Abdomen

Transcription

Abdomen

Scientific Exhibits
Abdomen
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interval for surveillance longer than 6 month may
not be effective in the detection of resectable cases.
Blood test for tumor markers and LFT are not sensitive for the detection of early CCAs.
Surveillance of Cholangiocarcinoma (CCA) in
a High Prevalent Area: the Initial Experience
Surachate Siripongsakun,
Prakongboon Sangkasuban, Terapat Engtrakool,
Sirachat Vidhyarkorn, Nisakorn Kijsawad
Department of Radiology, Chulabhorn Hospital, Thailand
Image-Guided Microwave Ablation with New
Generation Equipment in Liver Tumors:
Results of a Single Centre Prospective Study
Maria Franca Meloni1, Anita Andreano1,
Giovanni Turtulici2, Simone Schiaffino2, Maria Proiti3,
Alberto Frosi4
1
Department of Radiology, Ospedale Valduce Como,
Italy
2
Department of Radiology, Ospedale Evangelico
Internazionale Genova, Italy
3
Department of Internal Medicine, Policlinico Vittorio
Emanuele Catania, Italy
4
Department of Radiology, IRCCS Multimedica
SS.Giovanni, Italy
PURPOSE: To prospectively evaluate local tumor
control rates and incidence of complications in a
consecutively enrolled cohort of patients with liver
tumors treated with microwave ablation after a
median follow-up of 13 months.
MATERIALS AND METHODS: Fifty-four patients
(median age 73 yr) were prospectively enrolled to
undergo percutaneous MW ablation of liver tumors
between March 2009 and November 2011, using a
2.45 GHz device with a 14-gauge antenna. Thirty-six
patients had HCC and 18 had liver metastasis. The
total number of treated tumors was 60. Patients
underwent CEUS and contrast-enhanced CT before,
the day after, and one month after treatment and
every 4 months thereafter. Pre-ablation mean tumor
size at contrast CT was 24±11 mm.
RESULTS: Forty-five tumors (75%) required a single
insertion, 11 tumors 2 insertions and 4 tumors 3
insertions. Maximum and minimum diameters of
the obtained necrosis assessed the day after treatment, were 47± 12 mm and 37±8 mm at CEUS
and 48±12 and 38±9 cm at CECT, respectively. In
59/60 lesions the treatment was judged to be complete by both CEUS and CT at 24-hours. Two years
local recurrence rate per lesion was 19%. The differ-
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PURPOSE: High incidence rates of cholangiocarcinoma (CCA) have been reported in Eastern Asia,
especially in Thailand which reported to have
extremely high incidence rates. Early detection may
help identify early cases so that curative surgical
treatment can be performed and eventually improve
survival of the patients. Aim of the study is to develop an effective surveillance program for early CCA
detection in a high endemic area of CCA as well as
to identify potential information which helps triage
the person at risk for CCA.
MATERIALS AND METHODS: A 5-year planned
prospective cohort study have been started for 2
years in Banluang district, Northern Thailand,
included every Thai individuals in the district who
aged 30-60 years and have a legitimate record of residence. Clinical interview for common CCA risk factor, liver function test (LFT), tumor markers, stool
examination, and ultrasonography every 6 months
were performed. Demographic data, follow up rate
and annual incidence are recorded. Common risk
factors and imaging findings of patients who developed CCA were analyzed.
RESULTS: During the first 2 years, there were 4,161
participants included with follow up rates for range
95-97%. Twenty-two CCA were detected (8, 5, 4, 5
patients in each phase, respectively), accounting for
14 intrahepatic, 4 hilar, and 4 extrahepatic CCAs.
Eighteen cases were resectable and 4 cases were
unresectable. None of CCAs are aged less than 40
years and has a trend of increase incidence by age.
Tumor markers and LFT failed to depict some of
early CCAs.
CONCLUSION: Surveillance of CCA using US
helps finding early resectable CCAs and surveillance
starting from age 40 seems to be cost effective. The
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ence between pre and post-ablation mean diameter
at CT (ablation margin) was at least 0.5 cm for HCC
and 1 cm for metastases. We didn’t see any significant difference in recurrence for HCC vs. metastasis.
There were two major complications (3%). One
patient died because of bowel perforation; another
patient experienced bleeding from an intercostal
artery, requiring surgery. We also experienced three
asymptomatic thromboses of intrahepatic venous
branches and a biloma requiring no treatment
(minor complications, 6%).
CONCLUSION: Microwave ablation showed good
local control rates both for HCC and metastasis,
short ablation times, a low number of required insertions per tumor and a good safety profile.
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10.9), diffuse enlargement 11 (61.1±11.8), focal
enlargement 2 (12.1±7.9). Pancreas contour: clearly
visible 12 (66.7±11.4, p<0.05). Pancreatic structure:
homogeneous 1 (5.6±5.6), inhomogeneous 17 (94.4
±5.6, p<0.001). Loculated fluid collection in peripancreatic space was found 11 (61.1±11.8, p<0.05).
Necrotizing type (n=15): normal in size 1 (6.6±6.6),
diffuse enlargement 10 (66.7±12.6, p<0.05), focal
enlargement 4 (16.7±11.8). Pancreatic contour:
clearly visible 2 (13.3 ± 9.1), not clearly visible 13
(86.7±9.1, p<0.001), structure: homogeneous 3
(20.0±10.7), inhomogeneous 12 (80.0±10.7).
Loculated fluid collection in peri-pancreatic space
was found 9 (60.0 ± 13.1, p<0.05).
CONCLUSION: The ultrasound examination plays
crucial role in the diagnosis and evaluation the all
form of acute pancreatitis, also very helpful for therapeutic selection.
Ultrasonographic Assessment of Acute
Pancreatitis
Buyanjargal Burenjargal1, Badamsed Tserendorj2,
Jargalsaikhan Sodnombaljir2, Bayarjargal Nanzad1,
Aryasuren Zuunai3, Munkhbaatar Dagvasumberel1
1
Department of Radiology, Health Sciences University of
Mongolia, Mongolia
2
Department of Radiology, State Third Central Hospital,
Mongolia
3
Department of Radiology, State Second General
Hospital, Mongolia
PURPOSE: To evaluate specific ultrasound findings
of acute pancreatitis.
MATERIALS AND METHODS: This study was
conducted at State Third Central Hospital in
Mongolia from July, 2012 to September, 2013. This
study consisted of 81 cases of acute pancreatitis was
evaluated by ultrasonography. All our cases was
proven by CT, MRI, surgery and biopsy.
RESULTS: We have studied 81 patients by ultrasonography. Edematous type (n=48): normal in size
9 (18.75±5.6), diffuse enlargement 26 (54.17±7.2),
focal enlargement 13 (27.08±6.4). Pancreas contour:
clearly visible 34 (70.83±6.5, p<0.001), structure:
homogeneous 20 (41.67±7.1), inhomogeneous 28
(58.33±7.1). Loculated fluid collection in peripancreatic space was found 9 (18.75±5.6, p<0.001).
Hemorrhagic type (n=18): normal in size 5 (27.8±
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Accuracy of Ultrasound in Diagnosis of Groin
Hernia
Ka Lok Lee, James Griffith, Wing Hung Ng
Department of Radiology, Prince of Wales Hospital,
Hong Kong
OBJECTIVE: To evaluate the accuracy of ultrasound in diagnosing presence and type of groin hernia.
MATERIALS AND METHODS: 172 ultrasound
examinations in 151 patients (101 men : 50 women ;
mean age : 59 years, range 20 - 89 years), who
underwent ultrasound for suspected groin hernia
were studied. The presence and type of groin hernia
was determined by ultrasound. A total of 119 groin
hernias were diagnosed on ultrasound and 107
(90%) of these 119 hernias had surgery. Ultrasound
positive cases who did not undergo surgery (n=12)
and all ultrasound negative cases (n= 53) underwent
either pelvic MRI or CT. The sensitivity, specificity
and accuracy of diagnosing the presence of a groin
hernia (using operative, MRI or CT findings as a reference) and differentiating the type of groin hernia
(using operative findings as a reference) was determined. To investigate the change in ultrasound accuracy with time, sensitivity/specificity and accuracy
The 45th Annual Congress of Korean Society of Ultrasound in Medicine
Scientific Exhibits
of ultrasound was compared from January 2002December 2010 (n=54 groins) to January 2011December 2012 (n=118 groins).
RESULTS: The overall sensitivity and specificity of
diagnosing the presence of groin hernia was 95%
and 96% respectively With greater experience, the
sensitivity and specificity of hernia improved from
92% and 88% prior to 2011 to 98% and 100% after
2011. Similarly, the accuracy regarding the type of
hernia improved from 90% to 97% over this time
period.
CONCLUSION: Ultrasound is highly accurate at
diagnosing the presence and type of groin hernia.
This accuracy improves with greater experience.
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The Role of Ultrasonography in the
Diagnosis of Acute Phase of Chronic
Pancreatitis
Bayarjargal Nanzad1, Badamsed Tserendorj2,
Jargalsaikhan Sodnombaljir2,
Buyanjargal Burenjargal1,
Munkhbaatar Dagvasumberel1
1
Mongolia, Mongolia
2
Department of Radiology, State Third Central Hospital,
Mongolia
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Sonographic Appearance of Ascaris and
Typical Serpentine Movement
Musarrat Hasan
Department of Radiology, Thomas Jefferson University
Philadelphia PA USA, Pakistan
PURPOSE: The aim of this study was to share the
experience of serpentine movement of ascaris at different places in the abdomen.
MATERIALS AND METHODS: Ascaris worm is
very common in Pakistan especially in children and
infects the human bowels. In our experiences, we
have seen ascaris in bowels, Stomach, CBD, intrahepatic duct and gallbladder on ultrasonography.
Some of these ascaris were alive, and they had typical serpentine movement. We recorded these cases
on our video which will be shown during the presentation. The patient had various signs and symptoms ranging from acute intestinal obstruction, intermittent jaundice, right hypochondrium discomfort,
mimicking to acute appendicitis.
RESULTS: We saw ascaris in bowel, stomach, CBD,
intrahepatic ducts, and gallbladder, and recorded
their serpentine movement on video tape.
CONCLUSION: This paper will highlight the sonographic features and will show on video the typical
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PURPOSE: To estimate ultrasonography features in
acute phase of chronic pancreatitis.
MATERIALS AND METHODS: We made the
study for this study and 66 patients with acute phase
of chronic pancreatitis were investigated from July,
2012 to September, 2013. All our causes was proven
by CT, MRI, surgery and biopsy.
RESULT AND DISCUSSION: This study consisted
of 66 patients with acute phase of chronic pancreatitis. We estimated size of pancreas, contour visibility
of pancreas, structure of pancreas, pseudocyst,
dilatation of main pancreatic duct and extra-pancreatic manifestations and intra-pancreatic manifestations calcification. Size of pancreas was normal 8
(12.1±4.0), diffuse enlargement pancreas were in 17
(25.8±5.4), diffusely got smaller in 26 (39.4±6.0),
focal enlargement in 11 (16.7±4.6), focally got
smaller in 4 (6.1±2.9), pancreas structure were
homogeneous in 18 (27.3±5.5), pancreas structure
were inhomogeneous in 48 (72.7±5.5), pancreas
contour: clearly visible in 15 (22.7±5.2), not clearly
visible in 51 (77.3±5.2), calcification of pancreas
detected in 9 (13.6±4.2), calcification of parenchyma were in 7 (77.8±14.7), calcification of pancreatic
duct in 2 (22.2±14.7), calcification not detected in
57 (86.4±4.2), main pancreatic duct dilatation in 19
(28.8±5.6), ductal not dilatation in 47 (71.2±5.6).
CONCLUSION: This study showed acute phase of
chronic pancreatitis were diffuse enlargement of
pancreas was in 25.8%, diffuse got smaller was in
39.4%, pancreas structure inhomogeneous was in
72.7%, pancreas contour not clearly was in 77.3%,
pancreatic endocrine symptoms characterized predominantly established STD (p<0.001). Knowledge
of the ultrasonographic features of chronic pancreatitis will be helpful for differential diagnosis.
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serpentine movement.
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Role of Color Doppler Study in Living Donor
Liver Transplant: Experience of First Two
Successful Liver Transplants in Bangladesh
The Clinical Disparity of Gallstone Disease in
a Chinese Occupational Population in Taipei,
Taiwan
Wei-Hsiu Chiu1, Jui Wang2, Tao-Hsin Tung2,
Shuo-Hui Hung1, Ran-Chou Chen1
1
Department of Biomedical Imaging and Radiological
Sciences, School of Biomedical Science and
Engineering, National Yang-Ming University, Taipei,
Taiwan
2
Faculty of Public Health, College of Medicine, Fu-Jen
Catholic University, Taipei, Taiwan
PURPOSE: The authors sought to explore the disparity of gallstone disease (GSD) in a Chinese occupational population in Taipei, Taiwan.
MATERIALS AND METHODS: The study participants were conducted with a total of 8,352 (5,243
males and 3,109 females) healthy elderly subjects
voluntarily admitted to a teaching hospital for a
physical check-up in 2009. Blood samples and realtime ultrasound-proved sonography results were collected.
RESULTS: The results showed that the prevalence
of GSD was 3.89% and revealed a statistically significant increase with increasing population age. The
prevalence of GSD for females proves to be no substantially greater than it is for males (respectively,
3.99% vs. 3.83%, p-value for c2 test=0.72). Using
multiple logistic regression analysis, age (OR=1.06,
95% CI: 1.05-1.07) and the presence of obesity (�27
vs. 2, OR=1.70, 95% CI: 1.12-2.34) appeared to be
statistically significantly related to a GSD. For subjects with normal BMI, nonalcoholic fatty liver disease (NAFLD, OR=1.47, 95% CI: 1.01-2.14) was significantly related to GSD. The condition was not significantly related to GSD in overweight or obesity.
CONCLUSION: Occupational populations are
symptomatic GSD should be considered with older
age, higher BMI, and NAFLD.
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Nasreen Sultana, Raihan Hussain, Mohitul Alam,
Haider Ali Khan, Mohammad Ali
Department of Nuclear Medicine, 1. National Institute of
Nuclear Medicine and Allied Sciences, BAEC,
Bangladesh
BACKGROUND: Living donor liver transplantation
(LDLT) is the most effective treatment for various
end-stage liver diseases. Imaging is an important
part of the pre-liver transplantation and identification of post surgical complications. Bangladesh is
incorporated as one of the Liver transplanting country of the world. BIRDEM, Dhaka has the pioneered
the application of LDLT to patients using right lobe
grafts.
MATERIALS AND METHODS: With all aseptic
precaution, intra-operative Color Doppler ultrasound
is done to detect abnormal hepatic hemodynaemics,
allowing early intervention to ensure better patient
outcome. Grey scale Ultrasound and Color Doppler
Ultrasound (CDUS) are also the most important
tools in the follow-up of liver transplant patients
because they show high sensitivity and specificity in
detecting vascular complications. During transplantation, CDUS usually performed twice a day during
first week, and once a week in the following two
month, and is the key in the suspicion or identification of vascular complications.
RESULTS: Two successful liver transplants have
done and evaluations by color Doppler US of transplantations also successfully performed in intraoperatively and post-operatively. Higher mean blood
flow velocity with successive thick serrated wave
was seen in portal vein (range 30-50 cm/sec).
Hepatic artery blood flow with peak speed was 4085 cm/sec and resistive index = .50 to .70. Neither
thrombus nor any turbulence is seen in hepatic
artery and portal vein in both of these cases.
CONCLUSION: Color Doppler USG is the most
important tools in the follow-up of LT patients intraoperatively and post operatively, because they show
high sensitivity and specificity in detecting vascular
complications.
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Accuracy of Ultrasound to Identify Liver
Cirrhosis in End Stage
Tsevelmaa Dorj1, Munkh-Od Enkhjargal1,
Vaanchigsuren Seesregdorj1,
Badamsed Tserendorj2
1
Mongolia, Mongolia
2
Department of Radiology, 3rd Central Clinical Hospital
of Mongolia, Mongolia
AIM: To identify and assess studies reporting the
diagnostic performance of ultrasound imaging for
identifying liver cirrhosis in the last stage.
METHODS: A search was performed to identify
studies investigating the diagnostic accuracy of ultrasound imaging for liver cirrhosis in the last stage.
Diagnostic accuracy was determined for a range of
ultrasound techniques across all studies. There were
48 reports of diagnostic accuracy.
RESULTS: Majority of patients 34 (71.4%) presented with decreased liver size, liver echogenicity was
abnormal in 27 (57.1%), 40 (85.7%) presented with
an enlarged spleen, Portal vein was dilated in 39
(80.9%) and ascites was in 43 (90.5%).
CONCLUSION: We observed enlarged spleen,
shrunken liver, and portal hypertension and ascites
in the patients with liver cirrhosis in end stage.
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Computer-aided Classification of Liver
Tumors in 3D Ultrasound Images with
Combined Active Contour Model
Segmentation and Support Vector Machine
Myungeun Lee, Jong Hyo Kim
Department of Radiology, Seoul National University
Hospital, Korea
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Evaluation of the Accuracy of Abdominal
Ultrasound Focusing on the Missed Lesions
Based on the Abdominal Computed
Tomography in Health Screening
Noh Hyuck Park, Yong Suk Jang
Department of Radiology, Myongji Hospital, Korea
PURPOSE: To evaluate the accuracy of abdominal
ultrasonography (US), and the incidence, size and
types of lesions, easily missed on abdominal US in
health screening.
MATERIALS AND METHODS: We retrospectively enrolled 311 physical checkup patients (male-tofemale ratio, 156: 155; mean age, 53.1 years), who
underwent screening abdominal US and abdominal
computed tomography (CT) on same day from July,
2011 to October, 2013. Per-organ and per-lesion
analyses and verification of size and location of renal
and hepatic lesions which were frequently missed
on abdominal US were performed.
RESULTS: Overall, 209 additional lesions were
found on abdominal CT in 140 physical checkup
patients and the missing rate of the lesion was 45%.
Renal lesions were most common (105 lesions), followed by hepatic lesions (91 lesions). In renal and
hepatic lesions which were missed on abdominal
US, most (93.4%, 93.5%) lesions were less than 1.5
cm in longitudinal diameter. Most of missed renal
lesions were located in mid portion of left kidney
(24.7%). Most of the missed hepatic lesions on US
were located in the hepatic dome (segment 7, 8, 2)
(66%).
CONCLUSION: An awareness of the prevalence
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In this study, we propose a computer-aided classification scheme of liver tumor in 3D ultrasound by
using a combination of deformable model segmentation and support vector machine. For segmentation
of tumors in 3D ultrasound images, a novel segmentation model was used which combined edge,
region, and contour smoothness energies. Then four
features were extracted from the segmented tumor
including tumor edge, roundness, contrast, and
internal texture. We used a support vector machine
for the classification of features. The performance of
the developed method was evaluated with a dataset
of 79 cases including 20 cysts, 20 hemangiomas, and
39 hepatocellular carcinomas, as determined by the
radiologist’s visual scoring. Evaluation of the results
showed that our proposed method produced tumor
boundaries that were equal to or better than acceptable in 89.8% of cases, and achieved 93.7% accuracy
in classification of cyst and hemangioma.
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and location of easily missed lesions on screening
abdominal US is helpful to enhance diagnostic performance of abdominal US in physical checkup
patients.
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Abdominal Wall Lesions Presenting as
Palpable Mass: Identified on
Ultrasonography
Sung Eun Ahn, Seong Jin Park,
Soung Kyung Moon, Joo Won Lim, Dong Ho Lee
Department of Radiology, Kyung Hee University Medical
Center, Korea
PURPOSE: The purpose of this presentation is to
review the sonographic appearances of different
abdominal wall lesions presenting as palpable mass.
MATERIALS AND METHODS: Patients were
scanned with high-frequency (5- to 12- MHz) linear
transducers. Color Doppler US were recorded often
to show the vascularity of the mass. US findings of
different abdominal wall lesions were correlated
with comparative studies of CT and MRI.
RESULTS: The ultrasonographic and clinical differential diagnosis of abdominal wall lesions presenting
palpable mass include hernias, localized fluid collections in the abdominal wall (seromas, hematomas,
abscesses), inflammation (actinomycosis, inflammatory myofibroblastic tumor), tumors (desmoid tumor,
lymphoma), vascular lesions or metastatic masses.
CONCLUSION: US is a useful imaging modality in
detection of various abdominal wall pathology.
Hernias and localized fluid collections in the abdominal wall (hematomas, abscesses) can be well visualized. Infrequently tumors (desmoid tumor, lymphoma) and metastasis can be identified in the
abdominal wall.
