Contribution of tissue harmonic imaging and frequency compound imaging in interventional breast sonography.

OBJECTIVE: The purpose of this study was to retrospectively compare conventional imaging, frequency compound imaging (CI), and tissue harmonic imaging (THI) in interventional breast sonography. METHODS: Institutional Review Board approval and patient informed consent were not required. The authors reviewed 104 sonographically guided breast procedures in 83 patients. For each biopsy, 4 images obtained with conventional imaging, frequency CI at 10 and 14 MHz (CI10 and CI14), and THI were graded independently by 2 radiologists for lesion conspicuity, needle conspicuity, lesion and needle conspicuity, and overall image quality. Frequency CI at 10 MHz, CI14, and THI were compared with conventional imaging. Different clinical scenarios (fatty versus glandular background, fine needle versus core needle, and oblique versus horizontal needle direction) were evaluated. RESULTS: Statistical analysis showed that for overall image quality, CI10 was the best setting (odds ratios [OR], 3.67 and 7.48). For lesion conspicuity, CI14 (OR, 3.55) and THI (OR, 1.77) improved lesion visibility in a fatty background, whereas THI (OR, 0.26) was very limited in a glandular background. For needle conspicuity, no setting was better than conventional, whereas THI was the least valuable setting (OR, 0.011 and 0.049). For lesion and needle conspicuity, CI10 showed significantly better results than conventional for a dense background (P = .0268 and .4028; OR, 2.435 and 1.383) with 1 reviewer, whereas THI was the least valuable setting (OR, 0.014 and 0.042). CONCLUSIONS: Conventional imaging provided the best assessment of lesion and needle conspicuity. Frequency compounding is a useful setting for dense breast and for fine-needle aspiration. Tissue harmonic imaging has a role in the visualization of a lesion against a fatty background but is of limited value in needle visualization.     

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

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

Application of the breast imaging reporting and data system final assessment system in sonography of palpable breast lesions and reconsideration of the modified triple test.

OBJECTIVE: The purpose of our study was to evaluate the utility of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) sonographic final assessment system and palpation-guided fine-needle aspiration (FNA) for evaluation of palpable breast lesions. METHODS: Our computerized database identified 160 palpable lesions of the breast in which follow-up palpation-guided FNA, targeted sonography, and pathologic confirmation were performed. We used BI-RADS sonographic data on all lesions. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of malignancy were calculated for sonography and palpation-guided FNA. Two-sample binomial proportion tests were used as the statistical analysis (P<.05). RESULTS: The FNA results were defined as benign, atypical cells, suspicious for malignancy, malignancy, and insufficiency. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.9%, 82.7%, 84.3%, 57.7%, and 97.2%, respectively, on sonography and 75.8% to 90.9%, 82.7% to 98.4%, 84.3% to 94.4%, 57.7% to 92.6%, and 93.9% to 97.2% on FNA. There was no statistically significant difference for sensitivity and negative predictive value between the two examinations. CONCLUSIONS: The diagnostic accuracy of sonography was similar to that of palpation-guided FNA for not missing the malignancy. Clinical application of FNA results can be difficult, especially when the result is insufficiency or atypical cells. Moreover, FNA is invasive and overlaps other procedures. Therefore, we conclude that sonography can replace palpation-guided FNA for diagnosis of palpable lesions of the breast when the BI-RADS sonographic final assessment system is used appropriately.     

Tissue harmonic imaging, frequency compound imaging, and conventional imaging: use and benefit in breast sonography.

