Evaluation of the intratumoral vasculature of hepatocellular carcinoma by power Doppler sonography: advantages and disadvantages versus conventional color Doppler sonography

Background: To determine whether a difference exists in the relative ability of power Doppler sonography and conventional color Doppler sonography to detect the intratumoral vasculature of hepatocellular carcinoma based on lesion size and location. Methods: Sixty patients with 88 hepatocellular carcinoma lesions that showed tumor staining on angiography and were enhanced on dynamic computed tomography were evaluated. Power Doppler sonography and color Doppler sonography were used to detect the intratumoral vasculature, and their sensitivity to blood flow was evaluated. Results: Power Doppler sonography showed a superior detection rate for lesions smaller than 2 cm and located 4–8 cm from the abdominal surface in the right hepatic lobe as compared with color Doppler sonography (p < 0.01). Neither power Doppler sonography nor color Doppler sonography depicted the intratumoral vasculature of lesions located more than 8 cm from the abdominal surface (n = 14). Both color Doppler imagings exhibited a low detection rate for lesions in the left hepatic lobe (n = 31, p < 0.01). Conclusions: Power Doppler sonography should be applied in the evaluation of small or intermediate depth lesions because it is more sensitive to these lesions than color Doppler sonography, but it is not useful for left lobe and deep lesions. Received: 31 March 1999/Accepted: 14 July 1999     

Clinically unsuspected foreign bodies: the importance of sonography.

OBJECTIVE: To show the value of sonography in the detection of clinically unsuspected foreign bodies appearing as soft tissue masses. METHODS: High-resolution B-mode and color Doppler sonography was performed in 288 patients referred with superficial soft tissue masses over a period of 2 years. RESULTS: In 8 lesions in 6 patients, sonography showed small curved or linear echogenic structures surrounded by hypoechoic masses characteristic of foreign bodies with granulation tissue. One lesion had increased vascularity on color Doppler sonography. Patients were referred for other imaging studies, including magnetic resonance imaging, computed tomography, and bone and labeled red blood cell scintigraphy, which did not add relevant information. Three patients underwent surgery; foreign bodies were found in 2, and infected granulation tissue was found in 1. Spontaneous resolutions and no growth of the lesions were seen in the other 2 patients. CONCLUSIONS: The possibility of a foreign body should be considered when scanning soft tissue masses even in the absence of a relevant clinical history. Once a foreign body is diagnosed, no further workup is indicated.     

Splenic artery aneurysm: value of color Doppler and the limitation of gray-scale ultrasonography

Background: To reevaluate the advantages and limitations of gray-scale and color Doppler sonography in the diagnosis of splenic artery (Sp-A) aneurysm. Methods: We reviewed the gray-scale and color Doppler sonograms of five cases with Sp-A aneurysm (four patients with portal hypertension and one patient without portal hypertension). Color Doppler sonography was performed in all five patients, and power Doppler sonography was performed in three. Results: Gray-scale sonography failed to detect the aneurysm in four of five cases because of a surrounding splenorenal (Sp-R) shunt in three patients and marked calcification of the aneurysmal wall in one patient. Pulsed Doppler sonography showed a slightly turbulent pulsatile flow along the aneurysmal wall, which immediately led to the diagnosis in four cases, including the three cases with Sp-R shunt. In one case, color Doppler sonography failed to detect the aneurysm because of a markedly calcified aneurysmal wall, although power Doppler sonography could visualize the aneurysm. Conclusions: Gray-scale sonography is not a useful diagnostic tool for Sp-A aneurysm. Clinicians should use color Doppler sonography in the evaluation of the splenic hilus in patients with Sp-R shunt to find a small Sp-A aneurysm. The addition of power Doppler sonography is helpful in visualizing calcified Sp-A aneurysms.     

浅表组织肿块超声诊断与术后病理对照分析

目的评价高频彩色多普勒血流显像及频谱多普勒对浅表组织肿块诊断价值。方法应用Philipsiu22彩色多普勒高频超声对79例患者的浅表组织肿块进行二维（大小、形态、内部回声）、彩色多普勒（肿块内外血供）及频谱多普勒血流参数（血流速度及阻力指数）检测;并逐一追踪术后病理结果,将二者结果进行对照分析。结果良性病变74例,恶性病变5例;实性病变45例,囊性病变18例,混合性病变16例。超声对病变检出率为100％（79／79）,与术后病理对照诊断符合率96％（76／79）,良恶性病变频谱参数（峰值流速及阻力指数）存在统计学差异（P〈0．05）。结论超声检查具有检出率高和病理符合率高的特点,可作为诊断首选方法,彩色多普勒及频谱参数鉴别肿块的良恶性具有较高的价值。     

