Sonographic evaluation of the elbow in rheumatoid arthritis: a classification of joint destruction

The purpose of this study was to evaluate and classify sonographically the joint damage of the elbow in patients with rheumatoid arthritis. Standardized sonography of the elbow joint was performed in patients with rheumatoid arthritis between 1998 and 2002; from 2000 onwards in a controlled and prospective study. A grading of the joint damage was developed, evaluated and compared with the radiographic standard reference films of the Larsen classification. A total of 320 consecutive patients were included in this study; 250 elbows of 125 patients (93 women/32 men) were examined in a prospective way. Mean age was 62.5 years and mean disease duration was 11.9 years. The sonographically visible changes could be divided into six stages. In 24% of the patients graded Larsen 0, sonography detected definite abnormalities classified as stages 1 to 3. Sonography is a valuable tool to assess and classify elbow joint alteration in rheumatoid arthritis. Particularly in early stages of joint affection, ultrasound (US) is superior to X-ray in detecting soft tissue changes and minor erosions.     

Ultrasound assessment of elbow enthesitis in patients with seronegative arthropathies

Background

Enthesopathy is an evolving area for applied clinical research. MRI is the gold standard in the diagnosis of elbow joint pathology, but recent reports indicate that ultrasound imaging is more sensitive and accurate than MRI in detecting enthesopathy of the heels and knees. Too many patients are under-diagnosed and/or misdiagnosed because the early pathological changes of enthesitis in the different types of seronegative arthropathies are not detected.

Objectives

This study was undertaken to describe the ultrasound features of elbow enthesitis in patients with seronegative arthropathies.

Methods

We studied 38 diseased elbows in 38 patients with spondyloarthropathies (26 men and 12 women, mean age 32 years). All had elbow enthesopathy without typical conventional radiographic findings. Patients with histories of degenerative changes and/or local steroid injections were excluded. An HDI 3000 ATL ultrasound machine was used with a 5–12 MHz linear transducer to examine the affected elbow joints. The elbows of 10 normal healthy individuals were examined as normal controls. The patients were examined in the supine position with the elbow flexed 30°–50°. Longitudinal and transverse scans were obtained of the radiohumeral joint, the ulnahumeral joint, and the olecranon fossa. Two independent observers unaware of the clinical diagnosis read the ultrasound images and assessed the collateral ligaments, intratendinous echogenicity, tendon calcification, tendon thickness, presence of fluid, synovial proliferation, and bony changes. The reliability of the sonographic images was assessed by review of video recordings of the ultrasound examinations.

Results

Ultrasound revealed loss of the fibrillar echopattern (100 %), lack of a homogenous pattern with loss of the tightly packed echogenic dots (100 %), peritendinous edema with flaring of the tendon margins (84.2 %), irregular fusiform tendon thickening (100 %), and hyperechoic intratendinous lesions with ill-defined focal defects (18.4 %). Ultrasound also detected intratendinous calcifications of both the common extensor and common flexor tendons (52.6 %). Bony erosions were seen at the tendon insertions into the lateral epicondyles (13.15 %).

Conclusion

Ultrasonographic features of elbow enthesitis differed from those described in knee and heel enthesitis. Ultrasound clearly showed early signs of tendon calcification, tendon edema, peritendinitis, and bony entheseal erosions. However, in elbow enthesitis the early bone erosion was associated with bone marrow edema, and the common extensor tendon was diffusely thickened. Ultrasound is a reliable, reproducible bedside imaging procedure. It improves the documentation of disease activity, progression, and treatment responses in patients with spondyloarthropathies. We recommend its use for the diagnosis and post-treatment follow-up of patients with enthesitis and seronegative spondyloarthropathies.     

