彩色多普勒超声在甲状腺癌诊断与鉴别诊断中的应用

目的探讨彩色多普勒超声在甲状腺癌诊断及鉴别诊断中的应用价值。方法回顾分析甲状腺肿瘤患者64例,其中甲状腺癌33例,甲状腺腺瘤31例,全部经手术病理或组织活检证实。观察并比较分析两种病灶的形态、大小、分布、血流形态、动脉血流速度、阻力指数和血流分级。结果甲状腺癌病灶结节多为单发,内部回声减低或回声不均,沙砾样钙化多见,边界不规则,呈蟹足样或有明显毛刺状,结节后方多有声衰减。甲状腺腺瘤病灶结节内部回声减低,相对均质,囊性变多见,少有沙砾样钙化灶,边界规则并可见声晕。恶性结节血流信号丰富,多见穿入性血流,分布杂乱。良性结节中血流信号多分布于病灶的边缘,较规则,病灶内部血流较少。恶性病灶动脉血流速度高及阻力指数显著高于良性结节。结论彩色多普勒超声在甲状腺恶性结节诊断与鉴别诊断中有重要价值。     

超声对单发性结节性甲状腺与甲状腺瘤的鉴别诊断价值

目的：探讨超声对单发性结节性甲状腺肿与甲状腺瘤的鉴别诊断价值。方法：分析比较34例单发结节性甲状腺肿与30例甲状腺腺瘤的二维及彩色多普勒超声声像图。结果：34例单发结节结节性甲状腺与30例腺瘤比较,甲状腺大小、结节大小、结节内回声及周围回声均无显著性差异（P＞0．05）;结节边缘晕环及结节内部和周边血流信号具有显著性差异（P＜0．05）。结论：单发结节结节性甲状腺肿较易误诊为腺瘤,结节边缘晕环及结节内部和周边血流信号可以为鉴别诊断提供一定的帮助。     

肝上皮样血管内皮瘤的超声表现

目的探讨超声在肝上皮样血管内皮瘤(HEHE)诊断中的价值。方法对29例经病理证实为HEHE患者的超声图像进行回顾性分析,研究肿瘤的大小、位置、回声、边界、内部结构以及彩色多普勒血流信号特点。结果 29例HEHE患者共132个病灶,直径范围1~6.8cm,高回声病灶25个,低回声病灶36个,稍低回声病灶66个,等回声病灶5个。81个病灶回声欠均匀,51个病灶内部回声尚均匀;52个病灶边界欠清,26个病灶边界不清,54个病灶边界尚清。10例患者较大病灶周边伴晕环,6例患者伴钙化,4例患者病灶之间互相融合,9例患者显示周边彩色血流信号,11例患者显示周边及内部均有彩色血流信号,18例动脉血流,2例静脉血流,平均阻力指数(RI)0.63±0.06。结论灰阶超声结合彩色多普勒超声对于肝脏上皮样血管内皮瘤的诊断具有一定的帮助。     

甲状腺腺瘤与单发结节性甲状腺肿的超声诊断价值

目的　探讨超声在甲状腺腺瘤与单发结节性甲状腺肿鉴别诊断中的价值。方法　对两种疾病的二维及彩色多普勒声像图进行分析、比较。结果　甲状腺腺瘤与单发结节性甲状腺肿 ,二者在甲状腺的大小、结节大小、结节内部回声及结节内血流信号方面均无显著性差异 (P >0 .0 5 ) ;结节边缘低回声晕环和结节周边血流信号有显著性差异 (P<0 .0 5 ) ,腺瘤周边低回声晕多见 ,血流信号亦较结甲结节丰富。结论　单发结节性甲状腺肿易误诊为腺瘤 ,结节周边的低回声晕环及血流信号对鉴别诊断可提供帮助     