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Measurement of Hepatic Vascular Arrival
Times at Immediate Post-Transplantation
Period Using Contrast Enhanced
Ultrasonography
Ji Hye Min, Woo Kyoung Jeong, Won Jae Lee
Department of Radiology, Samsung Medical Center,
Korea
PURPOSE: To explore a median values of hepatic
vascular [hepatic arterial (HA), portal venous (PV),
and hepatic venous (HV)] arrival times (HVATs) at
the first post-operative day in the patients with following liver transplantation and to investigate the
clinical implication of HVATs for estimation of the
presence of vascular complication of transplanted
liver.
MATERIALS AND METHODS: We explored 35
consecutive patients (M:F=32:3; mean age, 52.6
years) who underwent liver transplantation from
March to July 2013. Contrast enhanced ultrasonography was performed at the first postoperative day
to estimate the vascular complication of liver transplantation using Sonovue and a video clip of contrast
US imaging per patient was recorded. For investigation of arrival time, two radiologists reviewed the
video clips without information about the patients,
and explored the time at which microbubbles
reached to hepatic artery, portal vein and hepatic
vein.
RESULTS: Median hepatic arrival times of the
patients without vascular complication were as followings: HA, 11 seconds; PV, 13 seconds; and HV,
17 seconds. Median differences between arrival
times were as followings: PV-HA, 2 seconds; HV-PV,
4 seconds; and HV-HA, 6 seconds. In a patient with
markedly decreased portal inflow due to a large portocaval shunt, PV-HA was slightly prolonged, and a
patient who underwent angioplasty for HV stenosis
showed that both PV-HA and HV-HA were prolonged. A patient with hepatic arterial thrombosis
showed that PV inflow was detected firstly because
HA inflow was not present.
CONCLUSION: Median values of HVATs were consistent in the patients without hepatic vascular complications. HVATs may be useful parameters for estimation of the presence of vascular complication fol-
Scientific Exhibits
lowing liver transplantation.
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Percutaneous Ultrasonography-Guided
Radiofrequency Ablation of Hepatocellular
Carcinomas: Usefulness of Image Fusion
with Three-Dimensional Ultrasonography
Hyun Jeong Park1, Min Woo Lee2, Hyunchul Rhim2,
Dong Ik Cha2, Sanghyeok Lim2, Tae Wook Kang2,
Hyo K Lim2, Kyoung Doo Song2
1
Department of Radiology, Chung-ang University
Hospital, Korea
2
Korea
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Doppler Ultrasound in Cirrhosis and Portal
Hypertension: Beyond Flow Reversal
Joon-Il Choi1, Chandana Lall2, Puneet Bhargava3,
Mohammad Helmy2, Sadhna Verma4,
Penny Roumanis2, Laura Findeiss2, David Imagawa5
1
Department of Radiology, The Catholic University of
Korea, Seoul St. Mary’s Hospital, Korea
2
Department of Radiology, University of California,
Irvine, USA
3
Department of Radiology, University of Washington,
USA
4
Department of Radiology, University of Cincinnati, USA
5
Department of Surgery-Hepatobiliary, University of
California, Irvine, USA
Portal hypertension is one of the common complications of the patients with liver cirrhosis. The
objectives of this presentation are 1) understanding
nuance of portal venous flow in cirrhosis and portal
hypertension, 2) reviewing atypical hepatic venous
and hepatic arterial flow patterns in cirrhosis and
portal hypertension, 3) understanding the findings
implicating portal vein thrombosis and differentiating bland thrombus from neoplastic ones, 4) reviewing the location of TIPS shunts, cavernous transformation, portal varices and the locations of porto-systemic collaterals: implications in surgical planning
prior to liver transplantation. Content organization
of this presentation includes variant portal venous
flow patterns including reversal, turbulence, helical
pattern, stasis and shunting. Also, states of hepatic
arterial flow in cirrhosis, and changes of splenic
artery, portal vein aneurysms and issues related to
transplantation will be included in this presentation.
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PURPOSE: To evaluate the usefulness of fusion
imaging with real-time ultrasonography (US) and 3dimensional (3D) US for the guidance of radiofrequency ablation (RFA) of hepatocellular carcinomas
(HCCs) with 2-5 cm in diameter.
conducted as a retrospective cohort study. This
study was approved by the institutional review
board and informed consent was waived.
Percutaneous RFA was performed for HCCs with 25 cm in diameter. Targeting was performed under
conventional fusion imaging guidance whereas monitoring and controlling under fusion with 3D US
guidance. Technical success, technique effectiveness,
major complication and local tumor progression rate
were evaluated. According to tumor size (small: < 3
cm vs. medium: 3-5 cm), roundness indexes of ablation zone and local tumor progression rate were
compared.
RESULTS: There were 29 small-sized HCCs (2.5 ±
0.3 cm) and 17 medium-sized HCCs (3.4 ± 0.5 cm).
All RFA procedures were performed in a single RFA
session. Both technical success and technique effectiveness rate were 100%. Hepatic abscess (n=1)
occurred in a patient with medium-sized HCC as a
major complication. Local tumor progression rate
was 8.7% (4/46) with mean follow-up of 18.2
months. All roundness indexes of ablation zone were
not significantly different between the small- and
medium-sized HCCs. Local tumor progression rate
was also not significantly different between the two
groups [3.4% (1/29) vs. 17.6% (3/17), (P=0.135)].
CONCLUSION: Image fusion with real-time US
and 3D US is useful for guidance of percutaneous
RFA of HCCs with 2-5 cm in diameter.
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Gastrointestinal Wall Lesions : Identified on
Routine Transabdominal Ultrasonography
Normal Right Hemidiaphragmatic Motion
Measured with M-Mode Ultrasonography in a
Large Healthy Population
Han Na Lee1, Sung Eun Ahn1, Sung Kyoung Moon1,
Hyun Cheol Kim2, Seong Jin Park1, Dong Ho Lee1
1
Department of Radiology, Kyung Hee University
Medical Center, Korea
2
Hospital at Gangdong, Korea
PURPOSE: The purpose of this presentation is to
review the sonographic appearances of GI wall
lesions and its differential diagnosis, detected during
routine transabdominal ultrasonography.
MATERIALS AND METHODS: We reviewed the
various US findings of GI wall lesions which can
occur in patients with abdominal pain and can be
detected during routine transabdominal ultrasonography. We differentiated the GI wall lesions based
on US findings and the US findings of GI wall
lesions are correlated with comparative studies of
gastroscopy, colonoscopy, CT and barium studies of
the GI tract.
RESULTS: The ultrasonographic differential diagnosis of GI wall lesions presenting as wall thickening
include gastritis, benign gastric ulcer, malignant gastric ulcer, infectious enterocolitis, inflammatory
bowel disease and adenocarcinoma. GI wall masses
(AGC, adenoma, GIST, leiomyosarcoma, lymphoma)
can be well visualized. Small bowel ileus (due to hernia, intussusceptions or mass) and postoperative
complication (afferent loop syndrome, duodenal
stump leakage) can be identified.
CONCLUSION: US is a useful imaging modality in
detection of various bowel wall pathology.
Recognition of possible bowel wall pathology based
on patient’s symptoms, specific segment of GI wall
and US findings can be more helpful in accurate US
diagnosis.
244
Won Hong Park, Jeong Eun Lee, June Sik Cho,
Kyung Sook Shin
Department of Radiology, Chungnam National
University Hospital, Korea
PURPOSE: To establish the reference value for normal right hemidiaphragmatic motion measured by
M-mode ultrasonography in a large healthy population.
MATERIALS AND METHODS: From May 2013 to
January 2014, a total of 288 adult subjects (140 men
and 148 women) who had regular checkup liver
ultrasound scans underwent M-mode ultrasonography for evaluation of right hemidiaphragmatic
motion. Examinations were performed three times:
during quiet breathing, deep breathing, and voluntary sniffing. Diaphragmatic excursion was determined as median value of the three measurements
during each examination. Relationships between
diaphragmatic motion and different variables [sex,
age groups(≤30, 31-60, ≥61), and BMI groups
(<18.5, 18.5-23, >23)] were assessed.
RESULTS: Right hemidiaphragmatic motion was
successfully evaluated in all 288 subjects during
quiet breathing, deep breathing, and voluntary sniffing. The median values of diaphragmatic excursions
of quiet breathing, deep breathing, and voluntary
sniffing were 1.9 cm(range, 0.9-4.2; mean ±SD, 2.0
±0.5), 4.9 cm(range, 1.8-8.6; mean ±SD, 4.9 ±
1.2), and 2.6 cm(range, 1.2-5.5; mean ±SD, 2.7±
0.8). There was no significant difference in diaphragmatic motion between sex and age groups, respectively, during quiet breathing, deep breathing, and
voluntary sniffing (p> .05 in all examinations). In
BMI groups, there was no significant difference in
diaphragmatic motion during quiet breathing and
voluntary sniffing (p=0.626 and 0.137, respectively);
however, there was significant difference during
deep breathing (P< .05).
CONCLUSION: The results of this study suggest a
reference value of normal right hemidiaphragmatic
motion, which can be used in study of diaphragmatic movement disorders such as diaphragmatic paral-
Scientific Exhibits
ysis.
SE 018
Comparison of Contrast-Enhanced
Ultrasonography and CT in Evaluation of
Immediate Treatment Response after
Radiofrequency Ablation of Malignant
Hepatic Tumors
Han A Lee, Young-Hwan Lee, See Sung Choi,
Hye-Won Kim, Kwon-Ha Yoon
Department of Radiology, Wonkwang University
Hospital, Korea
tumor progression. Evaluation of immediate treatment response of CEUS were concordance with that
of CECT, which showed statistically significant
(P<0.001).
CONCLUSION: The sensitivity, specificity and
accuracy of CEUS in assessment of treatment
response of radiofrequency ablation therapy in
malignant hepatic tumor is not inferior to those of
CECT. Evaluation of immediate treatment response
of CEUS showed consistent results in comparison
with CECT.
SE 019
Abdominal Tuberculosis with Hemolytic
Anemia
Maria Goretti Ametembun
Department of Internal Medicine, Private Practice,
Indonesia
PURPOSE: To describe ultrasound finding of peritoneal tuberculosis with hemolytic anemia case.
MATERIALS AND METHODS: This descriptive
study was conducted at a private clinic in Bandung,
Indonesia. A female, 36y, came with pale, weak,
headache since a month. Laboratory: severe anemia
(Hb 3.3-5.9 g%), Leucocyte 2200-3500, thrombocyte
96,000-102,000, Lympocyte 42 and Basal
Erythrocyte Sedimentation was very high 136.). She
was very nervous due to hemoglobin still low
although blood transfusion was given several time.
Direct and indirect Coomb test were strong positive,
Total bilirubin was 5.6-6.64 mg%, and indirect
bilirubin was 5.25-4.8 mg% according to hemolytic
anemia. She had history of recurrent colic abdomen
and mild fever since several months. Physical examination were anemia, icteric, moderate spleen
enlargement; doughy abdomen and ‘dam board phenomenon’ according to peritoneal tuberculosis.
Abdominal ultrasound using ALOKA SSD was performed, including also both on tympanic (normal &
painless area) and on dullness with abdominal pain
area according to ‘dam board phenomenon’ of peritoneal tuberculosis dry type on June 2, 2013.
RESULTS: Ultrasound examination showed spleen
enlargement. Hypo-peristaltic, irregular thickening
heterogenic hypo-echoic of the small bowel wall,
245
Scientific Exhibits
PURPOSE: The purpose of our study was to compare with diagnostic accuracy of immediate contrastenhanced ultrasonography (CEUS) and 24h contrastenhanced CT (CECT) in early treatment response
evaluation of liver tumor after radiofrequency ablation.
MATERIALS AND METHODS: From July 2012 to
December 2013, we included the patients with
malignant hepatic tumors who underwent radiofrequency ablation therapy and thereafter received
immediate CEUS and 24h CECT examination in our
hospital. CEUS were performed with an LOGIQ E9
ultrasound scanner and ultrasound contrast agent
(Sonovue�; Bracco Imaging SpA, Italy) were used.
Two radiologist reviewed immediate CEUS and 24h
CECT images to evaluate residual hypervascular
tumor and proper safety margin of ablation zone in
consensus. Sensitivity, specificity and diagnostic
accuracy of immediate treatment response evaluation were calculated using the results of follow up
CT imaging after 90 days as a reference standard.
RESULTS: During a follow-up period of 90-572
days (median, 288 day), total 34 lesions with 27
patients (21 men, 6 women; mean age 63) were
included (5 patients had two lesions each other and
two of them had additional ablation session for the
same lesion). Six patients were confirmed to show
local tumor progression on follow up CT imaging.
The sensitivity, specificity, diagnostic accuracy of
detecting incomplete ablation of CEUS were 33.3%,
100% and 88%, respectively. Those of CECT were
16.7%, 100% and 85%, respectively. Ill defined
tumor margin was the predictive factor of local
KSUM Open 2014
loss differentiation of the wall layers, irregular margin in addition to several round nodular structures
(patchy hyper-echoic non-shadowing with an irregular rim of lower echo-density) within the wall and
narrowing of the lumen were examined on the dullness pain area. No ascites. During treatment of
methyl prednisolone and anti tuberculosis drug for 9
months she only need once blood transfusion,
Hemoglobin as well as Leucocyte and thrombocyte
were raised gradually. After treatment: all complaints disappear, spleen became normal,
Hemoglobin 13,6, Leucocyte 5100 and Thrombocyte
148.000.
CONCLUSION: Ultrasound very usefully to know
the whole disease progression and proper treatment
as in this peritoneal tuberculosis with hemolytic anemia case.
SE 020
Appendiceal Intussusception into Cecum:
Case Report
Phai Ly
Department of Radiology, Medic Medical Center HCMC,
Vietnam
Appendiceal intussusception is not a common disease and is rarely diagnosed preoperatively. In our
case, a 25-year-old male patient living in Ho Chi
Minh City came to Medic Medical Center complaining about his epigastric abdominal pain, which lasting for 3 days. His body temperature was not high
and he did not have any other symptoms. He
recalled similar pain which had gone away without
any treatment three months ago. Abdominal ultrasound showed abnormalities in appendix and
cecum. During performing colonoscopy, we suspected appendiceal intussusception, and following computed tomography showed the images of enlarged
appendix with fluid-filled lumen and signs of intussusception at the appendix base. The patient underwent an operation to remove the appendix and
appendiceal intussusception was confirmed.
Microscopic result was consistent with chronic
appendicitis.
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SE 021
Fulminant Liver Failure with Pseudocirrhosis
from Malignant Metastatic Breast Infiltration
Grace Ho, KS Li, HL Lam
Department of Radiology, Queen Mary Hospital,
Hong Kong
Liver is one of the common sites for breast carcinoma to metastasize, after bone, pulmonary, pleura
and contralateral lymph nodes metastases. Majority
of liver metastases manifests as radiologically detected mass lesions that do not significantly compromise
liver function, and have classic target appearance on
ultrasound. Occasionally, hepatic metastases from
breast carcinoma can simulate cirrhosis morphologically, such as diffuse hepatic macronodular contour
and capsular retraction, especially after systemic
chemotherapy has been administered. Pseudocirrhosis is the term to describe the hepatic morphological changes that resemble cirrhosis on imaging, in
the absence of chronic liver disease, immunological
or histopathological evidence of hepatic cirrhosis.
Complication of portal hypertension and progression
to acute hepatic failure may occur, and is an uncommon pattern of metastatic liver disease during the
clinical course. We present a case report with serial
ultrasound findings of development of pseudocirrhosis and portal hypertension in three months’ time,
subsequent fulminant liver failure, in a patient with
hepatic metastases from primary breast carcinoma.
Pseudocirrhosis may resemble cirrhosis, however
the etiologies are seen in isolation. Recognition of
this entity of pseudocirrhosis, especially in cases of
acute liver failure, should alert one to review clinical
history and prior imaging, consider the possibility of
malignant hepatic infiltration and search of extrahepatic sites of disease, to avoid unnecessary
workup in misguided diagnosis of cirrhosis.
Scientific Exhibits
SE 022
Aneurysmal Portal-hepatic Venous Fistula:
a Case Report
Chau Tran Ngan, Hai Phan Thanh
Department of Radiology, Medic Medical Center,
Vietnam
BACKGROUND: Intrahepatic portal-hepatic
venous fistula is rare, and considered to be created
as congenital or portal hypertension. We report a
case that was diagnosed an aneurysmal portal-hepatic venous fistula incidentally by ultrasound (US) and
confirmed by computed tomography angiogram
(CTA).
CASE DESCRIPTION: A 31-yo-man with no medical or trauma history complained about his mild
fever and right subcostal abdominal pain for 3 days.
No fever, no mass but mild tenderness in the right
subcostal on physical examination. Laboratory test
results were normal. US findings detected a cystic
lesion in the sixth segment, 21×21×31 mm in size
with yin-yang sign, right portal vein flow and right
portal vein flow, it communicated with the right portal vein and the right hepatic vein. CTA confirmed
an aneurismal portal-hepatic venous fistula. The
patient underwent an open abdominal surgery to
resect the sac of the aneurysm for preventing the
rupture.
CONCLUSION: This case illustrates the role of
color US in detecting portal-hepetic venous fistula,
especially when it makes of an aneurysm.
SE 023
Appendiceal and Hepatic Mucormycosis in
Adult Immunocompromised Patient
Fungal infections occur in patients who are severely immunocompromised with profound and prolonged neutropenia. We report a case of a 41-yearold female with angioinvasive mucormycosis involving appendix and liver in adult immunocompromised patients presenting as abdominal pain. This
SE 024
Gastrointestinal Bleeding from Duodenal
Metastatic Renal Cell Carcinoma:
a Case Report
Sujin Ko, Seong Sook Hong, Ji Young Hwang,
Hyun Ju Kim, Jung Hwa Hwang
Department of Radiology, Soonchunhyang University
Hospital, Korea
Upper gastrointestinal bleeding due to malignant
causes is uncommon and duodenum is rarely
involved either by primary or secondary malignancy.
We will report a case of a 74-year-old male who presented with melena and anemia, showing no significant finding on the initial gastroduodenoscopy. We
will present ultrasonographic findings including contrast enhanced ultrasonography of the duodenal
hypervascular mass and the mass in right kidney,
which are important clues of diagnosis. We will also
describe MR imagings and angiographic images of
two hypervascular masses each in right kidney and
duodenum. The diagnosis was confirmed by surgical
resection which revealed primary renal cell carcinoma (RCC) in right kidney with duodenal metastasis.
In conclusion, we diagnosed RCC with rare presentation of isolated duodenal metastasis initially by
using various imaging modalities.
SE 025
A Case of Terminal Ileal Diverticultis
Mimicking the Acute Appendicitis:
Ultrasonography and CT Findings
Jewon Jeong, Seong Sook Hong, Ji Young Hwang,
Hyun Ju Kim, Jung Hwa Hwang
Hospital, Korea
Acquired small bowel diverticulosis is relatively
247
Scientific Exhibits
Seo-youn Choi, Hae Kyung Lee, Min Hee Lee,
Boem Ha Yi
Bucheon Hospital, Korea
patient was at the end of induction chemotherapy
for acute T-lymphoblastic leukemia. To our knowledge, it is the first described imaging findings including sonography of angioinvasive appendiceal and
hepatic mucormycosis. The diagnosis and management of mucormycosis are also reviewed.
KSUM Open 2014
rare disease, as compared to colonic diverticulosis.
Among the small bowel diverticulosis, jejunum is
more frequent occurring site than ileum. Small
bowel diverticulosis is usually asymptomatic.
However, if any complication such as inflammation,
perforation or bleeding developed, it could be symptomatic. Particularly in the case of terminal ileal
diverticulitis, it could mimic the acute appendicitis,
the commonest abdominal surgical emergency. We
experienced a case of a 68-year-old female patient
with a day of history of right lower quadrant pain
and tenderness suggesting acute appendicitis.
However, initial bowel ultrasonographic findings
revealed multiple inflamed diverticula with severe
regional fat infiltration and Doppler ultrasonographic findings presented increased vascularities around
the diverticula. And subsequent CT also noted multiple inflamed diverticula. Thus, the final diagnosis
was acute diverticulitis in the terminal ileum, which
was mimicked acute appendicitis. The patient
received only conservative treatment with antibiotics and clinical symptoms were improved.