OBJECTIVE: The purpose of this study was to evaluate different sonographic settings (tissue harmonic, frequency compounding, and conventional imaging) and to determine which setting optimizes breast lesion detection and lesion characterization. METHODS: Four hundred thirteen consecutive breast lesions (249 benign and 164 malignant) were evaluated by sonography using 4 different modes (conventional imaging at 14 MHz, tissue harmonic imaging at 14 MHz [THI], and frequency compound imaging at 10 MHz [CI10] and 14 MHz [CI14]). The images were reviewed by consensus by 2 breast radiologists. For each image, the lesion was graded for conspicuity, mass margin assessment, echo texture assessment, overall image quality, and posterior acoustic features. RESULTS: For lesion conspicuity, THI and CI14 were better than conventional imaging (P < .01) and CI10 (P < .01) particularly against a fatty background (P < .01 for THI versus conventional for a fatty background versus P = .13 for a dense background). Frequency compound imaging at 10 MHz performed the best in echo texture assessment (P < .01), as well as overall image quality (P < .01). For margin assessment, CI10 performed better for deep and large (> or =1.5-cm) lesions, whereas CI14 performed better for small (<1.5-cm) and superficial lesions. Finally, THI and CI14 increased posterior shadowing (P < .01) and posterior enhancement (P < .01). CONCLUSIONS: The standard breast examination incorporates 2 distinct processes, lesion detection and lesion characterization. With respect to detection, THI is useful, especially in fatty breasts. With respect to characterization, compound imaging improves lesion echo texture assessment. No single setting in isolation can provide the necessary optimized information for both of these tasks. As such, a combination approach is best.     

Application of power Doppler vocal fremitus sonography in breast lesions.

OBJECTIVE: The purpose of this study was to illustrate the method and use of power Doppler vocal fremitus (PDVF) sonography in the detection and diagnosis of breast lesions. METHODS: One case was evaluated by various sonographic parameters and equipment to determine how the VF images were affected. Cases illustrative of a broad range of breast conditions were also collected. Each image pair consisted of B-mode and VF images to maintain an identical projection and to illustrate the influence of PDVF sonography. RESULTS: With B-mode and PDVF sonography, we evaluated and compared various breast conditions, including normal anatomic structures and abnormal lesions. We found that PDVF sonography is useful for distinguishing abnormal masses from normal tissue, such as differentiating between isoechoic tumors and isoechoic glandular tissues, and discriminating entrapped fat lobules from isoechoic tumors. Furthermore, PDVF sonography was useful for determining whether intracystic echoes are attached to the cyst wall. CONCLUSIONS: Power Doppler VF imaging is a valuable adjunct tool to B-mode sonography in the evaluation of breast lesions.     

Computer-based margin analysis of breast sonography for differentiating malignant and benign masses.

OBJECTIVE: To evaluate the role of quantitative margin features in the computer-aided diagnosis of malignant and benign solid breast masses using sonographic imaging. METHODS: Sonographic images from 56 patients with 58 biopsy-proven masses were analyzed quantitatively for the following features: margin sharpness, margin echogenicity, and angular variation in margin. Of the 58 masses, 38 were benign and 20 were malignant. Each feature was evaluated individually and in combination with the others to determine its association with malignancy. The combination of features yielding the highest association with malignancy was analyzed by logistic regression to determine the probability of malignancy. The performance of the probability measurements was evaluated by receiver operating characteristic analysis using a round-robin technique. RESULTS: Margin sharpness, margin echogenicity, and angular variation in margin were significantly different for the malignant and benign masses (P < .03, 2-tailed Student t test). According to quantitative measures, tumor-tissue margins of the malignant masses were less distinct than for the benign masses. Although the mean size of the lesions for the two groups was the same, the mean age of the patients was statistically different (P = .000625). After logistic regression analysis, the individual features age, margin sharpness, margin echogenicity, and angular variation in margin were found to be associated with the probability of malignancy (P < .03). The area under the receiver operating characteristic curve +/- SD for the 3-feature logistic regression model combining age, margin echogenicity, and angular variation of margin was 0.87 +/- 0.05. CONCLUSIONS: The proposed quantitative margin features are robust and can reliably measure margin distinctiveness. These features combined with logistic regression analysis can be useful for computer-aided diagnosis of solid breast lesions.     

Imaging findings of chest wall lesions on breast sonography.