甲状腺功能自主性腺瘤的彩色超声和同位素显像特点分析

目的：分析甲状腺功能自主性腺瘤的彩色超声和同位素的声像图特点。方法：98例甲状腺功能自主性腺瘤患者均行外科手术和病理证实．术前全部患者均行彩色超声和同位素检查。结果：甲状腺功能自主性腺瘤的彩色超声表现为甲状腺局限性肿大，甲状腺内异常回声团，以低回声团为多，形态类圆形或椭圆形，内部回声尚均匀，较大结节内回声不均，为高回声多见，可见散在不规则形低或无回声．边界清晰，周围大部分可见低回声晕圈，后方无声衰减。彩色及能量多普勒显示多数腺瘤周围环绕血流信号，呈抱球征，结节内部多数出现血流信号，部分内部无血流信号。同位素声像图表现为甲状腺常规静态显像上常表现为孤立性热结节．对侧甲状腺不显像或显像不佳。结论：彩色超声检查对甲状腺功能自主性腺瘤的发现及良恶性判断有较为特征性的声像图特点．对甲状腺功能自主性腺瘤的功能性判断特异性欠佳。同位素检查对甲状腺功能自主性腺瘤的功能性判断有较为特征性的声像图特点，对甲状腺结节的发现及良恶诊断价值有一定价值，但敏感性、特异性欠佳。[著者文摘]     

甲状腺髓样癌的超声图像特征分析

目的对比分析甲状腺髓样癌(MTC)与甲状腺滤泡性腺瘤(FTA)的超声图像,探讨MTC的超声图像特征。方法回顾性分析79例MTC患者共85个结节(MTC组)和76例FTA患者共77个结节(FTA组)的临床资料和声像图特征,比较两组在年龄、发病部位、大小、边界、形态、声晕、钙化灶、内部及周边血流等方面的差异。结果 MTC组与FTA组发病年龄比较,差异无统计学意义;性别比、结节最大径、发病部位比较,差异均有统计学意义(均P0.05)。声像图特征方面,两组结节边界、形态、回声、成分、钙化、纵横比、声晕及周边血流比较,差异均有统计学意义(均P0.05);结节内部血流比较差异无统计学意义。MTC组27例术后发现淋巴结转移。结论 MTC的超声图像特征以低回声为主,囊性变较少,声晕厚薄不均,微钙化,内部血流紊乱,周边血流不完整等。     

超声对多发甲状腺结节的良恶性的鉴别诊断

目的：本文采用二维超声声像图，彩色和脉冲多普勒显像综合应用。对甲状腺结节性病变进行研究，分析各种方法对甲状腺良恶性结节病变的鉴别诊断价值。方法：对50例多发甲状腺结节性病变（共167个结节）分别行二维，彩色、脉冲多普勒显像检查，观察结节的二维声像图特征。结节内部及周边血流及其血流参数特点，将超声诊断结果与病理结果进行对照。结果：二维显示恶性结节多为低回声，边界模糊，无晕环，多见沙粒样钙化（P〈0．05）。CDFI对结节性甲状腺肿的诊断有帮助，但不能鉴别腺瘤和癌，恶性甲状腺结节内部动脉的平均血流峰值流速（PSV）和RI值高于良性甲状腺结节（P〈0．05）。结论：超声对甲状腺结节性病变的诊断有一定的优势，各种方法的综合应用能明显提高甲状腺结节诊断的准确性，对良恶性结节的鉴别具有重要价值。     

