Transvaginal Aspiration of Ovarian Cysts: Long-Term Follow-up

Background and purpose Transvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy. Methods Twenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G × 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness. Results Long-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy. Conclusion Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.     

Reducing Unnecessary Shoulder MRI Examinations Within a Capitated Health Care System: A Potential Role for Shoulder Ultrasound

PurposeMRI is frequently overused. The aim of this study was to analyze shoulder MRI ordering practices within a capitated health care system and explore the potential effects of shoulder ultrasound substitution.MethodsWe reviewed medical records of 237 consecutive shoulder MRI examinations performed in 2013 at a Department of Veterans Affairs tertiary care hospital. Using advanced imaging guidelines, we assessed ordering appropriateness of shoulder MRI and estimated the proportion of examinations for which musculoskeletal ultrasound could have been an acceptable substitute, had it been available. We then reviewed MRI findings and assessed if ultrasound with preceding radiograph would have been adequate for diagnosis, based on literature reports of shoulder ultrasound diagnostic performance.ResultsOf the 237 examinations reviewed, 106 (45%) were deemed to be inappropriately ordered, most commonly because of an absent preceding radiograph (n = 98; 92%). Nonorthopedic providers had a higher frequency of inappropriate ordering (44%) relative to orthopedic specialists (17%) (P = .016; odds ratio = 3.15, 95% confidence interval = 1.24-8.01). In the 237 examinations, ultrasound could have been the indicated advanced imaging modality for 157 (66%), and most of these (133/157; 85%) could have had all relevant pathologies characterized when combined with radiographs. Regardless of indicated modality, ultrasound could have characterized 80% of all cases ordered by nonorthopedic providers and 50% of cases ordered by orthopedic specialists (P = .007).ConclusionsAdvanced shoulder imaging is often not ordered according to published appropriateness criteria. While nonorthopedic provider orders were more likely to be inappropriate, inappropriateness persisted among orthopedic providers. A combined ultrasound and radiograph evaluation strategy could accurately characterize shoulder pathologies for most cases.     

小儿肠系膜囊肿的超声诊断

目的:探讨超声诊断小儿肠系膜囊肿的价值。材料和方法:回顾性分析43例经手术及病理证实的肠系膜囊肿的声像图表现。结果:超声检出肠系膜囊肿38例,误诊5例。肠系膜囊肿有典型的声像图表现:直径>5cm,形态不规则,壁薄,透声差,内有分隔,分隔上血流信号不明显。结论:超声对小儿肠系膜囊肿的诊断有重要价值,可作为小儿肠系膜囊肿的首选检查方法。     

Disparities Associated With Patient Adherence to BI-RADS 3 Assessment Follow-up Recommendations for Mammography and Ultrasound

ObjectiveTo assess the relationship between sociodemographic factors and adherence rates in patients with a BI-RADS 3 assessment.MethodsThis retrospective cohort study reviewed data from all patients with a BI-RADS 3 assessment on mammography and ultrasound examinations at a single, multisite academic institution, which serves a diverse urban-suburban population, from January 1, 2015, to December 13, 2017. Appropriate follow-up was defined as returning for the first follow-up examination 3 to 9 months after the index examination. Associations between BI-RADS 3 adherence rates and patient sociodemographic characteristics were evaluated using logistic regression.ResultsThere were 4,038 patients in our study period; 2,437 patients (60%) had appropriate follow-up, 765 (19%) patients had delayed follow-up, and 836 patients (21%) were lost to follow-up. The overall malignancy rate was 1.4% (46 of 3,202). Older age, retired employment status, and Medicare insurance status were associated with increased adherence to BI-RADS 3 follow-up recommendations. Black race, single relationship status, Medicaid and self-pay insurance status, and living in a top 15% disadvantaged zip code were associated with decreased adherence. On multivariate analysis, older age remained associated with increased adherence and Medicaid insurance status with decreased adherence. Time between index examination and cancer diagnosis was shorter in patients who had timely follow-up (202 days [interquartile range 183-358] versus 392 days [interquartile range 365-563], P ≤ .001), although there was not a significant difference in stage at diagnosis (P = .46).DiscussionMultiple sociodemographic factors are associated with low adherence to BI-RADS 3 follow-up recommendations suggesting that more frequent and targeted interventions are needed to close disparity gaps.     