SE 026
A Case of Arteriovenous Malformation of
Pancreas Diagnosed by Pylorus-preserving
Pancreaticoduodenectomy (PPPD): Doppler
Ultrasonography, CT and MRI Findings
Borahm Lee1, Jeongeun Lee1, Junsik Jo1,
Kyungsuk Sin1, Insang Song2, Kyunghee Kim3
1
2
Department of Surgery, Chungnam National University
Hospital, Korea
3
Department of Pathology, Chungnam National
Arteriovenous malformation (AVM) of the pancreas is extremely rare and can present with fatal
complications. We report a case of AVM of the pancreatic head combined with early gastric cancer
(EGC) in a 48-year-old man who presented recurrent
GI bleeding and severe anemia. Despite endoscopic
submucosal dissection being performed due to EGC
found on endoscopy, recurrent GI bleeding continued. He underwent further evaluation and was diag-
248
nosed as a pancreatic AVM based on characteristic
findings on Color Doppler Ultrasonography. Finally,
he underwent PPPD and no more GI bleeding
occurred. We present the findings of US, CT and
MRI and their correlation with pathologic features.
We also review the literature of pancreatic AVM.
Breast
SE 027
Should Internal Mammary Lymph Nodes be
Included in Breast Ultrasonographic Study
for Women with Breast Cancer?
Yi-Hong Chou1, Hsiao-Chuan Liu1, Chui-Mei Tiu1,
Hong-Jen Chiou1, Hsin-Kai Wang1, Yi-Chen Lai1,
Chih-Yi Hsu1, Ling-Ming Tseng2
1
Department of Radiology, Taipei Veterans General
Hospital, Taiwan
2
Department of Surgery, Taipei Veterans General
Hospital, Taiwan
PURPOSE: Patients with internal mammary lymph
nodes (IMLN) metastasis had a worse prognosis than
those who did not have. Therefore, assessing the
IMLN metastasis is important to identify patients
who might benefit the most from adjuvant parasternal radiation.
MATERIALS AND METHODS: One hundred and
twenty women aged from 29 to 91 years were retrospected from Department of Radiology, Taipei
Veterans General Hospital. Average age is 54.9 years
with 11.2 of the standard deviation (SD). There are
34 (28.6%) women, which aged from 29 to 81 years
and average age is 52.4 with 10.35 of SD, presented
the malignant tumor mixed positive IMLN. All
patients were referred for routine breast ultrasound
(US) examinations, and the initial breast US and axillary/IMLN status were reviewed by 2 radiologists,
and then fine-needle aspiration (FNA) biopsy, and
the histopathologic and immunohistochemical evaluation were performed. Pearson Chi-square test and
odds ratio (OR) were utilized to discuss the relationship between women with the breast cancer mixed
IMLN or not.
RESULTS: The patients who have suffered positive
axillary of the breast cancer, positive axillary of the
Scientific Exhibits
breast cancer mixed invasive ductal carcinoma
(IDC), medial location of the breast cancer+positive
axillary of the breast cancer+lymphovascular invasion (LVI)+IDC, or positive axillary of the breast
cancer+LVI+IDC+triple negative have significant
difference in IMLN metastasis with the p-value of
<0.001, 0.016, 0.032 and 0.017, respectively. For
triple negative, the women with the breast cancer
mixed IMLN metastasis had higher incidence of
triple negative (11.8%) than those without IMLN
metastasis (3.5%) during the ages between 41 and 50
years.
CONCLUSION: A positive IMLN indicates a very
high likelihood of women with malignant involvement aged ranges between 41-50 years. Therefore,
IMLN should be recommend to include in breast
ultrasonography study.
SE 028
Breast Density Evaluation in Mammography
and Ultrasound Examination in Mongolian
Women
59 age groups, retrospectively. BI-RADS category IV
grade of breast density was found in 8/24, 6/37, 1/45
and 1/23 in 20-29, 30-39, 40-49, 50-59 age groups,
retrospectively. The subsequent US revealed 8 cases
with rather benign masses in 20-29 age group, from
them 2/8, 1/8 and 5/8 in BI-RADS grade II, III and
IV, retrospectively. The 30-39 group showed rather
benign masses in 1/11,5/11, 3/11 and 2/ 11 in BIRADs grade I, II, III and IV dense breasts. The 4049 group revealed rather benign masses in 1/21,8/11,
11/21 and 1/ 21 in BI-RADs grade I, II, III and IV
dense breasts.
CONCLUSION: There are no data on dense breast
prevalence in Mongolian women. We showed that,
with increasing age, the incidence of focal masses in
dense breast is increasing, despite the decrease of
overall prevalence of dense breast patterns with
advancing age. As next, we need to correlate dense
breast prevalence with anthropometrics, menstruation and diet in Mongolian women.
SE 029
Nergui Bayanzul , Tuvshinjargal Dashjamts ,
Orkhon Gombosuren1, Bolorsaikhan Baatar1,
Ariunbolor Odkhuu1, Tuya Gansukh1,
Darkhijav Yanjiv1, Tugsjargal Purevsukh2
1
Department of Radiology, UB Songdo Hospital,
Mongolia
2
Department of Radiology, Health Science University of
Mongolia, Mongolia
Photoacoustic Imaging of Gold Nanoparticle
in Chicken Breast Tissue
MATERIALS AND METHODS: We retrospectively reviewed US and mammography of women who
underwent breast screening at Ulaanbaatar Songdo
Hospital in 2013. Data analysis was done on
SPSS17.0.
RESULTS: Totally we reviewed 137 women 14-74
years age, mean age was 40±10.68 years. BI-RADS
category II grade of breast density was found in
9/24, 18/37, 20/45 and 6/23 in 30-39, 40-49, 50-59
age groups, retrospectively. BI-RADS category III
grade of breast density was found in 9/24, 18/37,
20/45 and 6/23 in 20-29, 30-39, 40-49, 50-59 age
groups, retrospectively. BI-RADS category III grade
of breast density was found in 1/1, 7/24,9/37, 16/45
and 2/23 in below 20 years, 20-29, 30-39, 40-49, 50-
Photoacoustic imaging (PAI) is a rapidly emerging
non-invasive imaging technology that integrates the
merits of high optical contrast with high ultrasound
resolution. This study is undertaken to show the feasibility of PAI using gold nanoparticle (AuNRs) and
indocyanine green (ICG) at an integrated photoacoustic imaging and ultrasound system.
METHOD: ICG and methyl polymer-coated AuNRs
(30-50 nm of diameter) were used as optical contrast
agents. The chicken breast tissue was used to verify
the three-dimensional imaging. Tubes filled with
ICG and AuNRs at different concentration were
embedded at depth of 2 mm, 5 mm, 8 mm inside
chicken breast tissue. Photoacoustic images were
obtained using the Vevo LAZR Photoacoustic
1
2
Meihua Zhang1, Hoe Suk Kim1, Yujin Sun1, Ann Yi2,
Woo Kyung Moon1
1
Hospital, Korea
2
Department of Healthcare System Gangnam Center,
Seoul National University Hospital, Korea
Scientific Exhibits
249
KSUM Open 2014
Imaging System at a wavelength of 680-900 nm.
RESULTS: While the optical penetration was maximized with near-infrared laser pulses of 800-nm
wavelength, the optical contrast was enhanced by
ICG and AuNRs whose absorption peak matched
the laser wavelength. ICG (2 nM) and AuNRs (10
nM) have high photoacoustic contrast as compared
to chicken breast tissue ex-vivo. The optimized PAI
was able to image ICG and AuNRs embedded at
depths of as much as 8 mm in chicken breast muscle. The resolution was found to deteriorate slowly
with decreasing concentration of ICG and AuNRs as
well as increasing imaging depth.
CONCLUSION: We suggest that AuNRs can be
visualized in mice in vivo following subcutaneous
administration using PAI. With AuNRs as a contrast
agent, PAI has important potential applications in
the image guided therapy of superficial tumors such
as breast cancer, melanoma and Merkel cell carcinoma. In addition, PAI using selective biomarker-conjugated AuNRs can be applied for targeting organspecific metastatic cancer cells in advance.
ues for mammography alone were 67%, 73%, 64%,
46% and 85% respectively while for combined
mammography and ultrasound were 88%, 80%,
92%, 80% and 92% respectively. Furthermore, 7% of
malignant lesions that were diagnosed as benign on
mammography alone, were upgraded to malignant
on addition of ultrasound and 28% of benign lesions
that were falsely categorised as suspicious for malignancy or malignant on mammography alone were
downgraded to benign on additional use of ultrasound.
CONCLUSION: Ultrasound significantly increased
the diagnostic accuracy of mammography for characterization of breast lesions and reduced the number of false positive cases preventing unnecessary
histopathological examinations. Therefore, we
strongly recommend that all patients with breast
pathologies should be evaluated by mammography
along with ultrasonography for further characterization of lesions.
SE 031
SE 030
Role of Ultrasound as an Adjunct to
Mammography in Evaluation of Breast
Masses
Shelly Sharma
Department of Radiology, Jaypee Hospital, India
PURPOSE: The purpose of this study was to evaluate the adjunctive role of ultrasound in addition to
mammography for characterization of breast masses.
MATERIALS AND METHODS: In this prospective
study spanning over a two year period, we evaluated
50 female patients with a total of 51 breast masses.
The patients were first evaluated by mammography
alone and a BIRADS category was assigned based on
mammography findings. The patient was then evaluated with ultrasound and a combined BIRADS category was assigned. Both the examinations were performed by two separate radiologists. Definitive diagnosis was obtained from histopathological examination wherever applicable.
RESULTS: The diagnostic accuracy, sensitivity,
specificity and positive and negative predictive val-
250
Role of Targeted Breast Ultrasound as a
Problem Solver, in Cases of Breast
Incidentalomas Detected on Whole Body
PET/CT in Patients of Non-breast
Malignancies
Shelly Sharma1, Ankur Pruthi2
1
Department of Radiology, Jaypee Hospital, India
2
Department of Nuclear Medicine, RGCI & RC, India
In women undergoing PET/CT for non-breast
malignancies, unexpected increased focal 18F-FDG
activity within the breast tissue can be detected.
However, there are no clear-cut guidelines on further evaluation of these lesions and often pose a
diagnostic dilemma about the further course of
action. We prospectively evaluated the role of non
contrast CT, mammography and targeted breast
ultrasound in ten patients with focal incidental
uptake in breasts for further characterization of
these lesions. The non-contrast CT detected 9/10 of
these lesions. On mammography, 8/10 lesions were
detected. However, all the lesions (10/10) were identified on targeted ultrasound which was also used as
a guide for tissue sampling. Thus, we found targeted
Scientific Exhibits
ultrasound to be a useful adjunct to PET/CT for
localization and sampling of these lesions.
SE 033
SE 032
Eun Young Ko, Jung Whan Han, Boo-Kyung Han,
Ji Soo Choi
Korea
Sonomammographic Evaluation of Dense
Breast: Inchan Perspective
Sangeeta Saxena
Department of Radiology, Govt Medical College Kota
India, India
PURPOSE: To evaluate the accuracy of elasticity
scores and the reproducibility according to the lesion
size and elasticity.
MATERIALS AND METHODS: One breast radiologist (R1) and one radiologic technologist (R2) examined 20 targets of four different levels of stiffness
and five different sizes from 2.5 mm to 18 mm in
elasticity phantom (Customized 049A Elasticity QA
Phantom, CIRS, Norfolk, VA, USA) at a depth of 2
cm. B-mode image, color elastography image, measurement of kPa were obtained twice by each examiner with one week interval. Intra- and inter-observer reproducibility and the accuracy of measured kPa
were analyzed. The accuracy and reproducibility
were compared between the lesions with same size
and different elasticity and between the lesions with
same elasticity and different size.
RESULTS: Intra-observer reproducibility assessed
by ICC was 0.994, 0.929 in R1 and R2. Inter-observer reproducibility was 0.994. According to the level
of stiffness, both intra- and inter-observer reproducibility decreased in correlation with the increase
of stiffness. The accuracy of measured kPa also
decreased in correlation with the increase of stiffness. According to the lesion size, there was no significant difference in accuracy or reproducibility
between 5 different sizes of the lesions. But lesions
in 11 mm and 7 mm sizes showed more accurate
measurement of kPa than larger or smaller lesions.
Lesions of low stiffness showed lower measured kPa
in large size and higher measured kPa in small size,
while the lesions of high stiffness showed higher
measured kPa in large size, and lower measured kPa
in small size.
CONCLUSION: The accuracy of measured kPa and
intra-, inter-observer reproducibility were decreased
in correlation with increase of lesion stiffness.
Medium size lesions (7 mm, 11 mm) showed more
251
Scientific Exhibits
PURPOSE: Sonomammography evaluation of more
than 300 patients having dense breasts (age 23 to 87
yrs) were done with highly alarming results in
Indian subcontinent. There is paradigm shift at the
age of appearance of breast cancer from forties to
early twenties. The patients have also undergone
xray mammography and MR mammography. Cyto
and histopathological results were corelated. This
can be a landmark study providing efficacy of Sonomammography for evaluation of dense breasts.
MATERIALS AND METHODS: Ultrasound
machines GE P5, Siemens sonoline 60 Nemio toshiba scanners with linear high frequency transducers
with frequency 4 to 12 MHZ were used at Govt
medical collage Kota India. patients with dense
breasts age 23 to 87 yrs were evaluated for breast
carcinoma.
RESULTS: Sonomammographic detection of breast
cancer were as high as 98% in dense breasts. There
is a shift of age of occurrence of cancer from forty
plus to early twenties. This alarming state of breast
carcinoma at this early age in Indian subcontinent
leading the use of ultrasound for screening and diagnosis of breast cancer.
CONCLUSION: This study proposes the use of
sonomammography as diagnosing as well screening
modality of breast especially in dense breasts in
developing countries. The results are pretty high in
expert hands.
Accuracy and Reproducibility of Shear Wave
Elastography According to the Size and
Elasticity of the Lesions
KSUM Open 2014
accurate measure kPa, but the intra- and interobserver reproducibility were not different according to the lesion size.
SE 034
US-Guided Preoperative Localizations for
Breast Lesions
Eun Young Ko, Boo-Kyung Han, Eun Sook Ko,
Soo Yeon Hahn, Ji Soo Choi
Korea
US-guided localizations for nonpalable breast
lesions have been widely used before surgical biopsy
and breast cancer surgery. We present various methods of US-guided preoperative localizations using
metallic wire, surgical thread (Art wire), tattooing,
skin marking. In this poster, we briefly explain the
methods with pictures and present good indications
for each method and possible complications following the procedures.
3. Practical cases that radiologists should know
A. Typical cases
B. Pitfalls
- False positive findings
- False negative findings
2. C. Tips to deal with BI-RADS category 4 lesions
SUMMARY
Automated breast volume scanner (ABVS) is a rapidly emerging imaging modality with increasing adoption in both the screening and diagnostic setting.
Although image interpretation is in some ways similar to hand-held ultrasound, there remain vast differences and specific training is required for radiologists. The overview of image acquisition techniques
and interpretation methods of ABVS would help
radiologists to understand and use of ABVS. To make
an accurate diagnosis, tips and pitfalls of ABUS with
various false positive and false negative cases will be
presented.
SE 036
Hyperechoic Breast Lesions at
Ultrasonography
SE 035
You’re in Good Hands with ABVS: Tips and
Pitfalls of Automated Breast Volume Scanner
Hyun Jung Koo, Joo Hee Cha, Hak Hee Kim,
Hee Jung Shin, Eun Young Chae, Woo Jung Choi
Department of Radiology, Asan Medical Center, Korea
PURPOSE/AIM
To familiarize radiologists with a variety of false positive and false negative findings on automated breast
volume scanner (ABVS) for making an accurate diagnosis.
CONTENT ORGANIZATION
1. Introduction
A. Pros and cons of ABVS
B. Diagnostic value compared with hand-held US
2. Evaluation methods using ABVS
A. Image acquisition
- Patient factors
- Technical factors
2. B. Image reconstruction
C. Interpretation methods
- Locate the lesion: directions and diameters
252
Yoon Nae Seo1, Young Mi Park1, Suk Jung Kim2,
Hyun Kyung Jung2, Sun Joo Lee1, Hye Jung Choo1,
Seok Jin Choi1, Sang Suk Han1
1
Department of Radiology, Inje University Pusan Paik
Hospital, Korea
2
Department of Radiology, Inje University Haeundae
Paik Hospital, Korea
Hyperechoic lesions in the breast are rare, only
0.6%-5.6% of breast masses, and these lesions are
generally regarded as benign. However, according to
recent reports, 0.2%-4% of malignant lesions are
hyperechoic at ultrasonography (US). Therefore,
although the vast majority of hyperechoic breast
masses are benign, hyperechogenicity at US alone
does not allow exclusion of malignancy. The purpose: s of this exhibit are to illustrate various breast
diseases presenting as hyperechoic lesions including
benign (lipoma, galactocele, fat necrosis, fibroadenoma, hemangioma, hematoma, siliconoma, and
hamartoma) and malignant diseases (ductal carcinoma in situ, invasive ductal carcinoma, not otherwise
specified, mucinous carcinoma, and invasive lobular
Scientific Exhibits
carcinoma), and to investigate US and mammographic features that may predict malignancy.
SE 037
Fibroadenoma Variants and Fibroadenomaassociated Diseases
Young Mi Park1, Yoon Nae Seo1, Suk Jung Kim2,
Hyun Kyung Jung2, Sun Joo Lee1, Hye Jung Choo1,
Seok Jin Choi1, Sang Suk Han1
1
Hospital, Korea
2
Fibroadenoma of the breast is one of the most
common benign tumors and is usually diagnosed in
younger premenopausal women. Typical sonographic findings of fibroadenoma are oval shape, circumscribed margin, and homogenous hypoechogenicity.
There are several variants of fibroadenoma, including juvenile fibroadenoma, complex fibroadenoma,
lactating fibroadenoma, and tubular adenoma.
Sometimes, fibroadenoma causes secondary change,
including hyaline degeneration, and spontaneous
infarction. In addition, several benign and malignant
diseases may arise from fibroadenoma, such as phyllodes tumor, lobular carcinoma in situ, and ductal
carcinoma in situ. We illustrate each case in detail
and investigate mammographic and sonographic
appearance.
SE 038
Benign Proliferative Disease of the Breast
Showing Unique Manifestation
Bo Bae Choi
SE 039
Ultrasonographic Features in Breast
Malignancies Under 30 Years Old
Yeong Yi An1, Bong Joo Kang2, Sung Hun Kim2
1
Korea, St. Vincent’s Hospital, Korea
2
Korea, Seoul St. Mary’s Hospital, Korea
PURPOSE: The purpose of this study was to evaluate ultrasonographic (US) findings and correlation
with other imaging modalities in breast malignancies
under 30 years old.
MATERIALS AND METHODS: We performed a
retrospective review of the clinical, radiological and
pathological features of women under 30 years old
with breast cancer in our institution between March
2009 and October 2013. A total of 33 women were
analyzed. US findings were retrospectively evaluated
according to the Breast Imaging Reporting and Data
System (BI-RADS) lexicon. The mammographic
(MG) and magnetic resonance imaging (MRI) findings were also reviewed according BI-RADS category. Additionally, we reviewed the report of positron
emission tomography/computed tomography
(PET/CT) and the standardized uptake value (SUV)
of tumor. The US findings were correlated with
other imaging findings and final surgical pathology.
CONCLUSION: Although breast cancer in women
under 30 years old is a rare condition, it is important
to keep in mind the possibility of malignancy in
women with clinical symptom. Ultrasound may be
253
Scientific Exhibits
Benign proliferative breast disease is noncancerous
condition that may increase the risk of developing
breast cancer. This category comprises with ductal
hyperplasia, lobular neoplasia, moderate or florid
epithelial hyperplasia, sclerosing adenosis, radial
scar and papillomas. 50% of women undergoing
breast biopsies for breast disease may have prolifera-
tive changes. of these, 5-10% will have atypical
hyperplasia. Although a few proliferative breast
lesions such as radial scar or single papilloma may
show specific radiologic finding or may have
predilection site, it is difficult to diagnosis or categorize proliferative disease by imaging findings in most
cases. In this exhibition, I would like to present
benign proliferative disease with unique manifestation; sclerosing adenosis with multiple nodules or
even huge mass, complex fibroadenomas, myxoid
fibroadnoma in Carney complex, intraductal papillomas combined with DCIS showing multiple segmental masses, and radial scars.
KSUM Open 2014
the appropriate initial imaging test for symptomatic
young woman. Ultrasonography can provide more
accurate information by revealing additional lesions
missed on mammography and play an important
role in young women with dense breast.
mance in patients with nipple discharge, an additional 26.3% of malignant lesions were detected by
adding US to mammography.