彩色多普勒超声对肱骨外上髁炎的诊断价值

目的利用彩色多普勒超声检查(CDUS)观察肱骨外上髁炎(LE)患者肘关节外上髁的超声表现,评价CDUS对LE的诊断价值。方法对27例临床诊断为LE患者的27个患侧肘关节和18例对照者25个正常肘关节行超声检查,观察肱骨外上髁伸肌总腱的厚度、内部回声、有无钙化、撕裂以及内部血流情况,肱骨外上髁骨质是否光整、有无毛糙,并进行对比分析。结果对照组伸肌总腱平均厚度约(0.40±0.06)cm,LE组伸肌总腱平均厚度约(0.56±0.13)cm,较对照组明显增厚,差异有统计学意义(t=-5.43,P<0.01)。病变伸肌总腱回声减低,内部可有钙化或撕裂,彩色血流信号较对照组明显增多。肱骨外上髁骨皮质回声毛糙、不光整。结论 CDUS对肱骨外上髁炎具有一定的诊断价值,在临床应用中可作为诊断肱骨外上髁炎的首选检查方法。     

Community‐Based Practice Experience of Unsuspected Breast Magnetic Resonance Imaging Abnormalities Evaluated With Second‐Look Sonography

Objective. The purpose of this study was to assess the utility and efficacy of second‐look breast sonography in the evaluation of abnormalities identified on presurgical breast magnetic resonance imaging (MRI) examinations. Methods. A retrospective review was performed of 152 presurgical breast MRI examinations having 196 unsuspected abnormalities to identify findings that underwent subsequent breast sonography. Eligible examinations had a suspicious abnormality identified on presurgical MRI and documentation of the location and size of the finding on MRI and subsequent second‐look sonography. Fourteen examinations not meeting the criteria were excluded, with 182 abnormalities remaining. Patient medical records were reviewed. Results. Seventy percent (128 of 182) of breast MRI lesions were visible at second‐look sonography; 30% (54 of 182) were sonographically occult. Ninety‐five percent (121 of 128) of sonographically visible abnormalities underwent breast biopsy. Pathologic examinations of sampled sonographically visible lesions revealed 39 cancers, 9 high‐risk lesions, 72 benign lesions, and 1 lesion not specified at surgery; 23% (9 of 128) of cancers were in the contralateral breast. Fifty‐four lesions were sonographically occult. Needle biopsy was performed for 93% (50 of 54) of occult lesions, revealing 8 cancers, 1 high‐risk lesion, and 41 benign lesions; 3 of the benign lesions did not have sufficient pathologic specimens but were benign at follow‐up. Magnetic resonance imaging guidance was used in 86% (43 of 50) of these biopsies. One contralateral cancer was identified in the sonographically occult subset. Of the 182 lesions that underwent second‐look sonography, 20% (36 of 182) had a change in management. Conclusions. Second‐look sonography has value in the evaluation of abnormalities found on breast MRI. We found enhancements in 70% (128 of 182), yielding 39 cancers.     

Clinical Application of Real-Time Sonoelastography for Evaluation of Medial Epicondylitis: A Pilot Study

The aim of this study was to evaluate the diagnostic potential of real-time sonoelastography (RSE) in medial epicondylitis by comparing clinically diagnosed patients and patients without medial elbow pain. From July 2016 to December 2017, gray-scale sonographic findings (swelling, cortical irregularity, hypo-echogenicity, calcification and tear), color Doppler findings (hyperemia) and sonoelastographic findings (elastographic grade on a 3-point visual scale and strain ratio from two regions of interest) for 63 elbows of 56 patients were compared. Twenty-four patients with 29 imaged elbows were clinically diagnosed with medial epicondylitis, and 32 patients with 34 imaged elbows had no medial elbow pain. Cortical irregularity, hypo-echogenicity, calcification, elastographic grade and strain ratio revealed significant differences (p < 0.05). Among these, strain ratio had the highest diagnostic performance (area under the curve: 0.985). Real-time sonoelastography, which can obtain both elastographic grade and strain ratio, is valuable as a supplementary tool in the diagnosis of medial epicondylitis.     

Sonographically detected subacromial/subdeltoid bursal effusion and biceps tendon sheath fluid: reliable signs of rotator cuff tear?

