A Case of Non-Alcoholic Pancreatitis Treated with Steroid Followed-up Using Intraductal Ultrasonography and Endoscopic Retrograde Pancreatography

A 42-year-old man with jaundice was found to have a pancreatic mass in the head by ultrasonography. Endoscopic retrograde cholangiopancreatography (ERCP) showed a segmental narrowing of the main pancreatic duct (MPD) with a mild upstream dilatation and an extrinsic stenosis of the inferior common bile duct (CBD). lntraductal ultrasonography (IDUS) showed a diffuse hypoechoic area with echogenic spots surrounding the narrowed MPD and the stenotic CBD. He was suspected of having autoimmune pancreatitis because of a characteristic pancreatogram, and 30 mg/day predniso-lone was started. Two weeks later, the narrowing of the MPD and the stenosis of the CBD improved dramatically. But the hypoechoic area remained separate from the MPD with a fine reticular pattern on the inside. It completely disappeared in the eighth week. The diachronic changes in the IDUS were characteristic in that the hypoechoic area, which initially surrounded the MPD, disappeared near the MPD, followed by a distant area. This might explain the discrepancy between the images of ERCP and IDUS in the second week of steroid therapy.     

羊水B超检测法诊断胎儿畸形价值的研究

已知胎儿畸形常伴有羊水增多。本文以B超检测152例畸形胎儿和134例正常胎儿羊水为例,应用拟然比对这一特征提出新的诊断方法。结果表明,羊水最大深度≥80mm,表现出与胎儿畸形的高度相关性。其特异性98.5％,敏感性65.13％,阳性拟然比43.6,阴性拟然比0.35。     

Volumetric Assessment of Plaque Progression With 3-Dimensional Ultrasonography Under Statin Therapy

BACKGROUND AND PURPOSE: Lowering of serum cholesterol levels with HMG-CoA reductase inhibitors (statins) slowed the progression of atherosclerosis in the carotid arteries in several clinical trials using carotid artery intima media thickness as primary outcome measure. Whereas conventional ultrasonography is limited to thin 2-dimensional image planes, 3-dimensional (3D) ultrasonography provides quantitative measurement of the entire carotid artery plaque volume. This study aims to assess the feasibility of 3D ultrasonography to monitor plaque progression in hypercholesterolemic patients. METHODS: The authors prospectively assessed the progression of 31 carotid artery plaques over 15.1 +/- 4.5 months in a study of 23 patients (6 women, 17 men; mean age = 61.7 +/- 7.5 years) with hypercholesterolemia under therapy with HMG-CoA reductase inhibitors. All patients were maintained on a lipid-lowering diet. Sixteen patients were additionally treated with statins. Quantitative measurements of carotid artery plaque volumes were performed after 3D reconstruction of exactly parallel transverse duplex ultrasound scans (slice distance = 0.1 mm) into volumetric 3D data sets and segmentation of voxels representing the carotid artery plaque. RESULTS: Within the treatment group, plaques were significantly less frequently progressive if they had a hypoechoic echogenicity (11%, n = 9 vs 64%, n = 14; P = .016) or if baseline serum cholesterol levels were above 8.0 mmol/L (9%, n = 11 vs 75%, n = 12; P = .002). CONCLUSION: Three-dimensional ultrasonography extends the measurement of the arterial wall thickness to the 3D volume of an entire atherosclerotic plaque including analysis of its morphology and configuration. However, further clinical trials with an adequate sample size to achieve sufficient statistical power are necessary to assess the effect of statin therapy on plaque progression.     

