Ultrasonography for diagnosis of rotator cuff tear

 In this study the clinical usefulness of ultrasonography in the diagnosis of rotator cuff tears was assessed. One hundred twenty-two patients undergoing preoperative ultrasonography were evaluated surgically. Three different ultrasonographic machines were applied with a 7.5-MHz linear-array transducer. Surgery confirmed a sensitivity of 79% for full-thickness tears and 50% for partial thickness tears. In 73 patients with negative ultrasonographic findings, the specifity was 100% for full-thickness tears and 90% for partial-thickness tears. The diagnostic sensitivity for full-thickness tears of the Hitachi EUB-340 system was significantly lower than those of Hitachi EUB-415 and EUB-515, and thus the former cannot be recommended for detection of rotator cuff tears. The sensitivity with regard to partial-thickness tears was also significantly lower with the Hitachi EUB-340 system as compared to the Hitachi EUB-515. There were no significant differences in false-positive rate among the three machines used. In conclusion, accurate ultrasonographic diagnosis of rotator cuff tear requires a high-resolution machine, as well as considerable experience in interpretation.     

高频超声技术诊断肘管综合征的价值

目的：探讨超声技术诊断肘管综合征（CTS）的准确性。方法：对30例肘管综合征患者的30只手和50例无CTS志愿者的100只手肘部行动态超声检查,测量并比较两组尺神经的上下径、横径及截面积,并用ROC曲线评价超声诊断肘管综合征标准值的准确性。结果：CTS患者的尺神经在内上髁水平的截面积、上下径及左右径明显大于正常对照组,两组比较差异有统计学意义,尺神经的截面积增大对于诊断肘管综合征最有预测价值。以尺神经在内上髁水平的截面积7.5mm2为阈值,诊断敏感度为93%,诊断特异性为91%。结论：超声测量尺神经的截面积是诊断肘管综合征的可靠方法。     

The value of ultrasonography in the preoperative diagnostic evaluation of patients with recurrent anterior shoulder dislocation: a prospective study of 44 patients

The purpose of this study was to investigate the value of ultrasonography in the pre-operative assessment of patients with recurrent post-traumatic, anterior shoulder instability. Forty-four consecutive patients, 44 men and 12 women, with unilateral, post-traumatic, recurrent instability of the shoulder were included in the study. One experienced radiologist examined all patients, using a 5.0 or 7.5 MHz linear-array transducer, with the arm in different positions, one of which was used to provoke apprehension of the shoulder. Special attention was paid to the evaluation of the joint capsule, the anterior labrum, especially in terms of the presence of a Bankart lesion. All patients were subsequently treated surgically. After a diagnostic arthroscopy either an open or arthroscopic stabilisation of the shoulder was performed. Ultrasonography disclosed an unstable anterior labrum (equivalent to a Bankart lesion) in 36 shoulders; the lesion was verified in all 36 shoulders during arthroscopy. In three shoulders, arthroscopy disclosed an injured labrum, which had healed in an anterio-medial position on the scapular neck. In these three shoulders, ultrasonography failed to show any lesion. In five shoulders no Bankart lesion was found at arthroscopy. All these patients had increased shoulder laxity, and ultrasonography did not show any Bankart lesion. Furthermore a judgement of the joint capsule was not possible either. A bony Bankart lesion was found in four shoulders, using both arthroscopy and ultrasonography. The sensitivity of the ultrasonographic evaluation was 92%, and the specificity 100%. The positive predictive value was 100%, and the negative predictive value 63%. Ultrasonography showed a high correlation with the arthroscopic findings, with a high sensitivity and specificity. Therefore, we conclude that US can give important pre-operative information in patients with recurrent, unilateral, post-traumatic, anterior shoulder instability.     

Staging abdominal ultrasonography in nasopharyngeal carcinoma

Abdominal ultrasonograms were performed on 81 unselected patients with newly-diagnosed nasopharyngeal carcinoma without clinical evidence of distant metastases. Two patients had ultrasonographic features suspicious of, but not diagnostic of, hepatic metastases. One of these two patients developed hepatic metastases six months after the examination while the other was free of metastases at follow-up 33 months afterwards. Of the 79 patients without evidence of metastases on ultrasonogram, two developed hepatic metastases after 22 and 32 months. Based on these results, we do not recommend abdominal ultrasonography as a routine staging investigation for nasopharyngeal carcinoma.     