PURPOSE: Our purpose was to determine the association between sonographically detected subacromial/subdeltoid (SA/SD) bursal and biceps tendon sheath effusions and arthrographically proven rotator cuff tears. METHODS: Shoulder sonography reports and sonograms of 105 shoulders in 102 patients who also underwent arthrography were retrospectively reviewed for the presence of fluid within the biceps tendon sheath and SA/SD bursa. Reports and sonograms for 151 asymptomatic shoulders were also reviewed. RESULTS: Biceps tendon sheath effusion and/or bursal fluid were detected in 50 (48%) of 105 shoulders. Fifty-one patients had rotator cuff tears; 28 of them had effusions at 1 or both sites. The sensitivity, specificity, and positive predictive value (PPV) of biceps tendon sheath effusions for diagnosing rotator cuff tear were 35%, 74%, and 56%, respectively. For SA/SD bursal effusions, the sensitivity, specificity, and PPV were 8%, 94%, and 57%, respectively. For combined biceps tendon sheath and bursal effusions, the sensitivity, specificity, and PPV were 12%, 91%, and 54%, respectively. There was no statistically significant association between rotator cuff tears and effusions in the biceps tendon sheath, SA/SD bursa, or both. Among the 151 asymptomatic shoulders, 12 (7.9%) had biceps tendon sheath fluid, 5 (3.3%) had SA/SD bursal effusion, and 2 (1.3%) had both biceps tendon sheath and bursal effusions. CONCLUSIONS: The sonographic detection of intraarticular fluid, SA/SD bursal fluid, or both has a low sensitivity and PPV in the diagnosis of rotator cuff tears. Isolated intra-articular and/or SA/SD bursal effusions are not reliable signs of rotator cuff tear.     

Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow.

OBJECTIVE: Chronic tendinosis of the common extensor tendon of the lateral elbow can be a difficult problem to treat. We report our experience with sonographically guided percutaneous needle tenotomy to relieve pain and improve function in patients with this condition. METHODS: We performed sonographically guided percutaneous needle tenotomy on 58 consecutive patients who had persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the common extensor tendon, and the tip of the needle was used to repeatedly fenestrate the tendinotic tissue. Calcifications, if present, were mechanically fragmented, and the adjacent bony surface of the apex and face of the epicondyle were abraded. Finally, the fenestrated tendon was infiltrated with a solution containing corticosteroid mixed with bupivacaine. After the procedure, patients were instructed to perform passive stretches and to undergo physical therapy. During a subsequent telephone interview, patients answered questions about their experience, their functioning level, and their perceptions of procedure outcome. RESULTS: Fifty-five (95%) of 58 patients were contacted by telephone and agreed to participate in the study. Thirty-five (63.6%) of 55 respondents reported excellent outcomes, 16.4% good, 7.3% fair, and 12.7% poor. The average follow-up time from the date of the procedure to the date of the interview was 28 months (range, 17-44 months). No adverse events were reported; 85.5% stated that they would refer a friend or close relative for the procedure. CONCLUSIONS: Sonographically guided percutaneous needle tenotomy for lateral elbow tendinosis is a safe, effective, and viable alternative for patients in whom all other nonsurgical treatments failed.     

Ultrasound of the normal nongravid uterus: correlation with gross and histopathology

Accurate assessment of uterine size and significance of uterine enlargement are common clinical problems. We examined 156 patients by sonography prior to scheduled hysterectomy. Uterine volumes from normal-sized uteri were calculated from the sonograms using the equation of a prolate ellipsoid formula, and these calculated volumes were highly correlated with actual measured uterine volumes. Mean values and normal ranges of uterine weight were determined. These values are of particular value in postmenopausal patients in whom subjective evaluation of uterine enlargement is often difficult. When a sonographically enlarged, but otherwise normal uterus is discovered, it may contain a leiomyoma or other pathology not morphologically detectable by ultrasound.     

