Ultrasonography in inflammatory rheumatic disease: an overview

Modern ultrasonography enables clinicians to sensitively assess the progression of inflammatory joint and tendon disease, and to investigate vasculitides, connective tissue diseases and nerve lesions. Despite the advantages of musculoskeletal ultrasonography for diagnostic, prognostic and monitoring purposes, fewer than 10% of European rheumatologists use this technique in routine clinical practice. The reliability and limitations of rheumatic ultrasonography remain a concern, although good interobserver and intraobserver agreement in results from ultrasonography have been demonstrated among experienced sonographers. International recommendations for assessments and ultrasonography training courses are available, and will improve the standardization of the use of these techniques. In clinical practice, ultrasonography can complement the diagnostic evaluation of patients with rheumatic disease and might have value in confirming and extending clinical findings. Musculoskeletal ultrasonography can also be a valuable follow-up tool to monitor disease activity and support treatment decisions for specific patients. Furthermore, ultrasonography-guided articular injections provide better precision and a higher success rate for synovial fluid aspiration than clinically-guided injections. In the future, three-dimensional ultrasonography techniques, the fusion of ultrasonography and other imaging methods, and real time sonoelastography will be interesting new fields of investigation.     

Clinical benefit of carotid endarterectomy based on duplex ultrasonography

Carotid endarterectomy has been shown to significantly reduce the risk of stroke caused by carotid artery stenosis in selected patients. Limiting the morbidity and costs of this process without increasing the risks should further improve the benefits of this procedure. Results were prospectively collected from 123 consecutive carotid endarterectomies performed at a community teaching hospital. All patients underwent duplex ultrasonography for preoperative evaluation. Catheter angiography was used on a selective basis. Preferential use of regional anesthetic and selective use of the intensive care unit were applied. The mortality, morbidity, complications, and costs were then compared for the group receiving only preoperative duplex ultrasonography with those undergoing catheter angiography preoperatively. Age, comorbid risk factors, indications for carotid endarterectomy, and incidence of stroke were similar in both patient groups. The rates of mortality, morbidity, and stroke for carotid endarterectomy were low (mortality 0%, morbidity 6.5%, stroke 0.8%). For preoperative evaluation all patients underwent duplex ultrasonography (100%) and 28 (23%) underwent preoperative catheter angiography in addition to duplex ultrasonography. The complication rate associated with catheter angiography was 6/28 (21%). Complications included groin hematoma (7%), pseudoaneurysm (3.6%), bradycardia (7%), and unstable angina (3.6%). Costs for duplex ultrasonography averaged 165 US dollars and additional costs incurred by the use of catheter angiography averaged 4,200 US dollars. Intraoperative assessment of the carotid endarterectomy site did not change based on the use of preoperative catheter angiography. Morbidity, mortality, and stroke rates were the same for the 2 groups. The preoperative use of duplex ultrasonography for the sole evaluation in carotid endarterectomy is well established. The use of preoperative catheter angiography is still preferred by a subset of surgeons. The use of catheter angiography is associated with significant morbidity and additional costs when compared to performing carotid endarterectomy based solely on preoperative duplex ultrasonography. The added costs and morbidity of angiography increase the societal cost of this procedure without significant clinical improvement in patient outcome.     

The use of ultrasonography in the diagnosis of calculous gallbladder disease.

During a 12-month period from September 1976 to September 1977, 114 patients in a community hospital had ultrasonography as part of their diagnostic work-up for suspected gallbladder disease. While 65 per cent had an additional study, such as an oral cholecystogram or intravenous cholangiogram, 35 per cent had ultrasonography as the only study to make the diagnosis. All patients in this group had laparotomy and cholecystectomy to confirm or disprove the diagnosis of calculous gallbladder disease. The overall accuracy rate of ultrasonography for calculous gallbladder disease was 90 per cent, which compares favorably with the standard oral cholecystogram. Ultrasonography has some distinct advantages in certain clinical situations such as acute cholecystitis, jaundice, pancreatitis and pregnancy. A review of our clinical experience in the everyday use of ultrasonography for calculous biliary disease has been discussed, and guidelines for the use of ultrasonography as part of the diagnostic armamentarium for gallbladder disease are presented.     

