经会阴部超声检查肛管周围感染性疾病

目的：评价经会阴部超声检查法对肛周感染性病变的诊断意义。方法：通过对54例肛周肿物患者与10例正常组的对照检查，显示肛周括约肌及肛周病变，并与手术结果对照。患者取膀胱截石位，选用3-6MHz凸阵探头和5-10MHz线阵探头进行检查。结果：所有受检者均能清晰显示肛管内外括约肌。异常组发现肛周脓肿23例，肛周脓肿合并肛瘘或窦道形成31例，除未发现合并复合高位脓肿及肛瘘各1例外，其他均与手术结果相吻合。结论：经会阴部超声法检查肛管周围感染性疾病是一种简便、易行的方法，值得临床推广。     

Lipoma arborescens of the suprapatellar bursa and extensor digitorum longus tendon sheath: report of 2 cases.

OBJECTIVE: Lipoma arborescens (diffuse articular lipomatosis) is a rare intra-articular lesion consisting of subsynovial villous proliferation of mature fat cells. The usual clinical presentation is painless swelling. The aim of this series was to emphasize the importance of gray scale and color Doppler sonography through the investigation of chronic joint swelling. METHODS: Lipoma arborescens of the knee and extensor digitorum longus tendon sheath at the ankle region are described. The latter is extremely rare. We examined 2 patients with sonography before using cross-sectional modalities. RESULTS: Gray scale sonography revealed hyperechoic irregular villous and frondlike projections within prominent joint effusion. A wavelike motion of the projections was shown by dynamic compression and manipulation of the effusion. We observed moderate vascularity on color Doppler sonography. Spectral analysis revealed a low-resistance arterial waveform. CONCLUSIONS: Gray scale sonography is a useful diagnostic modality that can be performed to evaluate chronic joint swelling before the use of cross-sectional and more expensive modalities.     

Contrast-enhanced sonography of autoimmune pancreatitis: comparison with pathologic findings.

OBJECTIVE: We evaluated the vascularity of autoimmune pancreatitis lesions on contrast-enhanced harmonic gray scale sonographic images in comparison with the pathologic findings. METHODS: Six patients with autoimmune pancreatitis were examined. All patients held their breath from 20 to 50 seconds after the injection of a contrast agent while the vascularity of the lesion was examined by contrast-enhanced harmonic gray scale sonography (early phase), and lesion enhancement was monitored at about 90 seconds after the injection while the patients held their breath for a few seconds (delayed phase). We then compared the vascularity on the contrast-enhanced harmonic gray scale sonographic images with the pathologic findings (fibrosis and inflammation) in all lesions. The vascularity of 3 of the 6 lesions was also evaluated by contrast-enhanced harmonic gray scale sonography before and after treatment with corticosteroids. RESULTS: The autoimmune pancreatitis lesions exhibited mild (n = 1), moderate (n = 3), or marked (n = 2) enhancement throughout almost the entire lesions in both the early and delayed phases. The grade of lesion vascularity on the contrast-enhanced harmonic gray scale sonographic images correlated with the pathologic grade of inflammation and inversely correlated with the grade of fibrosis associated with autoimmune pancreatitis. The vascularity of all 3 lesions had decreased on the contrast-enhanced harmonic gray scale sonographic images after steroid therapy. CONCLUSIONS: Contrast-enhanced harmonic gray scale sonography may be useful for evaluating the vascularity of autoimmune pancreatitis lesions and the therapeutic efficacy of steroid therapy.     

Complex pelvic mass as a target of evaluation of vessel distribution by color Doppler sonography for the diagnosis of adnexal malignancies: results of a multicenter European study.

OBJECTIVE: To compare the diagnostic accuracy of gray scale sonography and color Doppler imaging in the differential diagnosis of adnexal malignancies from benign complex pelvic masses in a multicenter prospective study. METHODS: The study was performed as a collaborative work at 3 European university departments of obstetrics and gynecology. A total of 826 complex pelvic masses on which transvaginal sonography and evaluation of cancer antigen 125 plasma concentrations were performed before surgical exploration were included in the study. The scanning procedure was the same in the 3 institutions. An adnexal mass was first studied in gray scale sonography, and a probable histologic type was predicted. Second, solid excrescences or solid portions of the tumor were evaluated for vascular flow with color Doppler sonography (conventional or power). A mass was graded malignant if flow was shown within the excrescences or solid areas and benign if there was no flow. The overall agreement between the test result and the actual outcome was calculated by kappa statistics. RESULTS: Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with gray scale sonography (kappa = 0.82 and 0.65, respectively) because of significantly higher specificity (0.94 versus 0.84; P < .001). The evaluation of the cancer antigen 125 plasma concentration did not seem to increase the accuracy of either method. CONCLUSIONS: The evaluation of vessel distribution by color Doppler sonography in complex adnexal cysts seems to increase the diagnostic accuracy of gray scale sonography in the detection of adnexal malignancies in a large study population.     