Fetal magnetic resonance imaging in the evaluation of fetuses referred for sonographically suspected abnormalities of the corpus callosum.

OBJECTIVE: Fetal magnetic resonance imaging (MRI) has been shown to be useful in assessing the developing central nervous system. However, its utility in specific brain disorders has not been well investigated. We hypothesized that fetal MRI can better assess the integrity of the brain in cases with sonographically suspected callosal abnormalities. METHODS: We retrospectively reviewed fetal MRI and prenatal sonographic studies of 10 fetuses referred for MRI for sonographically suspected callosal abnormalities. RESULTS: An abnormal corpus callosum was identified on fetal MRI in 80% of cases. The type of callosal abnormality (complete or partial agenesis) was similar on both prenatal sonography and fetal MRI in all cases. All sonographically identified additional brain abnormalities were detected on fetal MRI, with the exception of choroid plexus cysts. Furthermore, in 63% (5 of 8) of cases with a callosal abnormality on both sonography and fetal MRI, additional brain abnormalities were detected on fetal MRI that were not apparent on sonography. These sonographically occult findings were confirmed on postnatal MRI or autopsy in 3 of 5 patients. CONCLUSIONS: Fetal MRI is an important adjunct to sonography in assessing the corpus callosum and other aspects of brain development when agenesis of the corpus callosum is suspected. It can identify frequent additional findings that are not visible on sonography such as abnormal sulcation. In light of the association between additional brain abnormalities and worse neurodevelopmental outcome, the potential of fetal MRI as an important adjunctive prognostic imaging test in fetuses with callosal agenesis can now be tested.     

Diagnostic value of ultrasonography for clinical medial epicondylitis

Park G-Y, Lee S-M, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis.

Objectives

To assess the ultrasonographic findings and to evaluate the value of ultrasonography as a diagnostic method for detecting clinical medial epicondylitis.

Design

A prospective, single-blind study.

Setting

An outpatient rehabilitation clinic in a tertiary university hospital.

Participants

Twenty-one elbows from 18 patients with clinical medial epicondylitis and 25 elbows without medial epicondylitis were evaluated.

Interventions

Not applicable.

Main Outcome Measures

The clinical diagnosis of medial epicondylitis was based on the patient’s symptoms and clinical signs in a physical examination performed by a physiatrist. An experienced radiologist made the real-time ultrasonographic diagnosis based on the detection of at least one of the following abnormal findings: a focal hypoechoic or anechoic area, tendon nonvisualization, intratendinous calcifications, and cortical irregularity.

Results

Ultrasonography revealed positive findings in 20 of 21 elbows with medial epicondylitis and was negative in 23 of 25 without medial epicondylitis. Ultrasonography showed sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for clinical medial epicondylitis of 95.2%, 92%, 93.5%, 90.9%, and 95.8%, respectively. Tendinosis was observed in 15 elbows, and a partial-thickness tear, including 1 intrasubstance tear, was detected in 5 elbows. The most common ultrasonographic abnormality was a focal echogenic abnormality (15 hypoechoic, 5 anechoic) of the tendons.

Conclusions

Our results indicate that ultrasonography is informative and accurate for the detection of clinical medial epicondylitis. Therefore, ultrasonography should be considered as an initial imaging method for evaluating medial epicondylitis.     

Fetal magnetic resonance imaging enhances detection of spinal cord anomalies in patients with sonographically detected bony anomalies of the spine.

