ray, ultrasound (US) and computed tomography (CT) evaluations. Conclusion We illustrate US and CT findings to increase the radiologists' awareness of this condition and to avoid diagnostic delay and unnecessary use of antibiotics, hospitalization and surgery.

Introduction Interprofessional collaboration (IPC) increases patient safety. IPC is learned through task-based exercises, such as ultrasound (U/S)-guided arterial lines. We set out to teach U/S-guided arterial lines as a framework to improve IPC between emergency medicine and neurosurgery residents. The objectives of the study were to provide a U/S session to teach the proper arterial line placement technique, to assess post-workshop arterial line placement competency and attitude toward U/S for procedural guidance, and to improve interdepartmental relationships through IPC. Methods The course was completed in 2018 and consisted of pre-workshop assignments, the workshop, a competency assessment, and a post-workshop survey for neurosurgical residents. After a didactic and hands-on training session, trainees completed a simulated U/S-guided arterial line placement. Trainees then completed a post-workshop assessment. Results There were a total of 21 participants out of 24 total residents, an 87.5% participation rate. Prior to the workshop, on a 5-point Likert scale, where 1 is not at all likely and 5 is very likely, the residents reported they would use U/S 1.7/5, with 57% of respondents answering 1 out of 5. After the workshop, on the same Likert scale, the residents reported using U/S first 3.6/5 (P < 0.05) with 52% of the respondents answering 4 out of 5. After the course, the belief that the landmark technique is non-inferior decreased to 28.6% of respondents. Conclusions The overall goal of this workshop was to improve patient care through continuing education. Using IPC as the framework, the workshop significantly increased the reported likelihood of using U/S for arterial line placement.

Background The aim of this study was to evaluate the clinical reliability of ultrasound (US) examination using relative laryngeal movement of 40% as a cutoff point to diagnose pharyngeal abnormalities of swallowing using ultrasonographic examination in dysphagic cerebral palsy (CP) patients and comparing its results with a flexible fiberoptic endoscope. Methods Twenty-five cerebral palsy children suffering from clinical dysphagia were included in this study. The rest distance between the thyroid cartilage and the hyoid bone and the shortest distance between them during swallowing were measured by ultrasound, then the approximation distance and the percentage of relative laryngeal movement were calculated. All children also have been submitted for flexible fiberoptic endoscopy (FEES). Results The mean value of the percentage of relative laryngeal movement was significantly less in the CP children with pharyngeal phase abnormality diagnosed by the flexible fiberoptic endoscope (p

Non-invasive longitudinal imaging of osseointegration of bone implants is essential to ensure a comprehensive, physical and biochemical understanding of the processes related to a successful implant integration and its long-term clinical outcome. This study critically reviews the present imaging techniques that may play a role to assess the initial stability, bone quality and quantity, associated tissue remodelling dependent on implanted material, implantation site (surrounding tissues and placement depth), and biomarkers that may be targeted. An updated list of biodegradable implant materials that have been reported in the literature, from metal, polymer and ceramic categories, is provided with reference to the use of specific imaging modalities (computed tomography, positron emission tomography, ultrasound, photoacoustic and magnetic resonance imaging) suitable for longitudinal and non-invasive imaging in humans. The advantages and disadvantages of the single imaging modality are discussed with a special focus on preclinical imaging for biodegradable implant research. Indeed, the investigation of a new implant commonly requires histological examination, which is invasive and does not allow longitudinal studies, thus requiring a large number of animals for preclinical testing. For this reason, an update of the multimodal and multi-parametric imaging capabilities will be here presented with a specific focus on modern biomaterial research.

Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in the United States of America and globally. Carotid arterial plaque, a cause and also a marker of such CVD, can be detected by various non-invasive imaging modalities such as magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound (US). Characterization and classification of carotid plaque-type in these imaging modalities, especially into symptomatic and asymptomatic plaque, helps in the planning of carotid endarterectomy or stenting. It can be challenging to characterize plaque components due to (I) partial volume effect in magnetic resonance imaging (MRI) or (II) varying Hausdorff values in plaque regions in CT, and (III) attenuation of echoes reflected by the plaque during US causing acoustic shadowing. Artificial intelligence (AI) methods have become an indispensable part of healthcare and their applications to the non- invasive imaging technologies such as MRI, CT, and the US. In this narrative review, three main types of AI models (machine learning, deep learning, and transfer learning) are analyzed when applied to MRI, CT, and the US. A link between carotid plaque characteristics and the risk of coronary artery disease is presented. With regard to characterization, we review tools and techniques that use AI models to distinguish carotid plaque types based on signal processing and feature strengths. We conclude that AI-based solutions offer an accurate and robust path for tissue characterization and classification for carotid artery plaque imaging in all three imaging modalities. Due to cost, user-friendliness, and clinical effectiveness, AI in the US has dominated the most.