甲状腺滤泡状癌与甲状腺滤泡状腺瘤超声表现与鉴别

目的探讨甲状腺滤泡状癌(FTC)和甲状腺滤泡状腺瘤(FA)彩色多普勒超声声像图特征,分析FTC的误诊原因。方法对福建医科大学附属协和医院经手术病理证实的28例FTC患者38个结节和29例FA患者34个结节常规二维超声及彩色多普勒超声声像图进行分析。采用非参数Mann-Whitney检验比较FTC与FA结节超声表现差异。采用两独立样本t检验比较FTC与FA结节纵横比差异。结果 28例FTC患者38个结节中27个单发;22个结节内部呈均匀低回声;28个包膜不完整或无包膜;15个边界欠清晰,2个呈蟹足状浸润;9个伴砂粒样微小钙化,2个伴粗大钙化灶者;23个结节呈Ⅲ型血流信号,8个伴Ⅳ型血流信号,18个提示伴发其他甲状腺弥漫性疾病;结节纵横比为1.46±0.45。29例FA患者34个结节中29个单发;12个结节内部回声呈均匀低回声,18个呈等回声者;30个有完整包膜,32个边界清晰,26个周边见声晕;17个结节呈Ⅰ型血流,12个呈Ⅱ型血流;结节纵横比为1.62±0.37。FTC与FA结节回声和纵横比差异无统计学意义(U=611.00,P=0.67;t=1.64,P=0.93),FTC与FA结节边界、声晕、钙化和血流分布差异均有统计学意义(U值分别为429.00、322.00、490.00、165.00,P均为0.00)。结论重点分析结节回声、边界、形态和血流信号并结合其生长速度有助于超声鉴别FTC。     

滤泡型甲状腺乳头状癌的声像图与病理基础对照研究

目的深入地认识滤泡型甲状腺乳头状癌（胛c）的超声表现,减少滤泡型PTC的误诊率。方法回顾性分析我院39个经病理证实为滤泡型PTC的术前超声图像指标（形态、边界、声晕、内部回声、钙化及肿瘤的血管分布状况）,并与指标相应的组织病理学进行对比分析。结果39个滤泡型PTC超声表现：形态光整33个、边界清楚30个、周边见声晕29个、实性低回声结节27个,砂粒样钙化17个,混合血管型20个;病理结果：瘤体几乎为滤泡细胞,且间质少（82．0％）,可见包膜（25．6％）及砂粒体（30．8％）;与病理结果对比,超声误诊率为71．8％。结论滤泡型PTC的病理基础决定了其超声多表现为：实性低回声、边界清、形态规则、可伴砂粒样钙化。     

甲状腺疾病的超声诊断

（接上期讲座２５４页） ３．３甲状腺肿瘤 ３．３．１甲状腺腺瘤（Ｔｈｙｒｏｉｄ ａｄｅｎｏｍａ）为最常见的甲状腺外科疾病之一，占甲状腺肿瘤的２／３。组织学分为滤泡性腺瘤、乳头状腺瘤及非典型性腺瘤三型，声像图表现肿瘤多为单发结节，患侧叶腺体切面呈局限性增大，可向表面突出，以致外形不规则。腺体内可见圆形、扁圆形或椭圆形的实质性异常回声区，其边缘光滑完整，轮廓清晰，周边常伴有低回声晕环。异常结节多为低回声，其内有散在较均匀或密集的细小点状回声，少数可为等回声或中等稍强回声。结节后方回声多数稍增强，一般无…     

Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics

OBJECTIVE: The purpose of this study was to determine the sonographic features of Hürthle cell neoplasms (HCNs) of the thyroid. METHODS: We retrospectively analyzed the sonographic appearance of 15 histologically proven HCNs in 15 patients aged 16 to 70 years (mean age, 44 years). Sonographic features that were reviewed included the size and echogenicity of the tumors, the presence of cystic areas or calcifications, and detectable blood flow on color Doppler imaging. Correlation of sonographic findings with pathologic results was performed. RESULTS: The tumors ranged from 0.4 to 7 cm in diameter, but most were less than 3 cm in diameter. Four (27%) of the 15 tumors were homogeneously hypoechoic. Two tumors (13%) were predominantly hypoechoic with isoechoic areas to thyroid parenchyma. Two (13%) neoplasms were isoechoic to thyroid parenchyma. Four (27%) tumors were predominantly isoechoic, containing hypoechoic areas, and 3 (20%) tumors were hyperechoic. Three neoplasms contained cystic components. None of the tumors contained calcifications. One tumor was avascular on Doppler examination. One neoplasm showed only peripheral blood flow. Thirteen tumors showed internal vascularity, 7 of them with peripheral blood flow. Twelve HCNs were benign, and 3 were malignant on pathologic examination. CONCLUSIONS: Hürthle cell neoplasms show a spectrum of sonographic appearances from predominantly hypoechoic to hyperechoic lesions and from peripheral blood flow with no internal flow to extensively vascularized lesions. Pathologic criteria differentiating benign and malignant HCNs (absence or presence of a capsular breach, vascular or extrathyroidal tissue invasion, nodal involvement, and distant metastasis) are beyond the resolution of sonography and fine-needle aspiration biopsy and require removal of the entire lesion. This precludes diagnosis and characterization of HCNs by sonography.     