种植性兔VX2肝肿瘤血供的研究

目的探讨种植性兔VX2肝肿瘤生长的自然血供特点。方法VX2瘤株接种于新西兰兔肝左叶,制成模型瘤兔15只,将其按瘤体直径分为3组:A组直径<2.0cm、B组直径2.0～3.0cm、C组直径>3.0cm,分别应用彩色多普勒超声仪检测各组VX2瘤兔的门静脉和肝动脉的血流动力学指标,以及肝动脉血管造影显示瘤体供血情况,分析不同直径大小的瘤体血流分布及构成。结果A组的VX2兔肝肿瘤供血不丰富,肝动脉部分参与供血;B组的VX2兔肝肿瘤瘤内血流丰富,供血以肝动脉为主;C组的VX2兔肝肿瘤中心部出现坏死,瘤周血流丰富,供血以肝动脉为主。C组的VX2兔肿瘤肝动脉最大血流速度(Vmax)(60.3±10.9cm/s)与A组(50.4±12.2cm/s)相比有差异(P<0.01),阻力指数(RI)(0.9±0.12)与A组(0.5±0.02)相比有差异(P<0.01);门静脉平均血流速度(V)及门静脉内径(D)各组差异不大(P>0.05)。结论种植性VX2肝肿瘤主要供血血管为肝动脉,肝动脉最大血流速度和阻力指数随肿块增大明显增加,多普勒流速曲线呈高速高阻型;门静脉平均血流速度及门静脉内径随肿块增大变化不明显。     

Sonographic appearance of aggressive angiomyxoma of the scrotum.

Aggressive angiomyxoma (AAM) is a rare, locally infiltrative tumor that occurs almost exclusively in the pelvic and perineal regions of women of childbearing age. We report the unusual case of a 26-year-old man with an AAM presenting as a slowly enlarging scrotal mass. Gray-scale scrotal sonography demonstrated a well-demarcated, hypoechoic, extratesticular, extraepididymal mass with multiple thin, echogenic internal septa. The mass arose inferior to the left testicle and displaced the testicle cephalad. Color Doppler sonography revealed surrounding vascularity but no Doppler signals within the mass. The testicles and epididymides demonstrated normal echogenicity and vascularity. Histologic examination of the excised mass revealed a well-demarcated, nonencapsulated lesion composed of spindle-shaped cells in a myxoid background with a prominent vascular component.     

Measurement of the transverse cerebellar diameter in preterm neonates and its use in assessment of gestational age

This study aims to confirm the relationship between gestational age (GA) and transverse cerebellar diameter (TCD), to define the prediction of GA by TCD, and assess the reliability of TCD measurements. Infants were included in the study if they had a routine cranial ultrasound scan by day 3, and the TCD was measured. Infants were excluded from the study if the GA was not known, if there was any cranio‐spinal malformation or grade 3 or 4 intraventricular haemorrhage (IVH). The GA assessment was an early pregnancy scan or certain dates. Cranial ultrasound scans were done with a LOGIQ 500 scanner (GE Medical Systems, Waukesha, WI, USA) with a 7 MHz curvilinear sector probe (GE LOGIQ‐C721; GE Medical Systems). The posterior fossa was scanned using the asterion as the acoustic window with the TCD measured in the coronal plane. Intra‐ and interobserver reliability were assessed. A total of 221 infants of known GA had their TCD measured. The linear regression for GA versus TCD is: GA_weeks = (0.470 × TCD_millimetres) + 13.162 (r = 0.89, r ² = 0.79, P < 0.001). The 95% confidence interval predicts GA to ± 2.33 weeks for a given TCD. Intra‐ and interobserver intraclass correlation coefficients are 0.98 and 0.99, respectively. Transverse cerebellar diameter correlates closely with GA and predicts GA to ± 2.33 weeks. Measurements of TCD have excellent reproducibility.     

ENDOSCOPICALLY RESECTED LIPOMA OF THE ESOPHAGUS: REPORT OF A CASE

Lipoma of the esophagus is rare. There are few reports of the endoscopic resection of esophageal lipoma. We present a 73‐year‐old woman with lipoma of the esophagus which was successfully extirpated using the technique of endoscopic mucosal resection. To determine the depth of tumor invasion, endoscopic ultrasonography was used. A total of 31 cases of esophageal lipoma have been reported in Japan. Of these, seven were successfully resected using endoscopic techniques. Lipomas of the esophagus can grow to become large pedunculated tumors which can obstruct the airway. The majority of these tumors occur in the cervical portion of the esophagus. Most patients have no symptoms. These tumors can be resected using minimally invasive surgery when they are small.     