Acute kidney injury (AKI) is characterized by a rapid loss of kidney excretory function. Ultrasound (US) helps nephrologists in AKI diagnosis, in order to describe and follow kidney alterations and find possible causes of AKI. US is a safe, non-invasive, and repeatable imaging technique. Approximately 70% of community-acquired cases of AKI are due to pre-renal causes. Acute tubular necrosis (ATN) is the most common type of AKI related to parenchymal damage. Conventional US shows enlarged kidneys with hypoechoic pyramids. Although the role of color Doppler in AKI is still debated, many studies demonstrate that renal resistive indexes (RI) vary on the basis of primary disease. Moreover, several studies assessed that higher RI values are predictive of persistent AKI. Acute interstitial nephritis is also a frequent cause of AKI and conventional US does not allow a definitive diagnosis. Kidneys appear enlarged and widely hyperechoic. Also in this condition, hemodynamic changes are closely correlated to the severity and the progression of the anatomical damage. Renal artery and vein thrombosis may also cause parenchymal AKI. Acute renal infarction is a rare pathological condition due to clots or cholesterol aggregates that occlude renal artery or its branches. Renal vein thrombosis may be primary or secondary to retroperitoneal neoplasm or inflammatory diseases. Color Doppler US can detect thrombus within the lumen and document the absence of venous flow. The incidence of AKI related to urinary tract obstruction is low. It occurs in bilateral renal or lower urinary tract obstruction or in ureter obstruction in patients with a single functioning kidney or with pre-existing chronic kidney disease. Conventional US has a high sensitivity (>95%), but low specificity (

Entrapment neuropathies constitute a significant albeit still neglected problem in athletes. Currently available diagnostic options in patients with suspected neuropathies, nerve conduction studies, and magnetic resonance imaging have some drawbacks, mostly related to their invasive character, high cost, and limited availability. This paper reviews published articles documenting the use of ultrasound elastography, a novel technique to determine tissue strain, in the evaluation of nerve stiffness in entrapment neuropathy, and it discusses potential pros and cons of this method in the examination of elite athletes. Based on the review of literature, ultrasound elastography – especially shear wave elastography – seems suitable for the evaluation of entrapment neuropathies in elite athletes. Published evidence from the general population suggests that most common entrapment neuropathies (carpal tunnel syndrome, ulnar neuropathy of the elbow, ulnar tunnel syndrome) are associated with a significant increase in the stiffness of affected nerves, which can be accurately detected with ultrasound elastography. Before adding ultrasound elastography to the armamentarium of diagnostic tests used routinely in athletes, its accuracy in the detection of entrapment neuropathies needs to be verified in this specific group, and the reference values for peripheral nerve strain in sportspersons need to be determined.

Assessing the risk of malignancy in the thyroid with ultrasound (US) is crucial in patients with nodules, as it can aid in selecting those who should have a fine-needle aspiration (FNA) biopsy performed. Many studies have examined whether the US characteristics of thyroid nodules are useful indicators of histological malignancy. Overall, these investigations have identified a few US features that are significantly more frequent in malignant thyroid nodules which can be coalesced into a defining set to be used as an indicator of a higher risk of malignancy. Despite these efforts, none of these classifications have been widely adopted worldwide, and there are still conflicting recommendations from different institutions. Understanding the role and appropriate utilization of these systems could facilitate the effective interpretation and communication of thyroid US findings among referring physicians and radiologists. In this comprehensive review, we outline the major US classification systems of thyroid nodules published in the last few years.

Purpose: To compare the performance US and MR in identifying placental adhesion spectrum (PAS) in placenta previa (PP) and to establish a potential method of image interpretation. Methods: US and MR examinations of 51 patients with PP were selected. The presence of imaging signs commonly used to detect PAS was assessed. Penalized logistic regression was performed considering histology as standard of reference; only signs statistically significant (p < 0.05) were considered for ROC and multivariate analysis. The probability of PAS according to the presence of US and/or MR signs was then assessed. Results: At univariate analysis, loss of retroplacental clear space, myometrial thinning (MT) and placenta lacunar spaces on US, intraplacental dark bands (IDBs), focal interruption of myometrial border (FIMB) and abnormal vascularity (AV) on MR were statistically significant (p < 0.01). Three diagnostic methods for PAS were then developed for both US and MR when at least one (Method 1), two (Method 2) or three (Method 3) imaging signs occurred, respectively. Method 2 for MR showed a significantly (p < 0.05) higher accuracy (91%) compared to the other methods. When MR IDBs and AV as well as IDBs and FIMB were present in combination with US MT the probability of PAS increased from 75 to 90% and from 80 to 91%, respectively. Conclusion: MR demonstrated a higher diagnostic accuracy than US to detect PAS. However, since the combination of MR and US signs could improve the probability to detect PAS, a complementary diagnostic role of these techniques could be considered.