Ultrasonography for rapid detection of pneumothorax after costal cartilage harvest

The rib is a generous source of donor cartilage. Thus, costal cartilage harvest is a frequently performed adjunctive procedure in facial plastic and reconstructive surgery. Pneumothorax is an uncommon complication of rib graft harvest but is potentially highly morbid. Although chest radiography is the current diagnostic study of choice to rule out air in the chest, there is growing evidence that ultrasonography is less expensive and more sensitive. Furthermore, the portability of the ultrasonographic unit allows for immediate evaluation and more rapid diagnosis. The use of ultrasonography also precludes exposing the patient to ionizing radiation. We present a case in which ultrasonography was used to rapidly confirm the absence of pneumothorax after costal cartilage harvest and review the literature associated with use of ultrasonography for detection of this uncommon but serious complication.     

Role of ultrasonography in the primary diagnosis of cholelithiasis: an analysis of fifty cases

The use of ultrasonography to diagnose cholelithiasis has recently been recommended to supplement standard reinforced oral cholecystography or as an alternative to reinforced oral studies when a single dose fails to visualize the gallbladder. As yet the use of ultrasonography in the primary diagnosis of cholelithiasis is not generally accepted. To assess the specificity and sensitivity of this mode of diagnosis, fifty patients were reviewed retrospectively. The findings of ultrasonography are compared with standard oral cholecystography and with the pathologic findings. The results of this analysis suggest that diagnosis of cholelithiasis by ultrasonography has a high level of accuracy. Use of this mode of evaluating the gallbladder is suggested as a primary diagnostic test for jaundiced or pregnant patients.     

Intraoperative ultrasonography in AVM surgery

Intraoperative ultrasonography was used for the surgical resection of arteriovenous malformations in three cases. In the first case, intraoperative ultrasonography clearly demonstrated residual micro-AVM, which had seemed to be resected completely during surgery. In the second case, diminished flow of the draining vein by clipping of the feeding artery was demonstrated by ultrasonography. In the third case, intraoperative ultrasonography revealed stasis of the flow in the varix by clipping of the feeding artery. Intraoperative ultrasonography is easy to use and less expensive compared with intraoperative digital subtraction angiography or MRI and it is also effective for identifying AVMs as well as the flow patterns of the feeding arteries or draining veins. Intraoperative ultrasonography is a useful device for AVM surgery.     

尿细胞学、NMP22和B超联合检查在膀胱癌患者随访中的应用

目的：了解联合应用尿细胞学、尿核基质蛋白22(NMP22)、经腹B超检查在膀胱癌术后患者随访中的价值。方法：对36例膀胱癌术后随访患者先行尿细胞学、尿NMP22、经腹B超检查，再行膀胱镜检查，以膀胱镜检查及活检为金标推，分析各种检查结果，。结果：36例经膀胱镜检查及活检证实肿瘤复发17例。尿细胞学、尿NMP22、经腹B超检查的灵敏度分别为47．1％、82．4％和70．6％。三种检查联合应用的灵敏度为94．1％，与膀胱镜检查比较差别无显著性意义。结论：尿细胞学、尿NMP22、经腹B超联合检查用于膀胱癌患者的术后随访灵敏性较高。     

尿细胞学、BTA、B超联合检查在膀胱癌病人随访中的应用

目的　了解联合应用尿细胞学、尿BTA、经腹B超检查在膀胱癌术后病人随访中的价值。方法　对 31例膀胱癌术后随访病人 ,先行尿细胞学、尿BTA、经腹B超检查 ,再行膀胱镜检查。以膀胱镜检查及活检为金标准 ,分析各种检查的效果。　结果　 31例经膀胱镜检查及活检证实肿瘤复发 14例。尿细胞学、尿BTA、经腹B超检查的灵敏度分别为 5 0 .0 %、78.6 %、6 4.3 %。三种检查联合应用的灵敏度为 92 .9% ,与膀胱镜检查比较 ,统计学差别无显著性意义。　结论　尿细胞学、尿BTA、经腹B超联合检查可以部分取代膀胱镜检查用于膀胱癌病人的术后随访     

