The accuracy of sonoelastography in fatty degeneration of the supraspinatus: a comparison of magnetic resonance imaging and conventional ultrasonography

Objective

Sonolastography (SE) technique is one of the new functional ultrasonic imaging techniques, which was developed in the past few years and can obtain the distributions of elasticity in tissues. Using magnetic resonance imaging (MRI) as the standard of reference, the purpose of this study was to evaluate the ability of SE to assess the fatty degeneration of suprasupinatus (SSP) and to compare it to the MRI and the conventional ultrasonography (US) findings.

Materials and methods

The institutional review board approved the study, and a retrospective analysis between January 2013 and September 2013 was performed on 101 shoulders of 98 consecutive patients using MRI, US, and SE for the evaluation of shoulder lesion. Oblique sagittal images of SSP were obtained using SE. The SE images were evaluated by reviewers using an experimentally proven color grading system.

Results

When comparing SE to standard MRI findings, the mean sensitivity of SE was 95.6 %, the specificity 87.5 %, and the accuracy 91.1 %. The interobserver reliability of the SE findings was “almost perfect agreement” with a weighted kappa coefficient of 0.81. On comparing MRI with the SE findings, the grades of MRI and SE have a positive correlation (r = 0.855, P = <0.001). Furthermore, the grades of US and SE also have a positive correlation (r = 0.793, P = <0.001).

Conclusion

SE is valuable in the quantitative assessment of the severity of the fatty atrophy of the supraspinatus and has an excellent accuracy, an excellent correlation with MRI and the conventional US, and an excellent interobserver reliability.     

Sonoelastography findings of biceps tendinitis and tendinosis

Objective

The purpose of this study was to evaluate sonoelastography (SE) in the assessment of the long head of biceps tendon (LHBT) in patients with symptoms of biceps tendinitis or tendinosis and in patients without biceps lesion. The findings were compared with those obtained at clinical examination, using ultrasonography (US).

Materials and methods

36 shoulders of 34 consecutively registered patients with clinical symptoms and US findings of biceps tendinitis or tendinosis, and 114 shoulders of 98 patients without biceps lesions were assessed with SE. Transverse and longitudinal images of LHBT were obtained using SE. SE images were evaluated by reviewers using an experimentally proven color grading system.

Results

The transverse images of SE showed a mean sensitivity of 69.4 %, a mean specificity of 95.6 % and a mean accuracy of 89.3 %. Good correlation of conventional ultrasound findings was found (p < 0.001, r = 0.763). The longitudinal images of SE showed a mean sensitivity of 94.4 %, a mean specificity of 92.1 % and a mean accuracy of 92.7 %. Good correlation of conventional ultrasound findings was found (p < 0.001, r = 0.585). Inter-observer reliability of SE was in “almost perfect agreement” with a weighted kappa coefficient of 0.84.

Conclusions

SE has potential to be clinically useful in the detection of the intratendinous and peritendinous alterations of LHBT and has excellent accuracy and excellent correlation with conventional ultrasound findings.     

Role of US in evaluating breast implant integrity

Purpose

To assess the diagnostic accuracy and inter-observer variability of ultrasound (US) in recognizing signs of intra or extra-capsular rupture of silicone breast implants by using the magnetic resonance imaging (MRI) findings as the reference standard.

Methods

150 patients for a total of 300 implants underwent breast US and subsequently MR examination searching for signs of intra or extra-capsular rupture. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for breast US having MRI findings as the reference standard. Cohen’s kappa statistics was used in order to assess inter-observer agreement for US.

Results

170/300 (57 %) implant ruptures were detected at US (intra-capsular n = 110, extra-capsular n = 60). By comparing US findings with MR results, overall sensitivity, specificity, accuracy, PPV, and NPV of 79, 63, 70, 65, and 77 %, respectively, were found for breast US. In case of intra-capsular rupture, sensitivity, specificity, accuracy, PPV, and NPV of 63, 63, 63, 45, and 77 %, respectively, were obtained; 100 % values were found for extra-capsular rupture US diagnosis.