Introduction. Doctors of various specialties – endocrinologists, endocrine surgeons, oncologists – pay much attention to the choice of tactics of treatment of small focal forms of thyroid gland. However, despite the tangible progress, the transition to a molecular or genetic level of the diagnosis is a reality of the next decades, but today we should not underestimate the need to improve the existing diagnostic methods. Aim. To find out the informativeness of preoperative examinations and causes of diagnostic errors in patients with thyroid nodes ≤ 1.0 cm. Materials and methods. A retrospective analysis of information from out-patient cards, history of diseases and protocols of operations of randomly selected 1 266 patients operated on thyroid lesions (thyroid nodules up to 1.0 cm) in the surgical department of the Kyiv Regional Clinical Hospital N 1 in 2009-2014 was conducted. The results of the pathomorphological, cytological and ultrasound findings were compared, the sensitivity and specificity of the ultrasound examination and the fine needle aspiration biopsy using the ultasound in a diagnosis of the subsantimetric thyroid nodes, including microcarcinoma were evaluated. The frequency of the erroneous results of the histological and ultrasound diagnostics of the thyroid microcarcinoma were determined. Results. Sensitivity and specificity of commonly used diagnostic methods of thyroid ultrasonography and thyroid gland with the following cytological examination are 73.9, 79.5 and 71.9 and 83.9% respectively, and therefore can not be applied separately for the verification of small thyroid glands. The reason for the diagnostic errors, in our opinion, in each case is a separate, rather than a comprehensive analysis of the results of the survey. Obtaining the informative material from the patients with the nodes less than 1 cm in diameter in the thyroid gland, depends on the concerted actions of the doctor of ultrasound and the surgeon, as well as the correct choice of nodes, which need to point out first. Conclusions. Today, for the early diagnosis of thyroid cancer in sub-arterial nodes, a comprehensive evaluation of the results of ultrasound scans and an aiming thin-blooded aspiration biopsy with the subsequent cytological study of the material are most optimal.

Purpose The purpose of this review is to illustrate and discuss the seldom used technique of three-dimensional (3D) saline infusion sonohysterography (SIS) based on instillation of sterile saline through a catheter into the uterus under real-time vaginal transducer observation for assessment of the endometrial cavity. Material and methods The cases for this pictorial review were selected from the imaging material collected at the Ultrasound Unit, Clinical Imaging Department, Women's Hospital of Hamad Medical Corporation during a seven-year period from 2011 to 2017. This was a retrospective collection of 216 consecutive cases that underwent two-dimensional (2D) and 3D SIS for evaluation of the uterine cavity, followed by verification of results with histopathology. An open-sided speculum is inserted into the vagina. An intrauterine catheter is then threaded into the endometrial cavity. After that, the speculum is removed carefully, and a vaginal transducer is inserted. Using a 60-ml syringe attached to the catheter, saline solution is instilled under direct real-time observation (2D SIS). Subsequently, reconstruction of the three-dimensional anatomy of the intrauterine cavity is performed. Pictorial review The review presents the most common indication for SIS, like abnormal bleeding in pre- and postmenopausal patients. SIS allows us to distinguish between focal lesions and global endometrial thickening. SIS should be supported as a second-line diagnostic procedure for abnormal uterine bleeding, when findings from transvaginal ultrasound are inconclusive. Conclusions The addition of 3D techniques to SIS procedure helps in the distinction between endometrial and myometrial lesions, also it facilitates delineation of uterine anatomy, resulting in more precise and accurate diagnosis.

Prevention of hemarthrosis is the key factor in the adequate management of people with hemophilia (PWH). If hemarthrosis occurs, early diagnosis of joint damage is essential to make personalized treatments. This study is aimed at gaining an understanding of the ability of point-of-care ultrasound (US) using the `Hemophilia Early Arthropathy Detection with Ultrasound´ (HEAD-US) protocol to detect abnormalities in joints without history of hemarthrosis and clinically asymptomatic joints of PWH.The sample included 976 joints from 167 PWH (mean age 24.86 years). Data were collected from routine practice over a 3-year period and analyzed based on history of hemarthrosis and results of clinical (HJHS 2.1) and HEAD-US examinations.In our series, 14% of patients exhibited HEAD-US signs of incipient arthropathy in joints with no history of bleeding and with a HJHS 2.1 score of 0. The most severely involved joint was the right ankle. Synovitis, articular cartilage and subchondral bone damage scores in joints with subclinical findings were slower than in joints with previous hemarthroses or HJHS 2.1 1 Conclusions: Our study demonstrates that HEAD-US is better than hemarthrosis records and the HJHS 2.1 scale in detecting the early signs of joint damage in PWH.