Evaluation of transcatheter arterial embolization therapy on hepatocellular carcinomas using contrast-enhanced harmonic power Doppler sonography: comparison with CT,power Doppler sonography,and dynamic MRI

Purpose The aim of this study was to assess and compare the sensitivity of power Doppler sonography, contrast-enhanced sonography, plain computed tomography (CT), and dynamic magnetic resonance imaging (MRI) for detecting hepatocellular carcinoma (HCC) nodules incompletely treated with transcatheter arterial embolization (TAE). Methods A total of 63 unresectable HCC nodules were examined in this study. The HCCs were treated with TAE. All patients underwent plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI 1 week after TAE. The sensitivity of each modality to incompletely treated HCC nodules was compared. Detection of the residual viable HCC on angiography or tumor biopsy was regarded as the gold standard for the diagnosis of incomplete treatment. Results Twenty-four nodules (38%) were diagnosed as incompletely treated. The sensitivities of plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI to these incompletely treated nodules were 42% (10/24), 46% (11/24), 88% (21/24), and 79% (19/24), respectively. Eighty percent (19 nodules) of the 24 incompletely treated nodules were located within a depth of less than 8 cm. The sensitivities of plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI to these superficial incompletely treated nodules were 37% (7/19), 53% (10/19), 100% (19/19), and 74% (14/19), respectively. In contrast, the sensitivities of each modality to deeply located nodules were 60% (3/5), 20% (1/5), 40% (2/5), and 100% (5/5), respectively. Conclusion Plain CT and power Doppler sonography had a low sensitivity to HCC nodules incompletely treated with TAE. Except for those that were deeply located, contrast-enhanced harmonic sonography showed the highest sensitivity in detecting incompletely treated HCC nodules.     

Transvaginal sonography in the diagnosis of acute appendicitis.

OBJECTIVES: To evaluate transvaginal sonography with power Doppler capacity in the diagnosis of acute appendicitis and in discriminating appendicitis from pelvic inflammatory disease. PATIENTS AND METHODS: We describe transvaginal sonographic findings of six women with acute appendicitis selected from 31 women seen in an emergency room setting for clinically suspected pelvic inflammatory disease. The study population underwent gray-scale transvaginal sonography, and specific sonographic landmark findings for acute appendicitis and pelvic inflammatory disease were used. Hyperemia of any infectious complex was identified by power Doppler. Laparoscopy was performed after transvaginal sonography and was used as the gold standard. RESULTS: Laparoscopy showed acute appendicitis in six (19%) of the 31 patients. A thick walled non-compressible gas-containing tubular structure with a diameter exceeding 6 mm was seen by transvaginal sonography in four of the six cases, consistent with uncomplicated appendicitis. A heterogeneous complex with surrounding hyperechogenic soft tissue was seen in two cases with gangrenous appendicitis. Power Doppler detected hyperemia in all six cases. Normal adnexal structures were imaged next to the inflamed appendix. The sonographic criteria consistent with acute appendicitis were clearly different from those of acute pelvic inflammatory disease. CONCLUSIONS: Transvaginal sonography provides an opportunity to distinguish between appendicitis and acute pelvic inflammatory disease. Prospective trials are needed in order to evaluate the impact of transvaginal sonography in the diagnosis of acute appendicitis.     

Power Doppler assessment of vascular changes during fracture treatment with low-intensity ultrasound.

OBJECTIVE: To study the use of power Doppler sonography for assessing changes in vascularity during treatment of fracture sites with low-intensity ultrasound. METHODS: In 6 dogs (3 pairs), subcutaneous dissection of the midshaft of the ulna allowed symmetrical osteotomies to be made with a reciprocation saw. Three dogs were treated and 3 were used as controls. The fracture site was subjected to 1.5-MHz low-intensity ultrasound (30 mW/cm2) for 20 minutes daily from a therapeutic ultrasonic device. Gray scale sonography was performed to evaluate the fracture site. Power Doppler sonography was used to assess flow patterns at the fracture site and surrounding soft tissue. A sonographic contrast agent was administered intravenously. The dose was 0.2 mL/kg. RESULTS: Power Doppler sonography showed an increase in flow around the fracture site in the treated dogs compared with that in control dogs. Color pixel values on day 7 were 3-fold higher in treated legs than control legs and on day 11 were 33% higher in treated legs than control legs. Enhancement after contrast agent administration was consistently higher in treated legs than control legs. CONCLUSIONS: Power Doppler sonography showed increased vascularity around the fracture sites in treated dogs with and without contrast agent administration.     