OBJECTIVE: The purpose of this presentation is to illustrate the sonographic findings of chest wall lesions that were depicted on breast sonography. METHODS: Chest wall lesions detected during breast sonography were collected and reviewed retrospectively. RESULTS: The sonographic findings of normal chest walls and various pathologic chest wall lesions, including inflammatory lesions, benign neoplasms, and malignant neoplasms, are discussed. CONCLUSIONS: Familiarity with normal sonographic anatomy and chest wall lesions could be helpful in differentiating a chest wall lesion from a breast lesion and in showing whether the origin of any palpable breast lump is in the breast parenchyma or the chest wall on breast sonography.     

Tissue harmonic imaging: utility in breast sonography.

OBJECTIVE: To determine the impact of tissue harmonic imaging on visualization of focal breast lesions and to compare gray scale contrast between focal breast lesions and fatty tissue of the breast between tissue harmonic imaging and fundamental frequency sonography. METHODS: A prospective study was performed on 219 female patients (254 lesions) undergoing sonographically guided fine-needle biopsy. The fundamental frequency and tissue harmonic images of all lesions were obtained on a scanner with a wideband 7.5-MHz linear probe. Twenty-three breast carcinomas, 6 suspect lesions, 9 fibroadenomas, 1 papilloma, 1 phyllodes tumor, 162 unspecified solid benign lesions, and 40 cysts were found. In 12 cases the fine-needle aspiration did not yield sufficient material. The gray scale intensity of the lesions and adjacent fatty tissue was measured with graphics software, and the gray scale contrast between lesions and adjacent fatty tissue was calculated. RESULTS: Tissue harmonic imaging improved the gray scale contrast between the fatty tissue and breast lesions in 230 lesions (90.6%; P < .001) compared with fundamental frequency images. The contrast improvement was bigger in breasts with predominantly fatty or mixed (fatty/glandular) composition than in predominantly glandular breasts. The overall conspicuity, lesion border definition, lesion content definition, and acoustic shadow conspicuity were improved or equal in the harmonic mode for all lesions.CONCLUSIONS: The tissue harmonic imaging technique used as an adjunct to conventional breast sonography may improve lesion detectability and characterization.     

Color Doppler sonography in the evaluation of superficial lymphomatous lymph nodes.

OBJECTIVE: We performed a retrospective study to document the sonographic and color Doppler characteristics of lymphomatous superficial lymph nodes. METHODS: We selected 130 individuals who underwent sonography, color Doppler imaging, fine-needle aspiration biopsy, and surgical removal of the nodes with the final diagnosis of lymphoma (87) and chronic adenitis (43). During sonography, for each node we considered the longitudinal and axial diameters, long/short axis ratio, visibility of the hilum, and the internal echogenicity of the node. During the color and power Doppler examination, we classified the nodes into 3 patterns: type I, "hilar normal"; type II, "hilar activated"; and type III, "peripheral." RESULTS: Sonographic evidence was not significant. With color Doppler sonography, 97% of nodes affected by non-Hodgkin lymphoma, 94% of nodes affected by Hodgkin lymphoma, and 100% of non-neoplastic nodes showed hilar vascularity. Type I seemed more frequently associated with inflammation, and type II was more frequently associated with lymphoma. CONCLUSIONS: The presence of peripheric subcapsular vessels, which is typical of metastasis, is definitely rare in lymphoma (with the possible exception of the uncommon subtypes of high-grade lymphomas). The differential diagnosis between lymphoma and lymphadenitis is frequently impossible on the basis of sonographic and color Doppler patterns alone; therefore, clinical evaluation and biopsy are generally mandatory.     

Color Doppler sonography in evaluation of spermatoceles: the "falling snow" sign.

OBJECTIVE: Doppler sonography is not commonly used in evaluation of cystic lesions with internal echoes. Here we report the use of the mechanical properties of color Doppler sonography to further characterize 3 spermatoceles. METHODS: Three patients who came to University of California San Francisco Imaging Center with painless unilateral scrotal enlargement were evaluated with sonography and were found to have large spermatoceles. Color Doppler sonography was applied to these spermatoceles, and digital video clips were obtained as the color beam was instituted. RESULTS: When color Doppler sonography was applied to each spermatocele, the internal echoes moved away from the transducer, resulting in an appearance similar to falling snow. CONCLUSIONS: The "falling snow" sign can be used to enhance the diagnosis of a spermatocele as well as to evaluate a superficial cystic lesion with echogenic fluid and internal microdebris that is difficult to distinguish from a solid mass.     