Transrectal ultrasonography for the early detection and staging of prostate cancer

Relatively recent changes and improvements in equipment have vastly increased image resolution for transrectal ultrasonography of the prostate. The expanded use of transrectal ultrasonography has greatly furthered knowledge of prostate zonal anatomy and permitted clinical evaluation of internal prostate architecture. The technique is operator dependent, as the quality of the results is related directly to that person's knowledge and experience. The significant majority of prostate cancers originate from the peripheral zone. Palpable stage B nodules characteristically have a hypoechoic appearance. There is disagreement about the tumor characteristics that cause hypoechogenicity, but large tumors may obscure the normal prostate anatomy and appear isoechoic because of the lack of contrast with surrounding prostate tissue. The transition zone of the prostate is the origin of benign prostatic hyperplasia and almost 20 per cent of prostate cancers. These tumors probably correspond to most stage A lesions. Transrectal ultrasonography is less accurate in identifying transition zone tumors because of the mixed echogenicity of the transition zone, interference from prostatic calculi or calcified corpora amylacea, and poorer image resolution in this area. Studies evaluating the use of transrectal ultrasonography for early detection of prostate cancer generally have shown a twofold increase in the detection rate compared with digital rectal examination. However, the decreased morbidity and expense of transrectal prostate biopsy using an automatic gun device have increased the frequency of biopsy in ultrasound-examined patients compared with those historically evaluated by digital rectal examination. The increased detection rate may in part be a function of the increased use of biopsies, independent of other factors. Transrectal ultrasonography rarely detects cancer in patient with normal digital rectal examination and a normal serum prostate-specific antigen level. Transrectal ultrasonography may be capable of identifying early capsular penetration or seminal vesicle invasion in some patients with known prostate cancer. However, its superiority to digital rectal examination for this purpose has not been demonstrated unequivocally. Ultrasonography does allow directed biopsies of the seminal vesicles or other suspect areas, and this may be helpful in staging the disease. The use of transrectal ultrasonography in prostate cancer has evolved rapidly, and changes in technology antiquate reports within a few years.(ABSTRACT TRUNCATED AT 400 WORDS)     

先天性肛门闭锁超声定位诊断探讨

目的 探讨应用超声检查对先天性肛门闭锁进行定位诊断。方法 对25例先天性肛门闭锁患儿术前使用超声检查,测定直肠盲端与肛门隐窝皮肤之间的距离(P-P间距),并设立耻尾线(PC线),从而决定首次手术方式,并将超声检查结果与手术实际结果对比。结果 25例患儿均能准确地测得P-P间距,并能满意设立PC线,超声检查结果与手术基本相符。结论 超声检查应用于肛门闭锁术前定位诊断,具有准确率高、安全简便、可重复性强等优点,值得推广应用。     

Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip

Although hip ultrasonography is gaining acceptance as the most effective method for the early diagnosis of developmental dysplasia of the hip, there is still some controversy regarding the use of ultrasonography as a screening method. The purpose of this study was to investigate prospectively the capacity of clinical examination findings and associated risk factors to detect developmental dysplasia of the hip defined ultrasonographically in infants. A total of 3,541 infants underwent clinical examination and hip ultrasonography. Measured against ultrasonography as a standard, the sensitivity and specificity of clinical examination were 97% and 13.68%, respectively. Graf type IIb or more severe developmental dysplasia was found in 167 infants (208 hips), at an overall frequency of 4.71%. Graf type IIa physiological immaturity was encountered in 838 hips, and of these, 15 hips (1.78%) developed Graf type IIb dysplasia and underwent treatment. Patient characteristics that were found to be significant risk factors were swaddling use, female gender, breech delivery and positive family history. Given its low specificity, our findings suggest that clinical examination does not reliably detect ultrasonographically defined developmental dysplasia of the hip in infants being screened for this disease.     

