US appearance of the rotator cable with histologic correlation: preliminary results

PURPOSE: To characterize the ultrasonographic (US) appearance of the rotator cuff cable in asymptomatic shoulders and in cadaveric specimens, with histologic comparison for the latter. MATERIALS AND METHODS: The cadaveric portion of this study was approved by the institution's Anatomical Donations Department. Institutional review board approval and informed consent were obtained from asymptomatic volunteers and clinical patients for the HIPAA-compliant portion of the study. Four fresh cadaveric shoulder specimens (two male subjects, 40 and 50 years old) were dissected, assessed for the presence of the rotator cable, and imaged with 12-MHz US. Histologic slides (hematoxylin-eosin stain) from three resected rotator cuff tendons were inspected for fibers in the expected location and orientation of the rotator cuff cable. The shoulders in 17 asymptomatic volunteers (seven men, two women; age range, 27-66 years; mean, 41 years) and contralateral asymptomatic shoulders in 10 patients (six men, four women; age range, 24-78 years; mean, 49 years) were scanned and evaluated for the presence and appearance of the rotator cable. RESULTS: The rotator cable was identified at gross dissection. Histologic examination and US of the cadaveric shoulders demonstrated an articular-sided fibrillar structure perpendicular to the rotator cuff tendon (average thickness and width, 1.2 mm and 4.5 mm, respectively). US of asymptomatic shoulders depicted a similar fibrillar structure in three (11%) shoulders up to 1.1-1.5 cm medial to the greater tuberosity (average thickness and width, 1.2 mm and 4.5 mm respectively). CONCLUSION: The rotator cable can be depicted with US.     

Assessment of muscle function in patients with COPD: preliminary results

Aim. – To investigate muscle function during brief maximal sprint exercise in patients with chronic obstructive pulmonary disease (COPD).Materials and methods. – Eight patients underwent three tests: three maximal sprints on a specialised cycle ergometer to assess individual velocity–power relationship, anthropometric measurement, maximal oxygen uptake (VO₂max).Results. – The maximal anaerobic power and corresponding optimal velocity were 3.9 ± 1.6 W kg^–1 and 85.4 ± 17.0 rpm, respectively. COPD patients showed a 30% decrease in maximal anaerobic power, compared to healthy older subjects (5.6 ± 1.1 W kg^–1). No such difference was observed in terms of optimal velocity. In addition, COPD patients showed a 43% lower VO₂max compared to healthy older subjects (Eur. J. Appl. Physiol. 77 (1998) 182; Eur. J. Appl. Physiol. 76 (1997) 81).Conclusion. – The decrease in maximal anaerobic power was less than the decrease in maximal aerobic power.     

Carotid disease: automated analysis with cardiac-gated three-dimensional US technique and preliminary results

Automatic analysis was performed of four-dimensional ultrasonographic (US) data in the carotid artery. The data, which were acquired in 31 subjects (eight healthy volunteers and 23 patients) by using a US scanner fitted with a special probe, were successfully processed. Acquisition time averaged 12 minutes. Data for all healthy volunteers (n = 8) and patients with complete occlusions (n = 3) were correctly classified. Data for two of the 12 patients with mild to severe (but not occlusive) disease were misclassified by one category.     

Effect of dutasteride therapy on Doppler US evaluation of prostate: preliminary results

PURPOSE: To prospectively determine the effect of short-term therapy with dutasteride on the suppression of Doppler ultrasonographic (US) signal in benign prostate tissue and thus on improvement in the depiction of prostate cancer with Doppler US-guided core-needle biopsy. MATERIALS AND METHODS: After institutional review board approval and informed consent were obtained as part of this HIPAA-compliant study, 11 men (age range, 59-77 years) were evaluated with gray-scale, color, and power Doppler US at baseline and weekly for up to 3 weeks while taking 0.5 mg of dutasteride per day. Flow intensity in the periurethral, transition, and peripheral zones was subjectively scored by using a four-point scale. The Wilcoxon matched-pairs signed-ranks test was used to compare pre- and posttherapy scores. After flow was reduced to "diminished" or "none" with at least a 1-score difference on the four-point scale, up to four targeted cores were obtained from areas of persistent flow within the peripheral zone, followed by laterally directed sextant biopsy. RESULTS: Doppler US flow suppression occurred in 11 of 11 patients after 1 week of dutasteride therapy (P < .01). Further suppression was noted after 2 weeks in eight of 10 patients (P = .04) and after 3 weeks in two of two patients. Biopsy was performed after 1 (n = 1), 2 (n = 8), or 3 (n = 2) weeks of therapy. Flow suppression was greatest in the peripheral zones (mean decrease: 0.64 and 0.76 after weeks 1 and 2, respectively) and least in the periurethral zones (mean decrease: 0.30 after 1 week). Cancer was detected in eight (20%) of 40 targeted cores and in five (8%) of 66 sextant cores. Four patients had cancer at targeted biopsy, and three of these four patients had cancer at sextant biopsy. In the four men with cancer, targeted cores were 5.9 times more likely to be positive (P = .027). Selective suppression of flow in benign tissue was observed in two of the four men with cancer. CONCLUSION: Short-term dutasteride therapy reduces Doppler US flow in the prostate and may improve depiction of hypervascular cancer.     

