Contrast-enhanced ultrasonography using Sonazoid® is useful for diagnosis of malignant ovarian tumors: comparison with Doppler ultrasound

Purpose

The purpose of this study was to assess the usefulness of Sonazoid^®-enhanced ultrasonography (US) in the diagnosis of ovarian cancer in comparison with Doppler US.

Methods

Twenty-five ovarian tumor patients who were scheduled to undergo surgery were recruited for this study. The day before the operation, each patient was evaluated with color and power Doppler and baseline US during intravenous infusion of Sonazoid. Each lesion was classified as “benign” or “malignant” on the basis of specific criteria for a Doppler signal or Sonazoid-enhanced pattern. The reference standard was the histology of surgically removed adnexal tumors.

Results

Twenty patients were diagnosed with malignant tumors (invasive cancer, n = 15; metastatic cancer, n = 1; borderline tumor, n = 4), and the remaining five were diagnosed with benign tumors. Sonazoid-enhanced US correctly depicted the presence or absence of intratumoral blood flow in all patients with an accuracy of 92 %. Color Doppler ultrasound depicted the malignancies with an accuracy of 64 %, and power Doppler ultrasound depicted them with an accuracy of 76 %.

Conclusion

Our study suggests that Sonazoid-enhanced US is superior to conventional color Doppler US for the diagnosis of malignant ovarian tumors, but not to power Doppler US. The data and their interpretation in our study should be taken with some degree of caution because of the small number of subjects. Further studies involving a larger sample size would be needed to confirm these findings.     

Percutaneous ultrasound-guided fine-needle aspiration of portal vein thrombi as a diagnostic and staging technique for hepatocellular carcinoma

Background

Detection of portal vein tumor invasion in hepatocellular carcinoma (HCC) is important in determining therapy and prognosis. Patients with portal vein thrombus (PVT) due to tumor are considered to have advanced disease and are only offered palliative therapy. Therefore, every possible attempt should be made to accurately differentiate benign from malignant PVT.

Methods

In this study, 20 patients presenting to the out-patient department with a PVT and a diagnosis/diagnostic suspicion of HCC were subjected to FNAC of PVT. Clinical, cytological, and histopathological data for these patients were analyzed.

Results

The patients had a median age of 58 years, with majority being cirrhotic (80%) and males (80%). Thirteen patients had a prior radiological diagnosis of HCC at the time of FNAC. In three patients without any mass on imaging, FNAC made the initial diagnosis and staged the disease simultaneously. 50% of the thrombi were limited to 1st-order portal vein branches (vp3). Sixteen of the aspirates were positive for malignancy with 50% of the tumors being moderately differentiated. On histologic follow-up, three of the patients with negative aspirates had bland thrombi in their portal veins. No complications resulted from the procedure.

Conclusions

FNAC of PVT is a simple, safe, effective, well-tolerated, and economical method for staging of patients with HCC. When used as the initial diagnostic procedure, in selected patients, it can provide the diagnosis and staging information simultaneously.     

Application of high-intensity focused ultrasound for fetal therapy: experimental study using an animal model of lower urinary tract obstruction

Objective

The purpose of this study is to investigate whether high-intensity focused ultrasound (HIFU) exposure is able to produce a fistula between the bladder and abdominal wall of a fetus with lower urinary tract obstruction (LUTO).

Materials and methods

We constructed a prototype HIFU transducer in combination with an imaging probe. HIFU was applied to the lower abdomen of a rabbit neonate that was complicated by LUTO as an experimental model to produce a fistula; HIFU was applied in a tank filled with degassed water. Exposed lesions were assessed by histological analysis at necropsy.

Results

When HIFU was applied at 5.5 kW/cm² of spatial-peak temporal average intensity (SPTA), a fistula was created between the lower abdominal wall and the urinary bladder; urine gushed out from the bladder through the fistula within 60 s after HIFU exposure.

Conclusion

The findings suggest that fetal diseases such as LUTO can be non-invasively treated using HIFU exposure from even outside the maternal body, though this study was performed in a water tank.     

Case-control study of the RFA therapeutic effect of newly developed 4D US and conventional 2D US

Purpose

For radiofrequency ablation (RFA) therapy of hepatocellular carcinoma (HCC), accurate positioning of the inserted needle in the index tumor seems to be an important factor affecting therapeutic effect. In a case-control study, we compared the therapeutic effect of RFA using 4D and 2D ultrasonography (US) to evaluate whether 4D US is more effective.