Persistent urogenital sinus (PUGS) is a congenital pathological condition characterized by an abnormal communication between the urethra and vagina, which has an estimated incidence of 0.6/10,000 female births. It could be the only known malformation or part of a syndrome. PUGS is commonly shown by a pelvic mass, related to a distended bladder, hydrometrocolpos which is due to an obstruction leading to the dilation of the vagina and uterus (i.e., imperforate hymen, transverse vaginal septum or atresia, and PUGS) or both. We present a case of female patient with classical congenital adrenal hyperplasia, diagnosed on the 7th day of life, with ambiguous genitalia, untreated surgically only with hormone therapy by parental decision. The patient, at the age of 5 years and 5 months, came to our observation for a pelvic ultrasound, which revealed retrovesical neoformation with anechoic content and regular walls. We performed the ultrasound examination that showed the dilation of the cervix and the vaginal canal with anechoic finely corpuscolated content in the declining portion, compatible with hydrometrocolpos from probable persistence of the urogenital sinus. The voiding cystourethrography (VCUG) confirmed the ultrasound diagnosis, with evidence of urogenital sinus. In conclusion, ultrasound is the first diagnostic tool, but need to be completed by other technical procedures, which VCUG or magnetic resonance imaging to observe the site of fusion of the urinary and genital tract. © 2018, Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).

This paper presents the evaluation results of the methods submitted to Challenge US: Biometric Measurements from Fetal Ultrasound Images, a segmentation challenge held at the IEEE International Symposium on Biomedical Imaging 2012. The challenge was set to compare and evaluate current fetal ultrasound image segmentation methods. It consisted of automatically segmenting fetal anatomical structures to measure standard obstetric biometric parameters, from 2D fetal ultrasound images taken on fetuses at different gestational ages (21 weeks, 28 weeks, and 33 weeks) and with varying image quality to reflect data encountered in real clinical environments. Four independent sub-challenges were proposed, according to the objects of interest measured in clinical practice: abdomen, head, femur, and whole fetus. Five teams participated in the head sub-challenge and two teams in the femur sub-challenge, including one team who tackled both. Nobody attempted the abdomen and whole fetus sub-challenges. The challenge goals were two-fold and the participants were asked to submit the segmentation results as well as the measurements derived from the segmented objects. Extensive quantitative (region-based, distance-based, and Bland-Altman measurements) and qualitative evaluation was performed to compare the results from a representative selection of current methods submitted to the challenge. Several experts (three for the head sub-challenge and two for the femur sub-challenge), with different degrees of expertise, manually delineated the objects of interest to define the ground truth used within the evaluation framework. For the head sub-challenge, several groups produced results that could be potentially used in clinical settings, with comparable performance to manual delineations. The femur sub-challenge had inferior performance to the head sub-challenge due to the fact that it is a harder segmentation problem and that the techniques presented relied more on the femur's appearance.

Photoacoustic (PA) imaging is an attractive technology for imaging biological tissues because it can capture both functional and structural information with satisfactory spatial resolution. Current commercially available PA imaging systems are limited by their bulky size or inflexible user interface. We present a new handheld real-time ultrasound/photoacoustic imaging system (HARP) consisting of a detachable, high-numerical-aperture (NA) fiber bundle-based illumination system integrated with an array-based ultrasound (US) transducer and a data acquisition platform. In this system, different PA probes can be used for different imaging applications by switching the transducers and the corresponding jackets to combine the fiber pads and transducer into a single probe. The intuitive user interface is a completely programmable MATLAB-based platform. In vitro phantom experiments were conducted to test the imaging performance of the developed PA system. Furthermore, we demonstrated (1) in vivo brain vasculature imaging, (2) in vivo imaging of real-time stimulus-evoked cortical hemodynamic changes during forepaw electrical stimulation, and (3) in vivo imaging of real-time cerebral pharmacokinetics in rats using the developed PA system. The overall purpose of this design concept for a customizable US/PA imaging system is to help overcome the diverse challenges faced by medical researchers performing both preclinical and clinical PA studies.

Necrotizing enterocolitis (NEC) is an inflammatory process, characterized by intestinal necrosis of variable extension, leading to perforation, generalized peritonitis and death. The classical pathogenetic theory focuses on mucosal damage related to a stress induced intestinal ischemia leading to mucosal injury and bacterial colonization of the wall. A more recent hypothesis emphasizes the role of immaturity of gastrointestinal and immune system, particularly of the premature, responsible of bowel wall vulnerability and suffering. NEC is the most common gastrointestinal emergency in the newborn, with a higher incidence in the preterm; improvement of neonatal resuscitation techniques enables the survival of premature of very low birth weight (VLBW) with prolongation of hospital stay for perinatal and neonatal care and a higher risk of NEC. Clinical presentation of NEC in newborn ranges from mild forms with moderate gastrointestinal tract disorder and that can heal spontaneously, to very serious forms with fulminant course characterized by perforation, peritonitis, sepsis, disseminated intravascular coagulation (DIC) and shock. Imaging modality in the diagnosis of NEC is historically represented by the plain-film abdominal radiographs which can be performed every 6 hours because of the rapid evolution that may occur in the patient’s clinical condition. However ultrasound (US), in recent years, is playing an increasingly important role in the evaluation of early stages of the disease as it provides images in real time of the abdominal structures being able to assess the presence and validity of peristalsis of the bowel loops, detect the thickness of the intestinal wall and the presence of minimal amounts of fluid in the peritoneal cavity. In this paper we review the pathogenesis, clinical presentation and imaging of NEC with a particular attention to the emergent role of US in the diagnosis of the disease.