Conclusion

US can be used as the first examination in patients with breast implants. US intra-capsular rupture detection requires further evaluation by MRI; in case of extra-capsular rupture US diagnosis, surgical implant removal could be proposed without further investigations.     

The role of ultrasonography in the assessment of peri-prosthetic hip complications

Purpose

Total hip arthroplasty (THA) is a widespread option for treating hip osteoarthritis. Peri-prosthetic complications after THA represent a common event influencing patient outcome and costs. The purpose of this paper is to report the use of ultrasonography (US) to detect peri-prosthetic complications in symptomatic patients who underwent THA.

Methods

We retrospectively reviewed the records of patients with THA who underwent imaging evaluation between January 2009 and December 2012 at two different institutions. We evaluated the presence/absence of superficial and/or deep peri-prosthetic collections as well as the presence/absence of a cutaneous sinus tract. For patients who underwent both MRI and US, a concordance correlation analysis between US and MR findings was performed.

Results

In the reference period, 532 symptomatic patients (mean age ± standard deviation 74 ± 12 years) underwent X-ray and MRI examinations for suspected peri-prosthetic complications. Among them, 111 (20.9 %) underwent also US. Overall, 108 patients underwent both US and MRI. US findings included 67 superficial collections, 48 subcutaneous fistulas, 74 deep peri-prosthetic collections. Twenty-four patients had solid, mass-like peri-prosthetic collections. In 11 patients, no peri-prosthetic complications were seen. MRI findings included 68 superficial collections, 49 subcutaneous fistulas, 79 deep peri-prosthetic collections. Twenty-four patients had solid, mass-like peri-prosthetic collections. In four patients, no peri-prosthetic complications were seen. Concordance analysis between US and MRI findings showed almost perfect agreement (k ≥ 0.89).

Conclusion

US is an efficient and practical imaging modality to evaluate peri-prosthetic complications in patients with THA, being almost comparable to MRI in detecting and characterizing these complications.     

Joint effusion of the knee: potentialities and limitations of ultrasonography

Purpose

This study aimed at comparing the diagnostic accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) for the detection of joint effusion of the knee.

Methods

For this retrospective study, approbation by the institutional review board was not required, and written informed consent from the patients was waived. One hundred and fifty-eight patients (83 men and 75 women; median age 41.2 years; age range 13–81 years) who underwent US and MRI of the knee were included in the study. The sensitivity and specificity of US with respect to MRI in the evaluation of the effusion of the knee and in each recess were compared.

Results

In evaluating joint effusion of the knee, compared with MRI, US correctly identified 78 of 96 patients with joint effusion, showing a sensitivity of 81.3 % and a specificity of 100 %, with a positive predictive value (PPV) of 100 % and a negative predictive value (NPV) of 77.5 % (p value = 0.001). Various results were obtained comparing ultrasound with MRI, regarding the various recesses.

Conclusion

US showed high specificity and sensitivity in diagnosing knee joint effusion and could be used in patients who cannot undergo MRI.

Electronic supplementary material

The online version of this article (doi:10.1007/s40477-015-0180-3) contains supplementary material, which is available to authorized users.     

Knee bursitis: a sonographic evaluation

Objective

To evaluate the use of ultrasound for the diagnosis of knee bursitis.

Materials and methods

One-hundred and fifty-eight patients who, from May 2013 to May 2014, had an ultrasound examination of the knee and magnetic resonance imaging (MRI) of the knee during the following month were eligible for the study. The exams were reviewed by two musculoskeletal radiologists with 20 years of experience.

Results

Of these patients, 15 (7 men, 8 women) had bursitis, while 143 (76 men, 67 women) had no bursitis. In evaluating knee bursitis, US, when compared to MRI, correctly identified 13 out of 15 cases of bursitis, showing a sensitivity of 86.67 %, specificity 100 %, and K index of 0.92. Particularly in the suprapatellar bursa, ultrasound showed bursitis in 5 cases versus 7 by MRI (sensitivity of 71.4 %, specificity of 100 %, and K index of 0.82).