Methods

Twenty subjects treated with percutaneous RFA using 4D US (4D group) and 20 subjects using conventional 2D US (2D group), who were matched for age, sex, and HCC diameter, were enrolled in this study. Aplio XG was used as the US system and PVT-375MV as the newly developed 4D US probe. The therapeutic effect of RFA was classified into four grades (A–D: “Grade A” is “absolutely curative”).

Results

In the 2D group, Grade A was achieved in 12 subjects (60 %). In contrast, Grade A was achieved in 19 subjects (95 %) in the 4D group. The proportion of cases in which Grade A was achieved was significantly higher in the 4D group (P < 0.01).

Conclusions

By using a 4D US device for RFA, more accurate insertion could be achieved and more effective therapy could be performed.     

B-flow imaging of vascular structure for the diagnosis of liver tumor

Purpose

B-flow is a non-Doppler-based technology for visualizing blood flow and has a high spatial resolution. The aim of this study is to evaluate the blood flow information of liver tumors using B-flow in comparison with color Doppler sonography (CDS).

Methods

Seventy-nine patients with 82 hepatic nodules were studied using B-flow and CDS. The study group included 45 HCC nodules, 23 liver metastasis nodules, four intrahepatic cholangiocarcinomas (ICC), and 13 hemangiomas. The visualized vascularity and morphological findings of the hepatic tumor vessel were evaluated.

Results

B-flow showed multiple vessels in 48 nodules (58.5 %) and a single vessel in 13 nodules (15.9 %). CDS showed multiple vessels in 44 nodules (53.7 %) and a single vessel in 23 nodules (28.0 %). Multivariate analysis showed basket pattern was significant for HCC (OR 49.263; p = 0.0002), and penetrating vessel was significant for liver metastasis or ICC (OR 14.545; p < 0.0001).

Conclusion

B-flow detects hepatic tumor blood flow with sensitivity as high as that of CDS. Vascular structure information obtained using B-flow could be potentially used to diagnose liver tumors.     

Basic study of less invasive high-intensity focused ultrasound (HIFU) in fetal therapy for twin reversed arterial perfusion (TRAP) sequence

Purpose

The objective of the present study was to develop a high-intensity focused ultrasound (HIFU) transducer more suitable for clinical use in fetal therapy for twin reversed arterial perfusion (TRAP) sequence.

Materials and methods

We created a cooling and degassed water-circulating-type HIFU treatment device. HIFU was applied to renal branch vessels in three rabbits. Sequential HIFU irradiation contains a trigger wave, heating wave, and rest time. The duration of HIFU application was 10 s/course. Targeting could be achieved by setting the imaging probe in the center and placing the HIFU beam and imaging ultrasonic wave on the same axis.

Result

We confirmed under sequential HIFU irradiation with a total intensity of 1.94 kW/cm² (spatial average temporal average intensity) that the vein and artery were occluded in all three rabbits.

Conclusion

Simultaneous occluding of the veins and arteries was confirmed with trigger waves and a resting phase using the HIFU transducer treatment device created for this study. Clinical application appears possible and may represent a promising option for fetal therapy involving TRAP sequence.

     

Sonographic diagnosis of symptomatic ureteral calculi: usefulness of the twinkling artifact

Purpose

Our aim was to analyze the value of ultrasound using the twinkling sign in the diagnosis of ureteral stones in patients with renal colic in the emergency setting.

Materials and methods

Prospective study of 100 patients with suspected renal colic who underwent an US examination, including color Doppler mode. We analyzed sensitivity, specificity, predictive values, and accuracy. We evaluated whether the stone was observed before or after the twinkling artifact, and whether the use of the Doppler color increased the examination time.

Results

US including color Doppler detected 76 of the 84 confirmed lithiasis. The sensitivity and specificity were 90 % and 100 %, respectively. The positive predictive value was 100 % and the negative 67 %. The accuracy was 92 %. A total of 59 calculi (78 %) examined by color Doppler sonography showed the twinkling artifact. Seventy percent of the twinkling-positive calculi showed the artifact before the stone itself was detected. Considering the location of the stones the twinkling sign was seen before the stone in 92 % of lithiasis located in the mid lumbar ureter (p = 0.02). The use of the twinkling artifact showed a trend to facilitate the detection of smaller calculi (<10 mm) (p = 0.08). The average examination time was 5.8 min [±4.3] (without differences between the stones detected before or after the twinkling artifact, p = 0.75).