Evaluation of liver parenchymal blood flow with contrast-enhanced US: preliminary results in healthy and cirrhotic patients

RATIONALE AND OBJECTIVES: To determine whether changes in hepatic parenchymal blood flow in cirrhotic patients can be evaluated with contrast-enhanced ultrasound (US) after Levovist administration. MATERIALS AND METHODS: Ten normal volunteers, 16 Child A and 16 Child C cirrhotic patients were evaluated with contrast-enhanced US. Frames obtained at progressively increasing pulse intervals of 2, 4, 7, and 10 seconds in the same scan plane during infusion of Levovist (300 mg/mL, 150 mL/h) have been digitally recorded. Pulse intervals versus signal intensity (PI-SI) plots were fitted to a straight line whose slope is proportional to the speed of blood in the liver parenchyma. Enhancement differences in late phase have been evaluated measuring the SI after 7 minutes from the beginning of the infusion. RESULTS: The slope of the PI-SI plot of the Child A cirrhotic patients was significantly lower than the slope of the normal controls (P < 0.05); conversely, no significant differences were found between the slope of the patients with Child C cirrhosis and that of the normal controls. In comparison with the normal subjects, the average SI at late phase decreased significantly both in patients with Child A (P < 0.05) and Child C (P < 0.001) cirrhosis. CONCLUSION: Microbubble contrast agents could provide a noninvasive tool to detect and monitor hemodynamic changes that occur in the cirrhotic liver. Changes in the hepatospecific properties at late phase have also been demonstrated.     

Perfluorochemicals as US contrast agents for tumor imaging and hepatosplenography: preliminary clinical results

In animals, perfluorochemicals (PFCs) are effective ultrasound (US) contrast agents that produce hepatic, splenic, and tumor enhancement. The use of Fluosol-DA 20%, an emulsion of perfluorodecalin and perfluorotripropylamine, was studied in nine non-critically ill patients with cancer who had liver lesions. US studies without Fluosol were compared with studies obtained 24, 48, and 72 hours after Fluosol infusion. Vital signs and extensive laboratory analyses are performed before and after Fluosol infusion. Liver metastases from colonic, pancreatic, and gastric carcinoma exhibited rim or diffuse enhancement after a Fluosol dose of 1.6 g/kg or greater. Fluosol produced echogenic enhancement of the liver and spleen relative to kidney at a dose of 2.4 g/kg, allowing the detection of nonenhancing lesions. In addition, Fluosol at a dose of 1.6 g/kg or greater allowed detection of lesions not seen before contrast medium was administered in three of the seven patients studied. There was a mild increase in the level of serum glutamic oxaloacetic transaminase in two patients, one given 2.4 and the other 3.2 g/kg of Fluosol. Mild and transient allergic reactions without change in vital signs were experienced by two patients.     

Classification of galactograms with ramification matrices: preliminary results

RATIONALE AND OBJECTIVES: The poor specificity of galactography, the imaging modality generally indicated in cases of nipple discharge, has led to a large number of biopsies with negative results. A quantitative scheme for classifying galactographic findings might help reduce the number of such biopsies in the future. As a first step toward that goal, the authors have studied one quantitative method for describing the branching of ducts by using ramification matrices (R matrices), and the correlation of the values of the matrix elements with clinical findings. MATERIALS AND METHODS: The ductal trees were manually segmented for 25 galactographic views from 15 patients, and corresponding R matrices were calculated. Patients were divided into two groups: those with no reported galactographic findings (NF) and those with reported findings (RF) of ductal ectasia, cysts, or papilloma. In a leave-one-out fashion, the authors evaluated a classification scheme that was based on R-matrix coefficients and used a Bayesian decision rule. The effects of segmentation were tested by successively removing each of the terminal ducts and computing the corresponding matrices of the pruned trees. RESULTS: With use of a single R-matrix element, 92% and 62% of NF and RF cases were correctly classified, respectively (P = .007). With use of two elements, 83% and 77% of NF and RF cases were correctly classified, but this result was not statistically significant (P = .108). In a test of robustness, an analysis of pruned trees yielded an average root-mean-square fractional difference of 9.7% between the elements of the original and the R matrix averaged over all pruned trees. CONCLUSION: The preliminary analysis indicates that it may be possible to identify cases with reported galactographic findings by using R matrices.     