Unusual sonographic finding in a patient with late recurrence of a perianal fistula

We describe a case of late recurrence of a perianal fistula in a 51-year-old man with a 4.5-year history of recurrent perianal fistulas and abscesses. This was the fourth recurrence he had experienced; at each occurrence, he had undergone various examinations, including sigmoidoscopy, anoscopy, barium enema, fistulography, probe exploration, instillation of hydrogen peroxide, and/or sonography, and he had also undergone surgery. At our examination, transperineal sonography with a portable ultrasound scanner revealed an echogenic linear structure within the fistulous tract. Under endoanal sonographic guidance, surgery was performed, and a tan solid cylindrical structure longer than 2 cm was removed. Histopathologic examination revealed stratified squamous epithelium and soft tissue with substantial fibrosis and mild chronic inflammation, findings consistent with the characteristics of a remnant cast from a previous fistulous tract. Our findings suggest that some patients may benefit from relatively inexpensive sonographic examination with appropriate transducers.     

Contrast-enhanced power Doppler sonography in breast lesions: effect on differential diagnosis after mammography and gray scale sonography.

OBJECTIVE: To evaluate the efficacy of contrast-enhanced power Doppler sonography in the differential diagnosis of breast lesions after a mammography-gray scale sonography combination. METHODS: Sixty-eight patients with 69 breast masses underwent power Doppler sonography before and after intravenous injection of a contrast agent. The lesions were diagnosed as "highly suggestive of malignancy" (category 5; n = 32), "suspicious" (category 4; n = 21), and "probably benign" (category 3; n = 16) by mammography and gray scale sonography, modeled on the American College of Radiology Breast Imaging Reporting and Data System classification. Power Doppler findings did not affect patient treatment. The authors subjectively evaluated the estimated area of vascularity, degree of enhancement following contrast agent administration, morphologic features, and distribution of vessels within the lesions. RESULTS: The final diagnoses were malignant in 28 lesions and benign in 41. Significant enhancement after contrast agent injection was detected in both the malignant and benign groups. Only 2 criteria, estimated area of vascularity and degree of enhancement following contrast agent administration, proved to be significant diagnostic determinants for contrast-enhanced power Doppler sonography (P < .001; interobserver agreements, 74.4 and 77.8, respectively). Contrast-enhanced power Doppler sonography provided a higher specificity, positive predictive value, and negative predictive value than power Doppler sonography but a lower sensitivity and negative predictive value than mammography-gray scale sonography. Only in the category 4 lesions could the combination of mammography-gray scale sonography and contrast-enhanced power Doppler sonography accomplish a higher specificity (71%) and positive predictive value (70%) than mammography-gray scale sonography (39% and 53%, respectively). CONCLUSIONS: Power Doppler and contrast-enhanced power Doppler sonography cannot be recommended as confirmatory tests in Breast Imaging Reporting and Data System category 3 and category 5 lesions. Although contrast-enhanced power Doppler sonography may help reduce unnecessary biopsies in Breast Imaging Reporting and Data System category 4 lesions, recommendation of its use has many drawbacks, such as imperfectly established criteria, lack of absolute certainty, and high cost.     

Sonographic evaluation of early-stage breast cancers that undergo neoadjuvant chemotherapy.