OBJECTIVE: Although fetal magnetic resonance imaging (MRI) is being increasingly used to evaluate sonographically suspected abnormalities, its utility in the evaluation of the spinal canal is not well studied. Because it is not susceptible to the limitations of fetal position, oligohydramnios, and shadowing from bony structures, we hypothesize that fetal MRI is better suited to assess the contents of the spinal canal compared with prenatal sonography. The purpose of this investigation was to determine whether fetal MRI could detect spinal abnormalities in cases in which they had not been originally suspected on prenatal sonography. METHODS: Fetal spine MR images were retrospectively reviewed over a 42-month period. Corresponding sonographic images were then rereviewed to determine whether there were findings in retrospect that might have suggested the cord abnormalities. Cases of myelomeningocele were counted as a spinal cord abnormality only if fetal MRI showed a cord anomaly other than the myelomeningocele. RESULTS: Of 33 cases referred for bony anomalies of the spine, fetal MRI showed additional abnormalities involving the spinal cord in 3 patients. These included diastematomyelia in 2 cases and segmental spinal dysgenesis in the third case. One case of diastematomyelia occurred in association with a lumbosacral myelomeningocele. The spinal cord anomalies were not visible on any of the prenatal sonograms, even in retrospect. CONCLUSIONS: Additional spinal cord anomalies were detected in 10% of cases reviewed. Fetal MRI can be useful in assessing the spinal cord in fetuses with bony spinal anomalies. Our findings suggest that fetuses with sonographically diagnosed bony abnormalities of the spine may benefit from further evaluation with fetal MRI.     

Diagnostic accuracy of sonography and combined sonographic assessment and sonographically guided cytology in nonpalpable solid breast lesions

PURPOSE: The aim of this study was to assess the diagnostic accuracy of sonography alone and combined sonographic assessment and sonographically guided fine-needle aspiration cytology in solid, nonpalpable lesions of the breast. METHODS: We retrospectively evaluated the sonograms from a series of 174 consecutive nonpalpable masses that were cytologically diagnosed using fine-needle aspiration under sonographic guidance and then histologically verified through surgical excision. We examined the relationships between the findings from sonography, combined sonographic assessment and cytopathology, and histology. RESULTS: Histologically, 95 lesions (55%) were malignant and 79 (45%) were benign. The overall sensitivity of sonography alone for diagnosing cancer was 98. 9% (94 of 95 lesions), and the specificity was 45.6% (36 of 79 lesions). One (3%) of 37 masses considered at sonography to be benign was correctly diagnosed on cytologic examination to be cancer. By establishing the benign status of 11 of 13 masses that were indeterminate at sonography, cytology increased the specificity of the combined method (to 56.3%). Cytology appropriately suspected or confirmed malignancy in 79 (84%) of 94 carcinomas considered at sonography to be suspicious or malignant. CONCLUSIONS: In this study, sonography alone demonstrated a high sensitivity but limited specificity in evaluating nonpalpable breast masses. The addition of sonographically guided cytology substantially increased the specificity of the combined method without compromising sensitivity.     

Sonographic diagnosis of abdominal wall relaxation.

PURPOSE: We report our experience using sonography to diagnose abdominal wall relaxation. METHODS: All patients with abdominal wall abnormalities from 1996 through 1997 underwent clinical and sonographic examination. Sonographic criteria for abdominal wall relaxation were continuity of the fascia (no gap), identification of all muscle layers, and decreased muscle thickness on the affected side. Fifty controls with no abdominal wall abnormalities were also examined for comparison. RESULTS: We sonographically diagnosed 5 cases of abdominal wall relaxation in 625 patients examined. The diagnosis in these 5 cases was confirmed by MRI. Muscle thickness on the affected side decreased by a mean of 38%+/-6% compared with muscle thickness on the unaffected side and was significantly different (p< 0.0001) from the mean muscle thickness seen in the controls. CONCLUSIONS: Sonography enabled the diagnosis of abdominal wall relaxation with the advantages of saving time and money and not requiring use of a contrast medium. Based on our results, we recommend sonography as the first-line imaging modality in the diagnosis of abdominal wall relaxation.     

高频超声对肱骨外上髁炎诊断价值

目的探讨高频超声对肱骨外上髁炎的超声诊断价值。方法应用高频超声检查我院临床诊断肱骨外上髁炎患者17例及对照10例。结果高频超声能满意显示肱骨外上髁及伸肌总腱的细微解剖与病变情况,对临床诊断提供可靠依据。结论高频超声诊断肱骨外上髁炎简便、价廉、准确,值得提倡推广。     

Breast sonography: technique to mimic mammographic position.