Conclusion

Ultrasound can be used as a valuable tool for the evaluation of bursitis of the superficial bursae in patients who cannot undergo MRI.     

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.     

Sonography of the optic nerve sheath beyond the hyperacute stage of intracerebral hemorrhage

Purpose

To evaluate the feasibility and utility of serial measuring of the optic nerve sheath diameter beyond the hyperacute and acute stage of intracerebral hemorrhage (ICH).

Methods

Four patients with extensive ICH in the left basal ganglia were followed using ultrasound (US) and cerebral CT scans.

Results

Optic nerve sheath diameter values assessed beyond the acute stage of ICH showed a high correlation (ρ = 0.84, p = 0.0022) with midline shift of the third ventricle seen on CT scans.

Conclusions

Optic nerve sonography can be useful to evaluate patients with extensive ICH beyond the acute stage and help monitoring clinical evolution in these patients, when ICP monitoring is not feasible.     

Nonalcoholic fatty liver disease (NAFLD) in nonobese patients with diabetes: Prevalence and relationships with hemodynamic alterations detected with Doppler sonography

Aim

To evaluate the prevalence, severity, and hemodynamic features of nonalcoholic fatty liver disease (NAFLD) in nonobese diabetics.

Methods

We studied 100 consecutive nonobese (body mass index [BMI] < 30) patients with type 1 (n = 17) or type 2 (n = 83) diabetes and no known causes of liver disease. Steatosis was diagnosed and graded with ultrasonography. Digital sonographic images of the liver and right kidney were analyzed with dedicated software (HDI-Lab), and the liver/kidney ratio of grey-scale intensity was calculated as an index of the severity of the steatosis. Severity scores ranging from 0 (none) to 5 (severe) were compared with sonographic and Doppler findings (right liver size, portal vein diameter and flow velocity, hepatic and splenic arterial pulsatility indices, hepatic-vein flow profile and A- and S-wave velocities).

Results

The prevalence of steatosis was 24% in type I and 80% in type II diabetes (grade 1 in 17%, grade 2 in 34%, grade 3 in 33%, grade 4 in 9%, grade 5 in 7%). In patients with steatosis (especially those with grades 4–5 disease), hepatic volume was increased (p < 0.005). Portal vein diameter was increased in grade 5 steatosis. The hepatic artery pulsatility index was significantly increased, particularly in grades 4 and 5 (p < 0.0001); portal and A-wave velocities were significantly reduced in grades 3–5 (p < 0.001); and the hepatic vein flow profile was altered in 27% (biphasic: 20%, flat: 7%) patients with steatosis, although there was no correlation with severity.

Conclusions

NAFLD is very frequent in nonobese diabetics with type 2 but not type 1 disease, and it is associated with hepatomegaly and liver hemodynamic alterations only when it is severe.     

Sonochemotherapy of breast adenocarcinoma: an experimental in vivo model

Purpose

Because the cytotoxic potential of hydrophilic drugs like bleomycin (BLM) is restricted by its low membrane permeability, the application of low-intensity ultrasound (US) on growing tumor cells enhances intracellular delivery of BLM after intratumoral administration, thereby potentiating its cytotoxicity. In the present study, the in vivo cell membrane permeability enhancement with US (1 MHz, 2, 5, and 10 min, I_SPTA = 2 W/cm²) is compared with the murine model of breast adenocarcinoma in BALB/c mice.

Methods

Tumor induction was performed through a homograft surgery procedure. Mice were anesthetized before putting them in sonication situations. Sonications were done in an aquarium. Seven groups of the tumor-bearing mice, each consisting of eight mice, were sonicated without or after intratumoral injection of 0.1 ml BLM at different exposure times. The tumor volume was evaluated to assess the growth process by use of a digital caliper.

Results

The results show that the BLM control group has a significant difference with BLM plus 10 min US on day 2 (p < 0.05). There is a significant difference between 2- and 10-min sonication on days 8 and 10 also. The difference between the Only US group and the other groups except Sham US was significant too (p < 0.05). Significant differences were seen only between the BLM plus US groups with Sham US and Only US control groups.