Diagnosis of the intraductal component of invasive breast cancer: assessment with mammography and sonography.

OBJECTIVE: The aim of this study was to investigate mammographic and sonographic features and their sensitivities for depiction of the intraductal component associated with invasive ductal carcinoma (IDC). METHODS: During a 1-year period, 132 patients with IDC underwent surgical treatment. All patients underwent mammography and high-resolution sonography, and the findings were reported according to the American College of Radiology's Breast Imaging Reporting and Data System lexicon. Tumors were classified as "pure IDC" and "IDC with an intraductal component" by histopathologic evaluation. We compared mammographic and sonographic features between the above 2 groups and attempted to correlate them with histopathologic findings. We also investigated separate and combined sensitivities, specificities, and accuracies of both mammography and breast sonography for showing intraductal components. Finally, imaging measurements were compared with pathologic measurements. RESULTS: One hundred four (79%) of the 132 IDCs contained an intraductal component. Patients with IDC with an intraductal component showed calcifications on mammography and showed an echogenic halo, duct dilatation, calcifications, and increased vascularity in surrounding tissue on sonography more frequently than patients with pure IDC. The sensitivities of mammography, sonography, and their combined assessment for detection of an intraductal component were 55%, 80%, and 86%, respectively. The combined assessment (r = 0.90) measured the extent of the tumor more accurately than mammography (r = 0.71) or sonography (r = 0.79) separately. CONCLUSIONS: Combined assessment with mammography and sonography offers more accurate information for the presence of an intraductal component and the extent of a tumor than each separate assessment.     

Pathologic breast conditions in childhood and adolescence: evaluation by sonographic diagnosis.

OBJECTIVE: The growing awareness of female breast cancer has led to increased sensitivity toward pathologic breast conditions in children and adolescents. Thus, approximately 15% of patients in child and adolescent gynecology are referred for the first time because of conspicuous features of the breast such as pain, palpable masses, and other findings on visual inspection. The aim of this study was to analyze the underlying diagnoses and diseases and determine the status of breast sonography in the diagnostic process. METHODS: The study population consisted of 62 female patients between 8 weeks and 20 years of age (1997-2002) who were examined clinically, followed by standardized sonography (7.5-13 MHz, conventional B-mode panoramic sonography). Presumed diagnoses were confirmed by biopsy in some patients (n = 16) and by follow-up with clinical examination and sonography in most cases (n = 46). RESULTS: The clinical and sonographic evaluation confirmed 4 main groups of diagnoses: benign tumors (15), developmental disturbances (14), cystic changes (11), and inherent defects (7). In the remaining cases, the findings were no abnormality (9), nipple discharge without evidence of pathologic or morphologic correlates (3), abscesses (2), and epidermoid cyst (1). CONCLUSIONS: Knowledge of regular breast development and its variants is essential for the physician. Given knowledge of the sonographic appearance of physiologic breast development and specific lesions, breast sonography is most helpful in identifying and characterizing abnormalities and guiding further investigation.     

Evaluation of hepatic focal nodular hyperplasia with contrast-enhanced gray scale harmonic sonography: initial experience.