1Radiology, and 2 Surgery, Gachon University Gil Hospital, Incheon 405-760, Korea Eccrine spiradenomas are rare, benign, cutaneous tumors that originate in the sweat glands. Eccrine spiradenomas in the breast are very rare and only a few cases have been reported. We report here on the case of a 47-year-old woman with superfi cial masses in the breast and these masses had gradually increased in size during follow-up. They were confi rmed to be an eccrine spiradenoma on pathologic examination. There have been a few reports about the radiologic fi ndings of eccrine spiradenomas of the breast. This is the fi rst case of an eccrine spiradenoma in the breast that was characterized by multiple imaging modalities, including mammography, ultrasonography and MRI. The lesion in our patient was fi rst diagnosed as an epidermal inclusion cyst based on the imaging fi ndings and the mass’s superfi cial location. Although the mammographic and ultrasonographic imaging fi ndings of eccrine spiradenomas and epidermal inclusion cysts are similar, the MRI fi ndings are different between epidermal inclusion cysts and eccrine spiradenomas. Eccrine spiradenomas should be considered in the differential diagnosis of cutaneous and subcutaneous lesions of the breast. Index terms: Eccrine spiradenoma; Breast; Mammography; Ultrasound (US); Magnetic resonance (MR)

The cystic lesions of the gastrointestinal (GI) tract demonstrate the various pathologic findings. Some lesions may present a diagnostic challenge because of non-specific imaging features; however, other lesions are easily diagnosed using characteristic radiologic features and anatomic locations. Cystic masses from the GI tract can be divided into several categories: congenital lesions, neoplastic lesions (cystic neoplasms, cystic degeneration of solid neoplasms), and other miscellaneous lesions. In this pictorial review, we describe the pathologic findings of various cystic lesions of the GI tract as well as the radiologic features of GI cystic lesions from several imaging modalities including a barium study, transabdominal ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging.

Percutaneous breast biopsy using vacuum-assisted biopsy (VAB) devices has many advantages over conventional percutaneous biopsy methods such as fine needle aspiration, core biopsy, or open surgical excision. VAB is fast and simple to perform, with a very low complication rate. Multiple contiguous specimens can be obtained with single insertion of a needle. The high quality specimen obtained offers accurate histologic diagnosis. It is also a recognized method of complete excision of benign lesions. In this review article, we discuss the role of VAB in breast care. We also highlight VBA techniques and provide some practical tips for performing successful ultrasound guided VAB. Also discussed are the role of VAB in complete removal of benign lesions such as fibroadenomas, comparison of the use of VAB with other biopsy devices, the advantages and disadvantages of various types of VAB devices, and new products.

Objective: The aim of this study was to determine the efficacy of the use of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) to diagnose thyroid nodules smaller than 5 mm in the maximum diameter and to evaluate pathological findings of small thyroid malignancies. Materials and Methods: From May 2007 to April 2008, we evaluated the findings of US-FNABs of small thyroid nodules less than 5 mm in the maximum diameter. The cytopathological findings were retrospectively reviewed and the diagnostic performance of the use of an US-FNAB was examined in all patients. Results: Of 201 small thyroid nodules in 180 patients, there were 162 adequate specimens (81%). Among 180 patients, 75 patients underwent thyroid surgery and 50 malignant and 33 benign nodules were identified based on a pathological examination. All small malignant thyroid nodules were identified as papillary thyroid microcarcinomas (PTMCs). There were 34 (55%) true positive, 0 (0%) false positive, 23 (37%) true negative and five (8%) false negative results for malignancy after performing a first US-FNAB in 62 surgically confirmed nodules. The sensitivity (87%), specificity (100%), positive predictive value (100%), negative predictive value (82%), accuracy (92%), false positive rate (0%) and false negative rate (8%) for an US-FNAB were determined. In 23 patients with a primary PTMC, capsular invasion (9%, 2 of 23), a perithyroidal lymph node metastasis (30%, 7 of 23), the rate of multifocality (9%, 2 of 23) and bilaterality (4%, 1 of 23) were also determined. Conclusion: An US-FNAB of thyroid nodules smaller than 5 mm in the maximum diameter is an effective diagnostic procedure.