Conclusion

It has been concluded that for significant permeabilization of the cell membrane, sonication time for more than 10 min is required. Significant difference between the Only US and other groups indicates that US has a promoting effect on cell division procedure, in spite of the no-carcinogen effect of the US.     

Ultrasound examination using contrast agent and elastosonography in the evaluation of single thyroid nodules: Preliminary results

Aim

To evaluate the usefulness of ultrasound (US) using contrast agent and elastosonography in the characterization of thyroid nodules.

Materials and methods

From November 2006 to July 2007, 23 patients with single thyroid nodules underwent B-mode US and power Doppler, US examination using contrast agent, elastosonography and fine needle aspiration cytology (FNAC). Sixteen patients underwent thyroidectomy.

Results

The 23 nodules included 14 benign and 9 malignant lesions. Analysis of time/intensity curves showed that wash-in (8.8 ± 1.3 vs 12.1 ± 2.6 s; p = 0.002, t-test) and peak enhancement (15.3 ± 4.6 vs 22.2 ± 3.9 s; p = 0.001, t-test) occurred significantly earlier in the malignant nodules than in the benign nodules. Wash-out was monophasic in 70% of benign nodules, but in none of the malignant nodules; polyphasic in 30% of benign nodules and in 100% of malignant nodules. Polyphasic wash-out showed a statistically significant association with malignancy (p = 0.0007, χ²). Polyphasic wash-out yielded a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 69%, negative predictive value (NPV) of 100% and diagnostic accuracy of 83%. In 78% of the benign nodules (11/14) elastosonographic patterns was 1–2 (elevated elasticity); in 88% of the malignant nodules (8/9) elastosonographic patterns was 3–4 (reduced elasticity). Elastosonography yielded a sensitivity of 88%, specificity of 78%, PPV of 72%, NPV of 91% and diagnostic accuracy of 82%. Elastosonographic patterns 3–4 is associated with malignancy (p = 0.001, χ²).

Conclusion

US using contrast agent and elastosonography can be a useful diagnostic tool in the evaluation of single thyroid nodules, particularly when FNAC result is non-diagnostic or suggests a follicular lesion, and in nodules <1 cm.     

Is intraoperative ultrasound (IOUS) still useful for the detection of liver metastases?

Purpose

To evaluate the clinical impact of intraoperative ultrasound (IOUS) in the detection of liver metastases during the years, as compared with those of other imaging modalities.

Materials and methods

All IOUS scans performed for detection of liver metastases from 2000 to 2006 were retrospectively reviewed and compared with the results of preoperative imaging modalities: Ultrasound (US), Computed Tomography (CT), and/or Magnetic Resonance (MR). The number of cases in which IOUS and preoperative imaging studies produced discordant results, in terms of presence/absence of focal liver lesions, was calculated per year. Statistical analysis was performed using the McNemar test. A p value < 0.05 was considered statistically significant.

Results

Eighty-three IOUS scans performed in 2000–2003 were reviewed, and discordance with preoperative imaging findings was found in 19/83 (23%) cases. Of the 42 IOUS scans done during the 2004–2006 period, 10/42 (24%) showed discordance with preoperative studies. All metastases diagnosed with imaging studies were pathologically confirmed. The number of discordant cases in the two periods were not significantly different (p = 0.2).

Conclusion

IOUS is still useful in the detection of liver metastases. Its decreased use is probably due to the improved accuracy of preoperative imaging modalities.     

Susceptibility-weighted cardiovascular magnetic resonance in comparison to T2 and T2 star imaging for detection of intramyocardial hemorrhage following acute myocardial infarction at 3 Tesla

Background

Intramyocardial hemorrhage (IMH) identified by cardiovascular magnetic resonance (CMR) is an established prognostic marker following acute myocardial infarction (AMI). Detection of IMH by T2-weighted or T2 star CMR can be limited by long breath hold times and sensitivity to artefacts, especially at 3T. We compared the image quality and diagnostic ability of susceptibility-weighted magnetic resonance imaging (SW MRI) with T2-weighted and T2 star CMR to detect IMH at 3T.