SE 041
SE 040
Adding Ultrasound in the Evaluation of
Patients with Nipple Discharge Can Diagnose
Additional Breast Cancers
Haesung Yoon, Jung Hyun Yoon, Eun-Kyung Kim,
Hee Jung Moon, Min Jung Kim
Department of Radiology, Severance Hospital, Korea
PURPOSE: The aim of this study was to assess the
malignancy yield of the BI-RADS classification and
diagnostic value of additional ultrasonography in
diagnosing breast cancer in patients with pathologic
nipple discharge.
MATERIALS AND METHODS: From February
2003 to March 2011, among the 267 patients with
nipple discharge, 198 patients with pathological confirmation and follow-up data were included. US and
mammography were analyzed according to the BIRADS by the American College of Radiology. The
malignancy rate of each BI-RADS category and difference in diagnostic performances by adding US to
mammography were calculated.
RESULTS: Of the 198 enrolled patients, 34 were
diagnosed with malignancy. The malignancy rate of
each BI-RADS category for adding US to mammography was 0.0% (0 of 27) for category 1, 5.9% (1 of
17) for 2, 9.4% (5 of 53) for 3, 21.5% (20 of 93) for 4,
and 100% (8 of 8) for 5. While those for mammography alone were 9.0-14.3% for categories 1-3, 68.5%
(13 of 19) for category 4 and 100.0% (5 of 5) for category 5. Adding US to mammography increased diagnostic sensitivity by 14.5% compared to mammography alone with marginal statistical significance
(p=0.069); however, other diagnostic performance
markers were not improved. Among patients with
available mammograms, US detected five other
breast cancers (26.3%) in addition to 19 breast cancers found by positive mammograms.
CONCLUSION: Although adding US to mammography did not increase the overall diagnostic perfor-
254
Unveiling the Bewildering Papillary
Neoplasm of the Breast: Clues That
Radiologists Should Know Beforehand
Haesung Yoon1, Min Jung Kim1, Ja Seung Koo2
1
2
Department of Pathology, Severance Hospital, Korea
PURPOSE/AIM
To aid the understanding of spectrum of papillary
lesions in the breast through sonographic and pathological findings with illustrations, presenting the
strategy of diagnosis and management before, at,
and after the biopsy.
1) Introduction
- Understanding lesion with wide spectrum of
imaging-pathologic findings.
- The difficulty and importance of diagnosis associated with breast malignancy.
2) Before the biopsy: How to suspect breast lesions
as papillomas
- Illustration for the spectrum of US findings
3) At the biopsy:
A. Pathologic diagnosis with H-E and immunohistochemistry staining
- Illustration for the spectrum of pathologic diagnosis
B. Diagnostic accuracy comparison (14 gauge automated core-needle vs vacuum-assisted biopsy):
Pros & Cons
4) After the biopsy:
A. How to predict the malignancy at surgery
when papillary lesion was diagnosed at 14Gautomated CNB- clinicopathologic factors associated with the upgrade at surgery.
B. Should we recommend further excision or follow-up? Based on the literature.
SUMMARY
- Suspecting papillary lesions on breast ultrasound
can be challenging and certain US appearances
can be useful.
Scientific Exhibits
- For the pathologic diagnosis, the overall area of a
lesion should be evaluated and larger sampling
can be useful.
- To predict upgrade at surgery, clinicoradiologic
factors can be helpful.
SE 042
Columnar Cell Lesions and Atypical Ductal
Hyperplasia Diagnosed by UltrasoundGuided Core Biopsy: Radiologic Findings
Associated with Underestimation of Breast
Carcinoma
Hye Shin Ahn1, Mijung Jang2, Sun Mi Kim2,
Bo La Yun2, Sung-Won Kim3, Eunyoung Kang3,
So Yeon Park4
1
Hospital, Korea
2
Bundang Hospital, Korea
3
Department of Surgery, Seoul National University
4
Department of Pathology, Seoul National University
SE 043
Various Sonographic Findings of Ruptured
Duct Ectasia: from Definite Benign to Highly
Suspicious Finding
Jin Hwa Lee1, Eun Cho1, Kyung Jae Lim1,
Ji Young Kang1, Dae Cheol Kim2, Miri Lee3,
Se Heon Cho3
1
Department of Radiology, Dong-A Medical Center,
Korea
2
Department of Pathology, Dong-A Medical Center,
Korea
3
Department of Surgery, Dong-A Medical Center, Korea
PURPOSE
1. To review the pathologic definition of the ruptured duct ectasia.
2. To demonstrate various sonographic findings of
the lesions from definite benign to highly suspicious finding.
3. To discuss the US findings of ruptured duct ectasia mimicking breast cancer.
CONTENTS ORGANIZATION
1. Pathologic definition of ruptured duct ectasia.
2. Sonographic findings of ruptured duct ectasia
according to BI-RADS assessment categories.
3. Radiologic-pathologic correlation.
SUMMARY
Ruptured duct ectasia shows various imaging findings from definite benign to highly suspicious malignancy. Inflammatory changes in the walls of mammary ducts and periductal tissues are a prominent
part of the pathologic findings in mammary duct
ectasia, therefore, disruption of the ectatic mammary duct can mimics the ductal carcinoma of the
255
Scientific Exhibits
OBJECTIVE: To determine the underestimation
rate of columnar cell lesions (CCLs) and atypical
ductal hyperplasia (ADH) on ultrasound-guided core
biopsy, and to identify the radiologic findings associated with underestimation of breast carcinoma.
MATERIALS AND METHODS: From May 2003
and May 2013, 33 CCLs without atypia, 17 flat
epithelial atypia (FEA), 9 FEA with ADH and 44
ADH(103 cases in total) which diagnosed on ultrasound-guided core biopsy were included. Imaging
and lesion classification was as per the American
College of Radiology (ACR), BI-RADS lexicon.
Excision (n = 85) or imaging follow-up (n = 18) was
performed for all patients. The underestimation rate
was determined by dividing the number of lesions
that proved to be carcinomas at surgical excision.
RESULTS: The underestimation rate of FEA, FEA
with ADH and ADH were 5.9% (1/17), 44.4% (4/9),
27.3% (12/44). There were no underestimated cases
in CCLs without atypia. The presence of calcification on ultrasound displayed the considerable correlation with underestimation (p = 0.010), and shape
of the lesions showed statistically equivalent correlation (p = 0.052). However, size, orientation, margin,
boundary, echogenicity, posterior acoustic feature,
BI-RADS category on ultrasound, and mammographic findings were not associated with underestimation.
CONCLUSION: FEA with ADH showed the highest underestimation rate. The presence of calcification of the lesions on ultrasound should be taken
into attention when classifying CCLs and ADH of
the breast ultrasound guided core biopsy.
KSUM Open 2014
breast. Awareness of imaging spectrum of ruptured
duct ectasia may be helpful for differential diagnosis
of breast lesions.
SE 044
A Wide Spectrum of Benign and Malignant
Hyperechoic Breast Lesions
Hye Won Kim
Hospital, Korea
Hyperechoinc masses of breast are frequently
benign. But some of malignant tumours that present
as hyperechoic lesions. Careful review of sonographic finding and correlation with clinical and mammographic findings are important. It is necessary to pay
attention to most worrisome sonographic finding
and biopsy for histologic confirmation.
This presentation illustrate hyperechoic breast masses as following categories.
1. Benign lesions ; hematoma, fat necrosis, hemangioma, abscess, galactocele, lactating adenoma,
fibroadenoma, foreign body granuloma
2. Malignant lesions ; invasive ductal carcinoma,
invasive lobular carcinoma, leiomyosarcoma,
metastasis
SE 045
Application of Gel Pad To Automated Breast
Ultrasonography
Yun Ju Kim1, Sung Hun Kim2, Su Kyung Jeh3,
Jae Jeong Choi3, Bong Joo Kang2, Jeong Dan Kim2
1
Department of Radiology, National Cancer Center,
Korea
2
Korea, Seoul St. Mary's Hospital, Korea
3
Department of Radiology, Hallym University Sacred
Heart Hospital, Korea
BACKGROUND: Many patients complain of pain
during the Automated Breast Ultrasonography
(ABUS). Degradation of the image at the peripheral
region due to contact defect is another drawback of
the examination. Using a suitable coupling agent
would be helpful for pain relief and for improve-
256
ment of contact defect.
PURPOSE: The purpose of this study was to show
application of gel pad to ABUS in technical aspect
and to show its effects in pain relief, scan coverage,
and image quality.
MATERIALS AND METHODS: Twenty patients
underwent two sets of ABUS with and without gel
pad application then were asked about the examination-related pain. Scan coverage and image quality
were compared quantitatively and qualitatively.
RESULTS: The pain degree was significantly
decreased after gel pad application. The scan coverage was expanded particularly at the mid portion of
the breast. Image quality was satisfactory without
significant difference between the two settings.
CONCLUSION: Application of gel pad to ABUS is
easy and simple with significant pain relief. The
scan coverage was expanded while the image quality
was maintained.
SE 046
Isoehcoic Lesions of the Breast on
Ultrasound: is Correlation Mammography
Useful?
Hye Seon Shin1, Okhee Woo1, Kyu Ran Cho2,
Bo Kyoung Seo3
1
Department of Radiology, Korea University Guro
Hospital, Korea
2
Department of Radiology, Korea University Anam
Hospital, Korea
3
Department of Radiology, Korea University Ansan
Hospital, Korea
Breast ultrasound (US) is used as a supplemental
diagnostic tool in the evaluation of mass detected on
mammography or clinical examination or useful
screening tool by detecting some breast lesions that
are not visible or are difficult to interpret on mammography. For this reason breast US tends to be
overused. In daily practice, radiologists often even
overlook previewing mammography when performing breast US exams. But to identify an isoechoic
lesion surrounded with fat is difficult to detect by
using just breast US and sometimes it can result in
false negative interpretations. Therefore we have to
pay attention to mammographic abnormal lesions.
Scientific Exhibits
During performing breast US exams, correlation
mammography with skin marker is useful to confirm whether the lesions or not. This exhibit illustrates the cases that had needed careful mammographic evaluation when performing breast US
exams. The purpose of this study is to assess the
importance of the correlation mammography and to
improve a diagnostic accuracy about isoechoic mass
between mammography and breast US.
SE 047
Sonographic and Mammographic Features of
Nodular Pseudoangiomatous Stromal
Hyperplasia in the Breast
In Soo Moon1, Young Mi Park1, Yoon Nae Seo1,
Sun Joo Lee1, Hye Jung Choo2, Suk Jung Kim1
1
Hospital, Korea
2
A New Automated Breast Ultrasound System
with Dual Wide Field-of-View Imaging
Jaeyoung Son, Jongho Park, Hyunjae Song,
Jin Ho Chang, Tai-Kyong Song, Yangmo Yoo
Department of Electronic Engineering,
Sogang University, Korea
Breast ultrasound imaging is useful for observing
the mass according to the desired locations and differentiating the shape of consistency of the mass
during breast cancer screening, but its performance
is dependent on the examiners’ skill and has a poor
reproducibility. Recently-introduced automated
breast ultrasound (ABUS) systems have a potential
to decrease user dependency due to its automated
scanning protocols. However, the current ABUS system suffers from the limited field-of-view (FOV) and
the long scanning time. In this paper, a new automated breast ultrasound system with dual wide FOV
imaging is proposed. To improve the FOV and the
scanning time, in the newly-developed ABUS system, ultrasound volume scanning is conducted while
compressing breast between two plates. New ABUS
system concurrently supports two 1024-element
wide FOV linear array transducers so that two imaging planes can be acquired to reduce the volume
scanning time. To enable the dual wide FOV imaging, the custom-built system has four transmit
(Tx)/Receive (Rx) boards and two 1024-to-128 highvoltage multiplexing board that support 128-channel
Tx/Rx beamforming simultaneously. The beamformed radio-frequency data are sent to an external
PC for mid and back-end processing running on
high-performance graphic processing units (GPUs)
using CUDA, via the PCI express 2.0 interface.
Ultrasound B-mode images generated by multi-planar reconstruction during volume scanning after
placing raw meat between two plates. The developed ABUS system can acquire a 3D breast volume
set with 20 cm (width)×25 cm (length)×8 cm
(length) within 20 seconds. Two image planes are
concurrently captured during the scanning with dual
wide FOV imaging. The further evaluation of the
developed system including pre-clinical studies is
under investigation. These results indicate that the
proposed dual wide FOV-based ABUS system can
257 The 45th Annual Congress of Korean Society of Ultrasound in Medicine
257
Scientific Exhibits
Pseudoangiomatous stromal hyperplasia (PASH) of
the breast is a benign proliferative disease of the
breast stroma that is seen more commonly in premenopausal and perimenopausal patients receiving
hormonal therapy. The disease spectrum varies from
insignificant incidental microscopic changes in the
breast to focal mass-like nodules (nodular PASH) to
diffuse breast involvement. Nodular PASH is uncommon, only 0.4% of breast biopsies. We present 7
cases of nodular PASH. All of the patients were
women (mean, 45 years; range, 40-48 years) and
four patients complained of a palpable lump. On
sonography, PASH has benign features, commonly a
well circumscribed oval mass with parallel orientation and no posterior acoustic features. Three PASH
showed hypoechoic mass with cystic component,
reflecting histopathological characteristics which are
complex anastomosing slit-like pseudovascular
spaces. Mammographic findings are nonspecific.
SE 048
KSUM Open 2014
enhance the FOV and the volume scanning time for
improving clinical productivity of breast ultrasound
imaging.
SE 049
Sonographically Guided 14-Gauge Core
Needle Biopsy: Medical Audit for One Year
Su Jeong Hyun, Ga Ram Kim, Se Jin Nam,
Jung Hyun Yoon, Hee Jung Moon, Min Jung Kim,
Eun-Kyung Kim
PURPOSE: The objective of our study was to determine the diagnostic accuracy, underestimation rate
and false negative rate of sonographically guided
core needle biopsy for breast lesions.
MATERIALS AND METHODS: In this retrospective study, we included a total of 1179 lesions from
1028 patients who had undergone sonographically
guided 14-gauge core needle biopsies between
March 2012 and February 2013. The sonographic
category of breast lesions and the pathologic results
of core needle biopsies were reviewed and correlated with that of surgery or vacuum assisted biopsy, or
long term (> 1 yr) imaging follow-up. Through this,
the positive predictive value for each sonographic
category, sensitivity, underestimation rate and false
negative rate of core needle biopsy were evaluated.
RESULTS: A total of 1179 cases, the pathologic
results for the core needle biopsy were benign in
647, high-risk in 157, ductal carcinoma in situ in 54,
invasive cancer in 321. The positive predictive values for each sonographic category were as follows:
0.0% in category 2; 3.9% in category 3; 13.4% in category 4a; 63.1% in category 4b; 84.7% in category 4c
and 99.0% in category 5. The sensitivity of core needle biopsy was 93.8% (375 of 400). The underestimation rate was 10.2% for high-risk lesion (47.4% of
atypical ductal hyperplasia, 5.1% for non-atypical
ductal hyperplasia) and 40.7% (22 of 54) for ductal
carcinoma in situ. Of 647 benign lesions, 9 lesions
were confirmed as malignancy, and the false negative rate was 1.4%.
CONCLUSION: Sonographically guided core needle biopsy for 1 year in our hospital was accurate
diagnostic tool for evaluating breast lesion.
258
SE 050
Vacuum-Assisted Breast Biopsy Under
Sonographic Guidance: Analysis of A 10-year
Experience
Seung Hyun Lee, Eun-Kyung Kim, Min Jung Kim,
Hee Jung Moon, Jung Hyun Yoon
PURPOSE: Vacuum-Assisted Breast Biopsy under
Sonographic Guidance: analysis of a 10-year experience.
MATERIALS AND METHODS: This was a retrospective analysis of 2920 breast lesions in 2477 consecutive patients who underwent US-guided VABB
between February 2002 and December 2011.
Indications for US-guided VABB were classified into
9 categories; (a) calcifications, (b) complex and intraductal lesions, (c) discordant benign lesions, (d)
growing lesions, (e) high-risk lesions, (f) low-suspicious lesions, (g) non-mass lesions, (h) palpable
lesions, and (i) patient's desire to remove the breast
lesion. The proportions of each indication for VABB
were analyzed as well as the trend of that over time.
Histopathologic diagnosis and malignancy rate of the
lesions with VABB were analyzed. Comparison of
pathologic diagnosis at VABB and gold standard diagnosis revealed the false negative rate, underestimate
rate, and the agreement rate.
RESULTS: Proportions of each indication for VABB
were as follows; palpable lesions (44.4%), low-suspicious lesions (15.7%), high-risk lesions (12.4%), calcifications (10.3%), patient's desire to remove the
breast lesion (7.4%), complex and intraductal lesions
(3.8%), discordant benign lesions (2.7%), non-mass
lesions (2.2%), and growing lesions (1.0%).
Malignancy rate of lesions submitted to VABB was
5.4%. Calcifications were the indication with the
highest malignancy rate (36.8%) followed by nonmass lesions (18.5%) and discordant benign lesions
(12.7%). False negative rate was only 0.1%, while
underestimate rate of high-risk lesions and DCIS
being 3.1% and 13.8%, respectively, with 98.7%
agreement rate. Among 1512 therapeutic VABB
cases, 85.3% showed no residual lesion on long term
follow-up US. Complications occurred in 1% of the
patients without need for a surgical intervention.
CONCLUSION: US-guided VABB is an accurate
Scientific Exhibits
and safe method that can be an alternative for excisional surgery.
SE 051
Can We Accurately Differentiate Between
Benign and Malignant Lesions in Mastectomy
Site Based on Ultrasonographic Features?
Sojung Kim, Kyunghee Ko, Hye Kyoung Jung,
Hyerin Kim
Department of Radiology, Bundang CHA, Korea
icantly associated with local recurrence (p<0.05).
CONCLUSION: For predicting local recurrence, the
ultrasonographic characteristics of suspicious mass
was not be helpful. Therefore, even though ultrasonographic features of chest wall lesion would suggest benign,if they have suspicious axillary LN or if
original cancer had larger size, LN metastasis or lymphovascular invasion, we should perform biopsy to
confirm local recurrence.
SE 052
Are Irregular Hypoechoic Breast Masses on
Ultrasound Always Malignancies?
Youe Ree Kim, Yoogi Cha, Hye-Won Kim
Hospital, Korea
There were many kinds of benign or borderline
breast diseases representing irregular hypoechoic
masses that can mimic carcinoma on ultrasonography. In this presentation, we classify benign or borderline breast lesions into 4 groups : Iatrogenic or
trauma-related breast lesions (foreign body reaction,
fat necrosis, fibrotic scar), Inflammation (abscess,
idiopathic granulomatous lobular mastitis, diabetic
mastopathy), proliferative disease (sclerosing adenosis, apocrine metaplasia, fibrocystic change), and
benign breast tumors (intraductal papilloma,
fibroadenoma). These lesions were assessed as BIRADS Category 4a-to-4c suspicious malignancy on
ultrasonography, resulting in US-guided biopsy.
Some of inflammation and trauma-related breast
lesions could be suspected from patient.
Scientific Exhibits
PURPOSE: The aim of this study is to assess which
ultrasonographic feature is more helpful for predicting local recurrence in patients who underwent mastectomy for breast cancer.
MATERIALS AND METHODS: Between March
2009 and December 2013, 2928 breast ultrasonographic examinations were performed for follow up
after mastectomy in our institution. Our study
included 25 patients, who were suspected for local
recurrence by ultrasonography following modified
radical mastectomy. Among 25 patients, five (20%)
had palpable masses on their chest wall. We evaluated ultrasonographic characteristics of the lesions
(size, shape, margin, multiplicity, location) and suspicious axillary lymph nodes (LNs). We also retrospectively investigated clinical data about the postoperative duration and the characteristics of original cancer (size, axillary LN metastasis, lymphovascular
invasion, histologic grade) to evaluate which factors
affected local recurrence. Eighteen (72%) were confirmed by US guided core biopsy and seven (18%)
by surgical excision.
RESULTS: Among 25 patients, seventeen (68%)
were confirmed as local recurrence and eight (32%)
confirmed as benign (5, fat necrosis; 3, fibrosis). The
mean size of recurred mass was 1.44 cm±0.78, and
that of benign lesions was 1.42±0.85 cm (p=0.97).