Conclusion

Doppler US examination shows good sensitivity and specificity for the diagnosis of symptomatic ureteral stones. The twinkling artifact is useful for the early detection of the calculi, especially in the middle tract of the ureter, usually the most difficult place in sonographic diagnosis. It also seems helpful for the detection of smaller stones. The use of color Doppler does not increase the exploration time.     

In vitro Characterization of Uptake Mechanism of l-[methyl-3H]-methionine in Hepatocellular Carcinoma

Purpose

Methionine (Met) could be a useful imaging biomarker for the diagnosis of hepatocellular carcinoma (HCC), as demonstrated by PET imaging with l-[methyl-¹¹C]-Met. In HCC cells, protein synthesis mainly contributes to radiopharmaceutical uptake. In contrast, lipid synthesis via the phosphatidylethanolamine (PE) methylation pathway is the major metabolic route of l-[methyl-¹¹C]-Met in normal hepatocytes, which contributes to the background contrast observed in PET images. However, the mechanisms of amino acid transport and the roles of the two key enzymes, methionine adenosyltransferase (MAT) and phosphatidylethanolamine N-methyltransferase (PEMT), are not yet completely understood. The aim of this study was to investigate the roles of the amino acid transporters and these two key enzymes in the uptake of l-[methyl-¹¹C]-Met in HCC cells.

Procedures

A well-differentiated woodchuck HCC cell line, WCH17, was used for the study. The amino acid transporter of WCH17 cells was assayed to investigate the Met transport process in HCC. WCH17 cells were treated with 5 mM S-adenosylmethionine (SAM) for 8, 16, 24, and 48 h to downregulate MAT2A gene expression. Control or SAM-treated WCH17 cells were pulsed with l-[methyl-³H]-Met for 5 min and chased with cold media to mimic the rapid blood clearance of radiolabeled Met (pulse-chase experiment). In parallel, WCH17 cells were transfected with a mouse liver PEMT2 expression vector, and the pulse-chase experiment was performed to investigate the uptake of the radiolabeled Met in HCC cells. The water-soluble, protein, and lipid phases from the total uptake were subsequently extracted and measured, respectively.

Results

Met was transported into HCC cells via a facilitative transport process, which was characterized as system L and ASC-like, Na⁺ dependent, and low affinity with partial energy dependence. The total uptake of l-[methyl-³H]-Met was decreased in HCC cells with SAM treatment. This reduction pattern followed that of MAT2A expression (the duration of SAM treatment). The incorporated ³H was mostly distributed in the protein phase and, to a lesser degree, in the lipid phase via PE methylation pathway in HCC cells with SAM treatment. The downregulated MAT2A expression led to the decreased uptake in protein and water-soluble phases. In addition, an increased uptake in the lipid phase was observed in WCH17 cells transfected with PEMT2 expression vector.

Conclusions

The amino acid transport processes may be responsible for the rapid accumulation of radiolabeled Met after the intravenous injection of tracers for the imaging of HCC. Upregulated MAT2A expression and impaired PEMT2 activities in HCC are associated with the specific metabolic pattern of l-[methyl-¹¹C]-Met detected by PET.     

Functionalized Magnetonanoparticles in Visualization of Intracranial Tumors on MRI

Purpose

The development of nonradioactive and targeted magnetonanoparticles (MNP) capable of crossing the blood–brain barrier (BBB) and of concentrating in and enhancing the contrast of intracranial tumors on magnetic resonance imaging (MRI).

Procedure

Nonradioactive 2-deoxy-d-glucose (2DG) was covalently attached to magnetonanoparticles composed of iron oxide and dextran and prepared for intravenous (tail) injection in the naïve rats and mouse models of glioma. MR images were acquired at 3 and 7 T.

Results

2DG-MNP increased tumor visibility and improved delineation of tumor margins. Histopathology confirmed that 2DG-MNP crossed the BBB and accumulated within brain parenchyma.

Conclusion

Nonradioactive 2DG-MNP can cross an intact BBB on and improve visualization of tumor and tumor margins on MRI.     

MRI-compatible positioning device for guiding a focused ultrasound system for transrectal treatment of prostate cancer

Background   

High-intensity focused ultrasound (HIFU) is a promising treatment method for many common cancers, including prostate cancer. Magnetic resonance image (MRI) guidance of HIFU permits targeting and monitoring of therapy. A prototype MRI-compatible positioning device that navigates a HIFU transducer was designed, fabricated and tested.