Methods

Forty-nine patients (42 males; mean age 58 years, range 35–76) underwent 3T cardiovascular magnetic resonance (CMR) 2 days following re-perfused AMI. T2-weighted, T2 star and SW MRI images were obtained. Signal and contrast measurements were compared between the three methods and diagnostic accuracy of SW MRI was assessed against T2w images by 2 independent, blinded observers. Image quality was rated on a 4-point scale from 1 (unusable) to 4 (excellent).

Results

Of 49 patients, IMH was detected in 20 (41%) by SW MRI, 21 (43%) by T2-weighted and 17 (34%) by T2 star imaging (p = ns). Compared to T2-weighted imaging, SW MRI had sensitivity of 93% and specificity of 86%. SW MRI had similar inter-observer reliability to T2-weighted imaging (κ = 0.90 and κ = 0.88 respectively); both had higher reliability than T2 star (κ = 0.53). Breath hold times were shorter for SW MRI (4 seconds vs. 16 seconds) with improved image quality rating (3.8 ± 0.4, 3.3 ± 1.0, 2.8 ± 1.1 respectively; p < 0.01).

Conclusions

SW MRI is an accurate and reproducible way to detect IMH at 3T. The technique offers considerably shorter breath hold times than T2-weighted and T2 star imaging, and higher image quality scores.     

Clinical and sonographic management of viable hydatid liver cysts

Aim

The aim of this study was to review our 18-year experience in the treatment of viable hydatid liver cysts (HLCs) with double percutaneous aspiration and ethanol injection (D-PAI) and to provide indications for the clinical management of HLCs.

Materials and methods

From January 1989 to December 2007, 127 patients (100 males; 13–80 years) with 184 viable HLCs (137 univesicular, 47 multivesicular; 2.8–20 cm) underwent D-PAI.

Results

Ultrasonography (US) showed complete disappearance of 125/184 (68%) cysts; in the remaining 59 cases, an inactive solid (37 cases, 20%) or liquid pattern (22 cases, 12%) was observed with volume decreases of 50–80%. The final US pattern was unmodified during the follow-up in 96.8%. Local recurrences were observed in 5 patients (3.9%): 4 patients with 8 multivesicular cysts and 1 patient with a bilocular cyst (with a solid pattern on US) that ruptured into the biliary tree 2 years after the procedure and disappeared after endoscopic sphincterectomy. The mortality rate was 0.8%, and the overall morbidity was 8.6%. The mean hospital stay was 2.9 days. The time of healing for smaller cysts (<5 cm) was shorter than that of large cysts (≥5 cm) (P < 0.001).

Conclusion

Our long-term results confirm the high effectiveness of D-PAI in the treatment of HLCs. These results suggest that multilocular cysts require closer follow-up than unilocular cysts.     

Drainage-related ultrasonography (DRUS): a novel technique for discriminating obstructive and nonobstructive hydroureters in children

Background

Despite advances in urologic imaging, the paucity of an optimal technique that accurately clarifies obstructive and nonobstructive hydroureter exists.

Objective

This study was conducted to introduce a novel and modified ultrasonographic technique, known as drainage-related ultrasonography (DRUS), discriminating obstructive and nonobstructive, nonrefluxing hydroureter.

Materials and methods

A total of 358 children (mean age, 3.7 years) with 418 nonrefluxing hydroureter were included. These children were composed of two groups of obstructive nonrefluxing (141 children with 157 dilated ureters) and nonobstructive, nonrefluxing (217 children with 261 hydroureter). The definite diagnosis regarding the subtype of hydroureter was derived from appropriate investigation. The maximum diameter of the dilated ureter, which was observed on ultrasonography, was recorded before and after 3 h of catheterization, as D1 and D2, respectively. To assess the D ratio, a formula was developed, that is, [(|D1 − D2|)/D1] × 100. Values were recorded and cutoff points were set to discriminate between subtypes.