OBJECTIVE: We prospectively evaluated low-stage breast cancers treated with neoadjuvant chemotherapy using whole-volume sonography and color Doppler imaging. METHODS: Thirty-four women with breast cancer (mean maximum size, 2.4 cm) received neoadjuvant chemotherapy with doxorubicin and docetaxel. Targeted whole-volume sonography of tumor sites was performed before and after chemotherapy to assess mass size, color pixel speed-weighted density, and American College of Radiology Breast Imaging Reporting and Data System sonographic characteristics. After chemotherapy, tumor sites were excised by lumpectomy or mastectomy. RESULTS: Three (11.3%) of 34 patients had a complete histologic response. After chemotherapy, correlation was r = 0.716 between final histologic and sonographic sizes. Compared with histologic residual tumors, sonography had 4 false-negative results, 3 false-positive results, and 27 true-positive results (sensitivity, 87%), with no false-negative results among a subgroup of tumors of 7 mm and larger (sensitivity, 100%). The 3 cases with false-positive results were histologic fibrosis or biopsy changes. Mean speed-weighted density was 0.015 before and 0.0082 after chemotherapy (P = .03). After chemotherapy, vascularity was less common within (P = .06) or adjacent to (P = .009) masses or in tumor sites (P = .05). Prechemotherapy variables of gray scale characteristics and vascularity were compared with final histologic size, and all had P > .20. CONCLUSIONS: Postchemotherapy sensitivity of sonography was high for residual tumors of 7 mm or larger. Correlation was moderate between histologic and sonographic final tumor sizes. False-positive results were caused by fibrosis or biopsy-related changes. False-negative results occurred with residual tumor size of 6 mm or smaller. After chemotherapy, vascularity usually decreased, and this was not specific for complete response. Before chemotherapy, no vascular or gray scale feature at initial imaging predicted complete responders.     

The role of power Doppler sonography in the evaluation of superficial soft tissue abscesses

Objective: To evaluate the efficacy of power Doppler ultrasonography in depicting increased vasculature and hyperemia around the superficial soft tissue abscess. Materials and methods: 21 patients with soft tissue abscess were evaluated with gray scale imaging, color Doppler sonography, power Doppler sonography and computed tomography. In each case attempts were made using power Doppler sonography to demonstrate any areas of increased vascularity around the lesion. The results were compared with computed tomographic findings. Results: Peripheral hyperemia and increased vasculature were demonstrated with power Doppler sonography in 19 of 21 patients with soft tissue abscess. The hyperemic area demonstrated around the wall of the abscess by power Doppler sonography was similar to the enhanced area shown by computed tomography performed after contrast administration. Conclusion: Power Doppler sonography shows increased vasculature and hyperemia in the wall of abscesses. Therefore, power Doppler sonography can be used to assist with the diagnosis of superficial soft tissue abscess.     

Differential diagnosis of focal epididymal lesions with gray scale sonographic, color Doppler sonographic, and clinical features.

OBJECTIVE: To determine whether focal epididymal lesions can be differentiated on gray scale sonographic, color Doppler sonographic, and clinical features. METHODS: This was a retrospectiveanalysis of 60 focal epididymal lesions in 57 patients. Focal epididymal lesions were classified into 3 groups: nonspecific epididymitis (n = 43), tuberculous epididymitis (n = 10), and benign epididymal masses (n = 7). The following gray scale sonographic, color Doppler sonographic, and clinical features were analyzed: size, location, echogenicity, and heterogeneity of the lesion; hypoechoic or hyperechoic rim presence; hydrocele presence; degree of blood flow in the lesion; patient's age; duration of symptoms; and scrotal tenderness. RESULTS: Lesions were larger in patients with tuberculous epididymitis than in those with either nonspecific epididymitis (P = .007) or benign epididymal masses (P = .0017). The hypoechoic or hyperechoic rim of the lesion was more common in patients with benign epididymal masses than in those with nonspecific epididymitis (P = .002). The degree of blood flow in the lesion was greater in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P = .0019) or benign epididymal masses (P < .001). The duration of symptoms was shorter in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P = .0092). The frequency of scrotal tenderness was higher in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P < .001). CONCLUSIONS: Gray scale sonographic, color Doppler sonographic, and some clinical features may be helpful for differential diagnosis of focal epididymal lesions.     

Lymph node hilus: gray scale and power Doppler sonography of cervical nodes.

OBJECTIVE: To investigate the difference in the nodal hilus evaluated by gray scale and power Doppler sonography. METHODS: One hundred ninety-two patients with proven cervical lymphadenopathy were included in the study (metastases, n = 118; tuberculosis, n = 56; and lymphoma, n = 18). Lymph nodes were evaluated by gray scale sonography for the echogenic hilus and power Doppler sonography for hilar vascularity. RESULTS: Hilar vascularity was found even though the lymph node did not show an echogenic hilus on gray scale sonography (metastases, 59%; tuberculosis, 66%; and lymphoma, 91%). CONCLUSIONS: Sonologists should be aware that gray scale and Doppler sonography show different aspects of the hilus, and the absence of the hilus on gray scale sonography does not necessarily imply an associated absence of hilar vascularity.     