Materials and methods   

The positioning device has two PC-controlled and one manually driven stage that allow endorectal access to the prostate. The positioning device was constructed using a 3-D rapid prototype manufacturing device. Software was developed that controls the motion of the positioning device and enables activation of a HIFU transducer. In vitro testing of the system was performed in a 1.5T MRI scanner using ex vivo turkey tissue. Optical encoders were employed to enhance the accuracy of this positioning device.

Result   

The positioning device was successfully tested for MRI compatibility. The movement error of the positioning device is approximately 20 \(\upmu \) m. The robot has the ability to accurately move the transducer for creation of discrete and overlapping lesions.

Conclusion   

An MRI-compatible HIFU positioning system was developed that has the ability to create thermal lesions with MRI guidance for endorectal treatment of prostate cancer.     

Differential diagnosis of solid pancreatic lesions using contrast-enhanced three-dimensional ultrasonography

Purpose

To investigate the usefulness of contrast-enhanced three-dimensional ultrasonography (CE 3D US) for differential diagnosis of solid pancreatic lesions.

Methods

Eighty-five patients with solid pancreatic lesions who underwent CE 3D US were retrospectively analyzed. Sixty-four patients had pancreatic ductal adenocarcinoma (PDAC), 10 had mass-forming pancreatitis (MFP), and 11 had neuroendocrine tumor (NET). Two blinded readers evaluated the enhancement patterns using four features: vascularity in the arterial phase, vascularity in the venous phase, vessel location, and vessel form. Vascularity in both phases was classified as hypervascular, isovascular, or hypovascular. Vessel location was classified into peritumoral or intratumoral. Vessel form was classified into fine or irregular. Kappa values were used to assess inter-reader agreement. The institutional review board approved this study, and informed consent was obtained.

Results

Kappa values of the four features were 0.75, 0.72, 0.85, and 0.65, which were graded as good or excellent. The most typical combined enhancement pattern in PDAC was hypovascularity in both phases with peritumoral and irregular vessels; MFP was isovascular in both phases with intratumoral and fine vessels; and NETs were hypervascular in both phases with intratumoral and irregular vessels. The sensitivity and positive predictive value of the three patterns were 93.8% and 96.7% for the PDAC pattern, 80.0% and 100% for the MFP pattern, and 81.8%, and 69.2% for the NET pattern, respectively. The accuracy of these diagnostic criteria was 90.5%.

Conclusion

CE 3D US allows detailed visualization of the enhancement patterns of various pancreatic lesions and can be used for the differential diagnosis.     

Hochintensiver fokussierter Ultraschall (HIFU) zur Linderung tumorbedingter Schmerzen bei inoperablem Pankreaskarzinom

Background

High-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer.

Objective

Evaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries.

Material and methods

In this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6 stage III, 12 stage IV according to UICC and 2 with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS).

Results

The average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3?% compared to the mean baseline score (n = 15, 75?%) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (n = 2) or the analgesic dosage could be reduced (n = 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1 week after HIFU, p < 0.05 for all pain scales).

Conclusion

US-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.

     

Ex vivo evaluation of high-intensity focused ultrasound with ultrasonic-induced cavitation bubbles

Purpose

In high-intensity focused ultrasound (HIFU) comprising high-intensity burst ultrasound (triggering pulse) and medium-intensity continuous wave ultrasound (heating wave), optimizing the effects of the triggering pulse conditions on the coagulated volume may help to reduce treatment times.

Methods

HIFU combined with a triggering pulse was applied to chicken deep pectoral muscles. The acoustic power of the heating wave was set to 36, 54, or 72 W. Four different triggering pulse conditions were used: heating wave only; or pulse widths and pulse repetition frequencies of 30 μs and 1 kHz, 300 μs, and 100 Hz, or 3 ms and 10 Hz.

Results

Compared to the heating wave only condition, the coagulated volume was significantly larger under all conditions that included a triggering pulse. Significant differences were also observed in the ellipticity of the coagulated region between some conditions.

Conclusion

HIFU combined with a triggering pulse may play an important role in reducing treatment times.     

Contrast advanced dynamic flow imaging and contrast pulse subtraction imaging: Preliminary results in hepatic tumors

Purpose

To investigate the usefulness of contrast advanced dynamic flow imaging and contrast pulse subtraction imaging in the intranodular hemodynamics of hepatic tumors.