Echo-enhanced color Doppler sonography in children and adolescents.

Fifty-one patients, with a range of underlying pathologic conditions, were studied prospectively to assess the diagnostic value of echo-enhanced color Doppler sonography in the pediatric and adolescent population Their diagnoses included various tumors, vascular disorders, cerebral bleeding, pathologic conditions of small parts, and focal lesions of parenchymal organs. All patients underwent color Doppler sonography before proceeding to echo-enhanced color Doppler sonography. Diagnoses were confirmed by additional imaging (computed tomography, magnetic resonance imaging, angiography, and scintigraphy) performed as appropriate, with or without histologic study. An additional 20 children did not proceed to echoenhanced color Doppler sonography as color Doppler sonography alone was found to be sufficiently diagnostic. Levovist (SHU 508A), a contrast agent based on galactose-encapsulated air microbubbles, is approved for pediatric applications in Austria and was used as the echo-enhancing agent. Echo-enhanced color Doppler sonography was performed a total of 63 times in 51 patients (mean age, 9.8 years). Compared to color Doppler sonography, echo-enhanced color Doppler sonography either detected or enhanced visualization of pathologic conditions in 55 investigations (87.3%), yielding an overall accuracy of 95.2% (sensitivity, 95%), versus 65.7% with color Doppler sonography. One spinal arteriovenous malformation, one cerebral cavernoma, and one liver lesion were missed. The contrast material was easy to administer; no adverse reactions were observed. We conclude that echoenhanced color Doppler sonography is beneficial in pediatric sonography. It enhances visualization of vessels and perfusion, thus offering a nonionizing imaging tool for detection and follow-up evaluation of pathologic conditions with disturbed vasculature in specific cases. In infants and in persons with superficial lesions it did not offer significant advantages over color Doppler sonography.     

浅表软组织肿块的超声检查评价

目的探讨二维高频超声及彩色多普勒超声对浅表软组织肿块的诊断价值.方法对121例浅表软组织肿块应用二维高频超声及彩色多普勒超声进行检查和分析.全部病例均经手术和病理学检查证实.结果良性肿块102例(其中脂肪瘤65例,腱鞘囊肿12例,神经鞘瘤7例,神经纤维瘤2例,血管瘤8例,结核脓肿5例,内膜移位1例).恶性肿块19例(其中恶性神经鞘瘤5例,恶性纤维组织细胞瘤4例,隆突性皮肤纤维肉瘤4例,脂肪肉瘤4例,恶性颗粒细胞瘤1例,横纹肌肉瘤1例).良性肿块中边界不清者40例(39%),圆度系数＞2.0者59例(57.8%),内部回声多半分布均匀,彩色血流检出率20.58%.恶性肿块边界清晰者10例(52.6%),圆度系数＜1.5者12例(63.1%),内部回声多半不均匀,彩色血流检出率100%.结论二维高频和彩色多普勒超声有助于确定浅表软组织肿块的形态、大小及深度,区分肿块的囊实性与血流特征,具有一定的临床应用价值.     

Diagnosis and follow-up of craniopharyngiomas with transcranial Doppler sonography.

OBJECTIVE: Craniopharyngiomas are the most common parasellar neoplasms in children. Because it is difficult to diagnose subtle visual or endocrinologic changes in young children at an early stage, craniopharyngiomas may grow to a considerable size before diagnosis. METHODS: We used transcranial Doppler sonography to diagnose and follow up 5 patients with craniopharyngiomas. There were 3 girls and 2 boys aged from 6 years 4 months to 10 years. RESULTS: The initial manifestations were visual defects (n = 4), headaches (n = 3), and growth restriction (n = 1). One patient had a diagnosis of a craniopharyngioma on the basis of sonography before brain computed tomography. All 5 patients were examined with transcranial color Doppler sonography before surgery and for postoperative follow-up. Sonography showed a cystic component with calcification in 4 patients and a solid component in 1 patient; these findings were compatible with the computed tomographic findings. Displacement of the vessels of the circle of Willis was found. Tumor recurrences were detected early on transcranial sonography in 4 patients at 1 to 8 months' follow-up; these were proved by computed tomography. CONCLUSIONS: Transcranial Doppler sonography is a convenient tool for the diagnosis, evaluation, and follow-up of craniopharyngiomas. It can adequately describe vessels around the tumors and show tumor recurrence at an early stage.     

