Clinical and pathologic correlation of endometrial cavity fluid detected by ultrasound in the postmenopausal patient

A registry of ultrasound procedures spanning nearly 5 years was searched retrospectively to discover cases of endometrial cavity fluid collections in postmenopausal women. Twenty cases were identified; all medical records were available for review. One patient was lost to follow-up. Seventeen patients had surgical procedures: 11 had only a D&C, and six had a primary evaluation of laparotomy with removal of the uterus and adnexa. Five women had cancer (two ovarian, one tubal, one endometrial, and one cervical); eight women had benign gynecologic conditions, including uterine fibroids (five), ovarian serous cystadenoma (two), and cervical dysplasia (one). There were two cases of apparent subclinical pyometra. Five women had endometrial pathology consistent with prescribed hormone therapy for breast cancer (four) or endometrial hyperplasia (one).     

Mathematical modeling of the dilution curves for ultrasonographic contrast agents

Most techniques using sonographic contrast agents are based on introducing the agent intravenously. The sonographic changes occur over time and follow a characteristic "skewed gaussian curve," often referred to as the indicator dilution curve. This study uses principles of linear acoustics and tracer kinetics to develop a quantitative model for the indicator dilution curve. A rapid increase in image brightness occurs after bolus injection; brightness peaks after a time related to the blood flow and stability of the contrast agent, which is followed by an asymptotic decrease in image brightness. The net image enhancement, represented by the area under the dilution curve, increases nonlinearly with the injected dose. In stable contrast agents the peak-time and mean transit time are related directly to the flow rate. This relationship changes when the microbubbles of a contrast agent collapse. In an unstable contrast agent the indicator dilution curve is attenuated and peaks earlier than expected on the basis of flow rate. The extent of shift in the mean transit time varies with the half-life of the contrast agent and follows a sigmoid relationship. In conclusion, the properties of the time-videointensity (indicator dilution) curves are significantly affected by the attenuation and stability of the contrast agents. These factors must be taken into consideration in deriving flow related information.     

Concurrent duplication and azygos continuation of the inferior vena cava

Duplication of the inferior vena cava and azygos continuation of the inferior vena cava arise from separate embryologic anlage. The former arises from persistence of both supracardinal veins and the latter from arrested development of the right subcardinal vein. Individually these entities are uncommon, but their occurrence together in one patient is exceedingly rare. A patient with both these anomalies of the venous system concurrently is described. This combination has been reported only once before in the radiologic literature.     

Transvaginal and transabdominal sonography: prospective comparison

Transvaginal (TV) and transabdominal (TA) sonography were compared in a prospective study. A total of 230 examinations (126 pelvic, 104 pregnancy) were performed on 215 patients, ranging in age from 14 to 80 years. The improved anatomic detail on TV scans yielded new information in 138 (60%) examinations and better visualization of pelvic structures in 51 (22%) examinations. There was no important difference in diagnostic information provided by the two imaging modalities in 36 (16%) cases, and TV images were worse in five (2%). The clinical diagnosis was altered on the basis of TV sonographic findings in 54 (24%) cases and confirmed with certainty in 166 (72%). Diagnostic problems posed by TA scanning were not resolved by TV scanning in ten (4%) instances. Statistical analysis indicated that TV scanning was significantly better than TA scanning in the visualization of gestational sac contents (P less than .005), detection of fetal heart motion (P less than .001), and evaluation of the endometrial canal in the retroverted or retroflexed uterus (P less than .001). TV scanning was significantly better than TA scanning in visualization of the ovaries in patients with uterine leiomyomas (P less than .005) but not significantly better in peri- and postmenopausal patients (P greater than .05).     

Shoulder soft tissue width as a predictor of macrosomia in diabetic pregnancies

Sonographic evaluation of 43 pregnant women with diabetes mellitus was performed in the third trimester of gestation for evidence of fetal macrosomia. The width of the soft tissues of the shoulder from the skin surface to the proximal humerus was compared with previously reported measurements for their ability to predict fetal macrosomia. The abdominal circumference and shoulder soft tissue measurements were the best individual predictors of macrosomia, but a combination of an abdominal circumference greater than the 90th percentile for gestational age or a shoulder soft tissue width greater than 12 mm was the best predictor with a sensitivity of 96%, specificity of 89%, and accuracy of 93%. The shoulder soft tissue width should be evaluated for evidence of macrosomia in diabetic pregnancies.     

Does Use of a PACS Increase the Number of Images Per Study? A Case Study in Ultrasound

The purpose of this study was to determine if the use of a picture archiving and communications system (PACS) in ultrasonography increased the number of images acquired per examination. The hypothesis that such an increase does occur was based on anecdotal information; this study sought to test the hypothesis. A random sample of all ultrasound examination types was drawn from the period 1998 through 1999. The ultrasound PACS in use (ACCESS; Kodak Health Information Systems, Dallas, TX) records the number of grayscale and color images saved as part of each study. Each examination in the sample was checked in the ultrasound PACS database,.and the number of grayscale and color images was recorded. The comparison film-based sample was drawn from the period 1994 through 1995. The number of examinations of each type selected was based on the overall statistics of the section; that is, the sample was designed to represent the approximate frequency with which the various examination types are done. For film-based image counts, the jackets were retrieved, and the number of grayscale and color images were counted. The number of images obtained per examination (for most examinations) in ultrasound increased with PACS use. This was more evident with some examination types (eg, pelvis). This result, however, has to be examined for possible systematic biases because ultrasound practice has changed over the time since the authors stopped using film routinely. The use of PACS in ultrasonography was not associated with an increase in the number of images per examination based solely on the use of PACS, with the exception of neonatal head studies. Increases in the number of images per study was otherwise associated with examinations for which changes in protocols resulted in the increased image counts.     

Sonographic enhancement of renal cortex by contrast media.

The purpose of this study was to evaluate whether a phase shift contrast agent could enhance the renal cortex. Four doses of the contrast agent EchoGen ranging from 0.25 to 0.65 ml/kg were injected intravenously in three healthy dogs. Images of the kidney were recorded on a videotape before and after each injection. The images were evaluated visually and were computer-analyzed for brightness change caused by the contrast agent. Marked changes in cortical brightness were observed at the doses of 0.45 and 0.65 ml/kg. At lower doses the changes in image brightness were significantly reduced but measurable. The brightness peaked at 65 +/- 9 seconds after injection and gradually decreased to the baseline value in approximately 12 minutes. The video density varied nonlinearly with dose, and at low doses its value drifted below the baseline. This is believed to be due to attenuation of echoes by the contrast agent. The results of this study indicate that the microbubbles formed by phase shift contrast media are sufficiently small and persist long enough to enhance sonographic images of the cortex. Contrast media whose effect is based on the phenomenon of phase shift permit enhancement of the gray scale characteristic of the kidney. The enhancements last up to several minutes and have strong potential to allow investigation of perfusion in kidney.