Ultrasonography of the rotator cuff: a comparison with arthroscopy in one-hundred-and-ninety consecutive cases

PURPOSE: To evaluate the accuracy of high-resolution ultrasonography compared to arthroscopy in the detection of rotator cuff tears. MATERIAL AND METHODS: Preoperative ultrasonography (US) with a 10-MHz commercially available linear-array transducer and a standardized study protocol was performed in 190 consecutive shoulders in 185 patients with a history of shoulder pain for more than 3 months. The findings at US were classified into intact cuff, partial-thickness, and full-thickness rotator cuff tears, and correlated with findings at shoulder arthroscopy. RESULTS: US correctly depicted 118 of 124 rotator cuff tears with sensitivity 95%, specificity 94%, PPV 97%, NPV 91% and accuracy 95%, all 94 full-thickness tears (sensitivity 100%, specificity 91%, PPV 91%, NPV 100%, and accuracy 95%), 24 of 30 partial-thickness tears (sensitivity 80%, specificity 98%, PPV 86%, NPV 96%, and accuracy 95%). CONCLUSION: US is a highly accurate diagnostic method for detecting full-thickness rotator cuff tears, but is less sensitive in detecting partial-thickness rotator cuff tears.     

Ultrasonography in patients with suspected acute appendicitis: a prospective study

The diagnostic accuracy of high-resolution real-time ultrasonography was prospectively studied in 240 patients admitted to the hospital with suspected acute appendicitis. The criteria for ultrasound diagnosis of appendicitis included a sausage-shaped, aperistaltic, hypoechoic structure when imaged along its longitudinal axis, with a target-like appearance on transverse section. The ultrasonographic findings were correlated with surgical-pathological outcome in 82 cases with proven appendicitis, with laparotomy findings in another 21 patients and with clinical follow-up in the remainder. The overall sensitivity, specificity and accuracy of ultrasonography in the diagnosis of acute appendicitis were 78%, 92% and 87%, respectively. The positive predictive value was 84% and the negative predictive value was 88%. Ultrasonography may significantly improve the diagnostic accuracy in patients with suspected acute appendicitis and should be performed in all patients in whom the clinical diagnosis is equivocal. The ultrasonographic findings must be interpreted in light of the clinical findings.     

Liver transplantation: diagnostic imaging in the preoperative assessment]

The correct selection of patients for liver transplantation, which is essential for surgical success, requires thorough radiological evaluation. The authors present their experience on 94 pretransplant adult patients that underwent a total of 251 diagnostic exams (Doppler US, CT, angiography and cholangiography) and interventional radiology maneuvers (biopsy, chemoembolization, biliary drainage). Three sclerosing cholangitis, 3 Budd-Chiari syndromes and 20 hepatocellular carcinomas in cirrhotic patients were identified; venous collaterals were present in 62.7% of the cases, 12.8%, of which had important spontaneous porto-systemic shunts; 6 patients had portal thrombosis; 20 arterial variations were found. Interventional maneuvers were useful and free of complications. US, CT and angiographic findings of each patient were compared. Integrating informations from different exams allowed a significant increase in the accuracy of diagnostic conclusions. Thanks to interventional maneuvers 5 patients could be selected for transplantation (hepatic arterial lipiodolization stopped the growth of 4 hepatic neoplasms; 2 infected fluid collections were sterilized by percutaneous US-guided drainage and topic therapy.     

原发性纵隔肿瘤的X线与B超诊断

本文对38例经手术和病理证实的原发性纵隔肿瘤的X线和B超显象表现作了对比观察研究。X线和B超的诊断准确率分别为63.2％(24/38)和84.2％(32/38),两种检查相结合可使诊断准确就提高到86.8％(33/38)。作者认为利用两种方法的优点有助于肿瘤的定性诊断和鉴别良恶性。本文讨论了两种检查的特点和诊断价值。     

高频超声对肢体肌疝的诊断价值

 目的 探讨高频超声对肌疝的诊断价值。方法 回顾分析2014-03至2015-10北京朝阳医院收治28例肢体包块疑似肌疝患者的资料,将术前高频超声检查与手术结果进行对照分析,计算高频超声的准确度、灵敏度、特异度等指标,并总结肌疝的发生特征及高频超声表现。结果 手术证实肌疝23例,其中22例被高频超声诊断。高频超声诊断肢体肌疝的灵敏度、特异度、准确度分别为95.65%、100.00%、96.43%。肌疝主要发生在小腿前外侧,超声表现为肌肉局部筋膜连续性中断及可复性包块。结论 高频超声对诊断肌疝具有重要参考价值。
     

输尿管结石的超声诊断与X线检查的对比分析

目的:探讨超声诊断对输尿管结石的临床应用价值,并与X线检查对比.方法:回顾本院2004年10月～2005年10月输尿管结石120例,其中单侧输尿管结石196例,双侧输尿管结石4例.全部病例中2例经手术证实,11例经输尿管镜证实,107例经体外排石证实.全部病例均行超声检查,并与腹部X线平片(KUB)、静脉肾盂造影(IVP)结果相比.结果:超声诊断输尿管结石的符合率较高(92.7%),明显高于KUB、IVP检查(62.0%);同时,超声可以为临床提供更多泌尿系的直接表现及伴发信息.结论:输尿管结石的首诊方法为超声.     