Results

Obstructive versus nonobstructive subtypes of nonrefluxing hydroureter were clarified with 78.5 % sensitivity and 83.4 % specificity, by setting a cutoff point of 22 % for the D ratio. Regardless of the cutoff point assigned to the reduction in D (D2 compared with D1), DRUS revealed 93.9 % sensitivity, 80.6 % specificity, 63.2 % positive predictive value, and 97.4 % negative predictive value in discriminating upper from lower obstruction.

Conclusion

DRUS affords favorable results in terms of differentiating between obstructive and nonobstructive, nonrefluxing hydroureter, as well as between upper and lower obstruction in obstructive cases. It has the potential to become an efficient imaging modality in the diagnostic algorithm of hydroureter.     

Characterization of a murine model of cardiorenal syndrome type 1 by high-resolution Doppler sonography

Abstract

Cardiorenal syndrome type 1 (CRS-1) is the acute kidney disfunction caused by an acute worsening of cardiac function. CRS-1 is the consequence of renal vasoconstriction secondary to renin–angiotensin system (RAS) activation. No animal models of CRS-1 are described in literature.

Purpose

To characterize a murine model of CRS-1 by using a high-resolution ultrasound echo-color Doppler system (VEVO2100).

Materials

Post-ischemic heart failure was induced by coronary artery ligation (LAD) in seven CD1 mice. Fifteen and thirty days after surgery, mice underwent cardiac and renal echo-color Doppler. Serum creatinine and plasma renin activity were measured after killing. Animals were compared to seven CD1 control mice.

Results

Heart failure with left ventricle dilatation (end diastolic area, p < 0.05 vs. controls) and significantly reduced ejection fraction (EF; p < 0.01 vs. controls) was evident 15 days after LAD. We measured a significant renal vasoconstriction in infarcted mice characterized by increased renal pulsatility index (PI; p < 0.05 vs. controls) associated to increased creatinine and renin levels (p < 0.05 vs. controls)

Conclusions

The mice model of LAD is a good model of CRS-1 evaluable by Doppler sonography and characterized by renal vasoconstriction due to the activation of the renin–angiotensin system secondary to heart failure.     

RELIABILITY OF TWO METHODS OF CLINICAL EXAMINATION OF THE FLEXIBILITY OF THE HIP ADDUCTOR MUSCLES

Background

An inadequate level of flexibility of the adductor muscles is one of the most critical risk factors for chronic groin pain and strains. However, measurement methods of adductor muscle flexibility are not well defined.

Purpose

To determine the inter‐session reliability of the biarticular and monoarticular adductor muscle flexibility measures obtained from passive hip abduction with the knee flexed over the edge of the plinth test (PHA) and the passive hip abduction test at 90° of hip flexion (PHA_90°).

Study design

Clinical Measurement Reliability study.

Methods

Fifty healthy recreational athletes participated in this study. All participants performed the PHA and PHA_90° on four different occasions, with a two‐week interval between testing sessions. Reliability was examined through the change in the mean between consecutive pairs of testing sessions (ChM), standard error of measurement expressed in absolute values (SEM) and as a percentage of the mean score (%SEM), minimal detectable change at 95% confidence interval (MDC₉₅), and intraclass correlation coefficients (ICC_2,k).

Results

The findings showed negligible or trivial ChM values for the two adductor flexibility measures analyzed (<2°). Furthermore, the SEM and MDC₉₅ were 2.1° and 5.9° and 2.2° and 6.2° for the measures obtained from the PHA and PHA_90°, respectively, with %SEM scores lower than 5% and ICC scores higher than 0.90.

Conclusion

The findings from this study suggest that the adductor muscle flexibility measures analyzed have good to excellent inter‐session reliability in recreational athletes. Thus, clinicians can be 95% confident that an observed change between two measures larger than 5.9° and 6.2° for the flexibility measures obtained from the PHA and PHA_90°, respectively, would indicate a real change in muscle flexibility.

