Ultrasound in Medicine and Biology
3D volume scans performance. To evaluate the breast lesion shape in longitudinal, sagittal, and coronal, the largest lengths of A-, B-, Cviews were analyzed using render program and the ratios of axis to axis in A-, B-, C- views were calculated. A receiver–operating characteristics curve (ROC) analysis was performed to determine the diagnostic performance. Results: In this preliminary study, the characteristics determined on the longitudinal, sagittal, and coronal were showed by largest lengths of A-, B-, C- views. The diagnostic accuracy of these views in the ROC analyses were 0.698, 0.741, and 0.888, respectively; the ratios of largest lengths of C- to A-view and B- to A-view showed area under the curve 0.918 and 0.729, respectively. Conclusion: The diagnostic accuracy of the ratio of largest lengths of Cto A-view in the ROC analyses showed 0.918. However, larger trials are needed to determine its clinical value.
P 101 se Panoramic Ultrasound Imaging of the Breast: Advantages and Limitations I. Yang, J. Hwang, S. K. Jeh, A. Y. Jung, J. Y. Woo, H. S. Hong, Y. Lee Radiology, Kangnam Scared Heart Hospital, Seoul/KR Purpose: To present a spectrum of panoramic ultrasound imaging (PUI) and to discuss the role of PUI in the diagnosis and evaluation of breast pathology. Material & Methods: During recent 3-month period, we applied PUI using a IU22 system (Phillips Medical System, Bothell, WA) in 260 patients with BI-RADS category. PUI was obtained after routine traditional 2D ultrasound examination. Cases were reviewed by two experienced radiologists and noteworthy findings were collected. We also evaluated whether PUI improved spatial resolution, identified other associated abnormalities, usefulness of contralateral side image for comparison, usefulness on follow-up evaluation. Finally we asked the clinicians if the PUI helped in global identification of lesion. Results: Final assessment in BI-RADS categories are C1-102 (39%), C2-94 (36%), C3-45 (17%), C5-4 (2%), C5-11 (4%), C6-4 (2%). By using PUI, all lesions were documented successfully as a single image. Nevertheless, no new cases were diagnosed solely based on the PUI. PUI was considered helpful for spatial orientation in all cases (100%) and for comparing routine breast ultrasound examination. It was useful for follow-up evaluation after breast operation. Majority of the clinician answered that PUI was helpful than 2D images. Conclusion: For detection and characterization of the various condition of the breast pathology, PUI provides helpful supplementary information; however, direct measurement of the lesion size still has limited value for individual lesion characterization.
Breast / US of the Axilla
Volume 37, Number 8S, 2011 Purpose: Our study by four institutions aimed to confirm the usefulness of sentinel lymph node (SLN) detection in breast cancer using contrastenhanced ultrasonography (CEUS) with subareolar SonazoidÒ injection. Material & Methods: A total of 181 patients with breast cancer at four institutions were enrolled. After 2 ml of SonazoidÒ was injected subareolarly, the axillary area was observed transdermally. If contrastenhanced LNs were seen, they were defined as CE-SLN. The skin directly above them was then marked, and their number and location were checked. The other SLN detection methods, the g-probe-guided and dye-guided methods, were performed together. We evaluated the SLNs detected by each method to determine if they corresponded with each other. After the SLNs were resected, pathological examinations were done. Results: In 166 of the 181 cases, CE-SLNs were detected by the CEUSguided method. The number of CE-SLNs was 1 or 2, each taking 2 to 20 minutes to detect. The CE-SLNs corresponded grossly with SLNs detected by the other methods. The pathological results of permanent sections revealed 31 cases of SLN metastasis amongst the total of 181 cases. In 142 cases of 150 without LN metastasis and 24 cases of 31 with LN metastasis, CE-SLNs were identified. Conclusion: The detection rate by CEUS-guided method with SonazoidÒ was 92%. The results in our multicenter study suggested that CEUS-guided method has potential as a SLN identification modality in breast cancer.