Three-dimensional quantification of tumor vascularity as a tertiary test after B-mode and power Doppler evaluation for detection of ovarian cancer.

OBJECTIVE: The purpose of this study was to investigate the role of 3-dimensional (3D) quantification of tumor vascularity in the differential diagnosis of pelvic indeterminate masses with a solid appearance or unilocular or multilocular cysts with a solid component showing central vascularization on 2-dimensional power Doppler sonography. METHODS: One hundred fifty-seven consecutive pelvic masses in 153 patients were included in this study and underwent sonography before surgery. Masses that showed a typical benign pattern on B-mode sonography (n = 112) and indeterminate masses with peripheral or absent flow on power Doppler sonography (n = 10) were not evaluated by 3D sonography. Only masses with central vascularization were submitted to 3D power Doppler imaging (n = 35). The following 3D vascular parameters were calculated: relative color and flow measure (similar to the vascularization flow index obtained with other systems). RESULTS: With receiver operating characteristic curve analysis, the best cutoff values for relative color and flow measure were 4.4 and 2.7, respectively. Flow measure had sensitivity of 68% and specificity of 40% in the overall population submitted to 3D power Doppler sonography. Accuracy slightly increased when masses with small papillary projections (<10 mL) were excluded. In this group (n = 22), sensitivity was 83%, and specificity was 50%. CONCLUSIONS: In masses with central vascularization on 2-dimensional power Doppler sonography, the use of 3D quantification of tumor vascularity had low diagnostic accuracy in the detection of adnexal malignancies, although an increase in accuracy in masses with a solid portion of greater than 10 mL was reported.     

Transvaginal gray scale and color Doppler sonography in primary ovarian cancer and metastatic tumors to the ovary.

OBJECTIVE: To compare gray scale and color Doppler features of primary and metastatic ovarian carcinomas. METHODS: Clinical, sonographic (gray scale and color Doppler), and histopathologic data of 143 patients with primary (n = 127 adnexal masses) and metastatic (n = 34 adnexal masses) ovarian cancer were reviewed. Morphologic gray scale parameters assessed were bilaterality, tumor volume, echogenicity, and presence of septa, papillary projections, or solid areas. Color Doppler parameters were presence of blood flow, tumor blood flow location (central versus peripheral), subjective impression of blood flow amount (scanty, moderate, or abundant), lowest resistive index, lowest pulsatility index, and maximal peak systolic velocity (centimeters per second). RESULTS: No statistical differences were found in bilaterality, tumor volume, presence of septa, papillary projections or solid areas, presence of blood flow, tumor blood flow location, subjective impression of blood flow amount, lowest resistive index, lowest pulsatility index, and maximal peak systolic velocity. Metastatic carcinomas were more frequently purely solid tumors (47% versus 26%; P = .001; likelihood ratio, 2.4; 95% confidence interval, 1.2-4.7). CONCLUSIONS: The presence of a purely solid tumor indicates a higher probability of metastatic carcinoma than primary ovarian cancer. However, with the use of gray scale and color Doppler sonography, it is difficult to differentiate primary ovarian carcinomas from metastatic tumors to the ovary.     

Endosonographic imaging of anorectal diseases.

OBJECTIVE: The normal sonographic anatomy of the anorectum, sonographic findings of anorectal diseases, and indications and limitations of endosonography compared with magnetic resonance imaging are reviewed. Methods. Endosonographic imaging was performed with a Siemens (Erlangen, Germany) FI 400 ultrasound scanner with an end-fire 7.5-MHz biplane endorectal probe and a B-K Medical (Sandhoften, Denmark) scanner with an 1850 axial-type side-fire 5.0- to 10.0-MHz rotating endoscopic probe. RESULTS: Rectal carcinoma appears on endorectal sonography as a low-echogenicity lesion that abruptly interrupts the normal sequence of layers. The internal anal sphincter is seen very clearly on endoanal sonography, and it is easy to appreciate atrophy and small tears of this sphincter. Endoanal sonography cannot accurately show thinning of the external anal sphincter. Peroxide-enhanced endoanal sonography is especially useful for patients with recurrent perianal fistulas in whom scarring should be distinguished from recurrent fistulas and detection of the internal opening. However, sonography does not provide an adequate deep and global display of all adjacent pelvic and perineal spaces. CONCLUSIONS: Endosonography can accurately stage primary rectal tumors and assess the internal anal sphincter. Peroxide-enhanced 3-dimensional imaging can increase the utility of endoanal sonography in detection and characterization of perianal fistulas and planning of optimal therapy. However, magnetic resonance imaging can be used a complementary modality to endosonography, especially for evaluation of external anal sphincter atrophy and deep pelvic inflammation.     