胆囊癌肝浸润的CT诊断(附25例与B超对照分析)

目的:探讨CT对胆囊癌肝浸润的诊断价值,并与B超对照。方法:回顾性分析25例经B超及CT检查并经临床证实为胆囊癌肝浸润的CT表现。结果:25例胆囊癌肝浸润的病例中有21例CT作出了正确的的诊断,大部分病例CT表现为胆囊癌肿与肝分界不清,邻近肝脏处出现不规则的低密度区,增强后呈不规则强化。而B超仅对其中的11例诊断准确。结论:CT对胆囊癌肝浸润的诊断有重要价值,且明显优于B超(P<0.005)。     

早期乳腺癌的超声和X线摄影的对照研究

目的 探讨早期乳腺癌的超声和X线的特征性表现,提高其诊断率。材料与方法 50例乳腺癌和20例乳腺良性病变均行B超和X线检查,乳腺摄片时间为月经后10天内,所有病例均经病理证实。结果 B超诊断早期乳腺癌39例,其敏感性和特异性分别为78．0％和85．0％,准确性为80．0％;X线诊断早期乳癌41例,其敏感性和特异性分别为82．0％和90．05,准确性为84．3％。二者综合诊断,其敏感性和特异性为96．0％和76．5％,准确性为90．4％。结论 二者综合检查可提高早期乳腺癌诊断的敏感性和准确性。     

腹腔镜超声在腹腔镜胰岛素瘤切除术中的定位诊断

目的 探讨腹腔镜超声在胰岛素瘤腹腔镜术中的定位诊断价值.资料与方法 回顾性分析64例行腹腔镜胰岛素瘤切除术患者的手术结果,计算术中超声对胰岛素瘤的检出率及定位诊断准确率,并评价术中超声引导下胰岛素瘤切除术的效果.结果 64例患者中,62例行腹腔镜胰岛素瘤切除术,2例因术中超声检查未发现明确肿瘤而未行任何手术.术中超声对肿瘤的检出率为96.9％,共检出69个结节,其对肿瘤个数的定位诊断准确率为100％.62例腹腔镜术中超声明确胰岛素瘤的患者中,59例单发肿瘤患者行腹腔镜单纯胰岛素瘤摘除术;3例多发肿瘤患者肿瘤结节均位于胰腺体尾部,其中1例行腹腔镜超声检查后直接转开腹手术,其余2例于腹腔镜切除1个肿瘤后采用中转开腹胰岛素瘤摘除并胰体、尾切除.结论 腹腔镜术中超声对胰岛素瘤的检出率及定位诊断准确率高,同时可显示肿瘤的毗邻关系,有助于术中选择合适的手术方式.     

超声对鉴别腹水性质的价值

目的：评价经腹部二维超声及彩色多普勒超声鉴别腹水性质的价值。方法：73例腹水患均经二维超声及彩色多普勒超声检查，并与手术病理或活检对照。结果：73例腹水患中，恶性腹水12例，良性腹水61例，超声诊断准确率为89％。在声像图上，肠管束缚征，腹水浑浊及网膜饼增厚征多见于恶性腹水，而胆囊壁增厚征与肠管浮游征则多见于良性腹水。结论：良性与恶性腹水的声像图征象有明显不同，因此，超声检查是鉴别腹水性质的主要方法。     

Pre-operative radiological and clinical assessment of hepatic tumours--is biopsy necessary?

The pre-operative investigations of 72 consecutive patients who underwent liver resection for hepatic tumours have been reviewed. A combination of clinical, biochemical and radiological findings correctly predicted histology in 93% of cases (the benign or malignant nature in 97%). Biopsy was performed in only 20 patients. Five of the biopsy reports were incorrect (75% accuracy, benign or malignant nature accuracy 90%). Although guided biopsy can be performed during radiological assessment of focal hepatic lesions we argue that it is rarely indicated and can be misleading in patients proceeding to hepatic resection.     