Positional changes in the breast between supine sonography and mammography may cause difficulties in correlating abnormalities. The problem is easily surmounted by performing the breast sonogram with the patient in the upright position. This study is a prospective evaluation of 10 patients examined sonographically in the supine and upright positions. The nipple to lesion distance was measured and the clock position estimated on the upright and supine sonograms. These parameters were compared to the original mammograms. In all patients the mammographic clock position and the distances from the nipple correlated more closely with the upright sonogram. The mammographic clock position was the same on the upright sonogram in six of 10 (60%), and the remaining four (40%) varied from one half to two clock positions. In supine sonography the clock position was the same in two of 10 (20%) patients, and the remaining eight (80%) varied from one to three clock positions. Most lesions were between 4.5 and 11 cm from the nipple on the mammogram. The distances of the lesions from the nipple ranged from 3 to 10 cm on upright sonography and from 0 to 4.5 cm on supine sonography. The difference between clock positions and the distances from the nipple on upright versus supine sonography were statistically significant. Therefore, upright sonography is more accurate in localizing mammographically identified lesions than the standard supine sonographic technique.     

Evaluation of hepatocellular carcinoma after treatment with transcatheter arterial chemoembolization: comparison of Lipiodol-CT, power Doppler sonography, and dynamic MRI

BACKGROUND: The purpose of this study was to compare the ability of Lipiodol-computed tomography (CT), power Doppler (PD) sonography, and dynamic magnetic resonance imaging (MRI) in evaluating the therapeutic effect of transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC). METHODS: TACE was performed by injecting an emulsion consisting of Lipiodol and a chemotherapeutic drug, followed by gelatin sponge particles, into 54 patients with 84 HCC lesions. Five to 7 days later, Lipiodol-CT, PD sonography, and dynamic MRI were performed. Findings from the three modalities were correlated with relapse within 1 year after TACE. RESULTS: All lesions with blood flow on PD sonography or intratumoral enhancement on dynamic MRI relapsed regardless of the findings with Lipiodol-CT. None of the negatively enhanced lesions on dynamic MRI relapsed regardless of the Lipiodol-CT findings. However, the readers could not evaluate the contrast uptake in 14 lesions that were already hyperintense on the precontrast images. These cases were considered unsuitable for qualitative assessment and reduced the applicability of MRI to 83% of the examined lesions (70 of 84). Although PD sonography perfectly predicted relapse in superficial (0-5 cm from abdominal surface) lesions of the right hepatic lobe, blood flow in deep (>5 cm) or left lobe lesions was undetectable regardless of the occurrence of relapse. As a result, Lipiodol-CT displayed 76.0% sensitivity, 67.6% specificity, and 72.6% accuracy. The sensitivity, specificity, and accuracy of PD sonography were 34.0%, 100%, and 60.7%, respectively. In the 70 lesions in which evaluation was possible, dynamic MRI achieved 100% sensitivity, 100% specificity, and 100% accuracy. CONCLUSION: Of the three modalities, dynamic MRI was the best for evaluating the efficacy of TACE in the treatment of HCC. We also found that superficial lesions of the right lobe are good candidates for PD sonography. However, high signals on precontrast MR images, motion artifacts, and ultrasonic attenuation remain key limitations.     

Three-dimensional sonographic evaluation of the infant spine: preliminary findings