Objective: Ultrasound-guided needle localization has been used prior to the surgical excision of nonpalpable breast lesions. The aim of the study was to assess the feasibility of the use of a saline immersion specimen ultrasound technique (immersion-US) to confirm the successful removal of breast lesions. Materials and Methods: The devised immersion-US technique was used to examine the excised tissues of 72 ultrasound-guided needle localized breast lesions of 58 patients (34 benign lesions, 30 high-risk lesions and 8 malignant lesions). Freshly excised specimens were placed in a container filled with saline and one radiologist scanned the surgically excised specimens using a high-frequency linear transducer. We evaluated successful lesion removal and the qualities of the immersion-US images. Miss rates were determined by the use of postoperative ultrasound during follow-up. Results: All 72 lesions were identified by the use of immersion-US and satisfactory or excellent quality images were obtained for most lesions (70/72, 97%). Five (7%) lesions were initially identified as incompletely excised, based on the immersion-US findings, and prompt re-excision was undertaken. Follow-up ultrasound examinations showed no residual mass in the surgical field in any patient. Conclusion: The immersion-US technique was found straightforward and efficient to perform. Immersion-US was able to determine whether nonpalpable breast lesions had been successfully excised after ultrasound-guided needle localization.

Currently, ultrasound (US), computed tomography (CT) and Magnetic Resonance imaging (MRI) represent the mainstay in the evaluation of pancreatic solid and cystic tumors affecting pancreas in 80-85% and 10-15% of the cases respectively. Integration of US, CT or MR imaging is essential for an accurate assessment of pancreatic parenchyma, ducts and adjacent soft tissues in order to detect and to stage the tumor, to differentiate solid from cystic lesions and to establish an appropriate treatment. The purpose of this review is to provide an overview of pancreatic tumors and the role of imaging in their diagnosis and management. In order to a prompt and accurate diagnosis and appropriate management of pancreatic lesions, it is crucial for radiologists to know the key findings of the most frequent tumors of the pancreas and the current role of imaging modalities. A multimodality approach is often helpful. If multidetector-row CT (MDCT) is the preferred initial imaging modality in patients with clinical suspicion for pancreatic cancer, multiparametric MRI provides essential information for the detection and characterization of a wide variety of pancreatic lesions and can be used as a problem-solving tool at diagnosis and during follow-up.

Background: The aim of this study was to evaluate the accuracy of clinical imaging of the primary breast tumour post-neoadjuvant chemotherapy (NAC) related to the post-neoadjuvant histological tumour size (gold standard) and whether this varies with breast cancer subtype. In this study, results of both magnetic resonance imaging (MRI) and ultrasound (US) were reported.Methods: Patients with invasive breast cancer were enrolled in the INTENS study between 2006 and 2009. We included 182 patients, of whom data were available for post-NAC MRI (n = 155), US (n = 123), and histopathological tumour size.Results: MRI estimated residual tumour size with Conclusions: In this study, US was at least as good as breast MRI in providing information on residual tumour size post-neoadjuvant chemotherapy. However, both modalities suffered from a substantial percentage of over- and underestimation of tumour size and in addition both showed a low negative predictive value of pathologic complete remission (Gov nr: NCT00314977).

OBJECTIVE We wanted to describe the characteristic ultrasonography (US) features and clinical findings for making the diagnosis of subacute granulomatous thyroiditis. MATERIALS AND METHODS A total of 31 lesions from 27 patients were confirmed as subacute granulomatous thyroiditis by US-guided fine needle aspiration biopsy. We analyzed the ultrasonographic findings such as the lesion's size, margin and shape, the discrepancy between length and breadth and the vascularity. The clinical findings such as acute neck pain or fever were reviewed. The follow-up clinical and ultrasonographic data were reviewed for 15 patients. RESULTS The thyroid gland was found to be enlarged in five patients, it was normal size in 20 patients and it was smaller in two patients. All the lesions had focally ill-defined hypoechogenicity. Hypervascularity was not noted in any of the lesions. Painful neck swelling was present in 18 patients. An accompanying fever was documented in nine of the 18 patients. Twelve patients showed disappearance (n = 3) or a decreased size (n = 9) of their lesions on follow-up US. CONCLUSION The presence of ill-defined hypoechoic thyroid lesions without a discrete round or oval shape is characteristic for subacute granulomatous thyroiditis, and particularly when this is associated with painful neck swelling and/or fever.

Generalized lymphangiomatosis is a rare disease that is characterized by widespread bony and soft tissue involvement of lymphangioma. Radiological evaluation is crucial because the site and extent of the lymphangioma are important prognostic factors. We reported here on three cases of generalized lymphangiomatosis and all three cases showed similar radiologic findings, but a different clinical course. The CT, US and MR images showed sharply defined, non-enhanced cystic lesions involving the mediastinum, bones, spleen, lung and lower neck. The whole body MR imaging with the short tau inversion recovery (STIR) sequence showed good capability for evaluating the extent of disease.