Time interval between surgery and recurrence was
longer than that of benign without statistical significance (p=0.192). Among the ultrasonographic features, only ipsilateral suspicious axillary LN showed
statistically significant difference between the
benign and malignant lesions (p=0.01). Among the
characteristics of original cancer, size, axillary LN
metastasis and lymphovascular invasion were signif-
259
KSUM Open 2014
SE 053
Pseudoangiomatous Stromal Hyperplasia
(PASH): a Series of 4 Cases
Soo Jin Kim, Sung Hee Park, Mirinae Seo,
Hyeshin Ahn
Hospital, Korea
Pseudoangiomatous stromal hyperplasia (PASH) is
a benign mesenchymal proliferative lesion of the
breast. We retrospectively reviewed data from 2005
to 2014 of patients diagnosed with PASH by US-guided biopsy. of our 4 cases, mean size was 2.2 cm
(0.59-3.1) and mean age was 39.3 (19-50). Three
(75%) patients presented with palpable breast masses clinically. On US, 3 masses were hypoechoic and
one mass was isoehoic. Three masses showed relatively circumscribed margin but one had angular
margin. Coexisting pathology were intraductal papilloma, sclerosing adenosis. Patients were treated with
local excision, vacuum-assisted biopsy or observation. After operation or vacuum-asisted biopsy, there
was no additional malignant potential.
SE 054
Recurrent Breast Sparganosis: Clinical and
Radiologic Findings
Jiyoon Park1, Ok Hee Woo1, Hye Seon Shin1,
Kyu Ran Cho2, Bo Kyung Seo3
1
Department of Radiology, Korea University Guro
Hospital, Korea
2
Department of Radiology, Korea University Anam
Hospital, Korea
3
Department of Radiology, Korea University Ansan
Hospital, Korea
Sparganosis is an uncommon parasitic infection
due to the plerocercoid (second stage) larva of
Spirometra erinacei. The infection is transmitted by
ingesting contaminated water, or eating raw or partially cooked fish, snakes, or fogs. This is a case
report of recurrent Sparganosis of the breast within
6 month after a surgical removal of a worm from the
breast. The patient was referred to our hospital with
palpable right breast mass. At admission, breast
ultrasonography showed tortuous tubular hypoe-
260
choic lesion with indistinct margin within surrounding hyperehoic area, which strongly suggested
Sparganosis. We surgically removed and confirmed
Sparganosis. After 6 month, she felt a new mass in
her right breast and visited our hospital.
Postoperative breast mammography revealed lobulated, circumscribed, isodense mass and subsequent
breast ultrasonography showed similar features as 6
month earlier, in different area of the same breast.
Once again, we surgically confirmed recurrent
Sparganosis. Breast Sparganosis is a rare disease, but
it shows characteristic features especially on ultrasonography, which is helpful in patient management. Also, any patient once diagnosed as
Sparganosis should be properly followed-up for a
certain period of time, since it can recur like in our
case.
SE 055
Sparganosis of The Breast and Lower
Extremities: Sonographic Appearance
Sung Hee Park1, Seung Joon Choi2,
Min Jung Kim2
1
Hospital, Korea
2
Department of Radiology, Gachon University Gil
Hospital, Korea
Sparganosis is a rare parasitic infection caused by
larvae of the genus Spirometra. It can involve any
part of the human body and usually manifests as a
mass in various locations. We report a case of recurrent sparganosis in the breast and lower extremities.
Our patient had recurrent subcutaneous masses in
her breast and lower leg that showed characteristic
ultrasonographic imaging findings of serpentine,
tubular structures with surrounding increased
echogenicity. These imaging findings are well correlated with pathologic findings. Worms were identified in resected specimens confirming sparganosis.
Scientific Exhibits
SE 056
A Solitary Axillary Lymph Node Metastasis
Without Breast Involvement from Ovarian
Cancer: a Case Report with Brief Literature
Review
Ji-in Choi, Soo Jin Kim
Hospital, Korea
Ovarian cancer is the fifth most common cause of
cancer death in women, usually presenting with
metastasis to other organs. However, ovarian cancer
presenting as axillary lymph node metastasis is quite
rare, especially without involving breasts. We reported a case of 68-year-old woman, who presented with
abdominal distension. There was no remarkable past
medical history, except hypertension and diabetes
mellitus. Ovarian malignancy was suspected when
abdominopelvic computed tomography (CT) and F-18
FDG Torso PET-CT were performed. In addition, a
hypermetabolic (SUV(max)=2.1 g/mL) lymph node
was detected as a reactive benign lesion. On surgical
diagnostic laparoscopy, the serous papillary carcinoma of the right ovary and metastatic papillary carcinoma of the omentum were proven. Mammography
and breast sonography showed three benign looking
lymph nodes, but ultrasound-guided core needle
biopsy revealed metastatic serous papillary carcinoma from ovarian origin. This report illustrates a rare
case of a solitary axillary metastasis from ovarian
cancer without breast involvement. In conclusion,
we need to consider the physical examination and
evaluations for breast and axillary regions in patients
with history of ovarian cancer.
SE 057
Sonographic Findings of Adenoid Cystic
Carcinoma of the Breast
Adenoid cystic carcinoma of the breast is a rare
type of primary breast cancer accounting for less
than 0.1% of all breast carcinomas. Adenoid cystic
carcinomas of the breast have favorable outcomes
SE 058
Multiple Symmetric Lipomatosis (Madelung's
Disease) : A Rare Cause of
Pseudogynecomastia
Woo Jin Yang1, Jung Kyu Ryu1, Sun Jung Rhee1,
Jeong Yoon Song2
1
2
Department of Surgery, Kyung Hee University Hospital
at Gangdong, Korea
A 66-year-old male presented with bilateral breast
bulging. His breasts had slowly enlarged for several
years and this led to a conspicuous deformity. He
had a history of excisional biopsy of a lipoma in the
central upper back region 1 year earlier. The patient
reported more than 25 years of alcohol abuse, and
he consumed alcohol five times a week.
Mammography and breast US demonstrated excessive fat tissue in both breasts without any glandular
tissue. His diagnostic chest MR and CT showed a
huge amount of subcutaneous fat deposition at both
breast regions extending to the posterior neck, shoulder, upper arm and upper trunk. Surgical excision of
the breast masses was performed and the pathologic
diagnosis was lipoma. He also had a paternal familial history of multiple large disfiguring masses in the
261
Scientific Exhibits
Hyo Soon Lim, Seo Yeon Park, Seo In Jeong
Department of Radiology, Chonnam National University
Hwasun Hospital, Korea
compared with other forms of breast cancer and
adenoid cystic carcinomas of the salivary glands.
This is due to its slower progressive biological
course, lower metastases of lymph nodes and
uncommon distant metastases. Because of the rarity,
there is scant information about the radiologic features of adenoid cystic carcinomas of the breast.
This series describes the sonographic findings of 3
cases of adenoid cystic carcinomas of the breast.
Sonograms showed masses with an irregular (n=2)
or oval (n=1) shape, angular (n=1), indistinct (n=1),
or circumscribed (n=1) margins, and mixed echoic
(n=2) or hypoechoic (n=1) internal echo texture.
Sonographic assessments were classified as BI-RADS
category 4 in all 3 cases. Although adenoid cystic
carcinoma is a rare breast malignancy, awareness of
its sonographic features will be helpful for the diagnosis.
KSUM Open 2014
occipital region, neck, shoulder, upper arm, and
upper trunk. Clinical history and pathologic result of
these lesions enabled us to confirm the final diagnosis as multiple symmetric lipomatosis (Madelung's
Disease). Madelung's disease is a very rare lipid
metabolism disorder characterized by the accumulation of multiple, symmetric, non-encapsulated lipomatous masses on the face, neck, shoulders, and
upper arms. Pseudogynecomastia looks much the
same as gynecomastia with the exception of the
underlying breast tissue. In this Madelung's disease,
the imaging process of mammography, US and MR
played an important role in discriminating pseudogynecomastia from gynecomastia.
SE 059
Breast Sparganosis and Incidentally
Detected Multiple Sparganosis in the
Remaining Body: Imaging Characteristics
and Pathologic Correlation
Eunjee Song, Yu-Mee Sohn
Center, Korea
Sparganosis is an infestation caused by the tapeworm in the Spirometra genus. Human infestation is
transmitted by ingestion of raw snakes and frogs and
drinking contaminated water with infected larva of
the tapeworm. We described a surgically confirmed
case of sparganosis in the multiple organ system
including breast, both the upper and lower extremities, anterior chest wall, inguinal area, psoas and gluteus muscles with various imaging modalities as
sonography, CT and MRI.
262
Cardiovascular
SE 060
The Features of the Pulmonary Artery Flow
Spectrum in Tetralogy of Fallot in Fetus with
Main Pulmonary Artery Stenosis
Xiao Hong Zhang, Hai Yan Wang, Yu Ling Gong,
Chuan Xi Liu
Department of Radiology, Qianfushan Hospital Affiliatied
Shandong University, China
OBJECTIVE: To analyze the features of the pulmonary artery flow spectrum in TOF fetus with
main pulmonary artery stenosis, so as to put forward
another clue to the diagnosis of TOF in fetus with
echocardiography.
MATERIALS AND METHODS: 21 cases of fetal
TOF with main pulmonary artery stenosis were analyzed retrospectively, and their cardiac malformation
and the features of main pulmonary artery flow
spectrum were investigated. 46 normal fetuses were
chosen and the same parameters of pulmonary
artery flow spectrum were measured. The parameters of the two groups were compared with each
other to find the differentia.
RESULTS: 26 cases of fetal TOF were detected with
different malformation in right ventricular outflow
tract, 1 case with pulmonary atresia, 4 cases with
pulmonary valves stenosis, and 21 cases with main
pulmonary artery stenosis. The fetus with pulmonary atresia had no flow signal; the 4 fetuses with
pulmonary valves stenosis showed obvious increase
in peak velocity. The peak velocity of pulmonary
artery were not that visibly increased in the 21 TOF
fetuses with main pulmonary artery stenosis, but
their ACT, DT, ET and VTI of pulmonary artery
were shorter than those of the control group, and
the differences were significant
（P < 0.01）
, and the
ratio of pulmonary peak velocity to aortic were
enlarged compared with the control group; while the
peak velocity of aortic artery showed no significant
difference between the two groups
（P=0.22）
. The 21
TOF fetuses with main pulmonary artery stenosis
also had narrow pulmonary artery blanch.
CONCLUSION: The pulmonary artery flow spectrum of TOF with main pulmonary artery stenosis in
Scientific Exhibits
fetus have clear different features with different
malformation.
SE 061
Percutaneous Treatment with
Radiofrequency Needles of Residual Crosse
Saphenofemoral Stump after Stripping
Giovanni Turtulici, Mario Maturanza,
Simone Schiaffino, Riccardo Sartoris, Enzo Silvestri
Department of Radiology, Ospedale Evangelico
Internazionale Genova Castelletto, Italy
A New High PRF Fast Color Doppler Imaging
Based on Sliding Angle Compounding
Hyohee Kim, Sunmi Yeo, Yangmo Yoo
Ultrasound color Doppler imaging (CDI) is useful
for interactively visualizing hemodynamics in real
time. With the recently-proposed ultrafast color
Doppler imaging based on plane wave excitation and
angle compounding (CDI-AC), its frame rates can be
substantially increased. However, the current CDIAC method suffers from the limited pulse-repetition
frequency (PRF) as the number of compounding
angles increases for enhancing spatial resolution and
sensitivity.
In this paper, a new color Doppler imaging technique based on sliding angle compounding (CDISAC) is presented for improving both frame rates
and PRF. In the proposed CDI-SAC method, unlike
CDI-AC, the angle compounding is updated as each
new angle compounding is acquired, so that there is
no reduction in both PRF and frame rates. Thus, as
more sub-angle excitations are compounded together, the spatial resolution and sensitivity in CDI-SAC
can be further improved. To evaluate the performance of the proposed CDI-SAD method, the radiofrequency (RF) data were captured by a L7-4 linear
array transducer connected to the research ultrasound platform (Vantage, Verasonics Inc., Redmond,
WA, USA) from a flow phantom (Gammex 1425A
LE, Gammex Middleton, WI, USA). The acquisition
PRF of each plane wave excitation was fixed to 2
kHz for the CDI-AC and CDI-SAC methods. In addition, six angle excitations were differently compounded in the CDI-AC and CDI-SAC methods.
The CDI-AC method suffers from the aliasing artifact due to the limited PRF (i.e., 333 Hz) due to six
angle compounding. On the other hand, the proposed CDI-SAC method clearly depicts the hemodynamics in the vessel-mimic phantom without aliasing since it can keep the PRF of 2 kHz. These results
indicate that the proposed new fast color Doppler
imaging with sliding angle compounding can
increase the PRF and frame rates while improving
spatial resolution and sensitivity in ultrafast color
263
Scientific Exhibits
PURPOSE: The aim of our study was to evaluate
the efficacy of treatment with radiofrequency needles in patients operated with stripping with varicose recurrences that are powered by the exuberant
and refluxing crosse saphenofemoral stump.
MATERIALS AND METHODS: Ten patients
(mean age 53 years old) with post-stripping recurrence for the presence of residual stump were treated by percutaneous ultrasound-guided treatment
with radiofrequency needles. Efficacy was assessed
by ultrasonography documented obliteration of the
saphenous stump, and the objective reduction of
varicose veins. The checks were carried out on the
same day, at 30 and 60 days after treatment.
RESULTS: An obliteration of the crosse saphenousfemoral stump was observed in 8 patients the day of
the treatment, and confirmed at 30 and 60 days. In
two patients obliteration was not total. In 5 patients
with varicose veins of the leg was observed a significant reduction in the tortuosity the day of surgery
that has been consolidated at a distance of 30 and 60
days. In the other five, there was a modest reduction
of the varicose veins of the leg.
CONCLUSION: This treatment is, in our opinion, a
possible solution to the problem of recurrent varicose post-stripping, incurred mainly from the reflux
of the crosse saphenofemoral stump.
SE 062
KSUM Open 2014
Doppler imaging.
tant for improving spatial resolution while reducing
the blocky artifacts.
SE 063
Analysis of Angle Compounding on a Fast
Color Doppler Imaging: Phantom Study
Hyohee Kim, Sunmi Yeo, Yeokyeong Yoon,
Yangmo Yoo
Fast color Doppler imaging (CDI) based on plane
wave excitation and angle compounding is useful for
evaluating vascular diseases with high frame rates.
Due to limited spatial resolution from plane wave
excitation, the image quality of CDI is substantially
degraded. To enhance the spatial resolution, angle
compounding, in which several tiled plane waves
are excited and coherently summed together during
receive beamforming, can be used. However, the
effect of angle compounding on fast CDI has not
been extensively analyzed. In this paper, the analysis
of angle compounding on fast CDI with phantom
studies is presented. To evaluate the effect of the
angle compounding, in this paper, the recently-proposed sliding angle compounding (SAC) method is
adopted. In SAC, the angle compounding is updated
as each new angle compounding is acquired. The
pulse-repetition frequency of 2 kHz and four different sets of compounding angles (i.e., 3, 6, 8 and 12)
were used for generating a color Doppler image. The
color Doppler images with plane wave excitation
and SAC angle sets are experiment conditions. When
3 angle excitations and corresponding SAC are
applied, the blocky artifacts are clearly shown in the
vessel region. These artifacts are decreased as the
number of angles for plane wave excitation increases. With 12 angle excitation, it is difficult to identify
the blocky artifacts. The parabolic flow profiles at
the 64th scanline with a parabolic are calculated,
which is consistent with the visual assessments in
result images. The measured root mean square
errors (RMSEs) for three angle sets (3, 6, 8) by
assuming the 12 angle set as the reference are
0.0124, 0.0107 and 0.0082, respectively. These
results indicate that the proper selection of the number of angles in fast color Doppler imaging is impor-
264
SE 064
Fetal Double Outlet Right Ventricle
Associated with Severe Pulmonary Artery
Stenois in Gestational Diabetes Mellitus
Xuan-Hong Tomai1, Minh-Le Nguyen2
1
Department of Obstetrics and Gynecology,
University of Medicine and Pharmacy in Hochiminh City,
Vietnam, Vietnam
2
Department of Internal Medicine-Cardiology,
Thong-Nhat Hospital, Vietnam
Prenatal double outlet right ventricle (DORV) is a
rare anomaly of congenital heart defects and an
adverse outcome is often prognostic. We presented a
case of fetal DORV associated with pulmonary
artery stenosis in pregnant woman suffering from
gestational diabetes mellitus at 24 weeks' gestation.
An elective termination of pregnancy was carried
out because of severe fetal heart defect. Prenatal
ultrasonography with standard fetal heart checking,
such as a four-chamber and long-axis view, plays an
important role to diagnose this anomaly. A routine
oral glucose tolerance test is necessary to detect earlier gestational diabetes mellitus and understand
more risk factor of cardiac structural anomalies.
KEYWORDS: Double outlet right ventricle, gestational diabetes mellitus, ultrasonography
Genitourinary
SE 065
Contrast Ultrasonography in Ovarian
Torsion-Confidence Boosting Initial
Experience
Asif Momin1, Shenaz Momin2, Avinash Gutte2
1
Department of Radiology, Prince Aly Khan Hospital,
Mumbai, India
2
Department of Radiology, B.Y.L Nair Hospital and T.N.
Medical College, Mumbai, India
B-mode ultrasounds along with colour duplex
imaging are known to help in diagnosis of suspected
Scientific Exhibits
ovarian torsion. In appropriate clinical setting the
diagnosis is offered with certain degree of suspicion
even though identification of twisted pedicle (snail
sign and whirlpool sign) with or without absence of
intra ovarian color flow are highly useful signs along
with unilateral ovarian enlargement and trapped follicles being the commonest features. Pre-existing
ovarian solid or cystic lesion could be a precursor in
some cases. By using this early laparoscopic intervention should be carried out to save the ovary in
time. Adding CEUS as an adjunct just prior to sending patient for surgery gives further quick confidence boosting exercise. We could study three such
cases in last six months. This topic is to highlight its
effectiveness as well as some technical difficulties.
SE 066
Therapeutic Role of Ultrasound in Reposition
of Renal Calculi for Better Clearance, a Novel
Method
Madan Mohan Gupta, Nandini Bahri
Department of Radiology, MP Shah Medical College,
Jamnagar, India
SE 067
Transvaginal Versus Transperineal
Ultrasonography: a Blinded Comparison in
the Assessment of Cervical Length in
Preterm Labor
Kaouther Dimassi, Aymen Hammami,
Salma Bennani, Amel Triki, Mohamed Faouzi Gara
Obstetrics and Gynecology Unit, Mongi Slim Hospital,
La Marsa Tunisia, Tunisia
INTRODUCTION: In the management of preterm
labor (PL) , transvaginal ultrasound (TVU) remains
the gold standard in terms of diagnosis and prognosis. The transperineal utrasound (TPU) can be a reliable alternative.
OBJECTIVES:
�Present the use of transperineal ultrasound technique in preterm labor.
�Compare results of TVU and TPU on cervical
length measurements and visualization of the
opening of the internal os.
METHODS: It is about a preliminary prospective
study, including study patients between 14 and 36
weeks' gestation with a preterm labor. All the
patients underwent transperineal and transvaginal
cervical length assessment. The Pearson correlation
coefficient and Lin concordance coefficient were
used. Acceptable concordance was defined as >0.82,
with an acceptable correlation of >0.9.
RESULTS: 50 patients underwent the protocol. The
Pearson correlation coefficient was 0.959, and the
Lin concordance coefficient was 0.955, with a 95%
confidence lower bound of 0.949. Close agreement
between transperineal and transvaginal measurements was observed across the full range of cervical
lengths.
CONCLUSION: Transperineal ultrasound is as reliable as transvaginal ultrasound. Moreover, this technique is: fast, precise, trivial and providing more
comfort for anxious patients.
265
Scientific Exhibits
The global burden of renal calculi is increasing
now days. Surgical intervention is the management
in symptomatic patients in which, nearly half experience complications associated with stone fragments
that are not passed and require follow-up surgical
intervention. The success of surgical management of
lower pole stones is principally dependent on stone
fragmentation and residual stone clearance. Focused
ultrasound using radiation force to reposition kidney
stones and guided by ultrasound imaging is novel
method. The device couples a commercial imaging
array with a focused annular array transducer. This
is in vitro study. During experiment; stones were
located by ultrasound imaging and repositioned by
delivering short bursts of focused ultrasound. Stone
motion was concurrently monitored by fluoroscopy,
ultrasound imaging, and video photography, from
which displacement and velocity were estimated.
Stones were seen to move immediately after delivering focused ultrasound and successfully repositioned
from the lower pole to the collecting system.
Estimated velocities were on the order of 1 cm/s. The
focused ultrasound demonstrates a promising role to
facilitate spontaneous clearance of kidney stones and
increased clearance of residual stone fragments after
surgical management.