Crohn's disease and color Doppler sonography: response to treatment and its relationship with long-term prognosis

PURPOSE: To evaluate the ability of sonography to detect changes in patients undergoing treatment for Crohn's disease and whether these findings are related to the patient's long-term outcome. METHODS: Twenty-eight patients with Crohn's disease were examined prospectively using gray-scale and color Doppler sonography before and during treatment. Three sonographic examinations were made: on the first day of treatment, between 3 and 8 days later, and approximately 4 weeks after starting the treatment. Sonographic examination included an evaluation of maximum bowel wall thickness and vascularity pattern. The sonographic data were compared with clinical and laboratory data, and possible relation with the patient's long-term outcome was considered. RESULTS: Initial baseline sonograms revealed at least 1 thickened segment of the bowel wall in all of the patients. In this initial examination, 18 of 22 patients (81%) with clinically active disease had moderate or marked parietal vascularity. A statistically significant reduction in the vascularity of the affected bowel was observed on the third sonographic examination (p < 0.05). Seventeen patients who were in clinical remission had relapses and were treated with immunosuppressive therapy or surgery during the follow-up. Eighty-six percent of the patients with residual hyperemia on sonographic examination after treatment had an unfavorable clinical course compared with only 30% of the patients with no, or barely visible, residual hyperemia (p < 0.01). CONCLUSION: Sonography can identify bowel inflammation and its changes during treatment. In patients with Crohn's disease, hyperemia on color Doppler sonography during clinical remission after treatment may reflect an increased risk of relapse.     

Cavernous transformation of the portal vein (CTPV): role of color Doppler sonography in the diagnosis

Objective: The aim of this study was to investigate the hemodynamics of cavernous transformation of the portal vein (CTPV) using color Doppler sonography and to correlate it with sonographic findings and clinical manifestations. Methods: Using color Doppler sonography, we studied 25 patients who satisfied the sonographic diagnostic triad of CTPV and compared clinical, sonographic, and color Doppler findings. We also compared the hemodynamics of the liver vasculature in a group of CTPV patients with that in a group of normal subjects. Results: We could differentiate five cases of dilated hepatic artery without formation of CTPV from 20 cases of CTPV. In 13 cases of CTPV, the cause of the portal vein thrombosis prior to CTPV could be determined. Two types of CTPV were distinguished: linear type (small diameter without tortuosity) and tortuous type (large diameter with tortuosity). There were no particular tendencies in the cause or distribution between the two groups, but the flow velocity was significantly higher in the tortuous type than in the linear type. Slow continuous flow with little or no respiratory variations was observed in CTPV by color Doppler sonography in agreement with previous reports, and the velocity of CTPV was slower than that of the portal flow in normal subjects. The flow velocity was not related to the cause or the presence of developed collaterals, and the flow direction was always hepatopetal. Conclusion: Color Doppler sonography was considered to be the most useful modality for the diagnosis and comprehension of the hemodynamics of CTPV.     

Color Doppler sonographic findings of inflamed and perforated Meckel diverticulum.

OBJECTIVE: To describe color Doppler sonographic findings in 2 cases of inflamed and perforated Meckel diverticulum. METHODS: Two patients with inflamed and perforated Meckel diverticulum underwent color Doppler sonographic studies. RESULTS: Gray scale sonographic examination identified a fixed cystlike structure with a gut signature surrounded by a hyperechoic layer. Color Doppler sonography revealed hyperemia in the diverticular wall and hyperechoic layer, which was more intense in 1 patient. CONCLUSIONS: Identification of a fixed cystlike structure with a gut signature and wall hyperemia suggests the diagnosis of inflamed Meckel diverticulum; when a hyperechoic layer surrounds this structure, perforation of the diverticulum should be suspected.     

Correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis.