Behavior of Hepatocellular Adenoma on Real‐time Low‐Mechanical Index Contrast‐Enhanced Ultrasonography With a Second‐Generation Contrast Agent

Objective. The purpose of this study was to describe the behavior of histologically proven hepatocellular adenoma (HCA) on low‐mechanical index (MI) contrast‐enhanced ultrasonography (CEUS). Methods. A review of the databases from 4 academic hospitals revealed 18 patients (15 female and 3 male; mean age, 40 years; range, 25–71 years) with 25 histologically proven HCA lesions who were studied with CEUS at a low MI (0.04–0.1). Results. Twenty‐four of 25 lesions (96%; 95% confidence interval [CI], 80.5%–99.3%) showed high‐intensity enhancement, scored as 3 on a scale of 0 to 3, whereas only 1 lesion (4%; 95% CI, 0.7%–19.5%) was scored as 2. The time of peak enhancement ranged between 10 and 19 seconds (average, 13 seconds). All but 1 of the 25 lesions (96%; 95% CI, 80.5%–99.3%) showed early homogeneous and centripetal enhancement during the hepatic arterial phase. No portal venous phase enhancement was observed in any lesion because all showed rapid wash‐out (100%; 95% CI, 86.7%–100%). Twenty lesions (80%; 95% CI, 60.9%–91.1%) were found to be isoechoic to slightly hypoechoic during the portal phase, and 19 (76%; 95% CI, 56.6%–88.5%) were isoechoic to mildly hypoechoic, whereas 7 (24%; 95% CI, 11.5%–43.4%) were hypoechoic during the late phase. Conclusions. Contrast‐enhanced ultrasonography is an effective technique for identifying the microvascular and macrovascular characteristics of HCA. Typically, HCA shows early (10–19 seconds) and centripetal enhancement during the arterial phase and isoechogenicity or mild hypoechogenicity during the portal phase, remaining slightly hypoechoic or isoechoic during the late phase in most cases.     

The common ultrasonographic features of pilomatricoma.

OBJECTIVES: The purpose of this series was to describe typical ultrasonographic features of 20 cases of pilomatricoma and to improve its diagnostic rate with the use of an ultrasonographic approach. METHODS: For 20 pilomatricomas in 19 patients with preoperative ultrasonography from 1995 to 2004, we reviewed age, sex, symptoms, duration, referring clinician, and tumor sites. The ultrasonographic findings were retrospectively analyzed for tumor location, shape, size, margin, echo texture, echogenicity, presence, amount, and shape of calcification, presence of a hypoechoic rim, and Doppler flow pattern. RESULTS: The mean age of the 19 patients was 6.9 years (range, 1-21 years), and the female-male ratio was 1.1:1. Patients had a painful palpable mass in 10 cases (50%). Nine lesions occurred in the neck, 5 in the cheek, 2 in the preauricular region, and 4 in the extremity. All tumors were located in the subcutaneous layer. The mean size of the tumors was 13.4 mm. Fourteen pilomatricomas (70%) appeared as well-defined oval masses. Tumors were heterogeneously hyperechoic in 80% of cases. All tumors had internal echogenic foci. A hypoechoic rim was seen in 17 cases (85%). Doppler flow signals were observed in the peripheral region in 14 cases (70%). A correct preoperative diagnosis was made in 33% on the basis of clinical findings and in 76% by ultrasonography. CONCLUSIONS: Diagnosis of pilomatricoma should be considered when a well-defined mass with inner echogenic foci and a peripheral hypoechoic rim or a completely echogenic mass with strong posterior acoustic shadowing in the subcutaneous layer of the head, neck, or extremity is found on ultrasonography.     