Hilar biliary obstruction: preliminary results with Levovist-enhanced sonography

OBJECTIVE: The aim of this study was to investigate the value of using Levovist in the postvascular phase of sonography performed to assess hepatic hilar biliary obstruction. SUBJECTS AND METHODS: In our prospective study, 50 patients underwent routine sonography followed by postvascular Levovist-enhanced pulse inversion imaging of the liver. Thirty-six patients had malignant disease (28 invasive parenchymal tumors and eight intraductal tumors), and 14 had benign disease. The 36 malignancies included 29 cholangiocarcinomas, six invasive gallbladder carcinomas, and one colon metastasis. Fourteen patients had benign disease: benign strictures (n = 5), primary sclerosing cholangitis (n = 5), chronic Mirizzi's syndrome (n = 1), varicosities of the parabiliary venous plexus (n = 1), and inflammatory liver lesions (n = 2). Sonographic findings in all 50 patients were correlated with findings from other imaging modalities (n = 50) as well as surgical specimens (n = 20), core biopsies (n = 3), and both clinical and imaging follow-ups (n = 24). RESULTS: Seventeen (61%) of the 28 invasive intraparenchymal malignancies were visualized on routine sonograms, whereas all 28 (100%) were visualized on enhanced sonograms (p < 0.01). In 15 (88%) of 17 patients in whom tumor was seen on routine sonograms, contrast-enhanced sonography showed further mass extent, increased conspicuity, or satellite nodules not visualized on the baseline image. All eight noninvasive intraductal malignancies were correctly identified and staged on the routine sonography. In one of these patients, hepatic invasion was prospectively overcalled on the enhanced image. Of the 14 benign lesions, three had inflammatory periductal abnormalities seen exclusively or to advantage on the enhanced study. Correct prediction of resectability in the 16 patients with malignant disease who underwent surgery improved from 11 (69%) of 16 on unenhanced sonography to 15 (94%) of 16 on enhanced sonography (p = 0.13). CONCLUSION: Detection and staging of malignant hilar obstructions are improved by the use of Levovist in the postvascular phase of sonography compared with routine sonography.     

Effect of Tadalafil on prostate haemodynamics: preliminary evaluation with contrast-enhanced US

Purpose

Phosphodiesterase-5 (PDE-5) inhibitors have an established role in the treatment of erectile dysfunction, but there is increasing evidence that these drugs are effective also for the treatment of lower urinary tract symptoms and benign prostatic hyperplasia (BPH). The mechanism of action of PDE-5 inhibitors in the prostate, however, is poorly understood. It is conceivable that these drugs act by reducing the smooth muscle tone of the organ, but this effect could produce vascular changes as well. The aim of this study was to investigate whether administration of Tadalafil, a PDE-5 inhibitor, in patients with BPH produces haemodynamic changes in the prostate that can be assessed using contrast-enhanced US (CEUS).

Materials and methods

Twelve consecutive patients with BPH underwent transrectal CEUS before and 90 min after administration of 20 mg Tadalafil. CEUS was performed during bolus injection of SonoVue (4.8 ml) using a nondestructive US mode. The same scan plane, imaging parameters and technique were used before and after Tadalafil administration. Digital clips were recorded and processed using dedicated software (QontraXt v.3.60. Signal intensity (SI) changes in a region of interest (ROI) encompassing the entire prostate were fitted to a gammavariate curve. Changes in enhancement peak, time to peak (TTP), sharpness of the bolus transit and area under the curve (AUC) were considered for further analysis.

Results

After Tadalafil administration, the enhancement peak and AUC increased significantly (p<0.01), reflecting changes in prostate vascularity. TTP and sharpness did not change significantly.

Conclusions

In patients with BPH, vascular changes are observed in the prostate after Tadalafil administration, which can be detected with CEUS.     