高频超声对皮脂腺囊肿的诊断价值

目的探讨高频超声对皮脂腺囊肿的临床应用价值。方法对21例经手术和病理证实的皮脂腺囊肿的超声检查,作回顾性分析,总结其声像图特征。结果16例经超声检查做出正确诊断,2例误诊为脂肪瘤,2例误诊为神经纤维瘤,1例误诊为表皮样囊肿。结论高频超声在皮脂腺囊肿的诊断具有重要价值。     

Survive蛋白与内皮抑素Endostatin在卵巢上皮癌中的表达及其相关性的探讨

目的：探讨Survive及内皮抑素Endostatin在卵巢上皮癌中的表达及临床意义。方法：应用Survive蛋白的单克降抗体及Endostatin的单克降抗体,以SP免疫组织化学方法,对41例卵巢上皮癌、11例良性卵巢上皮瘤和10例正常卵巢组织的石蜡标本作Survive及Endostatin的检测,并分析卵巢上皮癌的临床病理资料。结果：（1）正常卵巢组织Survive及内皮抑素Endostatin均呈阴性表达,良性卵巢上皮瘤Survive呈阴性表达,内皮抑素呈阳性表达。卵巢上皮癌中有Survive及内皮抑素Endostatin表达,Survive在正常卵巢、卵巢良性肿瘤与卵巢恶性肿瘤之间两者的表达有极显著差异（P〈0．01）;Endostatin在正常卵巢与卵巢肿瘤之间两者的表达有极显著差异（P〈0．01）;卵巢上皮癌与卵巢上皮瘤相比两者的表达呈升高趋势,但不具有统计学意义（P〉0．05）;（2）Survive、Endostatin的阳性表达与卵巢上皮癌的临床分期、组织分化程度及病理类型有关（P〈0．05）;（3）Survive及Endostatin的阳性表达与卵巢上皮癌的预后有关（P〈0．05）;（4）Survive及Endostatin在卵巢上皮癌中的表达呈一致性相关,两者表达无显著性差异（P〉0．05）,具有相关性（P=0．01）。结论：Survive及Endostatin可能是卵巢上皮癌发生的相关基因,与肿瘤的发展及转移有关,检测Survive及Endostatin可以估计卵巢上皮癌患者的预后、辅助指导临床化疗。     

Facilitating Surveillance of Incidental Findings Using a Novel Reporting Template: Proof of Concept in Patients With Pancreatic Abnormalities

ObjectiveTo determine the surveillance impact of utilizing a discrete field in structured radiology reports in patients with incidental pancreatic findings.MethodsWe implemented a dictation template containing a discrete structured field element to auto-trigger listing of patients with incidental pancreatic findings on a pancreas clinic registry in the electronic health record. We isolated CT and MRI reports with incidental pancreatic findings over a 24-month period. We stratified patients by presence or absence of the discrete field element in reports (flagged versus unflagged) and evaluated the impact of report flagging on likelihood of clinic follow-up, follow-up imaging, endoscopic ultrasound, surgical intervention, genetics referral, obtaining pathologic diagnosis, and time interval between index imaging to various outcomes.ResultsPatients with flagged reports were more likely to be seen or discussed in a pancreas clinic compared with those with unflagged reports (189 of 376, 50.3% versus 79 of 474, 16.7%; P <. 001). Patients with flagged reports were more likely to get follow-up imaging than patients with unflagged reports (188 of 376, 50.0% versus 121 of 474, 25.5%; P < .001) and were more likely to undergo appropriate management of actionable findings compared with patients in the unflagged group (23 of 62, 37.1% versus 28 of 129, 21.7%; P = .036).DiscussionImplementation of a structured discrete field element for reporting of patients with incidental pancreatic findings had positive impact on surveillance measures and can be applied in other organ systems with established surveillance guidelines to standardize patient care.     