KSUM Open 2014
SE 068
SE 069
Predicting the Duration of the Latency Period
in Preterm Premature Rupture of the
Membranes Using Ultrasound
Ultrasound Assessment of Twin Anemia
Polycythemia Sequence
Kaouther Dimassi, Ahmed Halouani,
Amel Triki, Mohammed Faouzi Gara
OBJECTIVE: To Assess the value of ultrasonographic measurement of cervical length and amniotic index for predicting the duration of the latency
period from admission to delivery in women with
preterm premature rupture of the membranes
(PROM).
METHOD: Prospective study in 26 women with
preterm PROM before 37 weeks of amenorrhea. The
average gestational age at admission was of 33.3
weeks. The clinical management included: no digital
examination of the uterine cervix, antenatal corticosteroids if gestational age < 34 weeks, antibiotics
(amoxicillin) for 7 days, and hooding back until 37
weeks. Cervical length and quantity of amniotic
fluid at admission were determined with ultrasonography. The duration of the latency period was studied in relation with cervical length and the amniotic
fluid index.
RESULTS: The average latency period was longer in
women with a cervical length ³25 mm (18.8 vs. 8.8
days, p< 0.001). The average latency period was not
longer in women with normal quantity of amniotic
fluid. In fact average latency period was shorter in
women with an amniotic index >8 cm (10.1 vs. 14.3
days, p = 0.5).
CONCLUSION: In women with preterm PROM,
the latency period from admission to delivery is
shorter when cervical length is < 25 mm. However,
normal amniotic fluid does not influence this latency
period.
266
Mohamed Zghaier, Kaouther Dimassi, Amel Triki,
Mohammed Faouzi Gara
OBJECTIVE: Twin anemia polycythemia sequence
(TAPS) is caused by small placental vascular anastomoses leading to chronic anemia in the donor and
polycythemia in the recipient. TAPS can result in
severe fetal or neonatal hematologic complications,
cerebral injury and perinatal death. The aim of this
study is to ascertain the most relevant echographic
signs that helps to make an early diagnosis so we
can improve the outcome of this sparse complication.
METHODS: It's about two observations of patients
treated in the department of gynecology and obstetrics of the Mongi Slim hospital Tunis in 2013.
RESULTS: The first case is about a 42 years old
patient with one miscarriage, one childbirth, blood
type O negative, actual pregnancy a spontaneous
monochorionic according to the early first trimester
echography. addressed at 31 SA for intra uterine
death of one the twins and hydrops fetalis of the second. The second patient is aged of 28 years, first
pregnancy hospitalized at 29 SA to explore an
hydramnios accidently discovered. The ultrasound
exam performed in our service showed for the first
twin: no bladder and anamnios, for the second twin:
a huge bladder with polyhydramnios. In this too
cases, the blood flow in the MCA was superior to 1.5
MoM. Furthermore ultrasound allowed the guidance
for fetal transfusion.
CONCLUSION: TAPS is fetal emergency. Ultrasound
is the only mean for the diagnosis and for the fetal
therapy.
Scientific Exhibits
SE 070
Ultrasound Management of Ectopic
Pregnancy in Uncommon Implantation Sites
Moez Attia, Kaouther Dimassi, Amel Triki,
Mohammed Faouzi Gara
SE 071
Sonographic Appearances and Typing of the
Testicular Epidermoid Cysts
Qingda Song
Department of Radiology, Shandong Provincial Medical
Imaging Research Institute, China
OBJECTIVE: The purpose of this study was to
describe the sonographic appearances of testicular
epidermoid cysts and summarize sonographic characteristics and typing.
METHODS: The sonographic features of 21 testicular epidermoid cysts confirmed by surgery and
pathological were retrospectively analyzed and
typed.
RESULTS: According to the different features of 21
cases testicular epidermoid cysts, we typed them
into five patterns: ① The onion ring type (12 cases)
with alternating hypoechoic and hyperechoic concentric rings by ultrasound; ② The perimeter calcification type (also known as egg-shell calcification
type) (3 cases) with lamellar circle hyperechogenicity
around the lesion homogeneous or heterogeneous
hypoechogenicity in the central area; ③ The similar
solid type (3 cases) with well-defined homogeneous
hypoechogenicity masses; ④ The mixed echo type (2
cases) combined with hypoechogenicity, calcification, and microcysts in the mass; ⑤ The entirely
calcified type (1 case), the whole mass was hyperechoic with posterior acoustic shadowing. All 21 case
had no flow signal inside the lesion. The diagnostic
accuracy of high-frequency ultrasonography was
95.2% (20/21).
CONCLUSIONS: The onion ring type and perimeter calcification type were typical appearances of the
testicular epidermoid cysts. Preoperative correct
identification could prevent unnecessary radical
orchiectomy.
KEY WORDS: sonography; testicular neoplasm;
epidermoid cyst.
267
Scientific Exhibits
INTRODUCTION: Ectopic pregnancies of unusual
location are encountered much less frequently, but
are perhaps more morbid. The treatment of these
unusual ectopic gestations may not be as common
place as treatment of tubal pregnancies, but with
early diagnosis and effective planning, their treatment can be equally as effective.
OBJECTIVE: Familiarizing the practitioner with the
imaging of unusual location in ectopic pregnancy.
Explaining the modalities of the conservative treatment and detailing the clinical biological and ultrasound monitoring.
METHOD: It’s a retrospective study over a period
of 3 years. Were included patients presenting an
ectopic pregnancy in uncommon implantation site
whose treatment was conservative. The medical
treatment consisted on injection of KCl in the gestational yak by ultrasound guidance in the case where
the pregnancy was scalable. Then, the treatment
was continued by one or more intramuscular
Methotraxate injections.
RESULTS: During the study period we collected 04
observations of unusual ectopic pregnancies treated
medically. There was an interstitial pregnancy in 2
cases, cervical pregnancy in one case and a scar
pregnancy in one case. The diagnosis was made by
ultrasound in all cases and confirmed by MRI in 2
cases. (details will be shown in the poster) The medium term at diagnosis was 6 weeks of amenorrhea.
Pregnancies were evolving with heart activity in 2
cases. The average number of injection of MTX was
1.3. Medical treatment was able to stop pregnancy
in all cases with good clinical and biological evolution.
CONCLUSION: The use of advanced ultrasonography in combination with ultrasensitive serum b-hCG
assays should lead to early diagnosis of such pregnancies. Early diagnosis and use of multiple modali-
ties can reduce morbidity and mortality in cases of
ectopic pregnancy at unusual location.
KSUM Open 2014
SE 072
the important screening process for IPB.
Ultrasound Diagnosis in Inverted Papilloma
of the Bladder
Yongguang Ban, Qinhua Luan, Qingda Song,
Jianbo Teng, Hengtao Qi
Department of Radiology, Shandong Medical Imaging
Research Institute, China
OBJECTIVE: To explore the ultrasound findings of
inverted papilloma of the bladder (IPB).
MATERIALS AND METHODS: To retrospectively
analyze the clinical manifestation, cystoscopy examination, intraoperative observation and ultrasonographic imaging of 24 patients with IPB, confirmed
by surgery and pathology examination.
RESULTS: 24 patients underwent ultrasound examination and 24 tumors were found. The maximum
diameter of tumors were from 1.0 cm to 3.4 cm: 1.0
cm-2.0 cm (n=17), 2.0 cm-3.4 cm (n=7). Tumors
were papillary (n=17) or cauliflower shape(n=7), 6
cases had pedicles and none in 18 cases, 2 cases
swung in the bladder cavity. Tumors were slight
hyperecho (n=14) or high-level echo (n=10), and
could be divided into three types: homogeneous
internal echoes (n=14), inhomogeneous internal
echoes with punctiform hyperecho in brim or internal part (n=7), inhomogeneous internalechoes with
peripheral hyperecho and hypoecho in internal part
(n=3). Color doppler Fflow imaging (CDFI) showed
that there were no blood flow signal in 17 cases,
punctiform blood flow signal in 4 cases, point and
strip blood flow signal or strip blood flow signal in 3
cases. Local bladder walls were continuous and
there were no attenuation behind the tumors. The
onset position were: triangular area (n=6), left posterior wall (n=5), internal urethral orifice (n=4), right
lateral wall (n=3), right posterior wall (n=3), posterior wall (n=2), left lateral wall (n=1). 5 cases were
misdiagnosed as bladder carcinoma, and 17 cases
wereconsidered as solid tumors, and only 1 case was
diagnosed as papilloma, and 1 case was considered
as benign lesion.
CONCLUSION: The representative ultrasonographic imaging of IPB are mostly single, pedunculated,
papillary or cauliflower shape with smooth surface,
neck and trigone of bladder are the most risk position. Color Doppler ultrasonography can be used as
268
SE 073
Early Diagnosis of Uncommon Implantation
Sites of Ectopic Pregnancies
Mohamed Zghaier, Kaouther Dimassi,
Moez Attia, Amel Triki, Mohamed Faouzi Gara
Department of Obstetrics and Gynecology, Obstetrics
and Gynecology Unit Mongi Slim Hospital La Marsa
Tunisia, Tunisia
PURPOSE: To report ultrasonographic features of
unusual ectopic pregnancy.
MATERIALS AND METHODS: A retrospective
study over a period of 3 years that included patients
within uncommon implantation site of ectopic pregnancy diagnosed before 12 WA.
RESULTS: During the study period we collected 05
observations of unusual ectopic pregnancies diagnosed before 12WA. There was an interstitial pregnancy in two cases, cervical pregnancy in one case
and a scar pregnancy in two cases.
The diagnosis was made by ultrasound in all cases in
the first trimester (The medium term at diagnosis
was 8 WA) and confirmed by MRI in 2 cases. For the
cases of interstitial pregnancies, A scan of the uterus
revealed that the eccentric gestational sac was located in the right uterotubal junctional area, lying 1 cm
outside the most upper lateral edge of the uterine
cavity with thick endometrial echoes, making the
typical image of the“interstitial line”
. In case of cervical pregnancy, we found an empty uterine cavity
and the presence of a gestational bag in cervical
location. In cesarian section scar pregnancies,
Transabdominal and pelvic ultrasounds demonstrated the gestational sac with surrounding decidual
reaction within the anterior myometrium at the site
of cesarean section scar. Magnetic resonance imaging of the pelvis demonstrated decidual reaction
extending into the scar, confirming a cesarean section scar ectopic pregnancy. In all cases, there was a
cardiac activity.
CONCLUSION: To be able to make the diagnosis of
these uncommon ectopic pregnancies we must
know how to recognize an intra-uterine pregnancy.
An empty uterine cavity is always present, but there
Scientific Exhibits
is no pelvic mass, we found an eccentric gestational
sac whether isthmic or cervical or far from the uterine cavity. This delicate ultrasound semiology needs
a well trained and warned operator.
Baseline prostate size is important for predicting
benign prostate hyperplasia progression. In future,
we need to correlate our data with anthropometrics
to estimate reference size of prostate with regard to
body constitution.
SE 074
Prostate Size and Volume in Normal
Mongolians as Measured by Ultrasound for
Baseline Reference
SE 075
Orkhon Gombosuren1, Bolorsaikhan Baatar1,
Nergui Bayanzul1, Delgerekh Sainjargal1,
Batsaikhan Narankhuu2, Tuya Gansukh1,
Darkhantsetseg Battsengel1,
Tuvshinjargal Dashjamts3
1
Mongolia
2
Department of Surgery, Intermed International Hospital,
Mongolia
3
Department of Radiology, Health Science University of
Mongolia, Mongolia
Tai Le, Hai Phan
Department of Radiology, MEDIC Medical Center,
HCMC, Vietnam
The incidence of tuberculosis is increasing worldwide, with more than 20% of cases exhibiting extrapulmonary manifestations. The genitourinary tract is
the most common site of extrapulmonary tuberculosis. We would like to present ultrasound finding of
three cases of tuberculous epididymo-orchitis, age
from 25 to 52. In which, there were one case of miliary tuberculosis of right testis and left tuberculous
epididymitis, other case of tuberculosis of right testis
and bilateral epididymis, final case of bilateral tuberculous epididymo-orchitis.
SE 076
A Study of Diagnostic Yield, Efficacy and
Complications of Ultrasound Guided Renal
Biopsy in Different Renal Pathologies
Dinesh Chataut, Kamal Subedi
Department of Radiology, Tribhuvan University
Teaching Hospital, Kathmandu, Nepal
INTRODUCTION: Renal biopsy is an integral part
of modern nephrology practice, being indicated in
renal diseases in both native and transplanted kidneys. The purpose of this study was to evaluate diagnostic yield, efficacy and complications of ultrasound
guided renal biopsy with automated biopsy gun.
MATERIALS AND METHODS: This was a
prospective cross sectional study involving 184
patients including renal transplant recipients. These
patients with new onset renal symptoms or deteriorating renal function post transplant underwent free
hand real time ultrasound guided renal biopsy with
269
Scientific Exhibits
BACKGROUND/INTRODUCTION: Baseline
prostate size is essential for assessment of benign
prostate hyperplasia and a strong indicator for future
prostate growth. Determination of baseline prostate
size together with PSA level is also important predictor for clinically significant therapy response. In
Mongolia, there was only a single publication on
normal prostate size which included less than 200
subjects. With increasing average body height and
obesity rate in Mongolia, we need to determine reference size for normal prostate at pelvic US examination, which is most safe and common screening
method for prostate evaluation.
MATERIALS AND METHODS: We reviewed data
of clinically unremarkable male patients who underwent screening pelvic US at Ulaanbaatar Songdo
Hospital in 2013. The demographics, prostate length,
width, thickness and volume were evaluated using
Windows Excel.
CONCLUSION: Our data showed steady increase
of prostate volume with advancing age, which is in
line with similar reports in other countries.
Nevertheless, the determination of reference range
for normal prostate evaluation is necessary in our
country, due to absence of representative data.
Ultrasound Finding of Tuberculous
Epididymo-orchitis in Three Cases
KSUM Open 2014
18 gauge automated biopsy gun. The diagnostic
yield, pathological and immunohistochemistry diagnosis and complications of the procedure were analyzed.
RESULTS: 184 patients underwent the ultrasound
guided biopsy, 17 were renal transplant recipients.
Male and female ratio was almost equal (51.1% and
48.9%, respectively). Most patients were in age
group of 20-40 years. Most cases presented clinically
with nephrotic syndrome (38.04%), followed by
equal number of lupus nephritic and nonnephrotic
range proteinuria. The average number of glomeruli
in the biopsy tissue was 11.8 per specimen. The
average length of biopsy tissue was 1.15 cm in
native kidneys and 0.9 cm in transplant kidneys.
Renal biopsy yielded pathological diagnosis in 97.2%
cases with adequate sample for diagnosis in 98.9%
cases. Major life threatening complication was noted
in a single patient. Rest of the patients showed
minor or no complications.
CONCLUSION: Ultrasound guided percutaneous
biopsy with automated biopsy gun is modality of
choice for renal biopsy since it has the greatest yield,
highest efficacy and least serious complication rates.
Keywords: glomeruli, nephrotic syndrome, renal
biopsy, ultrasound.
SE 077
Initial Study on Correlation of Prostate
Volume and Blood PSA Level with Bodymass-index in Mongolian
Tugsjargal Purevsukh , Orkhon Gombosuren ,
Nergui Bayanzul2, Tuya Gansukh2, Darkhijav Yanjiv2,
Tuvshinjargal Dashjamts1
1
Mongolia, Mongolia
2
Mongolia
1
2
BACKGROUND: We investigate on correlation of
body composition with PSA level and prostate volume to determine the baseline reference which is
needed to correctly discriminate patients with
hyperplasia at first examination.
MATERIALS AND METHODS: We reviewed data
of clinically unremarkable male patients who under-
270
went screening pelvic US at Ulaanbaatar Songdo
Hospital in 2013. The demographics, prostate volume, PSA and Body-mass-index were evaluated
using Windows Excel.
RESULTS: Among the age 20-29, the average
prostate volume (APV) and PSA level were 21.90 cm3
and 1.23 ng/ml; with regard to the BMI, lean subjects with BMI3/0.89 ng/ml; whereas lean subjects
had 19.89/0.89, normal weighted-19.44/0.85, obese19.43/0.87, morbidly-27.8/0.69. Between 40-49 aged,
APV and PSA volume were 21.74 cm3/0.84 ng/ml;
whereas lean subjects had 21.8/0.84, normal weighted-26.72/1.1, obese-22.2/0.76, morbidly-18.75/0.6.
Between 50-59 aged, APV and PSA level were 18.51
cm3/0.94 ng/ml; whereas lean had 18.51/0.94, normal weighted-16.1/0.79, obese-22.57, morbidly
obese-10.6/1.11. In the 60-69 aged, APV and PSA
level were 18.51 cm3/0.94 ng/ml; whereas lean had
18.30/1.01, normal weighted-17.14/0.62, obese19.01/1.78, morbidly obese-12.1/1.55. In subjects
over 70, above measurements were 14.32 cm3/ 1.73
ng/ml; whereas lean had 14.34/1.73, normal weighted-13.36/0.89.
CONCLUSION: In our study, the maximum
prostate volume and PSA volume were found in the
group of age 40-49 in normal weighted subjects with
BMI 18-25. Obese and morbidly obese subjects are
found to have the smaller prostate volume and higher PSA level, relative to the age average.
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Sonographic Parameter in Benign Prostatic
Hyperplasia
Vaanchigsuren Seesregdorj1, Tsevelmaa Dorj1,
Munkh-Od Enkhjargal1, Badamsed Tserendorj2
1
Mongolia, Mongolia
2
BACKGROUND: Benign prostatic hyperplasia
(BPH) can be detected in 80% of males over the age
of 80. Clinical symptoms do not correlate with organ
enlargement. Only 10% of patients with BPH need
surgical treatment. The decision for surgical treatment is made as a result of objective findings and
Scientific Exhibits
the symptoms reported by the patient.
GOAL: This study was aimed to evaluate the sonographic parameters of benign prostatic hyperplasia.
MATERIALS AND METHODS: Fifty seven
patients with symptoms and clinical signs of prostatic gland enlargement had transabdominal ultrasonography at Department of Radiology, AchtanElite clinic in Mongolia between 2012 and 2013. The
size, echotexture, shape, contour bulging, capsule,
volume of the prostate were evaluated by ultrasonography. With the subject lying supine, the transducer was positioned to view the maximum longitudinal section, usually at midline.
RESULTS: This study revealed the size of the
prostate which normal were 24.6%, and enlargement were 43 (75.4%), abnormality echogenicity
were 46 (81.7%), 36 (63.1%) of shape was round, 29
(50.9%) of capsule was thickness. Prostatic volume
was significantly increased 45 (78.9%) in benign prostatic enlargement and 16 (28.1%) of prostatic calcification were occurred.
CONCLUSION: Prostatic size and volume were significantly increased in benign prostatic enlargement
and echogenicity abnormal capsule thickness were
very common.
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Ultrasound Findings in Patients with Chronic
Prostatitis
Munkh-od Enkhjargal1, Tsevelmaa Dorj1,
Vaanchigsuren Seesregdorj1,
Badamsed Tserendorj2
1
Mongolia, Mongolia
2
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Sonoelastography and Contrast Enhanced
Ultrasound of Renal Masses: are They Useful
for Detection and Characterization of Benign
and Malignant Renal Lesions?
Sang Youn Kim, Sungmin Woo, Myong Seok Lee,
Jeong Yeon Cho, Seung Hyup Kim
Hospital, Korea
Most of renal masses are incidentally diagnosed by
gray scaled ultrasound. The next steps for characterization of detected renal masses are contrast
enhanced computed tomography (CECT). Accompanying problems of CECT are significant risks for
patients with impaired renal function, allergic reaction and hyperthyroidism due to iodinated contrast
agents. Sonoelastography can provide quantitative
information on tissue elasticity of an interesting
lesion in real time. Contrast enhanced ultrasound
(CEUS) which has been introduced for diagnostic
imaging in the liver, heart and several organs can
also show qualitative and quantitative information
on tissue perfusion of an interesting lesion in real
time. We performed sonoelastography and CEUS for
detection and characterization of various benign and
malignant renal lesions. The aim of this exhibition is
271
Scientific Exhibits
BACKGROUND: Prostatitis is the most common
urologic diagnosis in men younger than 50 years old
and the third most common urologic diagnosis in
men older than 50 age, representing about 8% of
male urology office visits.
PURPOSE: This study was conducted to evaluate
the sonographic features of chronic prostatitis.
MATERIALS AND METHODS: The study population included 38 men examined by the ultrasonogra-
phy at the department of Radiology, Achtan-Elite
clinic in Mongolia. These men had symptoms of
chronic prostatitis.