P 104 ee US Findings of Various Axillary Masses H. Kim, E. Kang, M. Kim, S. Juhng Radiology, Wonkwang University Hospital, Iksan/KR Learning Objectives: The purposes of this exhibit are to understand the normal ultrasonographic anatomy of the axilla and to illustrate various disorders that involve the axilla. Background: The axilla contains various mesenchymal tissues and a wide variety of pathologic conditions can develop. US is the first choice for evaluation of axillary masses. Sonography is useful to characterize the axillary mass with Doppler and to confirm with sono-guided biopsy. Imaging Findings or Procedure Details: Images were reviewed as following contents. 1) Normal US anatomy of the axilla; 2) axillary lymph nodes in various pathologic conditions; 3) accessory breastrelated masses: fibroadenomas, galactoceles, fibrocystic changes, breast cancer; 4) axillary soft tissue neoplasm: lipomas, epidermal inclusion cysts, hemangiomas, fibromas, lymphangiomas, schwannomas; 5) systemic disease; 6) post-surgical masses. Conclusion: Understanding of the normal anatomy and the characteristic sonographic findings of the various axillary masses will help in the differentiation of palpable axillary masses.
P 103 se Sentinel Node Identification Method Using Contrast-Enhanced Ultrasonography with Sonazoid Injected Subareolarly in Breast Cancer: A Multicenter Study K. Omoto,1 K. Futsuhara,2 O. Sekine,2 M. Sakuragi,2 F. Konishi,2 H. Matsunaga,3 N. Taniguchi,3 M. Kawano,1 Y. Hozumi,4 H. Oosawa,4 T. Ito,5 T. Okuno6 1 Laboratory Medicine, Saitama Medical Center, Jichi Medical University, Saitama-pref./JP, 2Surgery, Saitama Medical Center, Jichi Medical University, Saitama-pref./JP, 3Clinical Laboratory Medicine, Jichi Medical University, Tochigi-pref./JP, 4Surgery, Jichi Medical University, Tochigi-pref./JP, 5Rinku General Medical Center, Osaka-pref./JP, 6Nishi-Kobe Medical Center, Hyogo-pref./JP
Chest P 105 ee Chest Trauma Ultrasound I. Adomaitiene,1 V. Augaitiene,1 R. Janilionis2 1 Centre of Radiology and Nuclear Medicine, Vilnius University Hospital Santariskiu klinikos, Vilnius/LT, 2Centre of General Thoracic Surgery, Vilnius University Hospital Santariskiu klinikos, Vilnius/LT Learning Objectives: The appearance of chest traumatic lesions in ultrasound (US) imaging is shown. The role of US in the evaluation of chest trauma and decision making for treatment is described.
Abstracts Background: Trauma of the thorax is the fourth most frequent after head, abdominal, pelvic and extremities trauma. Chest trauma is an important cause of death in adults who suffer from accidents. The mortality rate is 20% and 77% if associated with shock or head trauma. Chest X-ray is frequent, but not sensitive enough in chest trauma. CT is not aplicable for unstable patients. Due to the inability of US to penetrate aerated tissues, clinicians are unable to utilise the excellent ability of US to visualize the chest wall, pleura and the pathology of the subpleural lung tissue. US is the method of choice for assessing chest trauma pathologies, because it provides detailed information abbout chest wall, lungs, pleura, heart and mediastinum structures. Imaging Findings or Procedure Details: In the exhibit, we describe chest US technique, classify chest traumatic injuries and show different patterns of traumatic lesions of the lung, pleura, heart, mediastinum, diaphragm and thoracic cage. Injuries are imaged using US. Conclusion: US assessment of the chest is widely accepted as the firstline imaging technique for patients with chest trauma due to low cost, abscense of ionizing radiation, allowing to proceed with chest trauma diagnosis, appropriate treatment and follow-up. US is irreplaceable for unstable emergency patients and allows making a prompt diagnosis at the bedside without interrupting life-saving procedures/immediate treatment. P 106 se Endosonographic Tumor Staging for Treatment Decision in Resectable Esophageal Cancer W. Bohle, P. Clemens, W. G. Zoller Klinik f€ ur Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und Infektiologie, KatharinenHospital, Klinikum Stuttgart, Stuttgart/DE Purpose: Nowadays, neoadjuvant preoperative chemotherapy is the standard of care in locally advanced (T3 or T4; or N+ irrespective of T) resectable esophageal cancer. Therefore, exact locoregional staging is essential for treatment decision. EUS is believed to be the most potent diagnostic method for locoregional tumor staging. However, it is questionable, if results from centers of excellence can be maintained in clinical routine. Material & Methods: We analyzed the data of 62 patients with resectable esophageal cancer (male 54, mean age 60 years; 38 adenocarcinomas) staged by EUS during routine clinical work-up. Preoperative variables (tumor size; advanced T stage; nodal infiltration) were compared with the postoperative pathology. No preoperative neoadjuvant therapy was performed. Results: After resection, 39/62 patients were pathologically staged as having T3-T4 carcinoma, and 55 as having nodal-positive disease. EUS correctly identified 31 of 39 T3-T4-tumors, and 48 of 55 tumors with lymph node metastasis. Therefore, accuracy for T-staging was 79%, and for N-staging 87%. Conclusion: Even in daily routine practice, the identification of locally advanced disease with EUS can be performed with high accuracy. Therefore, EUS is an essential part of the diagnostic procedure in patients with esophageal cancer.
