Laparoscopic ultrasonography of abdominal lymph nodes: correlation with pathologic findings.
van Delden OM. de Wit LT. Hulsmans FJ. Offerhaus GJ. Venema HW. Gouma DJ.
Department of Diagnostic Radiology, University of Amsterdam, The Netherlands.
The value of laparoscopic ultrasonographic criteria for distinguishing benign from malignant lymph nodes was assessed. The following criteria were evaluated in 41 lymph nodes: (1) long axis diameter, (2) short axis diameter, (3) long axis-short axis ratio, (4) nodal border delineation, (5) presence of hyperechoic hilar reflection, (6) echogenicity, and (7) inhomogeneity. Pathologic examination showed malignant infiltration in 11 lymph nodes and the absence of malignant infiltration in 30 lymph nodes. The presence of a hyperechoic center or a long axis-short axis ratio more than 2 suggested the absence of malignant infiltration, whereas inhomogeneity was suggestive of malignant infiltration. The other criteria did not seem useful in distinguishing benign from malignant lymph nodes.
Usefulness of intraductal ultrasonography in gallbladder disease.
Watanabe Y. Goto H. Naitoh Y. Hirooka Y. Itoh A. Taki T. Hayakawa S. Hayakawa T.
Second Department of Internal Medicine, Nagoya University School of Medicine, Japan.
This study was designed to compare intraductal ultrasonography of the gallbladder wall with histopathologic findings and to assess the clinical usefulness of this imaging method in gallbladder disease. Thirty-one gallbladder specimens were examined by intraductal ultrasonography retrospectively. The gallbladder is composed of three layers: an innermost hyperechoic layer, a middle hypoechoic layer, and an outermost hyperechoic layer. The second layer on ultrasonograms corresponds to the muscle layer plus the fibrous tissue of the superficial perimuscular connective tissue layer. In cases in which the thickness of the second layer was 500 microns or less, little fibrous tissue was seen and the second layer was approximately identical to the muscle layer on sonograms. Clinical study was performed on 22 gallbladders. The use of a guidewire through the papilla facilitated intraductal ultrasonographic examination. The intraductal sonographic probe could be inserted into the gallbladder fundus in 13 of 22 cases. In nine unsuccessful cases, technical difficulties were as follows: sharply angulated gallbladder (four cases), stenosis of the gallbladder (two cases), difficulty in transmitting power in the correct direction (three cases). With regard to the area visualized in 13 successful cases, in three cases the area visualized was 100%, in seven cases it was 75%, and three cases it was 50%. Intraductal ultrasonographic images could be obtained in 83.3% (10 of 12) of elevated lesions of the gallbladder. The indications for intraductal ultrasonography will be cases in which an abnormality was detected by transabdominal ultrasonography or other modalities in which the physician does not know whether or not to operate. In conclusion, we defined the intraductal sonographic images of gallbladder wall and clarified the clinical indications for use of this imaging method.
Vasculature in hepatocellular carcinoma after transcatheter arterial chemoembolization: comparison of power and color Doppler sonography.
Kim DE. Kim PN. Lee HJ. Shin BS. Kwon JS. Kim JK. Lee MG. Sung KB. Jeong YK. Ha HK. Auh YH.
Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan, Seoul, Korea.
The purpose of this study was to compare power Doppler sonography with conventional color Doppler sonography for the detection of the vascularity of hepatocellular carcinomas after transcatheter arterial chemoembolization. Of the 93 embolized hepatocellular carcinomas, hypervascularity was demonstrated in 36 on angiography; power Doppler sonography correctly identified pulsatile flow signals in 33 (92%) of these 36, whereas color Doppler sonography identified flow signals in 24 (67%). A statistically significant difference was noted when the sizes of the nodules were 30 mm or less. Despite technical difficulties, such as flash artifact, power Doppler sonography is superior to color Doppler sonography for detection of hypervascularity, especially in small embolized nodules of hepatocellular carcinoma (30 mm or less in diameter).
Gallbladder polyps: prospective study.
Collett JA. Allan RB. Chisholm RJ. Wilson IR. Burt MJ. Chapman BA.
Department of Gastroenterology, Christchurch Hospital, New Zealand.
The aim of this study was to describe the natural history of gallbladder polyps. Thirty-eight subjects who had been previously identified as having gallbladder polyps in an epidemiologic study of gallstone prevalence in 627 diabetic subjects and matched controls were followed longitudinally. Follow-up sonograms were obtained on 33 and 22 of the 38 subjects at 2 and 5 years, respectively. Prevalence for gallbladder polyps in this population was 6.7%, with a marked male predominance (odds ratio 2.3). No statistical difference in prevalence was found between diabetic subjects and nondiabetic controls. Ninety percent of the polyps were less than 10 mm in diameter, with no polyp being larger than 12 mm. During the follow-up period no changes suggestive of malignant transformation were observed. In conclusion, we found that gallbladder polyps were relatively common and that few significant changes occurred over a 5 year period. In asymptomatic subjects in whom gallbladder polyps less than 10 mm in diameter are found incidentally, the likelihood of malignant transformation is low.
Distention of the fetal duodenum: abnormal finding?
Levine D. Goldstein RB. Cadrin C.
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
We investigated whether a fluid-filled duodenum is observed in normal fetuses. In part 1 of the study a view in the region of the duodenum was obtained during routine obstetric ultrasonography from 123 low-risk patients. All examinations demonstrated a collapsed duodenum. No gastrointestinal abnormalities were found in these infants. In part 2 of the study, 1163 fetuses (both high-risk and low-risk) were evaluated with real-time scanning, and duodenal fluid without a "double bubble" was seen in one fetus who had a duodenal web. We conclude that a nondistended fetal duodenum is the norm. If fetal duodenal dilation is visualized, this may allow for earlier detection of duodenal obstructions.