RESULTS: We found the following US characteristics. There were 16 (42.1%) of echotexture was normality and 22 (57.9%) was heterogeneous. The shape
were 27 (71.1% of half-moon, 11 (28.9%) was triangle, 24 (63.2%) was round. We determined prostate
volume, 23 (60.5%) was increased, 3 (7.9% was
decreased and 12 (31.6%) was normality. Twenty five
men had significant calcification (65.8%). Contour
bulging of 71.1% was regular and 11 (28.9%) was
irregular.
CONCLUSION: Sonographic features were statistically confirmed that shape was round, echotexture
was abnormality and volume seem to have the
potential to increase in patients with chronic prostatitis. And also prostatic calcification were common.
KSUM Open 2014
to show the image findings and the quantitative data
of various renal lesions and to find out the usefulness of them for detection and characterization of
benign and malignant renal lesions.
dicitis, the possibility of the ectopic appendicolith
from perforated appendicitis as a cause of TOA
should be considered.
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Tubo-Ovarian Abscess Related with Postappendectomy Remained Appendicolith for
One Year in a 19-Year-Old Female
Jongchul Kim
BACKGROUND: The proximity of the fallopian
tubes (especially right oviduct) to the appendix and
the peristaltic nature of the fallopian tube make it
reasonable to believe that there would be a risk of
tubo-ovarian abscess (TOA) following perforation of
the appendix with or without appendicoliths. We
report a case of a right TOA developed secondary to
remained intrapelvic appendicolith for one year after
laparoscopic appendectomy for perforated appendicitis with generalized peritonitis.
CASE: A 19-year-old, sexually active female was
transferred to the emergency department of our hospital with the clinical impression of acute appendicitis at local clinic. Abdominopelvic computed tomography (CT) performed at local clinic could not show
appendicoliths due to contrast-filled bowel loops.
She underwent laparoscopic appendectomy, which
revealed perforation of the appendix of pelvic type
with generalized acute peritonitis. Her postoperative
course has been good. After one year, she visited our
emergency department again due to abdominal pain,
fever, right lower quadrant tenderness & rebound
tenderness, nausea, and leukocytosis. Pelvic ultrasonography and abdominopelvic CT showed right
adnexal multilocular cystic mass with (enhancing)
thick wall (indicative of right TOA) and a remained
appendicolith (1 cm in diameter) behind the right
TOA and right lateral to the rectum. After marsupialization of right TOA and removal of appendicolith,
her symptoms subsided.
CONCLUSION: In female patients with persistent
postoperative abdominal pain, fever, and leukocytosis following appendectomy for perforated appen-
272
Malignant Melanoma in Vagina Mimicking
Cervix Cancer
Jongchul Kim
BACKGROUND: Primary melanoma of the vagina
is an extremely rare neoplasm, accounting for no
more that 2% of melanomas among women, and
2.4-2.8% of all vaginal cancers. Malignant
melanoma of the vagina (either melanotic or amelanotic) is a disease of postmenopausal women, with
75% of women being over 50 years of age. It may
arise anywhere in the vagina with a predilection for
the lower third.
CASE: A 55-year-old, sexually active female was
transferred to the gynecologic department of our
hospital with the chief complaints of continuous
vaginal bleeding for 2 months. On gynecologic examination, vaginal mass was also palpable, and the clinical impression was cervical cancer with vaginal
extension. Transvaginal ultrasonography (US) reveals
relatively homogeneous irregular vaginal mass with
upward extension to the uterine cervix. Pelvic MR
imaging showed a large enhancing irregular mass at
the upper vagina, vaginal fornices, and uterine
cervix. Pathologic report of punch biopsy of uterine
cervix said poorly differentiated papillary squamous
cell carcinoma. Radical hysterectomy with bilateral
salpingo-oophorectomy & pelvic lymph node dissection were done at our hospital with the pathologic
diagnosis of poorly differentiated malignant
melanoma. After wound debridement with repair
for postoperative wound dehiscence, chemotherapy
has been done at this woman.
CONCLUSION: Although US finding of vaginal
melanoma is nonspecific, the melanotic melanoma
may show high signal intensity (SI) on T1-weighted
images and low SI on T2-weighted images, which is
not suppressed by a fat-saturated sequence.
Scientific Exhibits
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SE 085
Long-term Experience of Transrectal Prostate
Fiducial Markers Placement
Evaluation for Combined Therapy of RFAblation with Double Anti-angiogenic Protein
Using Contrast Enhanced Ultrasound in
Murine Renal Carcinoma Model
Sung Hwan Bae, Seong Sook Hong,
Jiyoung Hwang
Hospital, Korea
Invasive image-guided frameless robotic radiosurgery is widely used for extracranial lesions, such
as lesions in intra-abdominal organs, especially
prostate cancer. Tracking by the circumstantial insertion of fiducial markers helps plan the CyberKnife
treatment. In this exhibit, we will describe the technique of transrectal prostate fiducial markers implication for image-guided radiation therapy such as
CyberKnife treatment. And also, we will present the
successful rate of the procedure and failure rate
including discrimination failure. Minor and major
complications associated with transrectal prostate
procedure will be discussed; transient hematuria,
nausea, transient rectal bleeding, or voiding difficulty. The purpose of this exhibit is to inform the intervention radiologists that this procedure is a feasible
and safe technique without changing patients
SE 084
Sonographic Findings of Perineal Diseases
with Perineal and Transvaginal Ultrasound
Boem Ha Yi, Hae Kyung Lee, Min Hee Lee,
Seo-youn Choi, Sun Huh
Bucheon Hospital, Korea
PURPOSE: To evaluate the efficacy of combined
therapy of double anti-angiogenic protein (DAAP)
and radiofrequency ablation (RFA) in renal cell carcinoma (RCC) model in mice.
MATERIALS AND METHODS: RCC cell lines was
implanted subcutaneously into 8 nude mice. Eight
mice were randomly assigned into one of two
groups when tumors reached approximately 10 mm
in diameter: Four mice received DAAP adenoviral
treatment (1×109 pfu); four mice received Lac-adenoviral treatment (1×109 pfu). Effect of DAAP in
murine RCC model were evaluated a vascularity of
the inner tumor by contrast-enhanced ultrasound
(CEU) using microbubbles (MBs). MBs were prepared by sonic dispersion of decafluorobutane gas in
an aqueous medium containing L-A-phosphatidylcholine-distearoyl and PEG 40 stearate in a 77:15:8
molar ratios. CEU images were analyzed using
ImageJ software within the tumor and assessed
Kruskal-Wallis test. RF ablation was performed by
using a 1-cm active tip, with mean temperatures of
approximately 70�C for 5 minutes. To assess RFablation, mitochondrial staining was performed by
2% 2,3,5-triphenyltetrazolium chloride, and it was
compared between the groups.
RESULTS: Combined therapy group of RFA with
antiangiogenic agent DAAP showed the significantly
increased tumor coagulation compared to control
group (P < .001). The contrast enhancement ratio
for tumor vascularization on CEU images were significantly reduced in combined therapy group than
273
Scientific Exhibits
Ultrasound is easily adaptable, and useful diagnostic tool in most body parts, and various perineal or
genitourinary diseases could be detected and diagnosed by ultrasound examination. We’d like to present ultrasound findings of disease in perineal area
including vulvar neoplasm, uterine or vaginal tumor,
urethral diseases, inflammatory diseases and parasitic diseases involving perineal soft tissue with perineal and transvaginal sonographic images.
Hong Young Jun1, Jong-Hyun Ryu1,
Young Hwan Lee2, Seung Jae Byun3,
Kwon-Ha Yoon2
1
Department of Imaging Science based Lung and Bone
Disease Research Center, Wonkwang University
Hospital, Korea
2
Hospital, Korea
3
Department of Surgery, Wonkwang University Hospital,
Korea
KSUM Open 2014
that of control group (30.15 ± 9.88% vs. 77.43 ±
17.26%, P < .001). After RF-ablation, area of viable
mitochondria within the tumor was 2.13 ± 0.65%
and 10.27 ± 4.46%, respectively (P < .001).
CONCLUSION: Combined therapy of double antiangiogenic protein and RFA presented significantly
increased effect for tumor coagulation necrosis. Our
study suggests that combined therapy of RFA with
DAAP might be useful for thermal tumor ablation
therapy.
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The Role and Clinical Significance of
Simultaneous Scrotal Ultrasound (US) and
Transrectal Ultrasound (TRUS) Examination
in the Patients with Scrotal Pain
Sung Kyoung Moon, Joo Won Lim
Center, Korea
PURPOSE: To assess the clinical significance of
simultaneous scrotal US and TRUS examination in
the patients with acute or subacute scrotal pain.
MATERIALS AND METHODS: We enrolled 16
patients who underwent scrotal US simultaneously
with TRUS because of acute or subacute scrotal pain
in this retrospective study. We retrospectively
reviewed their demographic data, clinical symptoms
(scrotal, LUTS, and systemic), laboratory test (UA,
serum PSA level, and urine culture), and pathologic
reports. Two experienced genitourinary radiologists
reviewed their scrotal US and TRUS images retrospectively with consensus. In scrotal US and TRUS,
the involving segments (proximal and distal vas deferens, epididymis, testis, prostate, and seminal vesicle), laterality (right and left), and the presence of
echogenicity change, swelling, mass formation, and
hyperemia in color Doppler US were assessed. We
compared the image findings and clinical data of the
patients with positive and negative TRUS findings.
RESULTS: All of the 16 patients had epididymitis or
epididymo-orchitis in scrotal US. Among them, 8
patients (50%) showed positive TRUS findings. In
TRUS, they showed wall thickening and hyperemia
of ipsilateral (87.5%) or bilateral (12.5%) proximal
vasa deferentia, and seminal vesicles. Five patients
274
(5/8, 62.5%) showed prostate echogenicity change
and hyperemia. In scrotal US, 8 patients with positive TRUS findings showed vasitis (100%). On the
other hand, 5 patients without TRUS abnormality
showed vasitis in scrotal US (62.5%). Patients with
TRUS abnormality had significantly severe UA
abnormality (75% vs. 25%), elevated serum PSA
level (7.907 vs. 1.058), and LUTS (62.5% vs. 12.5%)
than patients without TRUS abnormality. Among the
patients without TRUS abnormality, 2 cases were
diagnosed as tuberculosis and 1 as mumps epididymo-orchitis.
CONCLUSION: Simultaneous scrotal US and TRUS
examination is useful to assess the extent of urinary
tract infection in patients with scrotal pain and
severe LUTS.
SE 087
Ruptured Rudimentary Horn Pregnancy:
Does Previous Normal Vaginal Delivery
Safely Excludes It?
Nitin Mishra, Nitin Yadav, Darshan Koshiya,
Vikas Jhanwar
Department of Radiology, SMS Medical College and
Hospitals, Jaipur, India
Rudimentary horn pregnancy is a rare event with
an estimated incidence of 1 in 76,000 to 1 in 140,000
pregnancies. Unicornuate uterus with rudimentary
horn has high incidence of obstetric and gynecological complications. Ruptured ectopic pregnancy in
the rudimentary horn is one of the most dreaded
complication which can have grave consequences
for both mother and fetus. In majority of cases it is
detected after rupture of the horn, usually during
first or second trimester of pregnancy. A pre rupture
ultrasonographic diagnosis may prevent this catastrophic outcome. We report a case of G2P1L1 with
rupture left rudimentary horn pregnancy at 16
weeks of gestation which was misdiagnosed as pregnancy in left uterine horn of a bicornuate uterus on
prenatal ultrasound. Patient presented to our hospital with pain abdomen and per vaginal bleed. A
diagnosis of ruptured left rudimentary horn pregnancy was made on the basis of emergency ultrasound and was later confirmed on laparotomy. Left
Scientific Exhibits
rudimentary horn along with ipsilateral fallopian
tube was excised.
SE 088
acterization and diagnosis is essential to optimal
management while avoiding radical surgery. We
hope that this help you differentiate non-neoplastic
miscellaneous ovarian lesions that are faced frequently in daily practice.
Miscellaneous Tumor-like Lesions of the
Ovary: US, CT, and MR Imaging
Jung-Hee Yoon, Kyeong-Wha Rhyu, Seung-Ho Kim,
Yedaun Lee, Kwang-Hwi Lee, Suk-Jung Kim,
Ji-Hwa Ryu, Ok-Hwa Kim, Hong-Dae Kim
Department of Radiology, Inje University Haeundae Paik
Hospital, Korea
Left Renal and Ovarian Venous Aneurysm:
Imaging Features and Clinical Presentation
Jeongin Yoo, Sung Bin Park, Jong Beum Lee,
Hyun Jeong Park, Mack Shin
Hospital, Korea
Primary venous aneurysms are characterized by
the dilatation of a localized segment of a vein in the
absence of associated varicose vein and not as common as arterial aneurysms. Venous aneurysms are
described in the popliteal, jugular and saphenous
veins, but rarely described in other veins including
renal and ovarian veins. Although visceral venous
aneurysms are rare lesions, they are increasingly
described in recent years, probably because of the
increasing availability of advanced radiological imaging in clinical practice. Thus radiologists should be
familiar with venous aneurysms. We report two rare
cases of left renal and ovarian venous aneurysms.
The lesions were depicted on gray scale and color
Doppler US as anechoic saccular structures with
compressibility, increased blood flow those are characteristics of aneurysm. Spectral Doppler US
showed venous flow. Enhanced CT scan confirmed
these findings and diagnosed as left renal and ovarian venous aneurysms. We also review the clinical
presentation or implications of visceral venous
aneurysms: mimicking mass or lymph node enlargement and risk or association with pulmonary
emboli.
Scientific Exhibits
LEARNING OBJECTIVES: Miscellaneous tumorlike ovarian lesions are histologically diverse, and
are often mistaken for the more common ovarian
cancers, leading to aggressive management.
Knowledge of characteristic clinical, laboratory and
US, CT or MR imaging of these non-neoplastic ovarian entities allows correct diagnoses and permits optimal management.
BACKGROUND: In practice, we daily meet various
cystic or solid tumor or tumor-like lesions in the
ovary or pelvic location from simple functional cyst
to cancerous lesion. The therapeutic strategy and
clinical courses are very different between each disease that presents as tumor-like lesions of the ovary.
So it is important to differentiate with noninvasive
diagnostic methods. In this exhibit, each disease
entity is introduced with US and CT findings and
correlated pathologic findings. Imaging Findings:
The contents of ovary lesions are inflammatory and
infectious disease (acute oophoritis, xanthogranulomatous oophoritis, tubo-ovarian abscess, ovarian
cyst rupture, inflammatory pseudotumor), pregnancy-related ovarian masses (ectopic pregnancy, ovarian hyperstimulation syndrome, polycystic ovarian
syndrome, endometrioma) and other miscellaneous
ovarian lesions (ovarian torsion, massive ovarian
edema). These patients were underwent US, CT or
MRI images were reviewed the shape, morphology,
presence of septum and solid vegetation, and correlated with pathologic characteristics.
CONCLUSION: Miscellaneous ovarian non-neoplastic entities comprise a wide spectrum.
Histopathological evaluation is warranted in some
cases to establish definitive diagnosis. Accurate char-
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SE 090
Ultrasound Follow-up of Testicular Adrenal
Rest Tumors with Congenital Adrenal
Hyperplasia: Report of Three Cases
Dong Won Kim, Seong Kuk Yoon, Jung Hyun Jo,
Hee Jin Kwon, Jin Han Cho, Jong Young Oh,
Kyung Jin Nam
Department of Radiology, Dong-A Medical Center,
Korea
Testicular adrenal rest tumor (TART) is a rare
intratesticular tumor, but frequently found in
patients with congenital adrenal hyperplasia (CAH).
The tumors are diagnosed and followed up by ultrasound (US) examination because these tumors are
non-palpable and symptomless in most cases and
always benign. US imaging features would be
changed depending on how CAH would be controlled. We herein report three cases of testicular
adrenal rest tumors with different usual and unusual
imaging findings and follow-up imagings. Patient 1
was a 14-year-old boy who presented with poor
compliance to medication. Patient 2 and patient 3
were 10-year-old boy and 13-year-old boy who presented with precocious puberty and short stature,
respectively. US examinations demonstrated oval
hypoechoic masses and irregular speculated hyperechoic masses in the testes and different serial imaging findings.
SE 091
US and MRI Findings of Spindle Cell Lipoma
Arising from the Spermatic Cord
Sung Kyoung Moon, Joo Won Lim
Center, Korea
A 29-year-old male patient had the palpable mass
at right inguinal region. In scrotal and inguinal US, a
right spermatic cord mass was shown. It showed
well-circumscribed margin, lobulating contour, and
slightly heterogeneous and high echogenicity. In
CDUS, there was no significantly increased vascularity in the mass. It was considered as a lipoma of
spermatic cord on US images. In MR images, it contained gross fat portion, but also had enhancing solid
276
portion with heterogeneously intermediate and low
signal intensity on T2WI. It was presumed as welldifferentiated liposarcoma with MR images.
Surgically-resected mass was pathologically diagnosed as spindle cell lipoma (pleomorphic lipoma).
SE 092
Wegener’s Granulomatosis with Renal
Involvement: Imaging Findings
Chong-ho Lee, Young-Hwan Lee, Kwon-Ha Yoon,
Seong-hoon Park, Young Jun Sohn, Taeyeong Heo
Hospital, Korea
Wegener’s granulomatosis (WG) is a systemic disorder which affects small- and medium-size vessels
in many organs. Although the kidneys are the second most commonly involved organ in WG, its manifestation as multiple intrarenal aneurysms is rare,
only a few cases were reported in literature. We present here this unusual manifestation of biopsy
proven WG as multiple intrarenal aneurysms in a
71-year-old man, who presented to our hospital with
generalized weakness. Pre-admission evaluation
revealed impaired renal function, which was not
improved in spite of prolonged treatment. Chronic
renal parenchymal disease was suspected and US
guided renal biopsy was done. The histopathologic
exam showed findings of Wegener’s granulomatosis.
Chest CT showed reticular opacities and GGO of
both lower lobes, which is not a specific finding of
Wegener’s granulomatosis. However, both kidneys
showed multiple subcentimeteric hyperenhancing
nodular lesions with similar enhancement degrees to
renal arteries, which gave suspicion of aneurysms or
pseudoaneurysms. Subsequent contrast enhanced
US and dynamic MRI showed multiple small
aneurysms. Renal arterial angiography further elaborated their detailed appearance. The patient received
immunosuppressive treatment with cyclophosphamide and steroids. Two weeks later chest CT was
performed to evaluate pneumonia. Both kidneys
showed no visible aneurysms, on the contrary to
previous chest CT which showed multiple
aneurysms. There have been only a few reported
cases of Wegener’s granulomatosis with bilateral
Scientific Exhibits
multiple intrarenal aneurysms. In this case report,
we’ll present the changes of imaging features along
the disease course with various imaging modalities
including contrast enhanced ultrasound, CT, MRI,
and angiography.
SE 094
Usefulness of Standard Deviation of on the
Histogram of Ultrasound as a Quantitative
Value for Thyroid Parenchymal Echotexture
Heung Cheol Kim
Department of Radiology, Chuncheon Sacred Heart
Hospital, Korea
Head & Neck
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Role of Ultrasound and Color Doppler in
Differentiation Between Malignant from
Benign/reactive Lymph Nodes
Madan Mohan Gupta, Nandini Bahri
Department of Radiology, MP Shah Medical College,
Jamnagar, India
Scientific Exhibits
PURPOSE: The purpose of this study was to evaluate role of ultrasound and color Doppler for differentiating malignant from benign/reactive lymph nodes.
MATERIALS AND METHODS: A total of 50
patients with oral cancer were evaluated with ultrasound and color Doppler examination of neck.
Correlation between ultrasound and color Doppler
findings and histopathology results was done to evaluate sensitivity, specificity, positive predictive value
and negative predictive value of ultrasound and
color Doppler in detecting metastatic neck nodes.
RESULTS: Study results showed that malignant
lymph nodes were round in shape, showed loss of
central hilar echogenicity and peripheral vascularity
and had high resistive index and pulsatility index
values. In our study, nodal shape (round) and RI and
PI values on color Doppler were more accurate for
differentiating benign from malignant lymph nodes.
CONCLUSION: We conclude that ultrasound and
color Doppler had relatively high accuracy in differentiating benign from malignant cervical lymph
nodes. So, Ultrasound with color Doppler can be
used for initial non-invasive workup in patients with
oral cancers for cervical lymph nodes.
This study examined whether the standard deviation values, which has measured automatically on
the histogram in the picture archiving and communication system (PACS) views of an ultrasound (US),
can be used as an index to determine the homogeneity or heterogeneity of a thyroid parenchymal echo.