Pharmacy, Cluj-Napoca/RO, 3Imagistic Department, University of Medicine and Pharmacy ‘‘Iuliu Hatieganu’’, Cluj Napoca/RO, 4 Computer Science Faculty, Technical University, Cluj-Napoca/RO Purpose: Finding a reliable, non-invasive method for inflammation quantification of the bowel wall in cases of Inflammatory Bowel Disease (IBD) for the therapeutic follow-up. Material & Methods: 48 patients diagnosed with IBD using endoscopy, with positive biopsy, have been recruited into the study from January 2009 to December 2010. The bowel segment mostly affected was examined natively and after i.v. contrast injection (2, 4 ml SonoVue + 10 ml saline) using a GE Logiq 7 machine, with follow-up after 2 months. 90 s long clips were saved and standardized time-intensity curves (TIC) were obtained from the bowel wall. Raw data was exported and processed on a workstation, obtaining the following parameters: peak intensity (PI), time to peak (TTP), maximum GRADient (GRAD), and area under the curve (AUC). Means were correlated with the clinical activity scores (CDAI for CD, Truelove-Witts for Ulcerative Colitis) using Pearson’s and Kendall tests, respectively, and compared before and after treatment using Student’s test. Results: After treatment, significant parameters were decreased: GRAD 0.37 vs. 0.55, p 5 0.05; AUC 174.6 vs. 345.4, p 5 0.07. A correlation was found between AUC and the clinical scores (r 5 0.75, p 5 0.001 for CDAI; t 5 0.52, p 5 0.002 for Truelove-Witts). Conclusion: TIC quantitative analysis allows a good assessment of perfusion in IBD. Favorable therapeutic outcome could be anticipated by the decrease of TIC parameters, specifically GRAD and AUC. P 110 ee Contrast-Enhanced Ultraound in Colorectal Tumors D. Weiss Internal Medicine, Hospital of Thun, Thun/CH Learning Objectives: Colon polyps and cancers have different vascular structures. These as well as the depth of the cancer can be visualized using contrast-enhanced ultrasound (CEUS). Background: The value of B-mode sonography in the diagnosis of colonic polyps and cancers is relatively small. CT scan is normally performed to define the size and depth of the tumor, as well as the assessment of lymph node metastasis. A recent pilot study indicated that CEUS, under good visual conditions, provides additional information about tumor vascularisation and vascular structure. Imaging Findings or Procedure Details: Accuson Sequoia (Siemens) device was used to inverstigate our patients. The contrast medium was 12 ml SonoVueÒ (Bracco Suisse). Polyps show a clear arterial structure and normally have one feeding vessel. A wide base, multiple feeding vessels and late enhancement of the base of the polyp due to desmoplastic reaction are all considered as signs of malignancy. In large cancers, typical tumor vessels are detected with pathological branching, calibre irregularities, interruptions and avascular areas. The depth of the cancer is better judged by CEUS than by B-mode sonography. Conclusion: CEUS is able to depict the vascular structure of colon tumors and to judge the depth of the cancer. Future controlled studies will show the extent to wich CEUS can replace CT examinations in suitable patients.
Contrast Agents / CEUS GI P 108 se
P 111 ee
Quantification of the Inflammation Intensity in the Inflammatory Bowel Diseases, Using Contrast-Enhanced Ultrasound L. Ciobanu,1 R. Badea,2 M. Socaciu,3 B. Diaconu,1 C. Hagiu,1 D. Mitrea4 1 Gastroenterology, Medicalca III Clinic, Cluj-Napoca/RO, 2Department of Ultrasonography, 3rd Medical Clinic, University of Medicine and
Oral Contrast in Ultrasound Investigation of Upper Gastrointestinal Tract Pathologies D. Weiss Internal Medicine, Hospital of Thun, Thun/CH Learning Objectives: Oral application of ultrasound contrast agents permits the visualisation of several pathologies between the distal