Three-dimensional color Doppler sonography and uterine artery arteriography of fibroids: assessment of changes in vascularity before and after embolization.

OBJECTIVE: To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. METHODS: Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. RESULTS: In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%-78%). CONCLUSIONS: Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.     

Hormonal variations in the vascularity of breast tissue.

OBJECTIVE: The purpose of this study was to determine whether there are sonographically detectable variations in breast glandularity and vascularity due to hormonal changes during the course of a normal menstrual cycle. METHODS: Gray scale and color and power Doppler sonographic evaluations were performed on 7 premenopausal patients over the course of 1 menstrual cycle. Progesterone and estradiol levels were measured from saliva collected from the patients. Vascularity was measured by mean color level, area covered by color pixels, and color-weighted fractional area. RESULTS: Of the 5 volunteers not taking oral contraceptives, 4 had peaks in vascularity correlating with midcycle peak hormonal levels (50%-320% from baseline) on power Doppler sonography. On color Doppler sonography, 3 of 5 patients also had peaks in vascularity (60%-190% from baseline). The 2 patients taking oral contraceptives did not have any peaks in vascularity. CONCLUSIONS: Vascularity changes in normal breast tissue that correlated with peak hormonal levels were detected in most of the volunteers. Therefore, hormonal variations in breast vascularity should be considered when evaluating breast lesions by sonography.     

Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion.

Objective. The purpose of this study was to prospectively investigate the role of high‐resolution and color Doppler sonography in the differential diagnosis of acute scrotum and testicular torsion in particular. Methods. Patients who underwent sonography for acute scrotum between April 2000 and September 2005 were included in the study. Gray scale and color Doppler sonography of the scrotum was performed. The spermatic cord was studied on longitudinal and transverse scans from the inguinal region up to the testis, and the whirlpool sign was looked for. Results. During this period, 221 patients underwent sonography for acute scrotum. Sixty‐five had epididymo‐orchitis with a straight spermatic cord, a swollen epididymis, testis, or both, an absent focal lesion in the testis, and increased flow on color Doppler studies along with the clinical features of infection. Three had testicular abscesses. Sonography revealed features of torsion of testicular appendages in 23 patients and acute idiopathic scrotal edema in 19. Complete torsion was seen in 61 patients who had the whirlpool sign on gray scale imaging and absent flow distal to the whirlpool. There was incomplete torsion in 4 patients in whom the whirlpool sign was seen on both gray scale and color Doppler imaging. Nine patients had segmental testicular infarction, and 1 had a torsion‐detorsion sequence revealing testicular hyperemia. In 14 patients, the findings were equivocal. There was a complicated hydrocele, mumps orchitis, and vasculitis of Henoch‐Schönlein purpura in 1 patient each. Five patients had normal findings. Fourteen were lost for follow‐up. Conclusions. Sonography of acute scrotum should include study of the spermatic cord. The sonographic real‐time whirlpool sign is the most specific and sensitive sign of torsion, both complete and incomplete. Intermittent testicular torsion is a challenging clinical condition with a spectrum of clinical and sonographic features.     

B-flow sonographic evaluation of hemodialysis fistulas: a comparison with low- and high-pulse repetition frequency color and power Doppler sonography.