Ultrasound,Computed Tomography,and Magnetic Resonance Imaging of Ovarian Vein Thrombosis in Obstetrical and Nonobstetrical Patients

Ovarian vein thrombosis is an uncommon clinical entity, most familiar to radiologists as a source of postpartum sepsis, which, if unrecognized and left untreated, has the potential for septic shock, pulmonary thromboembolism, and death. Ovarian vein thrombosis also occurs with other common inflammatory and malignant conditions in the nonobstetrical patient. This article reviews the pathophysiology, predisposing conditions, clinical findings, imaging features on ultrasonography, computed tomography, and magnetic resonance imaging of acute and chronic ovarian vein thrombosis and its appropriate clinical management.     

彩色多普勒超声血流阻力指数结合CA125对卵巢肿瘤的诊断价值

目的探讨彩色多普勒超声血流阻力指数(RI)结合肿瘤标志物CA125判断卵巢肿瘤良恶性的价值.资料与方法107例卵巢肿瘤患者采用Finkler 超声评分系统进行评分,经彩色多普勒超声检查测定 RI,同时测定患者血清 CA125判断卵巢肿瘤良恶性,并与术后病理进行对照.结果恶性卵巢肿瘤患者 Finkler 超声评分明显高于良性卵巢肿瘤患者,RI 值低于良性卵巢肿瘤患者,CA125明显高于良性卵巢肿瘤患者(P <0.01、P <0.05).Finkler超声评分、RI 结合 CA125对卵巢肿瘤良恶性诊断的敏感性及特异性分别为94.59%、89.47%,均高于单一检查方法.结论彩色多普勒超声、RI 及肿瘤标志物 CA125联合应用对提高卵巢肿瘤良恶性的诊断有一定临床价值.     

彩色多普勒超声在急性阑尾炎中的应用价值（附110例分析）

目的：分析急性阑尾炎（包括不同病理类型）的彩色多普勒超声声像图并评价其诊断价值。方法对110例手术病理证实的急性阑尾炎患者进行超声声像图的分析。结果110例急性阑尾炎中,超声确诊100例,漏诊10例,总符合率91.1％,其中急性单纯性阑尾炎符合率88.7％（55／62）,化脓性阑尾炎符合率93.7％（30／32）,坏疽性阑尾炎符合率92.6％（11／12）,阑尾周围脓肿符合率100％（4例）。结论彩色多普勒超声能根据超声声像图特征进行急性阑尾炎的诊断及分型,对诊断急性阑尾炎有较高的准确性,可为临床诊断和治疗阑尾炎提供可靠的依据。     

Medicare Utilization of Vascular Ultrasound From 1998 to 2013: Continued Growth in Both Radiologist and Nonradiologist Imaging

PurposeThe aim of this study was to assess national trends in the utilization of vascular ultrasound (VUS) and changing relative specialty roles in examination interpretation.MethodsService-specific claims data for VUS studies were identified using Medicare Physician Supplier Procedure Summary Master Files for the period from 1998 to 2013. Longitudinal national utilization rates were calculated using annual Medicare enrollment data for 1998 to 2012. Procedure volumes by specialty group and site of service were analyzed.ResultsTotal annual claims for VUS studies for Medicare fee-for-service beneficiaries increased from 4,422,360 to 8,599,677 (+94.5%) between 1998 and 2013. Per 1,000 beneficiaries, overall utilization rose from 145.93 in 1998 to 264.26 in 2012 (+81.1%). However, this peaked in 2009 at 270.43 and has been slowly declining each year since. Overall market share decreased from 43% to 41% for radiology and increased from 10% to 16% and from 9% to 17% for vascular surgery and cardiology, respectively. Compound adjusted growth rate increases were 4.2% for radiology, 7.8% for vascular surgery, and 8.7% for cardiology.ConclusionsUtilization of VUS in the Medicare population increased from 1998 through 2009 but has been declining ever since. Although radiology has maintained the dominant market share over time, relative growth by cardiology and vascular surgery has outpaced that by radiology.     