Sonographic features of hepatic adenomas with pathologic correlation

BACKGROUND: We compared the sonographic characteristics of hepatic adenomas with pathologic findings. METHODS: Information over 10 years was collected on 12 patients (six men, six women; mean age = 47 years) with surgically proven hepatic adenomas. Clinical data, sonographic features, and histopathologic findings were reviewed. RESULTS: The tumors in males were smaller and simpler than those in women (p < 0.05, Fisher's exact test). Four of the six larger tumors (>5 cm) showed mixed-echoic patterns corresponding with pathologically intratumoral hemorrhage and necrosis. Four homogeneously hypoechoic tumors had less change in tumor composition. Three homogeneously hyperechoic tumors had evident fatty changes inside. One isoechoic tumor had a hypoechoic rim, that correlated mostly to the tumor itself and compressed liver parenchyma. Seven of the 12 tumors had thin fibrous capsules that were not seen on sonography. CONCLUSION: Hepatic adenomas have variable sonographic appearances depending on changes in the tumor. Hypoechoic, hyperechoic, and mixed-echoic patterns represent simple adenoma, adenoma with fatty metamorphosis, and hemorrhagic necrosis, respectively, in tumors.     

Color Doppler Sonography of Merkel Cell Carcinoma

We illustrate the color Doppler sonographic findings in primary cutaneous Merkel cell carcinoma. Eight cases (4 female and 4 male; mean age, 75.4 years) were collected. The most common affected regions were the face (63%) and the hip/buttock (25%). The mean transverse diameter and thickness were 21 and 14 mm, respectively. Fifty percent were oval, and 50% were dome shaped. All lesions were hypoechoic, with variable degrees of heterogeneity. All but 2 lesions were poorly defined. An acoustic reinforcement artifact was present in 3 and epidermal thickening in 2. All tumors had prominent and chaotic hypervascularity with arterial vessels (mean peak velocity, 11 cm/s; mean resistive index, 0.57).     

Ultrasonographic Features of Eccrine Spiradenoma

The purpose of this series was to evaluate the features of eccrine spiradenoma on ultrasonography (US). We reviewed the clinical data of 8 patients with eccrine spiradenoma who underwent preoperative US at 4 different medical institutions from 2004 to 2016 and analyzed the US features in terms of the tumor location, size, shape, margin, echo texture, echogenicity, posterior acoustic enhancement, calcification, septum, and color Doppler flow. There were 7 female patients and 1 male patient. The mean patient age was 45.6 years (range, 28–60 years). Most of the tumors were located primarily in the subcutaneous fat layer. The mean size of the tumors was 14.3 mm. The masses had a lobular appearance in 7 patients and had a tractlike structure in 3 patients. In 6 patients, the masses had a heterogeneous echo texture. Six cases showed hypoechogenicity with more hypoechoic foci in the masses, and 2 cases showed hypoechogenicity only. Color Doppler flow was evaluated in 7 patients; the blood flow was central and peripheral in 4 patients and only peripheral in 3 patients. All cases showed posterior acoustic enhancement and had well‐defined margins. Calcification and septa were not seen in any cases. Eccrine spiradenoma is usually located in the subcutaneous fat layer, has a well‐defined margin, a lobulated appearance, occasionally with a tractlike structure, a heterogeneous echo texture, a hypoechoic appearance with internal hypoechoic foci and posterior acoustic enhancement, and shows blood flow in the peripheral portion, with or without blood flow in the central portion.     