OBJECTIVE: To record the correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis. METHODS: Women with palpable breast masses scheduled for excision biopsy were scanned with two- and three-dimensional color power Doppler sonography before and after the administration of a sonographic contrast agent. Vessel counts were performed on two- and three-dimensional sonographic images before and after contrast agent administration. All tumors were surgically removed and underwent immunohistochemical analysis for microvessel density assessment. The sonographic measure of tumor vascularity was correlated with microvessel density. RESULTS: Pathologic examination showed 43 breast cancers and 14 benign breast masses. Higher microvessel density was noted in malignant than benign breast masses (P < .0005). Color power Doppler sonographic measurement of tumor vessel number showed a significant positive correlation with tumor size (P < .05) and progesterone receptor negativity (P < .05). A significant positive correlation was observed between microvessel density and the number of intratumoral blood vessels assessed by both two- and three-dimensional color power Doppler sonography (P < .05). Regression models showed three-dimensional color power Doppler sonography to have a significantly higher correlation with microvessel density when compared with two-dimensional color power Doppler sonography at baseline (P < .005). The administration of a sonographic contrast agent did not improve correlation with microvessel density. CONCLUSIONS: A significant correlation was shown between color power Doppler sonographic measurement of tumor vascularity and microvessel density by immunohistochemical analysis. Further improvement in Doppler sonographic techniques to map capillary vessel flow should be explored to improve the current association with pathologic findings.     

Spectral Doppler sonography of musculoskeletal soft tissue masses.

OBJECTIVE: To determine whether resistive indices obtained from spectral Doppler waveforms can be used to distinguish benign from malignant musculoskeletal soft tissue masses. METHODS: A retrospective review of Doppler sonograms was performed for 52 patients with 53 soft tissue masses. All masses showed internal flow on color or power Doppler sonography, and spectral Doppler sonography yielded waveforms from which resistive indices were calculated. This information was analyzed along with the histologic diagnosis of each lesion with significance set at P > .05. RESULTS: There were 19 benign lesions and 34 malignancies. The resistive indices of the benign masses ranged from 0.44 to 1.0 (mean +/- SD, 0.72 +/- 0.42), whereas the malignant masses had resistive indices ranging from 0.28 to 1.0 (mean, 0.62 +/- 0.36). There was no statistically significant (P > .05) difference between the resistive indices of benign and malignant lesions. CONCLUSIONS: Resistive indices cannot be used to distinguish benign from malignant musculoskeletal soft tissue masses.     

Hyperemia following aneurysmal subarachnoid hemorrhage: incidence,diagnosis, clinical features,and outcome

OBJECTIVE: Hyperemia is a known phenomenon after aneurysmal subarachnoid hemorrhage, but only a few reports describe and analyze hyperemia in these patients. This could be the result of diagnostic difficulties in order to identify elevated cerebral blood flow; thus, it seems that hyperemia could be an underdiagnosed clinical state. The aim of the study was to evaluate this phenomenon in comparison with clinical outcome and imaging data in order to describe the frequency of hyperemia after subarachnoid hemorrhage and maybe improve clinical diagnosis. DESIGN: Retrospective analysis of our cerebral blood flow and transcranial Doppler sonography data bank. SETTING:. Neurosurgical/Anesthesiological intensive care unit University of Regensburg, Regensburg, Germany. PATIENTS AND PARTICIPANTS: A total of 37 patients were included (24 women and 13 men). All patients suffered from aneurysmal subarachnoid hemorrhage. MEASUREMENTS AND RESULTS: Standard transcranial Doppler ultrasonography, as well as the Xenon(133) clearance technique for cerebral blood flow measurements, was employed. We observed 37 increases of flow velocities in 37 patients according to Doppler ultrasonography. In order to distinguish between ischemia and hyperemia a Xenon(133) regional cerebral blood flow examination was performed. Global hyperemia was detected in 5 patients (14%). Hyperemia correlated only to favorable outcome ( p=0.01) and fewer ischemic lesions in the computed tomography ( p<0.05). CONCLUSION: The results indicate that while global hyperemia is a frequent phenomenon that cannot be detected by standard Doppler ultrasonography or clinical examination, hyperemic cerebral blood flow values following aneurysmatic subarachnoid hemorrhage are correlated to favorable outcome.     

Gray-scale and power doppler sonographic appearances of acute inflammatory diseases of the scrotum