Background Cystic lymphangioma is a rare benign lesion derived from the detachment of the lymph sacs from venous drainage systems; the treatment of choice is a surgical excision and the final diagnosis is of histological type. Purpose To compare the results of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) in patients with cystic lymphangioma to clearly evaluate the anatomic as well as the structural lesion features necessary for differential diagnosis and for the patient treatment planning. Material and Methods We analyzed the imaging results of six patients admitted in our department to evaluate cyst-like tumor masses clinically palpable or detected by US. All the patients underwent US, CT, and MRI. The pathology reports demonstrated a mesenterial cystic lymphangioma in five cases underwent surgical resection and in the last case a chest cystic lymphangioma underwent a fine needle aspiration biopsy (FNAB). Results In all the cases, the results of US, CT, and MRI were concordant showing cyst-like tumor masses in the abdomen ( n = 5) and chest ( n = 1) ranging in size from 3.5 to 15 cm. Conclusion According to our experience, we suggest that the appropriate diagnostic imaging protocol in patients with cystic lymphangioma should initially include the US study and followed by a MRI scan with contrast administration. CT should be avoided because of radiation exposure. US and MRI may also be useful in the follow-up of patients who refuse surgical resection or in whom surgery is contraindicated or postponed as well as to early detect a possible disease relapse.

International audience; We propose a technique for myocardial motion estimation based on image registration using both B-mode echocardiographic images and tissue Doppler sequences acquired interleaved. The velocity field is modeled continuously using B-splines and the spatiotemporal transform is constrained to be diffeomorphic. Images before scan conversion are used to improve the accuracy of the estimation. The similarity measure includes a model of the speckle pattern distribution of B-mode images. It also penalizes the disagreement between tissue Doppler velocities and the estimated velocity field. Registration accuracy is evaluated and compared to other alternatives using a realistic synthetic dataset, obtaining mean displacement errors of about 1 mm. Finally, the method is demonstrated on data acquired from six volunteers, both at rest and during exercise. Robustness is tested against low image quality and fast heart rates during exercise. Results show that our method provides a robust motion estimate in these situations.

Oral administration of ultrasound contrast agents has been described very little so far in medical literature. These agents are mainly administered intravenously and, less commonly, intracavitarily. We present the case of a patient with a cervical mass in whom sonographic examination with per os administration of SonoVue led to the diagnosis of a pharyngoesophageal tumour. The diagnosis was confirmed on barium swallow and endoscopy-guided biopsy.

Background: In ultrasonic micro-devices, contrast agent micro-bubbles are known to initiate cavitation and streaming local to cells, potentially compromising cell viability. Here we investigate the effects of US alone by omitting contrast agent and monitoring cell viability under moderate-to-extreme ultrasound-related stimuli.Results: Suspended H9c2 cardiac myoblasts were exposed to ultrasonic fields within a glass micro-capillary and their viability monitored under different US-related stimuli. An optimal injection flow rate of 2.6 mL/h was identified in which, high viability was maintained (~95%) and no mechanical stress towards cells was evident. This flow rate also allowed sufficient exposure of cells to US in order to induce bioeffects (~5 sec), whilst providing economical sample collection and processing times. Although the transducer temperature increased from ambient 23 [degree sign]C to 54[degree sign]C at the maximum experimental voltage (29 Vpp), computational fluid dynamic simulations and controls (absence of US) revealed that the cell medium temperature did not exceed 34[degree sign]C in the pressure nodal plane. Cells exposed to US amplitudes ranging from 0--29 Vpp, at a fixed frequency sweep period (tsw = 0.05 sec), revealed that viability was minimally affected up to ~15 Vpp. There was a ~17% reduction in viability at 21 Vpp, corresponding to the onset of Rayleigh-like streaming and a ~60% reduction at 29 Vpp, corresponding to increased streaming velocity or the potential onset of cavitation. At a fixed amplitude (29 Vpp) but with varying frequency sweep period (tsw = 0.02-0.50 sec), cell viability remained relatively constant at tsw >= 0.08 sec, whilst viability reduced at tsw < 0.08 sec and minimum viability recorded at tsw = 0.05 sec.Conclusion: The absence of CA has enabled us to investigate the effect of US alone on cell viability. Moderate-to-extreme US-related stimuli of cells have allowed us to discriminate between stimuli that maintain high viability and stimuli that significantly reduce cell viability. Results from this study may be of potential interest to researchers in the field of US-induced intracellular drug delivery and ultrasonic manipulation of biological cells.