Extended applications of ultrasonography by the surgeon. A preliminary report

The application of ultrasonography by surgeons in hospitalized patients and the potential benefits thereof were evaluated in 52 patients. Ultrasonography was used to diagnose emergent conditions in 30 patients, nonemergent conditions in 16 patients, and as a guide for interventional procedures in 6 patients. The procedure was carried out by a specially trained member of the surgical team, thus providing use of the technique as required. In assessing the degree of reliability of ultrasonography for surgical decision-making, it was found to be helpful in arriving at a decision in 47 patients, not helpful in 3 patients, and misleading in 2 patients in whom results were misinterpreted. The use of ultrasonography by the surgical team may help to provide early diagnosis, and thus may shorten the delay in necessary surgical intervention. It can also serve as a guide during interventional procedures and thereby can increase their safety and accuracy. We believe that the ability to carry out and interpret ultrasonographic tests is a helpful addition to the surgeon's armamentarium.     

Comparison of digital examination and transrectal ultrasonography for the diagnosis of prostatic cancer

The ability to detect prostatic cancer by transrectal ultrasonography was evaluated in a prospective blind study of 216 men. The sensitivity of transrectal ultrasonography was 86 per cent but the specificity was only 41 per cent. Tumors less than 1 cm. in diameter were most difficult to detect by transrectal ultrasonography. The positive and negative predictive values of transrectal ultrasonography were 36 and 89 per cent, respectively. Abnormal scans that strongly suggested carcinoma were present in 10 per cent of the men who had a normal digital examination but no biopsy was performed. Transrectal ultrasound is a sensitive method to detect all but small prostatic tumors and it can detect tumors that are not evident by digital examination. To date, however, transrectal ultrasonography may be difficult to use for routine screening in the United States because of the low positive predictive value. Nevertheless, further investigation of this technique is warranted to define its role in improving the diagnosis of prostatic cancer.     

Intraoperative ultrasonography (IOUS) in thoracolumbar fractures

The thoracolumbar levels are the second most common region for spinal trauma. A major surgical effort often entails removal of retropulsed bone fragments with decompression of the spinal contents or realignment of vertebral subluxations. The ability to determine intraoperatively the completeness of such a procedure could impact on the surgical approach and, ultimately, the operative result. The intraoperative use of ultrasonography has gained popularity and applicability. This comparison study of intraoperative ultrasonography versus postoperative computed tomography (CT) assessed the accuracy of intraoperative ultrasonography in determining the status of the spinal canal following surgical intervention in a group of 21 patients with thoracolumbar fractures. In all cases a patent ventral subarachnoid space or complete spinal canal decompression was deduced following intraoperative ultrasonography. The postoperative assessment by CT concurred in 20 of 21 (95%) situations. Intraoperative ultrasonography proved useful during the operative management of these fractures and gave good supportive evidence that the neural elements were decompressed by surgical procedure.     

肾脏良性占位病变的术前诊断(附37例报告)

目的 提高肾脏良性占位病变的术前诊断及鉴别诊断水平。方法 对１５年来收治３７例肾占位病变患者的临床资料与Ｂ超、ＣＴ、彩超之表进行分析总结。结果 肾脏良性占位病变占肾实性占位病变有提示诊断有意义。结论 随着Ｂ超、ＣＴ的普及,肾脏良性占位病变检出率呈上升趋势。Ｂ超、ＣＴ及彩超联合检查可绝大多数肾良性占位病变在术前作出诊断和提示,结合术前穿刺或术中冰冻活检可与肾癌相鉴别,避免不必要的根治性肾切除。     

Targeted microbubbles in the experimental and clinical setting

BackgroundMicrobubbles have improved ultrasonography imaging techniques over the past 2 decades. Their safety, versatility, and easiness of use have rendered them equal or even superior in some instances to other imaging modalities such as computed tomography and magnetic resonance imaging. Herein, we conducted a literature review to present their types, general behavior in tissues, and current and potential use in clinical practice.MethodsA literature search was conducted for all preclinical and clinical studies involving microbubbles and ultrasonography.ResultsDifferent types of microbubbles are available. These generally improve the enhancement of tissues during ultrasonography imaging. They also can be attached to ligands for the target of several conditions such as inflammation, angiogenesis, thrombosis, apoptosis, and might have the potential of carrying toxic drugs to diseased sites, thereby limiting the systemic adverse effects.ConclusionsThe use of microbubbles is evolving rapidly and can have a significant impact on the management of various conditions. The potential for their use as targeting agents and gene and drug delivery vehicles looks promising.     