PURPOSE: The aims of this study were to evaluate normal spinal anatomy in neonates and infants as seen by 3-dimensional sonography (3D US), to determine the value of 3D US in the evaluation of occult spinal dysraphia in infants, and to correlate the findings of 3D US with those of 2-dimensional sonography (2D US) and MRI, when available. METHODS: We used 2D US and 3D US to examine the lumbosacral spine in infants with cutaneous stigmata, syndromes associated with spinal dysraphia, and abnormal radiographs. We also evaluated, as controls, healthy infants who had no markers of spinal abnormality. 2D sonograms, 3D sonograms, radiographs, and MRI scans, when available, were compared to assess differences in the display of the infant spine. RESULTS: In total, we examined 29 infants: 18 subjects and 11 control infants. The correlation between 2D US and 3D US was 100% in the detection of congenital defects of the spinal cord, although 3D US allowed superior visualization of the vertebral bodies and posterior spinal elements. When a gross abnormality of the posterior spinal elements occurred with pathologic overlying soft tissue, interpretation was simpler with MRI than with sonography. CONCLUSIONS: 3D US is a useful adjunct to 2D US when screening the infant spine for congenital defects, particularly in showing alignment of posterior spinal elements and integrity of vertebral bodies. This ability is important because posterior spinal defects may be associated with underlying spinal cord abnormalities.     

Sonographic prediction of viability in testicular torsion: preliminary observations

This study was performed to determine if sonography can assist in predicting testicular viability in the setting of testicular torsion. Sixteen patients with sonographically diagnosed and surgically proved testicular torsion were studied. The preoperative sonograms were reviewed retrospectively to determine testicular echogenicity and homogeneity, testicular size and vascularity, scrotal skin thickness and vascularity, and the presence or absence of a hydrocele. These findings were correlated with the viability of the testis at surgery. All nine patients with normal homogeneous testicular echogenicity had viable testes at surgery. All seven patients with hypoechoic or inhomogeneous testes had nonviable testes at surgery and pathologic evidence of necrosis. The other findings were less helpful in predicting viability. In the setting of testicular torsion, normal testicular echogenicity is a strong predictor of viability. Immediate surgical detorsion in these patients carries a very high likelihood of salvaging the affected testis.     

Ultrasonographic-surgical correlation of ankle tendon tears.

This study evaluates the accuracy of ultrasonography in detecting ankle tendon tears of the peroneal, posterior tibial, and flexor digitorum longus tendons based on operative findings and clinical follow-up. A prospective study was performed in 33 patients with clinically suspected tendon injury. Sixty-eight tendons were evaluated sonographically. The diagnosis of an intrasubstance tear was made when disruption of uniform tendon architecture by hypoechoic linear or globular clefts was observed. Criteria used to diagnose complete tendon rupture included discontinuity or gap within the tendon or complete nonvisualization of the tendon. Treatment decisions were based on a combination of clinical parameters and imaging studies. Twenty-six patients had the presence or absence of tear confirmed at surgery. Five patients had a final diagnosis based on clinical findings, and two were lost to follow-up. Of the 68 tendons evaluated sonographically, 54 were directly inspected at surgery; 20 were found to be torn and 34 were intact. Ultrasonography was able to identify all tears correctly with an accuracy of 93%, a sensitivity of 100%, and a specificity of 88%. The positive and negative predictive values were 83% and 100%, respectively. The combined accuracy, sensitivity, and specificity of ultrasonography in detecting tendon tears in all patients evaluated both surgically and by clinical follow-up were 94%, 100%, and 90%, respectively.     

Detection of achilles tendon xanthomas in familial hypercholesterolemia: sonography vs. radiography

Objective: To compare high frequency linear array sonography and radiography for the detection of Achilles tendon xanthomas. Methods: Same-day high frequency linear array sonography and radiography were prospectively performed upon 42 Achilles tendons in 21 individuals with heterozygous familial hypercholesterolemia. Xanthomas were detected by the presence of intratendinous hypoechoic regions sonographically and by tendon enlargement radiographically. Results: Radiography detected xanthomas in 24 of 40 (60%) tendons, and was technically inadequate in two tendons. Sonography was superior to radiography, detecting xanthomas in 38 of 42 tendons (90%), and in all radiographically abnormal tendons. Conclusion: Sonography is superior to radiography for detecting Achilles tendon xanthomas. Radiography should only be considered for xanthoma detection if sonography is unavailable or if costs are so constrained that sonography cannot be justified.