先天性心脏病患儿肺动脉内超声成像与右心导管检查的对比研究

目的:探讨在先心病合并重度肺动脉高压(PH)时,肺动脉血管内超声(IVUS)的临床应用价值。材料和方法:对12例合并PH的先心病患儿行右心导管检查的同时进行肺动脉IVUS成像。右心导管测定mPAP、TPR、Qp/Qs,IVUS观测肺动脉管腔大小、内膜和中层的厚度,计算肺动脉管壁厚度比(WTR)以及血管的搏动性。结果:吸入纯氧后mPAP及TPR明显降低,Qp/Qs则明显增高;高阻力组与低阻力组间,肺动脉搏动性在吸氧前后未见显著性差异;在吸氧前后,WTR与TPR具有直线相关。结论:IVUS可以应用于临床,其监测结果与右心导管监测的肺动脉血流动力学变化情况呈高度相关。     

超声观察银屑病中医分型的血管变化研究

目的　探讨银屑病中医分型皮损处与正常皮肤处血管血流的变化情况。方法　将 3 0例寻常型斑片状银屑病按中医辨证分型 ,超声观察患者正常皮肤处及皮损处浅层动脉血管、静脉血管血流情况。结果　“血热型”皮损处及正常皮肤处动脉血管增大、扩张、血流加快 ;“血瘀型”及“血燥型”未发现异常。结论　银屑病动脉血管及静脉血管增大、扩张、血流加快与中医分型“血热型”密切相关 ,这些将有助于临床根据中医分型进行辨证施治     

Impact of Emergency Medicine Point-of-Care Ultrasound on Radiology Ultrasound Volumes in a Single Pediatric Emergency Department

PurposePoint-of-care ultrasound (POCUS) is growing, but few data exist regarding its effects on radiology ultrasound (Rad US) volumes. The authors studied changes in Rad US ordered by emergency medicine (EM) as POCUS began and grew at their pediatric hospital.MethodsThis retrospective study included EM POCUS and EM-ordered Rad US volumes between 2011 and 2017, during three 2-year intervals: before POCUS, early POCUS, and expanded POCUS. Changes in overall Rad US and POCUS volumes per visit during these intervals were studied. Changes in skin and soft tissue infection (SSTI) US per SSTI visit, an examination performed diagnostically by both radiology and EM, were also assessed. Volume differences were examined using the Mann-Whitney U test (significance threshold, P < .05), and process control charts were used to identify nonrandom variations.ResultsThe study included 49,908 Rad US and 2,772 POCUS examinations during 647,890 emergency department visits. Rad US volumes per visit remained unchanged during early POCUS (P = .858) but increased with expanded POCUS (P < .005). A transient nonrandom increase in Rad US occurred as POCUS began. SSTI Rad US per SSTI visit significantly increased (P < .001) during early POCUS but did not change with expanded POCUS (P = .143). An SSTI management pathway in the emergency department before expanded POCUS may have affected ordering. Other variation occurred in proximity to practice changes and seasonal patterns.ConclusionsRad US overall and specifically for SSTI increased or remained stable during the introduction and growth of EM POCUS. Rather than decreasing Rad US, EM POCUS had a complementary role.     

消糜栓联合聚焦超声治疗慢性宫颈炎疗效观察

目的探讨消糜栓联合聚焦超声治疗慢性宫颈炎的临床疗效。方法将我院门诊200例慢性宫颈炎患者,随机分成消糜栓联合聚焦超声治疗组(A组)100例和微波治疗组(B组)100例。观察两组治疗后的疗效及并发症发生情况。结果一次痊愈率A组明显高于B组;治疗后阴道排液、阴道出血等并发症的发生率A组明显低于B组。结论消糜栓联合聚焦超声安全有效,副作用小,术后并发症少。     

血管内超声弹性成像中成像参数的比较研究

目的验证血管内超声弹性成像用于检测血管斑块的有效性。方法建立血管斑块的平面应变模型并生成超声仿真数据。通过一维数值优化算法获得血管径向位移分布和应变分布。通过有限元分析和迭代的方法得到血管的弹性模量分布。结果位移、应变、弹性模量3个分布图均能够检测到血管斑块,弹性模量能够提供斑块的形状大小信息,位移和应变分布图上斑块的轮廓尚不清晰。结论相对于位移和应变,弹性模量对于斑块的检测有着明显的优势,但受应变估计准确度的影响。