Correlation between sphincter of Oddi manometry and intraductal ultrasound morphology in patients with suspected sphincter of Oddi dysfunction

BACKGROUND AND STUDY AIMS: Intraductal ultrasonography (IDUS) makes it possible to study sphincter of Oddi morphology during endoscopy. Two recent IDUS studies have described the sphincter of Oddi as a circumferential hypoechoic layer in the papilla, but there have as yet been few published data from patients with suspected sphincter of Oddi pathology. PATIENTS AND METHODS: Twenty-one consecutive patients with suspected biliary sphincter of Oddi dysfunction (seven men, 14 women; age 54 +/- 17 years) were enrolled in the study. Endoscopic sphincter of Oddi manometry was carried out using a 4-Fr electronic microtransducer device. After this, a wire-guided 6-Fr ultrasound catheter was placed in the common bile duct (CBD), and IDUS was carried out while the ultrasound catheter was being withdrawn from the CBD toward the duodenum. RESULTS: Sphincter of Oddi manometry and IDUS were carried out successfully in 18 of the 21 patients. Sphincter of Oddi manometry revealed sphincter of Oddi hypertension (baseline pressure > 35 mmHg) in eight patients. The mean sphincter of Oddi baseline pressure was 32 +/- 17 mmHg, and the mean phasic sphincter of Oddi pressure was 132 +/- 31 mmHg. During IDUS, a circumferential hypoechoic layer was clearly delineated in all patients. There was a significant correlation between the manometrically determined length of the sphincter of Oddi (8 +/- 2 mm) and the thickness of the hypoechoic layer (6 +/- 2 mm) as assessed by IDUS (r = 0.66, P < 0.001). However, no correlation was found between the baseline or phasic sphincter of Oddi pressures and the thickness of the hypoechoic layer. Accordingly, IDUS did not allow identification of patients with sphincter of Oddi hypertension. Mild pancreatitis was observed in one of the 18 patients (6 %). CONCLUSIONS: The circumferential hypoechoic layer of the papilla visualized by IDUS is the ultrasonographic correlate of the sphincter of Oddi. IDUS of the papilla is technically feasible and safe in patients with suspected sphincter of Oddi dysfunction. IDUS may provide additional information at the sphincter of Oddi level, but cannot be used as a substitute for sphincter of Oddi manometry.     

Preoperative sonographic features of borderline ovarian tumors.

OBJECTIVE: To determine the sonographic findings that distinguish borderline ovarian tumors (BOT) from both benign and invasive malignant tumors, thus allowing conservative treatment and laparoscopic management of these tumors. METHODS: We reviewed retrospectively transvaginal sonograms of 33 women who, when evaluated further by surgery and histology, were found to have BOT. Twenty-three were premenopausal and 10 were postmenopausal (mean age +/- SD, 45.8 +/- 15.7 years). For each mass, size and morphological features and power Doppler characteristics were evaluated. We compared these findings with those of 337 patients with benign ovarian tumors and those of 82 patients with invasive malignant ovarian tumors. Patients with dermoid cysts were not included in the study. RESULTS: Of the 33 BOT, 15 were mucinous and 18 were serous cystadenomas. The presence of papillae, defined as a small number of solid tissue projections, 1-15 mm in height and 1-10 mm in width (base) and length (base), into the cyst cavity from the cyst wall, was significantly more frequent in BOT (48%) than it was in benign (4%) and invasive (4%) malignant tumors. Intracystic solid tissue (> 15 mm in height or > 10 mm in width or length) was observed in 48% of invasive malignant masses but in only 18% of BOT and in 7% of benign tumors (P < 0.001). No sonographically unilocular, hypoechoic, smooth-walled adnexal cysts were invasively malignant but three unilocular cysts with a diameter of > 6 cm were serous BOT. Although close attention was paid to the cyst wall at ultrasound examination we did not observe in these three cysts the very small papillae which were found at histological analysis. CONCLUSIONS: The most frequent diagnostic feature on imaging BOT is the presence of papillae within the cyst. However, neither papillae nor other sonographic features constituted highly sensitive sonographic markers of BOT.     