OBJECTIVE: To assess the potential of contrast-enhanced gray scale harmonic sonography in the evaluation of the typical vascular and enhancement patterns of hepatic focal nodular hyperplasia. METHODS: Thirteen patients with 13 lesions of hepatic focal nodular hyperplasia underwent contrast-enhanced gray scale harmonic sonography. After the injection of a microbubble contrast agent (SH U 508A), gray scale harmonic sonographic studies using a Coded Harmonic Angio technique were performed with a combination of a period of continuous scanning to assess the vascular pattern (vascular imaging) and interval delay scanning to determine the sequential enhancement pattern (acoustic emission imaging). Each imaging pattern was categorized and analyzed by consensus of 2 experienced radiologists. RESULTS: In 12 (92%) of 13 lesions, vascular imaging during the arterial phase showed central arteries of a spoked wheel pattern, whereas the remaining lesion had stippled vascularity. On acoustic emission imaging, 11 (85%) of 13 lesions were hyperechoic during the early phase, and the remaining 2 (15%) were isoechoic compared with surrounding parenchyma. Ten (77%) of 13 lesions remained either hyperechoic (5 of 13) or isoechoic (5 of 13) during the delay phase, whereas the remaining 3 lesions (23%) were hypoechoic. CONCLUSIONS: Contrast-enhanced gray scale harmonic sonography showed the typical vascularity of a spoked wheel pattern during the vascular phase and persistent enhancement on serial acoustic emission imaging in most cases of hepatic focal nodular hyperplasia, and thereby it can be a promising technique in noninvasive diagnosis of this entity.     

Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions.

OBJECTIVE: The purpose of this study was to evaluate the value of ultrasound elastography (UE) in differentiating benign versus malignant lesions in the breast and compare it with conventional sonography and mammography. METHODS: From September 2004 to May 2005, 296 solid lesions from 232 consecutive patients were diagnosed as benign or malignant by mammography and sonography and further analyzed with UE. The diagnostic results were compared with histopathologic findings. The sensitivity, specificity, accuracy, positive and negative predictive values, and false-positive and -negative rates were calculated for each modality and the combination of UE and sonography. RESULTS: Of 296 lesions, 87 were histologically malignant, and 209 were benign. Ultrasound elastography was the most specific (95.7%) and had the lowest false-positive rate (4.3%) of the 3 modalities. The accuracy (88.2%) and positive predictive value (87.1%) of UE were higher than those of sonography (72.6% and 52.5%, respectively). The sensitivity values, negative predictive values, and false negative rates of the 3 modalities had no differences. A combination of UE and sonography had the best sensitivity (89.7%) and accuracy (93.9%) and the lowest false-negative rate (9.2%). The specificity (95.7%) and positive predictive value (89.7%) of the combination were better, and the false-positive rate (4.3%) of the combination was lower than those of mammography and sonography. CONCLUSIONS: In a clinical trial with Chinese women, UE was superior to sonography and equal or superior to mammography in differentiating benign and malignant lesions in the breast. A combination of UE and sonography had the best results in detecting cancer and potentially could reduce unnecessary biopsy. Ultrasound elastography is a promising technique for evaluating breast lesions.     

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

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

Galactoceles mimicking suspicious solid masses on sonography.

OBJECTIVE: The purpose of this study was to evaluate the sonographic appearance of a galactocele that can sonographically mimic a suspicious solid mass and to differentiate between a galactocele and a solid mass. METHODS: From September 2002 to February 2004, 33 galactoceles classified as Breast Imaging Reporting and Data System category 4 were included. They were all confirmed by sonographically guided core biopsies. Their sonographic imaging and clinical findings were reviewed retrospectively. RESULTS: The lesions had a round or irregular shape in 26 patients (78.8%), a noncircumscribed margin in 31 (93.9%), a nonparallel orientation in 22 (66%), and posterior shadowing in 13 (39.4%). Twenty-five nodules (75.8%) had internal hypoechogenicity or mixed echogenicity. Twenty-nine (87.9%) of 33 lesions showed a relatively sharp convex echogenic rim on the anterior or posterior wall. CONCLUSIONS: Galactoceles have various sonographic findings, many of which are similar to those of suspicious solid breast masses. However, there is a tendency for a galactocele to appear as a small, round hypoechoic nodule with an indistinct or microlobulated margin and mild posterior shadowing. It is helpful to search for a partial anterior or posterior echogenic rim to identify a galactocele.     

Prospective evaluation of the value of negative sonographic and mammographic findings in patients with palpable abnormalities of the breast.