Materials and Methods

Ten patients underwent contrast advanced dynamic flow imaging and contrast pulse subtraction imaging using Levovist^®, a microbubble contrast agent. Fourteen hepatic tumor nodules were studied: 9 were hepatocellular carcinoma, 1 metastasis, 1 hemangioma, 1 adenomatous hyperplasia, and 2 metastatic lymph nodes of hepatocellular carcinoma. Real-time scanning of contrast advanced dynamic flow imaging and intermittent interval-delay scanning of contrast pulse subtraction imaging were carried out in the early arterial phase, the late vascular phase, and the postvascular phase. The results obtained from contrast advanced dynamic flow imaging and contrast pulse subtraction imaging were compared with those obtained by precontrast power Doppler imaging and three-phase dynamic CT, respectively.

Results

The rate of detection of intranodular vascularity by contrast advanced dynamic flow imaging (93%) or contrast pulse subtraction imaging (93%) was significantly higher than that of precontrast power Doppler imaging (29%) and was as high as that of dynamic CT. Characteristic intranodular hemodynamics were detected in hepatocellular carcinoma, metastasis, hemangioma, and adenomatous hyperplasia with typical appearance of an intranodular blood vessel image in the early arterial phase, a parenchymal stain image in the late vascular phase, and a perfusion defect image in the post-vascular phase.

Conclusion

Contrast advanced dynamic flow imaging and contrast pulse subtraction imaging clearly show the intranodular hemodynamics in hepatic tumors.     

In Vitro and In Vivo Characterization of Two C-11-Labeled PET Tracers for Vesicular Acetylcholine Transporter

Purpose

The vesicular acetylcholine transporter (VAChT) is a specific biomarker for imaging presynaptic cholinergic neurons. Herein, two potent and selective ¹¹C-labeled VAChT inhibitors were evaluated in rodents and nonhuman primates for imaging VAChT in vivo.

Procedures

For both (?)-[¹¹C]2 and (?)-[¹¹C]6, biodistribution, autoradiography, and metabolism studies were performed in male Sprague Dawley rats. Positron emission tomography (PET) brain studies with (?)-[¹¹C]2 were performed in adult male cynomolgus macaques; 2 h dynamic data was acquired, and the regions of interest were drawn by co-registration of the PET images with the MRI.

Results

The resolved enantiomers (?)-2 and (?)-6 were very potent and selective for VAChT in vitro (K _i ?35-fold selectivity for VAChT vs. σ receptors); both radioligands, (?)-[¹¹C]2 and (?)-[¹¹C]6, demonstrated high accumulation in the VAChT-enriched striatum of rats. (?)-[¹¹C]2 had a higher striatum to cerebellum ratio of 2.4-fold at 60 min; at 30 min, striatal uptake reached 0.550?±?0.086 %ID/g. Uptake was also specific and selective; following pretreatment with (±)-2, striatal uptake of (?)-[¹¹C]2 in rats at 30 min decreased by 50 %, while pretreatment with a potent sigma ligand had no significant effect on striatal uptake in rats. In addition, (?)-[¹¹C]2 displayed favorable in vivo stability in rat blood and brain. PET studies of (?)-[¹¹C]2 in nonhuman primates indicate that it readily crosses the blood-brain barrier (BBB) and provides clear visualization of the striatum; striatal uptake reaches the maximum at 60 min, at which time the target to nontarget ratio reached ~2-fold.

Conclusions

The radioligand (?)-[¹¹C]2 has high potential to be a suitable PET radioligand for imaging VAChT in the brain of living subjects.     

Segmentation of the liver in ultrasound: a dynamic texture approach

Objective

The segmentation of ultrasound (US) images is useful for several applications in computer aided interventions including the registration of pre-operative CT or MRI to intra-operative US. Shadowing, intensity inhomogeneity and speckle are the common effects on US images. They render the segmentation algorithms developed for other modalities inappropriate due to poor robustness. We present a novel method for classification of hepatic structures including vasculature and liver parenchyma on US images.

Methods

The method considers B-mode US images as a dynamic texture. The dynamics of each pixel are modelled as an auto regressive (AR) process perturbed with Gaussian noise. The linear coefficients and noise variance are estimated pixel-wise using Neumaier and Schneider’s algorithm. Together with mean intensity they comprise a parametric space in which classification (maximum a posteriori or K-nearest neighbour) of each pixel is performed. We emphasize the novelty of studying dynamics rather than static features such as intensity in the segmentation of various structures.