OBJECTIVE: The purpose of this study was to determine the effectiveness of B-flow sonography in the evaluation of hemodialysis fistulas and to compare this new technique with color and power Doppler sonography. METHODS: In this study, 32 randomly selected patients (mean age, 46 years; age range, 18-87 years) with normally functioning hemodialysis fistulas were evaluated with low- and high-pulse repetition frequency (PRF) color and power Doppler sonography (PRF values of 3 and 10 kHz) and B-flow sonography. All images were reviewed and graded independently by 2 observers for luminal filling with flow signals, visibility of the intimal layer, and overall image quality. The study was approved by the Institutional Review Board, and informed consent was obtained from all patients. RESULTS: Statistical analysis with Friedman and Wilcoxon signed rank tests revealed that B-flow sonography was superior to other techniques for luminal filling and visibility of the intimal layer (P = .000). For overall image quality, B-flow sonography was also the best method according to the Friedman test (P = .000). However, the Wilcoxon test showed no significant difference between B-flow and high-PRF (10-kHz) color and power Doppler sonography (P = .131). The kappa scores reflected moderate to good interobserver agreement (kappa = 0.285-0.784). CONCLUSIONS: B-flow sonography is a relatively new and superior imaging technique that provides direct visualization of the blood echoes and the morphologic characteristics of the surrounding vessel wall simultaneously. During the evaluation of hemodialysis shunts, the major advantage of this technique is its ability to avoid artifacts such as aliasing and overwriting.     

Sonographic depiction of intratumoral vascularity with 2- and 3-dimensional color Doppler techniques.

OBJECTIVE: The purpose of this study was to describe patterns seen on 2- and 3-dimensional color Doppler sonographic depiction of intratumoral vessels and to correlate these patterns to histopathologic findings in an attempt to assess their clinical importance. METHODS: We conducted a retrospective analysis of 26 patients with ovarian masses and intratumoral abnormalities in whom standard 2- and 3-dimensional color Doppler sonography was performed. RESULTS: Two- and 3-dimensional color Doppler sonography depicted several patterns of vascularity within ovarian masses. These included masses with vascularity confined to the wall or loculus and those with central versus peripheral vascularity. The presence of central intratumoral vascularity had a high positive predictive value (90%) for malignancy. Conversely, the absence of intratumoral vascularity had a high negative predictive value (96%). CONCLUSIONS: Three-dimensional color Doppler sonography is helpful in depicting overall vessel density and branching patterns within an intratumoral abnormality. This technique seems to be useful in distinguishing benign from malignant ovarian masses.     

Occurrence and outcome of residual trophoblastic tissue: a prospective study.

OBJECTIVE: The purpose of this study was to evaluate the occurrence of residual trophoblastic tissue after miscarriage or delivery, to assess the diagnostic value of sonography with color Doppler examination in the detection of retained tissue, and to define in what cases expectant management may be an option. METHODS: We conducted a prospective observational study using sonography with color Doppler imaging in consecutive patients at routine follow-up after miscarriage or delivery. Expectant management was proposed in all patients with suspected retained tissue providing they were hemodynamically stable and in the absence of signs of infection. In case of surgical removal of retained tissue, the histologic examination was compared with the sonographic findings. RESULTS: In total, 1070 patients were assessed. In 67 patients (6.3%), sonographic and color Doppler examination showed retained tissue, and in 41 (61%) of them, curettage was performed. In all but 1 case, retained tissue was confirmed on histologic examination. Cases of retained tissue were more often seen after first-trimester (17%) or second trimester (40%) miscarriage, in the presence of abnormal uterine bleeding (57%), and with areas of enhanced myometrial vascularity (77.3%). CONCLUSIONS: Sonography with color Doppler examination is clinically useful to confirm or exclude residual trophoblastic tissue.     

Sonography in primary hyperparathyroidism: review with emphasis on scanning technique.

OBJECTIVE: To review the sonographic features and focused sonographic scanning techniques that may assist in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism. METHODS: The sonographic findings were reviewed in 54 of 58 consecutive patients with pathologically proven parathyroid adenomas. A systematic scanning approach including real-time gray scale, color and power Doppler, and graded compression gray scale imaging was used in all patients. RESULTS: Fifty-four (93%) of 58 proven adenomas were correctly identified by sonography. Gray scale imaging alone was sufficient for identifying 26 (100%) of 26 large (> or =1-cm) and 3 (11%) of 25 small (<1-cm) parathyroid adenomas. However, for 25 (89%) of 28 small adenomas, a combination of color and power Doppler and graded compression real-time gray scale imaging was required for sonographic localization and identification. CONCLUSIONS: Knowledge of typical locations and characteristic imaging features, as well as a systematic scanning approach, can result in accurate preoperative sonographic localization of parathyroid adenomas.