US-guided percutaneous biopsy of small (< or = 1-cm) hepatic lesions

PURPOSE: To determine the accuracy of ultrasonography (US)-guided percutaneous biopsy in diagnosing malignant neoplasms for hepatic lesions 1 cm or smaller. MATERIALS AND METHODS: In this prospective study, 64 consecutive patients with 74 discrete focal hepatic lesions depicted at US were referred for liver biopsy to confirm the exact nature of the lesions. Mean lesion size was 0.84 cm +/- 0.13 (range, 0.5-1.0 cm). Biopsy was performed with an 18-gauge automated biopsy gun in 46 lesions (once [n = 37], twice [n = 7], three times [n = 2]) or a 22-gauge needle in 28 lesions (once [n = 23], twice [n = 4], three times [n = 1]). Measures were taken to ensure accurate and effective lesion sampling. The histologic diagnosis of malignant tumor and findings on follow-up US images of "benign" nodules for 15-39 months were the criterion standard. RESULTS: No complications occurred. All specimens obtained were sufficient for diagnosis. Histologic examination revealed various types of primary and secondary malignant tumors (n = 44), hemangioma (n = 5), cirrhosis (n = 13), focal fatty change (n = 8), focal fatty sparing (n = 2), and abscess (n = 2). The diagnostic discrimination of US-guided biopsy in diagnosing malignant tumors in these small lesions was sensitivity, 98%; specificity, 100%; positive predictive value, 100%; negative predictive value, 97%; and accuracy, 99%. CONCLUSION: Percutaneous biopsy under US control is highly accurate in providing a definitive histologic diagnosis of malignant neoplasms for small hepatic lesions if measures for ensuring precise and effective lesion sampling are taken.     

Ultrasound findings in ectopic gestation

To study the diagnostic accuracy of real-time ultrasonography in the evaluation of ectopic pregnancy, the case records and preoperative sonograms of 57 patients with surgically proven ectopic pregnancy were reviewed. Some 81% of these patients had abnormal sonograms. However, the ultrasonographic findings were often nonspecific and in only 8.7% of the cases was an ectopic fetal heart beat demonstrated. Two patients in this series had coexistent intrauterine and extrauterine gestations. Other findings such as an adnexal mass, an empty uterus, fluid in the cul-de-sac, and a decidual reaction in the uterus are all suggestive of an ectopic pregnancy but can be seen in other conditions. The presence of a normal intrauterine gestation practically rules out the possibility of ectopic pregnancy.     

A prospective study of soft-tissue ultrasonography in sickle cell disease patients with suspected osteomyelitis

AIM: A prospective study was done to assess the accuracy of soft tissue ultrasonography in patients with sickle cell disease (SCD) presenting with suspected osteomyelitis. MATERIALS AND METHODS: Thirty-one SCD patients had soft tissue ultrasonography on 38 occasions (18 men, 13 women; mean age 8.2 years). The initial ultrasonographic signs and diagnosis were compared with the final clinical diagnosis, which was based on clinical progress and scintigraphy. RESULT: The overall sensitivity of ultrasound in diagnosing osteomyelitis was 74% with a specificity of 63%. The principal ultrasonographic finding of subperiosteal fluid was present in 14 (74%) patients with osteomyelitis and seven (37%) patients without infection. A finding of a subperiosteal fluid depth of 4 mm or more was significantly associated with osteomyelitis (P < 0.01). CONCLUSION: Ultrasonography should be the initial investigation in SCD patients if osteomyelitis is suspected clinically. In such a clinical setting, a finding of 4 mm depth or more of subperiosteal fluid appears to be diagnostic. Previous statements that the presence of any subperiosteal fluid indicates infection are shown to be inaccurate. Patients with less than 4 mm of subperiosteal fluid require further imaging or aspiration to establish the diagnosis of osteomyelitis.     

Echotomography in the diagnosis of Crohn's disease

The diagnostic accuracy of abdominal ultrasonography in Crohn's disease has been assessed in a prospective, randomized, simple-blind controlled study. A group of 181 out-patients (89 with accertained Crohn's disease and 92 controls) was studied. Considering "target sign" and/or "probable signs" of Crohn's disease, ultrasonographic sensitivity in diagnosing Crohn's disease was 84% and specificity 83%. Abdominal ultrasonography is indicated in the differential diagnosis of inflammatory bowel diseases, in the screening and follow-up of patients with Crohn's disease and in cases with contraindications to X-Ray examinations.     

The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome

AIM: The aim of study was to assess the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. MATERIALS AND METHODS: Eighty-six patients with carpal tunnel syndrome confirmed by electromyography and 45 asymptomatic controls were included in the study and underwent high-resolution ultrasonography of the wrists. The cross-sectional area and flattening ratio at the level of the pisiform bone of the proximal carpal tunnel were measured. Data from the patient group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) analysis. RESULTS: One hundred and forty-eight wrists of 86 patients with carpal tunnel syndrome and 76 wrists of 45 control patients were examined. All measurements showed significant differences between patients and controls. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a cut-off value of >10.5 mm2 at the level of pisiform bone provided a diagnostic sensitivity of 89% and specificity of 94.7% CONCLUSION: The ultrasonographic measurement of the median nerve cross-sectional area is a sensitive, specific and useful non-invasive method for the diagnosis of carpal tunnel syndrome.