Characterization of sonographic and mammographic features of granular cell tumors of the breast and estimation of their incidence.

OBJECTIVE: The purpose of this series was to review the spectrum of sonographic and mammographic features of granular cell tumors (GCTs) of the breast and to compare their frequency relative to breast carcinoma. METHODS: Ten cases of a breast GCT diagnosed during the last 13 years were analyzed for the imaging characteristics and clinical features. Sonographic images were reviewed for location, size, echogenicity, margins, height-width ratio, and sound transmission. Mammograms were reviewed for tumor size, location, margin characteristics, spiculations, and calcifications. The frequency of GCTs was compared with that of breast carcinoma during the same study period. RESULTS: Of 10 GCT cases, 9 tumors occurred in female patients, and 1 occurred in a male patient. The mean patient age was 51.8 years, and the mean lesion size was 1.57 cm. All 7 tumors visualized on sonography were hypoechoic masses. Posterior enhancement was noted in 3 of 7 cases, and posterior shadowing was noted in 2 of 7 cases. Two of 7 did not show any posterior enhancement or shadowing. Two of 7 masses were taller than wide. Of 8 tumors visualized on mammography, 5 were spiculated, and 3 were well circumscribed. Calcifications were not visualized in any tumor. During the same period, 1482 cases of breast carcinoma were diagnosed, making the frequency of GCTs of the breast about 6.7 per thousand breast carcinomas. CONCLUSIONS: Granular cell tumors of the breast are rare neoplasms with a relative frequency of 6.7 per thousand breast carcinomas in our series, which was higher than reported in literature. Spiculations are a common imaging feature and mimic carcinoma when present.     

Sonography of wrist ganglion cysts: variable and noncystic appearances.

OBJECTIVE: In our clinical practice, we have noted wrist ganglion cysts that do not fulfill the criteria for simple cysts. This study retrospectively evaluated the sonographic features of wrist ganglia. METHODS: After Institutional Review Board approval, medical records from 1993 through 2003 were searched using International Classification of Diseases, Ninth Revision codes and key words, and sonography log books from 2000 through 2004 were reviewed, which identified 20 wrist ganglion cysts in 16 patients that were proven at surgery or aspiration. A retrospective review of sonographic images was carried out by 2 musculoskeletal radiologists by consensus. Images were evaluated for cyst location, volume, largest dimension, joint or tendon extension, echogenicity, septations, internal echogenicity, posterior acoustic enhancement, margins, lobularity, and vascularity. RESULTS: Of the 20 wrist ganglia, 15 were volar (10 between the flexor carpi radialis and the radial artery), and 5 were dorsal (2 over the scapholunate ligament). The mean volume was 2081 mm3 (range, 90-15,000 mm3), and the mean largest dimension was 17.3 mm (range, 7-30 mm). Seven volar ganglia showed joint communication. Ten ganglia were anechoic; 7 were hypoechoic; and 3 had anechoic and hypoechoic areas. Eight had septations; 8 had internal echogenic areas; 15 had posterior acoustic enhancement; 13 had well-defined margins; 12 were lobular; and none were vascular. Cysts that were anechoic (P < .0001) or with posterior acoustic enhancement (P = .04) were significantly larger than those that were hypoechoic or without posterior acoustic enhancement. CONCLUSIONS: Small wrist ganglion cysts (< or = 10 mm in the mean largest dimension) often appear hypoechoic without posterior acoustic enhancement and do not fulfill the criteria for a simple cyst.