Results

We assessed the automatic segmentations of ten US sequences using Dice Similarity Coefficients. The algorithm’s capability of vessel extraction was tested on three sequences where Doppler US failed to capture vasculature.

Conclusion

The modelling of image dynamics with AR process combined with MAP classifier produced robust segmentation results indicating that the method has a good potential for intra-operative use.     

高强度体外聚焦超声热疗治疗盆腹部转移癌疗效的超声观察

目的：评价高强度体外聚焦超声热疗（HIFU）治疗盆腹部转移癌的临床应用价值及彩色多普勒超声治疗前后声像图变化。方法：15例转移癌共21个癌瘤HIFU治疗前后均进行彩超检测。观察其大小，内部回声及血供改变情况。并观察HIFU治疗后癌瘤病理组织学改变。结果：治疗有效率76%（16/21），治疗后彩超表现为癌瘤缩小，回声增强，血供明显减少或消失，病理组织学上表现为凝固性坏死或纤维化形成。结论：HIFU对盆腹部转移癌治疗有效。彩超能直观反映其疗效。     

Ultrasonography of tubular ectasia of the rete testis with associated scrotal findings

Purpose

Tubular ectasia of the rete testis (TERT) is a rare disorder that can be seen on ultrasonography (US) during a routine examination. In this study, we aim to discuss 15 cases of TERT and concomitant scrotal pathologies.

Methods

A total of 405 patients who were admitted to our department between March 2009 and December 2011 for scrotal US with different complaints such as scrotal pain, palpable mass, infertility, varicocele, or hydrocele were evaluated. Presence or absence of TERT and associated scrotal anomalies if TERT was present were considered on gray-scale US and color Doppler US.

Results

Tubular ectasia of the rete testis was detected in 15 patients (3.7 %). It was unilateral in eleven patients (73.3 %) and bilateral in four patients (26.7 %). The mean age of the patients with TERT in this study was 43.7 years (range 24–85 years). Five patients (33.3 %) with TERT presented with infertility, four of them (26.7 %) presented with palpable mass, and six of them (40%) were admitted with scrotal pain. In 14 patients (93.3 %), at least one of the following disorders associated with TERT was seen: epididymal cyst, spermatocele, hydrocele, and varicocele.

Conclusion

Tubular ectasia of the rete testis shows characteristic appearances on gray-scale and Doppler US evaluation, and no other modality is necessary for diagnosis. TERT is usually associated with epididymal pathologies such as epididymal cyst or spermatocele located on the same side. Testicular neoplasms, intratesticular varicocele, and cystic dysplasia of the testis should be considered in the differential diagnosis of TERT.     

Dorsal acoustic windows may ameliorate liver ultrasound in patients with chronic liver disease and meteorism/obesity/ascites

Purpose

To identify dorsal acoustic windows (DAWs) for the study of the liver and to investigate whether they could improve the visualization of the liver in patients with chronic liver disease and ascites, meteorism, and/or obesity.

Methods

The study was based on a single ultrasound examination and divided into three successive stages. Firstly, we performed a preliminary study involving 10 cirrhotic patients to identify new DAWs. Inter-observer reproducibility of measurements obtained through the DAWs was then assessed in another 29 cirrhotic patients. Finally, in 50 patients with chronic hepatitis/cirrhosis, we employed the DAWs when ascites, meteorism or obesity hampered the conventional ultrasound examination.

Results

With patients sitting, we found three new DAWs, by the combined use of which it was possible to explore the liver, spleen, and their vascular structures, and which provided reproducible measurements. In the clinical setting, we found 11 of 50 patients in whom the addition of the new DAWs led to better results in terms of successful visualization/Doppler measurements for portal vein (ratio = 100 % vs 27 %, p = 0.001), hepatic artery (ratio = 90 % vs 27 %, p = 0.004), and hepatic veins (mean number = 2.4 ± 0.2 vs 1.0 ± 0.2, p = 0.01). Among these 11 patients, in one case the addition of DAWs led to visualization of hepatic focal lesions in the right lobe, not previously displayed through conventional ultrasound.

Conclusion

These DAWs may be an additional tool that improves the accuracy of ultrasound examinations in patients with meteorism, ascites, or obesity.