PURPOSE: We describe the spectrum of gray-scale and power Doppler sonographic appearances in inflammatory scrotal diseases. METHODS: Twenty-five patients ranging in age from 3 to 69 years underwent gray-scale and power Doppler sonography with multifrequency transducers of 7-9 MHz or 10-13 MHz. In addition, color Doppler and power Doppler findings were compared in 7 cases. RESULTS: In all 5 prepubertal patients, power Doppler imaging demonstrated hyperemia associated with epididymitis and, in some cases, orchitis. Among the 20 pubertal and adult patients, power Doppler imaging revealed increased vascularity associated with spermatic cord involvement, epididymitis, orchiepididymitis, or orchitis. Enlargement and heterogeneity of the epididymis and/or testis were seen in 11 patients, with vas efferens ectasia in 3 patients. Abscess formation and testicular infarction were easily depicted by power Doppler imaging. In 5 cases total, hyperemia was the only sonographic finding of inflammation. In the comparison between color and power Doppler imaging, a subjective increase in the number and length of vessels was seen with power Doppler imaging. CONCLUSIONS: Power Doppler imaging is an easy and fast Doppler modality for evaluating inflammatory conditions of the scrotum and proved especially useful in cases with no gray-scale sonographic anomalies, in prepubertal patients, and in patients with abscesses or ischemic lesions.     

手部小关节滑膜炎超声诊断的临床研究

目的 探讨超声检查在小关节滑膜炎诊断中的应用价值.方法 应用高分辨力超声对40例类风湿关节炎(RA组)患者的腕关节、掌指关节(MCP)及近端指间关节(PIP)均行双侧对比扫查,观察类风湿关节炎腕关节、掌指关节、指间关节滑膜炎的超声声像表现及血流特点,并与20例健康志愿者(对照组)双側相应关节扫查结果对比.结果 RA组共检出578个关节积液,总检出率72.25%;共检出498个关节滑膜增厚,总检出率62.25%;检出140个关节内血管过度增生,总检出率17.50%.结论 高分辨力超声是手部小关节滑膜炎病变和类风湿关节炎早期诊断简便易行及安全有效的检查方法.     

Hepatocellular carcinoma: therapeutic experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with the contrast agent Levovist.

OBJECTIVE: To describe our experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with Levovist (SH U 508A; Nihon Schering, Osaka, Japan) for hepatocellular carcinoma after transcatheter arterial infusion. METHODS: Twenty patients (17 men and 3 women; mean age, 58.4 years) with 23 hepatocellular carcinoma nodules (mean +/- SD, 2.7 +/- 1.5 cm) underwent percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography 1 week after transcatheter arterial infusion. Therapeutic effects were assessed by contrast-enhanced computed tomography and posttreatment fine-needle biopsy. This study was performed on a prospective basis. RESULTS: After the transcatheter arterial infusion, contrast-enhanced color Doppler sonography showed intense intratumoral color signals in all 23 hepatocellular carcinomas. After the percutaneous ethanol injection, contrast-enhanced color Doppler sonography, fine-needle biopsy, and contrast-enhanced computed tomography showed no color signals, no viable tumor tissues, and no enhancement in any of the 23 hepatocellular carcinomas. Three to 5 (mean, 3.3) percutaneous ethanol injection sessions with a 5.2- to 15.6-mL (mean, 12.8-mL) total volume of ethanol per tumor were required for complete disappearance of color signals on contrast-enhanced color Doppler sonography. CONCLUSIONS: Percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography has considerable efficacy in treating hepatocellular carcinoma.     

Sonographic findings of ruptured epidermal inclusion cysts in superficial soft tissue: emphasis on shapes, pericystic changes, and pericystic vascularity.

OBJECTIVE: The purpose of this study was to retrospectively evaluate the sonographic findings of ruptured epidermal inclusion cysts in superficial soft tissue, with an emphasis on shapes, pericystic changes, and pericystic vascularity. METHODS: The cases of 61 patients with surgically confirmed epidermal inclusion cysts were reviewed, and 13 patients were found to have ruptured cysts. The Ethics Committees of our institutions did not require patient approval or informed patient consent for this retrospective study. We evaluated the shapes, sizes, locations, pericystic changes, and pericystic vascularity for the 13 cases. RESULTS: The shapes of the ruptured epidermal inclusion cysts were classified into 3 types: with lobulations (type I, 2 cases), with protrusions (type II, 8 cases), and with abscess pocket formations (type III, 3 cases). The mean long diameter of the cysts was 3 cm. Common sites of ruptured epidermal inclusion cysts were the plantar surface of the metatarsophalangeal joint (4 cases) and buttocks (3 cases). Pericystic changes were noted in all of the type II and III cysts. Increased vascularity on color Doppler sonography was prominent in 3 type II cysts and 3 type III cysts. Deep abscess formation was noted in the epidermal inclusion cysts, especially for the type III cysts. CONCLUSIONS: A ruptured epidermal inclusion cyst visualized by sonography had variable shapes; the sonographic findings can be useful for obtaining a correct diagnosis of a ruptured epidermal inclusion cyst.