Appendiceal ultrasonography performed by nonradiologists: does it help in the diagnostic process?
Pohl D. Golub R. Schwartz GE. Stein HD.
Department of Surgery, New York Flushing Hospital Medical Center, 11355, USA.
We performed a retrospective study to compare the sensitivity, specificity, predictive value, and diagnostic accuracy of appendiceal ultrasonography performed by unsupervised technicians during the nighttime hours with studies performed during the day by supervised technicians. Fifty-nine percent of the 163 sonographic examinations were done during the day, and 41% were performed at night. The sensitivity during the day (61%) was significantly higher than at night (26%), as was the positive predictive value (93% day, 71% night). We conclude that ultrasonography is an operator-dependent study. Its sensitivity is so diminished when not performed by an experienced radiologist or technician that a negative examination is not reliable.
Sonographic analysis of gallbladder findings in Salmonella enteric fever.
Shetty PB. Broome DR.
Department of Radiology, St. John's Medical College Hospital, Bangalore, India.
The purpose of this study was to analyze gallbladder sonographic findings associated with Salmonella typhi enteric fever. Sixty-two patients with culture positive Salmonella enteric fever were analyzed with serial sonography. The following gallbladder sonographic findings were noted: globular gallbladder distention (33 of 62 patients, 530%), positive sonographic Murphy sign (25 patients, 40%), pericholecystic edema or fluid (25 patients, 40%), gallbladder wall thickening > 4 mm (21 patients, 34%), low-level nonshadowing intraluminal echoes or sludge (nine patients, 15%), intramural linear sonolucency or striation (eight patients, 13%), and mucosal irregularity or sloughed membrane (four patients, 6%). Using the sonographic findings a gallbladder score was devised to assess the severity of gallbladder changes, and the score was correlated with the following clinical parameters--duration of fever, multidrug resistance, and clinical outcome. An abnormal gallbladder score was noted in 37 patients (60%), and multidrug resistance was noted in 35 of these patients (95%). The gallbladder scores showed a strong positive correlation with the duration of fever and the frequency of multidrug resistance. All 62 patients were treated with intensive antibiotic therapy without any deaths.
Sonographic demonstration of Couinauds liver segments.
Smith D. Downey D. Spouge A. Soney S.
Department of Diagnostic Radiology and Nuclear Medicine, London Health Sciences Centre, University Campus, University of Western Ontario, Canada.
The segmental localization of liver tumors is critical to planning appropriate resection. Couinaud's nomenclature is a surgically relevant system of hepatic segmental anatomy, which defines the liver segments by their relationships to vascular structures, hepatic ligaments, and the gallbladder. We demonstrate a way to accurately localize hepatic masses with sonography.
Gallbladder cancer: can ultrasonography evaluate extent of disease?
Bach AM. Loring LA. Hann LE. Illescas FF. Fong Y. Blumgart LH.
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
This study reviews the spectrum of sonographic findings in patients with gallbladder cancer, attempts to determine if sonography can identify patients with potentially resectable disease, and emphasizes the limitations of ultrasonography in the evaluation of -gallbladder cancer. Thirty-five consecutive patients with histologically proven gallbladder carcinoma who had preoperative abdominal ultrasonography and surgery were identified. Involvement of the gallbladder and gallbladder fossa, metastases, bile ducts, portal vein, and adjacent lymph nodes was assessed sonographically. The extent of disease and staging as revealed by sonography was compared to operative and surgical pathologic findings. Masses in the gallbladder or gallbladder fossa were present at surgery in 26 patients; 22 (85%) of these masses were shown by sonography. Sonography identified six (67%) of nine cases of pathologically confirmed liver metastases, 11 (79%) of 14 cases of bile duct involvement, and two (67%) of three cases of portal venous involvement by tumor. Sonography revealed lymph node metastases in only five (36%) of 14 patients. None of the 12 cases with peritoneal metastases was identified sonographically. By surgical staging 16 (46%) patients had potentially resectable disease (stage III or less), and 19 (54%) patients had unresectable stage IV disease. Sonography correctly identified 15 (94%) of 16 patients with potentially resectable disease and seven (37%) of 19 patients with advanced disease. Twelve patients with advanced disease were under-staged: nine had peritoneal metastases, two had liver metastases, and one had celiac adenopathy, which was not shown by sonography. In conclusion, sonography is reliable in the detection of a primary gallbladder mass or of local extension of tumor into the liver. However, sonographic findings do not accurately reflect the full extent of disease, and sonography is particularly limited in the diagnoses of metastases to the peritoneum and lymph nodes.
Comparison of sonograms and liver histologic findings in patients with chronic hepatitis C virus infection.
Kutcher R. Smith GS. Sen F. Gelman SF. Mitsudo S. Thung SN. Reinus JF.
Department of Radiology, The Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10467, USA.
Gray scale ultrasonographic images of the liver were correlated with histologic findings in patients with chronic hepatitis C virus infection. The gray scale patterns of 64 livers with chronic hepatitis C virus infection were categorized as normal, fatty, fibrofatty, fibrotic, or inflammatory and were graded as mild, moderate, or severe. Liver biopsy specimens also were analyzed for the presence of fat, inflammation, and fibrosis and graded similarly. No correlation was found between fatty and fibrofatty sonographic findings with any of the three histologic patterns. Correlations were found between fibrotic sonographic findings and both fibrotic and inflammatory histologic findings (r = 0.27; P = 0.03). Although some pathologic features of liver disease were detected by ultrasonography, no useful correlation was noted between results of sonography and histologic examination.