Review article: diagnostic ultrasonography: applications in orthopaedic surgery

Diagnostic ultrasonography of musculoskeletal diseases in the United States has been used most often for detection of rotator cuff tears or developmental dysplasia of the hip. Diagnostic ultrasonography also is useful in imaging the periarticular soft tissues about the knee, hip, ankle, occult pediatric fractures, muscle injury, bone healing, and foreign bodies. Recent technologic improvements have made this imaging modality increasingly more accurate while providing significant benefits over traditional modalities such as magnetic resonance imaging, particularly regarding cost, patient satisfaction, and ease of usage. Increasing use in the future of diagnostic ultrasonography for musculoskeletal conditions is likely as acceptance grows. This review focuses on recent, practical applications of diagnostic ultrasonography of the musculoskeletal system.     

The effect of ipsilateral whole breast ultrasonography on the surgical management of breast carcinoma

BACKGROUND: Patients can be selected for breast conservation therapy using mammography and physical examination. Whole breast ultrasonography has been shown to identify lesions not seen on mammography. This study sought to determine how often whole breast ultrasonography changes the surgical management of breast cancer. METHODS: All patients with stage 1 and 2 breast cancer undergoing whole breast ultrasonography were identified. A change in surgical management was defined as the identification by ultrasonography alone of foci of carcinoma greater than 1 cm from the primary tumor site or in another quadrant of the breast. RESULTS: There were 1385 breast cancer patients; 31% had ultrasonography. Eighteen percent of patients had abnormalities identified by ultrasonography alone. Changes in management occurred in 2.8%. The additional lesions led to four wider resections and eight mastectomies. Patients with ultrasonography abnormalities were significantly younger, and more likely to have histologic grade 2 or 3 disease. CONCLUSIONS: These findings do not support the routine use of ultrasonography in all breast cancer patients. Significant abnormalities were more commonly seen among younger patients with higher grade lesions.     

Methods of intraoperative localization in the surgery treatment of persistent and recurrent secondary hyperparathyroidism

The intraoperative localization of residual parathyroid tissue during re-operations for persistent or recurrent secondary hyperparathyroidism (HPT) could have difficult due to cicatricial phenomena, anatomic modifications, ectopic or super-numerous glands. The use of intraoperative localisatin methods, as ultrasonographic and gamm-camera, permits a great level of success in identifying residual gland tissue. The Authors report their experience in the treatment of 5 cases of persisten HPT and 3 cases of recurrent HPT using gamma-camera and ultrasonography intraoperatively. Gamma-camera presented a sensitivity of 88% while ultrasonography did 100%. According to the experience, even numerically limited, of the Authors, intraoperative ultrasonography offers better results than gamma-camera, with less technical complexity.     

Detection of preoperatively unrecognized multiple pancreatic pseudocysts by intraoperative ultrasonography. Report of two cases

During two pancreatic operations, intraoperative ultrasonography detected multiple pancreatic pseudocysts that were unrecognized preoperatively. In each operation, a single pseudocyst was detected by preoperative ultrasonography, computed tomography, and intraoperative surgical exploration. In addition, high-resolution ultrasonography used during the operations also identified and precisely localized additional smaller pseudocysts. Also, the use of color Doppler imaging during the operations enabled the delineation of small blood vessels around the pseudocysts. The accurate diagnosis of multiple pseudocysts and the precise anatomic information provided by intraoperative ultrasonography permitted appropriate surgical treatment of the pancreatic pseudocysts which, in turn, might help prevent recurrence of the disease.