Intima-media thickness (IMT) is now being considered as an indicator of atherosclerosis. Our group has developed several feature-based IMT measurement algorithms such as the Completely Automated Layer EXtraction (CALEX) (which is a class of patented AtheroEdge Systems from Global Biomedical Technologies, Inc., CA, USA). These methods are based on the hypothesis that the highest pixel intensities are in the far wall of the common carotid artery (CCA) or the internal carotid artery (ICA). In this paper, we verify that this hypothesis holds true for B-mode longitudinal ultrasound (US) images of the carotid wall. This patented methodology consists of generating the composite image (the arithmetic sum of images) from the database by first registering the carotid image frames with respect to a nearly straight carotid-artery frame from the same database using: (1) B-spline-based nonrigid registration and (2) affine registration. Prior to registration, we segment the carotid-artery lumen using a level-set-based algorithm followed by morphological image processing. The binary lumen images are registered, and the transformations are applied to the original grayscale CCA images. We evaluated our technique using a database of 200 common carotid images of normal and pathologic carotids. The composite image presented the highest intensity distribution in the far wall of the CCA/ICA, validating our hypothesis. We have also demonstrated the accuracy and improvement in the IMT segmentation result with our CALEX 3.0 system. The CALEX system, when run on newly acquired US images, shows the IMT error of about 30 μm. Thus, we have shown that the CALEX algorithm is able to exploit the far-wall brightness for accurate IMT measurements.

Despite being time-consuming and observer-dependent, CDUS is a method of choice for performing and controlling dialysis shunts. It contributes to increasing the number of native AVFs and enables early detection of lesions therefore allowing quick percutaneous or surgical therapy.

Purpose We examined the relationship between portal venous velocity and hepatic-abdominal fat in patients with nonalcoholic fatty liver disease (NAFLD), using spectral Doppler ultrasonography (US) and magnetic resonance imaging (MRI). Materials and Methods In this prospective study, 35 patients with NAFLD and 29 normal healthy adults (control group) underwent portal Doppler US. The severity of hepatic steatosis in patients with NAFLD was assessed by MRI through chemical shift imaging, using a modification of the Dixon method. Abdominal (intra-abdominal and subcutaneous) fat was measured by MRI. Results The difference in portal venous velocity between the patients with NAFLD and the control group was significant (p < 0.0001). There was no correlation between the degree of abdominal or hepatic fat and portal venous velocity (p > 0.05). There were strong correlations between the hepatic fat fraction and subcutaneous adiposity (p < 0.0001), intraperitoneal fat accumulation (p = 0.017), and retroperitoneal fat accumulation (p < 0.0001). Conclusion Our findings suggest that patients with NAFLD have lower portal venous velocities than normal healthy subjects.

Objective: To report and assess the usefulness of ultrasound (US) findings foroccult fractures of growing bones.Materials and Methods: For six years, US scans were performed in childrenyounger than 15 years who were referred with trauma-related local pain andswelling of the extremities. As a routine US examination, the soft tissue, bones,and adjacent joints were examined in the area of discomfort, in addition to theasymptomatic contralateral extremity for comparison. Twenty-five occult fracturesin 25 children (age range, five months -15 years; average age, 7.7 years) wereconfirmed by initial and follow-up radiograms, additional imaging studies, andclinical observation longer than three weeks. Results: The most common site of occult fractures was the elbow (n = 9, 36%),followed by the knee (n = 7, 28%), ischium (n = 4, 16%), distal fibula (n = 3, 12%),proximal femur (n = 1, 4%), and humeral shaft (n = 1, 4%). On the retrogradereview of the routine radiographs, 13 out of the 25 cases showed no bone abnor-malities except for various soft tissue swelling. For the US findings, cortical discon-tinuity (direct sign of a fracture) was clearly visualized in 23 cases (92%) and wasquestionable in two (8%). As auxiliary US findings (indirect signs of a fracture),step-off deformities, tiny avulsed bone fragments, double-line appearance of corti-cal margins, and diffuse irregularity of the bone surfaces were identified. Conclusion: Performing US for soft tissue and bone surfaces with pain andswelling, with or without trauma history in the extremities, is important for diag-nosing occult or missed fractures of immature bones in pediatric-aged children. o diagnose occult fractures in skeletally immature children, radiographyis often insufficient because a subtle fracture is obscured by overlappingstructures and by non-perpendicular X-ray beams to the fracture line.Also, it is difficult to interpret radiographs as to whether a fracture is present or not;especially in the joint regions where growing bones are composed of unmineralizedphysis and cartilaginous ossification centers (1-4). Fractures account for 71% of thedelayed diagnoses in pediatric trauma, with the extremities having the most commoninvolvement (5). In contrast to trauma in adults, the evaluation of a pediatric patient isoften confounded by the patient’s inability to participate in the history and physicalexamination (1-3, 5). In these situations, performing ultrasound (US) is helpful for theearly diagnosis of both soft tissue and bone injuries, resulting in appropriate and timelymanagement. The high reflectivity of US at the interface between the cortical boneand peri-osseous soft tissues can delineate the bone cortical outline and adjacent softtissue changes at a fractured site (4, 6). US can be performed in young childrenwithout sedation, which is frequently required for MRI to prevent a motion artifact.Kil-Ho Cho, MD