Anal incontinence: diagnosis by endoanal US or endovaginal MRI

Preoperative evaluation was made of the diagnostic value of endoanal ultrasound (EAUS) and endovaginal magnetic resonance imaging (EVMRI) in diagnosing anal sphincter defects as the cause of anal incontinence. Nineteen female individuals with anal incontinence were examined clinically with EAUS and with EVMRI at 1.5 T using a prostatic coil. The findings were evaluated independently and compared with findings at surgery. In diagnosing external anal sphincter defects, EAUS and EVMRI showed almost similar agreement with surgical findings, 12 (63%) out of 19 vs 11 (58%), respectively. Internal anal sphincter defects were equally detected by EAUS and EVMRI as compared with surgical diagnosis. There was considerable variation between radiologists in diagnosing defects by EVMRI. EAUS and EVMRI are equal in diagnosing anal sphincter defects.Abbreviations IAS Internal anal sphincter - EAS External anal sphincter - EAUS Endoanal ultrasound - MR Magnetic resonance - PPV Positive predictive value - NPV Negative predictive value - EVMRI Endovaginal magnetic resonance imaging - EAMRI Endoanal magnetic resonance imaging     

Scaphoid fractures: evaluation with high-spatial-resolution US initial results.

PURPOSE: To evaluate the diagnostic accuracy of high-spatial-resolution ultrasonography (US) in the diagnosis of scaphoid fractures. MATERIALS AND METHODS: In 72 hours after acute wrist trauma, 15 consecutive patients were examined for possible scaphoid fractures clinically and with conventional radiographs, including scaphoid views. Thereafter, high-spatial-resolution US was performed by two experienced radiologists blinded to the results of the previously performed investigations. High-spatial-resolution US of the scaphoid bones was performed from the palmar, lateral, and dorsal directions in the longitudinal and transverse planes. US findings indicative of a scaphoid fracture were cortical discontinuity and/or periosteal elevation. Finally, magnetic resonance (MR) images (short inversion time inversion-recovery, T1- and T2*-weighted) (ie, the standard) of the affected wrist were obtained and evaluated for a possible scaphoid fracture by two radiologists in consensus. RESULTS: Nine of 15 patients had scaphoid fractures. Seven (78%) of nine patients had positive findings at high-spatial-resolution US and five (56%) had such findings at conventional radiography (ie, four occult scaphoid fractures), with an accuracy of 87% and 73%, respectively. Two (50%) of four radiographically occult scaphoid fractures were depicted with high-spatial-resolution US. Sonographic findings of scaphoid fractures were either cortical discontinuity (n = 4), periosteal elevation (n = 2), or a combination of these two findings (n = 1). CONCLUSION: High-spatial-resolution US is a reliable diagnostic tool for the evaluation of occult scaphoid fractures and should be considered an adequate alternative diagnostic tool prior to computed tomography or MR imaging.     

Assessment of liver steatosis in chicken by using acoustic radiation force impulse imaging: preliminary results

Objective

To evaluate acoustic radiation force impulse (ARFI) imaging as a non-invasive tool for quantification of the grades of liver steatosis in chickens.

Methods

We used two different diets: a standard diet (SD group) and a hyperlipidaemic diet (HD group). The ARFI technique was performed in all the animals in the right hepatic lobe and shear wave velocity (SWV) was measured and expressed in metres per second (m/s). Plasma lipid levels were analysed. Steatosis was quantified by using semiquantitative analysis. Statistical analysis was used and Pearson’s correlation coefficient was calculated.

Results

Mean SWV was 0.94?±?0.16 m/s (range 0.8–1.3 m/s) in the SD group and 1.91?±?0.25 m/s (range 1.3–2.2 m/s) in the HD group (p?<?0.001). The lowest SWVs (≤1.3 m/s) corresponded to the chickens in the SD group, with 100% of the animals returning a score of 0, whereas the range of SWV in the HD group chickens was between 1.6 and 2.2 m/s. A substantial correlation was observed between SWVs with histological semiquantitative analysis of steatosis (r?=?0.85, p?<?0.001).

Conclusion

ARFI imaging is a non-invasive diagnostic tool that allows discrimination between the grades of liver steatosis in chickens.     

CO2 splenoportography: preliminary results

OBJECTIVE: Previously, splenoportography with 18-gauge needles provided excellent portal imaging. However, because of concern about bleeding, this technique was replaced with arterial portography and noninvasive techniques, which are not always accurate. We present a modification of splenoportography using CO2 and an ultrafine needle in eight patients whose previous imaging studies were inconclusive. CONCLUSION: CO2 splenoportography is safe and expedient and provides adequate visualization of the portal system for surgical planning in selected patients.