OBJECTIVE: To evaluate the value of combined negative sonographic and mammographic findings in patients with palpable breast abnormalities. METHODS: One hundred seventy-two patients with 186 palpable abnormalities who had combined negative sonographic and mammographic findings were prospectively studied. Patients who did not undergo biopsy had imaging and clinical follow-up; the mean follow-up period was 28.9 months (range, 24-33 months). RESULTS: Twelve patients underwent biopsy; benign histologic diagnoses were reported in all 12 (12 [6.9%] of 172). In the remaining 160 patients who were followed, there was no interval development of breast cancer at the site of the palpable abnormality. The negative predictive value of combined negative mammographic and sonographic findings in a patient with a palpable abnormality of the breast was 100%. CONCLUSIONS: Our findings suggest that in a patient with a palpable abnormality of the breast, the negative predictive value of combined normal sonographic and mammographic findings is very high and is therefore reassuring to the patient.     

Splenic trauma: evaluation with contrast-specific sonography and a second-generation contrast medium: preliminary experience.

OBJECTIVE: To report our experience in the assessment of splenic trauma with contrast-coded sonography and a second-generation contrast medium. METHODS: From January to May 2002, 120 patients were studied with sonography for suspected splenic trauma. Twenty-five were selected for further imaging because of sonographic findings positive for splenic injury, findings positive for peritoneal fluid only, indeterminate findings, and negative findings with high clinical or laboratory suspicion. These patients underwent contrast-enhanced harmonic sonography and contrast-enhanced helical computed tomography. RESULTS: Among the 25 patients studied, 6 had no spleen trauma at initial and follow-up evaluation. One patient had a hypoperfused spleen without parenchymal damage, and 18 had splenic injuries; these 19 patients were considered positive. Hemoperitoneum was identified by sonography, contrast-enhanced sonography, and contrast-enhanced computed tomography in 74% of the 19 positive cases. Perisplenic clots were recognized in 58% of the cases by computed tomography and in 42% by baseline and enhanced sonography. Splenic infarctions were found in 11% of cases by contrast-enhanced sonography and computed tomography; none was found by unenhanced sonography. Parenchymal traumatic lesions were identified in 12 of 18 patients with splenic injuries by unenhanced sonography, in 17 cases by contrast-enhanced sonography, and in all 18 cases by contrast-enhanced computed tomography. A minimal splenic lesion was found in the single patient with a false-negative contrast-enhanced sonographic finding. Contrast-enhanced sonography correlated appreciably better than unenhanced sonography in detecting injuries and in estimating their extent. Findings undetectable on unenhanced sonography were also noted: splenic hypoperfusion in 11% of positive cases on both contrast-enhanced sonography and contrast-enhanced computed tomography, contrast medium pooling in 21% of cases on both contrast-enhanced sonography and computed tomography, and contrast extravasation in 11% of cases on computed tomography and 5% on contrast-enhanced sonography. CONCLUSIONS: Contrast-enhanced sonography is a promising tool in the assessment of splenic trauma. In institutions where sonography is used as the initial procedure, this technique may increase its effectiveness.     

Transcranial sonography in the evaluation of Parkinson disease.

OBJECTIVE: With transcranial sonography (TS), it is possible to visualize hyperechoic signals in the sub-stantia nigra (SN) in patients with Parkinson disease (PD). Our objective was to correlate the level of echogenicity in the SN with clinical status in patients with PD. METHODS: In our pilot study, using TS, we examined 15 patients with the confirmed presence of PD. Staging of the latest clinical status was evaluated according to the Hoehn and Yahr scale. According to TS, the level of echogenicity was graduated as hypoechogenicity, moderate hyperechogenicity, and severe hyperechogenicity. RESULTS: Of the patients with severe hyperechogenicity (8 patients), 7 had Hoehn and Yahr stage III disease, and 1 had stage II disease. Of the patients with moderate hyperechogenicity (6 patients), 4 had stage II disease; 1 had stage III disease; and 1 had stage I disease. The patient with hypoechogenicity had stage I disease. Statistical analysis showed that there was a significant correlation between the level of echogenicity in the SN and the clinical stage (r = 0.7735; P = .0007). CONCLUSIONS: In our pilot study, although only a small number of patients were included, we confirmed the usefulness of TS in the evaluation of PD.