Level of evidence

2     

Transrectal ultrasound in patients with hematospermia

Introduction

To illustrate the lesions detected with transrectal ultrasound (TRUS) in patients with hematospermia.

Material and methods

This study included 74 male patients (25–73 years old) affected by hematospermia. Clinical history was obtained and all patients underwent rectal examination as well as TRUS examination in both axial and coronal planes to evaluate the prostate, ejaculatory ducts and seminal vesicles. Biopsy was performed in 10 patients.

Results

Abnormalities were detected in 59 patients. Calculi (n = 20) were seen within the prostate, seminal vesicles and along the course of the ejaculatory ducts. Chronic prostatitis (n = 14) appeared as hyperechoic and hypoechoic areas within the prostate with capsule thickening suggesting seminal vesiculitis (n = 8). Granulomatous prostatitis (n = 3) appeared as hyperechoic and calcified areas scattered within the prostate and the seminal vesicles. Hypoechoic focal lesions and heterogeneous texture were seen in prostate cancer (n = 5). Utricular cysts (n = 3) appeared as small midline lesions, and Mullerian duct cysts (n = 8) appeared as larger midline cysts protruding above the prostate. Ejaculatory duct cysts (n = 4) appeared as thick walled cystic lesions along the course of the ejaculatory duct. Seminal vesicle cysts were detected in 2 patients.

Conclusion

Our conclusion is that TRUS is a safe, non-invasive technique which can be used to detect lesions of the prostate, seminal vesicles and the ejaculatory ducts in patients with hematospermia.     

Contrast-enhanced ultrasound findings in soft-tissue lesions: preliminary results

Objectives

There is currently no widely available, minimally invasive first-level examination that allows physicians to identify soft-tissue lesions that are likely to be malignant. The aim of this pilot study was to explore the potential suitability of dynamic contrast-enhanced ultrasound (DCE-US) for this purpose.

Materials and methods

23 patients were referred to the Veneto Oncological Institute for work-up of superficial soft-tissue lesions. Fourteen lesions were examined with CEUS and enhancement kinetics was analyzed. Subsequently, all lesions were surgically removed and subjected to histological analysis.

Results

The 14 lesions included in the study were histologically classified as malignant (n = 7) or benign (n = 7, including 3 schwannomas). A statistically significant difference between benign and malignant lesions was found in terms of mean times to peak enhancement intensity (p = 0.03) but not mean filling times (FT). When schwannomas were analyzed as a separate group, their mean FT was found to be significantly different from that of the other benign lesions (p = 0.001) and from that of the group comprising other benign lesions as well as malignant lesions (p < 0.005).

Conclusions

CEUS with analysis of contrast-enhancement kinetics is a relatively low-cost, minimally invasive imaging technique, which appears to be a potentially effective first-level method for identifying suspicious soft-tissue masses.     

Doppler ultrasonographic evaluation of ductus venosus blood flow in 55 canine fetuses

Purpose

The ductus venosus (DV) blood flow has been studied in fetal lambs and in humans. This study aims to describe the velocities, the Doppler indices and the morphological patterns of the venous blood flow in the DV of canine fetuses during physiological pregnancy.

Methods

The DV of 55 canine fetuses has been evaluated and the waveforms described using B-mode, color and pulsed-wave Doppler ultrasound technology.

Results

We found 48 diphasic waves and 7 threephasic waves. No monophasic waveform was found. Six of seven threephasic waveforms belonged to litters in which perinatal mortality occurred. The peak velocity during ventricular systole S (cm/s), the peak velocity during the ventricular diastole D (cm/s), the velocity during atrial contraction aV (cm/s), the S/D index, the pulsatility index (PI) and the resistance index were measured.

Conclusions

All Doppler indices and velocities were significantly correlated with each other (p < 0.05). The number of newborn puppies and the age of bitches were not related to DV vascular indices or flow rate (p > 0.05). Gestational age was proportional to the PI (p < 0.02). Doppler ultrasonography allows the assessment of DV blood flow in canine fetuses during pregnancy.