Sonographic diagnosis of diastematomyelia in utero: A case report and literature review

Fetal diastematomyelia is a rare form of spinal dysraphism that is characterized by a complete or incomplete division of the spinal cord by an osseous or fibrocartilaginous septum. A case of diastematomyelia, which was detected on the routine third trimester detailed ultrasound scan, is presented. The diagnosis was based on the detection of an echogenic focus in the posterior aspect of the spine in association with widening of the interpedicular vertebral space. The case illustrates that diastematomyelia can occur in the absence of overt spina bifida and that prenatal detection will allow timely postnatal investigation and treatment. Prenatal literature is further reviewed to assess the clinical significance of this finding.     

Power Doppler imaging and resistance index measurement in the evaluation of acute renal transplant rejection.

PURPOSE: This study was designed to test the hypotheses that power Doppler imaging has a predictive value in the assessment of acute renal allograft rejection and that the information garnered from the combination of resistance index (RI) determination and power Doppler imaging has an even greater predictive value in this assessment. METHODS: Power Doppler images obtained prior to 96 sequential renal allograft biopsies in 92 patients with suspected renal transplant rejection were retrospectively graded for parenchymal vascularity on a scale of 1 to 4: 1, normal, uniform cortical flow; 2, mild peripheral cortical hypoperfusion; 3, vascular pruning in cortex and medulla; and 4, no visible parenchymal flow, with flow seen only in central vessels. Power Doppler grades and RIs for these cases were compared to graft biopsy results. RESULTS: No statistically significant association was observed between parenchymal vascularity as graded by power Doppler imaging, RI, and the presence of acute transplant rejection. CONCLUSIONS: Neither grading of vascularity on power Doppler images, RI measurement, nor the combination of these methods is an accurate means of detecting renal allograft rejection.     

Prediction of birth weight using fetal thigh and upper-arm volumes by three-dimensional ultrasonography in a Brazilian population

Objective.?To assess the accuracy of three-dimensional (3DUS) upper-arm (VolArm) and thigh (VolTh) volume measurements in the prediction of birth weight (BW).

Methods.?A cross-sectional study involving 81 live singletons was performed. VolArm and VolTh were obtained using 3DUS multiplanar mode with 5?mm slices. Linear and polynomial regressions were calculated to determine the best formula to predict BW using VolArm and VolTh. Analysis of variance was used to compare errors in BW using these formulae and using Shepard's and Hadlock's formulae. The interclass correlation coefficient (ICC) was used to assess intra and interobserver variability of measurements.

Results.?The best formula to predict BW based on VolArm was a simple linear equation (BW?=?803.91?+?39.89VolArm), and for VolTh it was a second degree polynomial equation (BW?=?32.37VolTh ? 0.06VolTh²). A third formula using both parameters was also constructed (BW?=?792.87?+?22.81VolArm?+?7.54VolTh). The error (E), percent error (PE), absolute error (AE) and absolute percent error (APE) for the BW prediction using VolArm were 0?g, 163.4?g, 0.5% and 5.4%, respectively. The same results for E, PE, AE and APE using VolTh were 0.99?g, 155.5?g, 0.3% and 5.2% and for the combined formula using both VolArm and VolTh the E, PE, AE and APE were 0?g, 138.4?g, ?0.4% and 4.6%, respectively. VolArm and VolTh were highly reproducible with intraobserver ICC of 0.98 and 0.99 and interobserver ICC of 0.96 and 0.97, respectively.

Conclusions.?BW estimated through formulae that use the fetal arm and thigh volumes assessed through 3DUS are not superior to two-dimensional formulae.