The study groups consist of 30 normal control
groups and 30 patient groups who had diagnosed
with thyroiditis. We performed thyroid US using a 715 MHz linear array transducer (Philips Ultrasound,
Bothell, WA) and measured the parenchymal
echogenicity in each region-of-interest (ROI) of the
both thyroid lobes. The SD values of thyroid
parenchymal echo were calculated automatically on
the histogram in the ROI of the PACS view. In a
patient, two ROIs were selected in mid-level axial
scan images from both thyroid lobes and the average
value of SDs of 2 ROIs was used as a representative
number. The mean SD of normal control group and
thyroiditis group were 11.19±2.12 and 16.24±3.96,
respectively. There were significant difference
(p<0.0001) between two groups. The SD values of
US examination of thyroid parenchyma are thought
to reflect the homogeneity or heterogeneity of the
thyroid parenchyma. So, larger SD values are
thought to represent coarse parenchymal echotexture and the possibility of thyroiditis. Our study
revealed that the SDs of the ROI was useful quantitative diagnostic method in differentiation of coarse
and normal echotexture of thyroid lobe.
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SE 095
The Assessment of Nasal Septal and Lateral
Cartilage by Ultrasonography
Heung Cheol Kim
Department of Radiology, Chuncheon Sacred Heart
Hospital, Korea
We studied the usefulness of ultrasonography (US)
as a diagnostic tool in the assessment of the nasal
cartilage. The study group consists of 92 patients (18
female, 74 male lies within average age of 25 years,
ranging from 3 year to 80 years) who had an US and
CT scan with nasal trauma. We performed nasal US
using a 7-15 MHz linear array transducer and evaluate the ability to identify the nasal septal, upper and
lower lateral cartilage. The US examination has identified the septal cartilage in 88 (95.6%), upper lateral
cartilage in 89 (96.7%) and lower lateral cartilage in
62 (67.3%) of 92 patients. In US examination, the
pathologic findings of interruption of continuity and
acute angulation of septal cartilage indicating a septal injury could be recognized in 6 and 10 patients,
respectively. In contrast, those findings could not be
found on CT exam. Our study revealed that nasal
US was very useful diagnostic method in assessment
of nasal cartilages.
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A Case of Thyroid Papillary Carcinoma
Arising from Ectopic Thyroid Tissue in
Cervical Lymph Node: US and CT Findings
Bo Yeon Kim, Dae Young Yoon, Young Lan Seo
Department of Radiology, Kangdong Sacred Heart
Hospital, Korea
Ectopic thyroid tissue in cervical lymph node is a
very rare entity resulting from developmental
defects at early stages of thyroid gland embryogenesis. A 61-years-old female presented with a palpable
neck mass. She had undergone total thyroidectomy
for nodular hyperplasia 7 years earlier. Ultrasonography (US) demonstrated a 1-cm, well-defined,
ovoid mass in the right lateral cervical region (level
IV). This mass shows internal heterogeneous
echogenicity and multiple microcalcifications. CT
was performed subsequently and showed a strongly
278
enhancing mass with well-circumscribed margin.
Patient underwent US-guided fine needle aspiration
biopsy and surgical excision and the final diagnosis
was PTC in lymph node. The repeated histopathologic examination of previous thyroidectomy specimen showed no evidence of primary PTC. We finally concluded that it was PTC arising from ectopic
thyroid tissue in cervical lymph node.
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Ultrasound and MRI Findings of the Solitary
Subcutaneous Neurofibroma: a Case Report
Da Mi Kim
A neurofibroma is a benign nerve sheath tumor in
the peripheral nervous system. Solitary isolated neurofibroma of the subcutaneous layer not associated
with neurofibromatosis type I (von Recklinghausen
disease) is even more infrequent. The exact cause of
solitary neurofibroma remains unknown. It has been
postulated that solitary neurofibroma is hyperplastic
hamartomatous malformations rather than a neoplasm. We reviewed a 19-year-old man with an
uncommon solitary subcutaneous neurogenic tumor.
The patient presented with painless palpable mass
in the paramedian infranasal area in 3 months.
Ultrasonography demonstrated a 1.8×0.8×1.7 cm,
ovoid shaped, heterogeneously hypoechoic lesion in
the subcutaneous layer (between dermis and orbicularis oris muscle) of philtrum area. Color Doppler
and Power Doppler ultrasound revealed marked
hypervascularity. There was no distinct close contact
with the peripheral nerve bundle. T2-weighted
images showed slightly high signal intensity in the
region which was iso signal intensity to adjacent
muscle on T1-weighted images. T1-weighted contrast-enhanced fat suppressed images showed strong
enhancement of the lesion. Complete surgical excision was done. Histopathology composed of
Schwann cells, perineural cells, and fibroblasts consistent with neurofibroma.
Scientific Exhibits
Musculoskeletal
SE 098
Evaluation of Medial Patellofemoral Ligament
Tears after Acute Lateral Patellar
Dislocations: Comparison of High-frequency
Ultrasonography and MR
Guang Ying Zhang1, Lei Zheng2, Hong Yu Ding1,
Hao Shi1
1
Department of Radiology, Qianfoshan Hospital of
2
Department of Radiology, Shandong Provincial Corps
Hospital of Chinese People's Armed Police Force, China
SE 099
Evaluation of Articular Cartilage Lesions
after Acute Lateral Patellar Dislocations:
Comparison of High-frequency
Ultrasonography and MR
Guang Ying Zhang1, Lei Zheng2, Hong Yu Ding1,
Hao Shi1
1
Department of Radiology, Qianfoshan Hospital of
2
Department of Radiology, Shandong Provincial Corps
Hospital of Chinese People's Armed Police Force, China
OBJECTIVES: To compare the diagnostic performance of high-frequency ultrasonography with MR
in the evaluation of articular cartilage lesions after
acute lateral patellar dislocation (LPD).
MATERIALS AND METHODS: Ninety-seven consecutive patients with acute LPD who had undergone high-frequency ultrasonography and MR were
included in this study. Arthroscopy or arthrotomy
performed within 2 weeks of the imaging, was used
as reference standard. In each patient, ultrasound,
MR images were retrospectively evaluated by two
radiologists. Sensitivity, specificity and accuracy of
high-frequency ultrasonography and MR were compared by using the Chi-square test.
RESULTS: Thirty-four cases of chondral lesion and
twenty-seven cases of osteochondral lesion occurred
at the medial patellar facet. Fifteen cases of chondral
lesion and twenty-one cases of osteochondral lesion
occurred at the lateral femoral condyle. The sensitivity, specificity, accuracy regarding chondral and
osteochondral lesion of the medial patella were 50%,
77.78%, 64.28% and 74.07%, 77.78%, 76.19% for
high-frequency ultrasonography; 70.59%, 88.89%,
80% and 92.59%, 88.89%, 90.48% for MR, respectively. The sensitivity, specificity and accuracy
regarding chondral and osteochondral lesion of the
279
Scientific Exhibits
OBJECTIVES: To compare the diagnostic performance of high-frequency ultrasonography with MR
in evaluation of medial patellofemoral ligament
(MPFL) lesions after acute lateral patellar dislocation
(LPD).
MATERIALS AND METHODS: Ninety-seven consecutive patients with acute LPD who had undergone high-frequency ultrasonography and MR were
included in this study. Arthroscopy or arthrotomy
performed within 2 weeks of the imaging was used
as the reference standard. For each patient, ultrasound and MR images were retrospectively evaluated by two radiologists. Sensitivity, specificity and
accuracy of high-frequency ultrasonography and MR
were compared by using the Chi-square test.
RESULTS: Fifty-three cases of complete MPFL tear
and 41 cases of partial MPFL tear were identified in
operation. At 28.9%, it occurred in more than 1
localization. Among a total of 291 sites, 127 showed
proven MPFL tear, including 51 sites of complete
tear and 76 sites of partial tear. Overall, 54 sites of
MPFL tear located at their femoral attachment, 47
sites of tear at patellar attachment and 26 sites of
mid-substance tear. On a site-based analysis, the sensitivity, specificity, accuracy regarding partial and
complete MPFL tear were 90.8%, 96.3%, 94.6% and
86.3%, 96.3%, 94% for high-frequency ultrasonography; 81.6%, 95.7%, 91.3% and 80.4%, 95.7%, 92.1%
for MR, respectively. There was no statistic difference in sensitivity, specificity and accuracy between
high-frequency ultrasonography and MR in the
assessment of partial and complete MPFL lesions
(P=0.1, 0.777, 0.155) and (P=0.425, 0.777, 0.449).
Interobserver agreement was very good for high-frequency ultrasonography and good for MR.
CONCLUSION: Data suggest that high-frequency
ultrasonography and MR have similar diagnostic
performance for the evaluation of MPFL tears after
acute LPD.
KSUM Open 2014
lateral femoral condyle were 20%, 85.25%, 72.36%
and 19.05%, 85.24%, 68.29% for high-frequency
ultrasonography; 75.33%, 93.44%, 89.47% and
85.71%, 93.44%, 91.46% for MR, respectively.
Compared with US, MR showed higher accuracy in
diagnosis of chondral and osteochondral lesion of
the medial patella, higher sensitivity and accuracy in
diagnosis of chondral and osteochondral lesion of
the lateral femoral condyle. Interobserver agreement
in the assessment of articular cartilage lesion of the
medial patella and lateral femoral condyle were fair
and fair for high-frequency ultrasonography; good
and very good for MR, respectively.
CONCLUSION: MR provided superior diagnostic
performance in the evaluation of articular cartilage
lesions after acute LPD, including interobserver
agreement, compared to high-frequency ultrasonography.
SE 100
Musculoskeletal Applications of Supersonic
Shear Imaging (SSI): Pictorial Essay
Hung Nguyen
Vietnam
PURPOSE: To apply the supersonic shear imaging
(SSI) technique to musculoskeletal disorders in the
situation of clinical utility is yet to be established.
MATERIALS AND METHODS: A pictorial essay
presentation using conventional ultrasound and SSI
technique with the linear probe (4-15 MHz) of the
Supersonic Imagine System, AiXplorer. The range
we used was 0-180 kPa. Using a Qbox of 1 cm in
diameter, elasticity values were measured. The
results were confirmed by MRI and histopathologic
correlations later.
RESULTS: The present pictorial essay includes rotator cuff tears, supraspinatus, Achilles tendinosis,
plantar fasciitis, synovitis, soft tissue lesions (inflammatory myositis, muscle tuberculosis).
CONCLUSION: SSI technique can be used for various musculoskeletal applications. SSI is able to provide quantitative and local elastic information in real
time. Further multicenter studies with the
histopathological correlation need to be performed
280
in order to establish the clinical utility of supersonic
shear imaging.
REFERENCES: 1/ Minoru Shinohara, Karim Sabra,
Jean-Luc Gennisson, Mathias Flink and Mickael
Tanter: Real-Time Visualization of Muscle Stiffness
Distribution with Ultrasound Shear Wave Imaging
During Muscle Contraction, Muscle & Nerve Month
2010.
SE 101
Developmental Dysplasia of the Hip of High
Risk Neonates in an Outpatient Clinic
Chau Tran Ngan, Hung Nguyen Thien,
Hai Phan Thanh
Vietnam
OBJECTIVE: The aim of this study is shown the
roles of ultrasound in detecting and following-up in
the developmental dysplasia of the hip (DDH).
MATERIALS AND METHODS: A cross- sectional
prospective study of ultrasound on 1,622 hip joints
of 811 under-9-month-old babies who have high risk
(family history of DDH, breech presentations, club
foot deformity or metatarsus adductus on clinical
examination…). We use the Graf’s method (alpha
and beta angle) and the Terjesen’s method (the proportion of femoral head coverage) for investigation
the studied population.
RESULTS: Of 190/ 1622 (11.71%) was detected
DDH, dominant type through females (78/1622 or
4.8% males and 119/ 1622 or 7.33% females) and
affected on the left hip joints approximately 3 times
more than the right one (71.26% vs. 25.15%). Relying
on Terjesen’s method (the proportion of femoral head
coverage < 37%) the proportion of DDH is 160/1622
(9.68%) and Graf's method (the alpha angle < 43
degree) the proportion of DDH is 91/1622 (5.61%)
while using both methods it is 61/811 (3.76%).
Although the alpha angle > 43 degree, of 60/ 1622
(3.69%) was detected DDH on physical examination
and recovered after treatment.
CONCLUSION: US plays an important role in
detecting and following-up DDH in early days after
birth, instead of screening with the standard pelvis
X-ray. Terjesen’s method is easier to apply than
Scientific Exhibits
Graf’s method.
SE 103
SE 102
Sonographic Evaluation of Plantar Fasciitis
and Relation to Body Mass Index and Heel
Pad Thickness
Sonographic Diagnosis of Occult Talar
Fracture
Chia-Yu Hsu1, Yi-Pin Chiang2
1
Department of Rehabilitation Medicine,
Ten-Chan General Hospital, Taiwan
2
Department of Rehabilitation Medicine,
Mackay Memorial Hospital, Taiwan
OBJECTIVES: To study the sonographic appearance of plantar fascia in clinically suspected cases of
plantar fasciitis using both qualitative and quantitative parameters; and to establish the correlation
between plantar fasciitis, body mass index and heel
pad thickness.
MATERIALS AND METHODS: In this case controlled analytical study, we evaluated sonographically 100 consecutive patients with plantar fasciitis
(unilateral: 90, bilateral:10 with mean age 46.92
years) and control group of 60 (120 heels) healthy
volunteers with mean age 45.3 years. Plantar fascial
thickness, heel pad thickness, decreased echogenecity, biconvexity, perifascial fluid, intrafascial
calcification and subcalcaneal spurs were evaluated
sonographically. The plantar fascia thickness was
measured 5 mm distal to insertion of the calcaneus
of plantar aponeurosis. The unloaded heel pad thickness was measured from the skin surface to the
nearest calcaneal tuberosity.
RESULTS: Mean plantar fascia thickness was greater
on the symptomatic side for patients with bilateral
and unilateral plantar fasciitis than on the asymptomatic side for patients with unilateral plantar fasciitis, and also control subjects (4.41±0.59, 4.63±0.55,
2.83±0.36, 2.62±0.37 mm, respectively).
The heel pad thickness was also greater on the symptomatic side for patients with bilateral and unilateral
plantar fasciitis than on the asymptomatic side for
patients with unilateral plantar fasciitis, and also control subjects (17.64±1.07, 17.28±1.10, 16.91±1.06,
16.73±1.13 mm, respectively) (p<0.0001).
Mean BMI values of the case and control groups
were 26.14±1.9 and 24.42±0.89 kg/m2, respectively
(p<0.05).
Qualitative parameters of plantar fasciitis were also
positively correlated in the plantar fasciitis group.
281
Scientific Exhibits
PURPOSE: To investigate whether comprehensive
scanning with high-resolution ultrasound (US) can
aid in the diagnosis of occult talus fractures in
patients with negative X-ray findings.
MATERIALS AND METHODS: We retrospectively searched the musculoskeletal US database of
patients with negative X-ray findings and talus fracture in a tertiary hospital of Northern Taiwan from
December 1, 2008, to September 30, 2013. Patients
who had negative standard anterior-posterior and
lateral views of radiographs were included. We then
reviewed the image studies and medical records for
these patients. From this database, we reviewed the
ultrasonographic descriptions of the location of talar
fracture and its associated findings, such as ligamentous injury, anterior tibio-talar joint recess effusion,
or hematoma.
RESULTS: Among 55 patients (32 males) aged 1869 years who has sonographic diagnosis of talus fracture, 38 demonstrated significant fracture.
Significant fracture of lateral process had the largest
number (44.7%, 17/38), followed by medial process
(34.2%, 13/38), talar head (7.9%, 3/38) ranked the
third. Insignificant fracture or bony irregularity was
noted as followed: medial process (29.4%, 5/17), lateral process (29.4%, 5/17), talar dome (17.6%, 3/17)
and head (17.6%, 3/17).
CONCLUSION: It is found that comprehensive
scanning of talus with high-resolution US can aid in
the diagnosis of occult talus fractures in patients
with negative X-ray findings. The two most common
sites of occult talar fracture are lateral and medial
process. Routine coronal sonograms over lateral and
medial process of the talus are suggested in scanning
ankle joint.
Kamal Subedi1, Prashant Khatiwada2
1
Department of Radiology, Tribhuvan University
Teaching Hospital, Kathmandu, Nepal
2
Department of Radiology, Kanti Children's Hospital,
Kathmandu, Nepal
KSUM Open 2014
CONCLUSION: Sonography remains an useful tool
in diagnosis of plantar fasciitis. Both qualitative and
quantitative parameters can be used to characterize
inflamed plantar fascia.
SE 104
Comparison of the Capsular Thickening in
Patients with Adhesive Capsulitis and
Spastic Hemiplegic Shoulder Using
Ultrasound
Kwang Jae Lee, Yong-Soon Yoon, Ki Pi Yu,
Eun Sil Kim
Department of Rehabilitation Medicine, Presbyterian
PURPOSE: To compare the capsular thickening at
the rotator cuff interval between affected and unaffected shoulder in patients with adhesive capsulitis
(AC) and spastic hemiplegic shoulder (HS) using
ultrasound.
MATERIALS AND METHODS: 10 patients with
AC and 12 patients with HS having less than poor
grade of shoulder muscle power and more than
grade 1 of modified Ashworth scale (MAS) at the
affected upper limb and more than 1 month duration after stroke were enrolled. The thickness of the
rotator cuff interval (RCI) was measured on RCI on
the both shoulder.
RESULTS: Age was 53 ± 6.2 years in AC and 68 ±
11.8 years in HS, disease duration was 6.5 ± 7.2
months in AC and 2.9 ± 2.3 months in HS. In HS,
the average MMT was trace and the average MAS
was grade 2. Shoulder passive external rotation,
internal rotation and abduction range of motion of
the affected side were significantly decreased than
those of the unaffected side (P<0.05). The thickness
of capsule of affected side at the RCI was markedly
increased in AC (2.05 ± 0.41 mm vs. 1.31 ± 0.24
mm) (P<0.05), but no significant change on both
side in HS (1.25 ± 0.37 mm vs. 1.28 ± 0.30 mm).
CONCLUSION: (1) Capsular thickening can be a
main cause of limitation of range of motion (LOM)
of the shoulder in AC. (2) LOM of the shoulder was
not related to the capsular thickening in HS. (3)
Ultrasound can be useful to evaluate the capsular
thickening at the RCI.
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SE 105
Diagnostic Value of the Ultrasound in
Patients with Various Causes of Median
Neuropathy Around the Wrist
Yong-Soon Yoon, Kwang Jae Lee
Department of Rehabilitation Medicine, Presbyterian
LEARNING OBJECTIVES: To recall the normal
and ultrasound (US) anatomy of the median nerve
around the wrist. To present the US finding of various causes of the median neuropathy around the
wrist.
BACKGROUND: Median entrapment neuropathy
at the wrist, known as carpal tunnel syndrome, is
the most common type of compressive neuropathy,
resulting from nerve compression in the carpal tunnel, which causes paresthesia, pain, numbness, and
weakness in the distribution of the median nerve.
But we can find several different causes of median
neuropathy around the wrist during ultrasound
examination. Accurate diagnosis can lessen patient
discomfort and lead to the correct choice of the
appropriate treatment (surgical versus medical).
Peripheral nerve evaluation represents probably one
of the best applications of musculoskeletal ultrasound (MSUS) since recent high-frequency broadband transducers and US can detect subtle abnormalities of nerve and adjacent structures. Dynamic
examination is also available and is a peculiar advantage of MSUS. Median neuropathies due to various
causes can be assessed by MSUS if the examiner has
a great knowledge of the anatomy, uses a standardized technique of examination and has a clinical
knowledge of the main disorders affecting them.
IMAGING FINDINGS OR PROCEDURE
DETAILS: In the first part, I present the normal and
US anatomy of median nerve around the wrist using
comprehensible, annotated drawings and sonograms. Then, I illustrate various causes of neuropathy using US images stored in my patient examination files, associated with schematic drawings to
increase comprehension of the US images.
CONCLUSION: US allows an accurate assessment
of various causes of median neuropathy around the
wrist. When experienced operator exams them using
a high-resolution equipment, MSUS can detect a fine
Scientific Exhibits
and subtle structural abnormality and also well correlate with electrodiagnostic study.
CONCLUSION: US-guided injection therapy may
be useful and effective in patients with piriformis
syndrome.
SE 106
Effects of Ultrasound-Guided Steroid
Injection Therapy in Patients of Piriformis
Syndrome
SE 107
Hee Seok Jeong, Guen Young Lee, Eu Gene Lee,
Eu Gene Joe, Joon Woo Lee, Heung Sik Kang
Jung Eun Lee1, Kyung Nam Ryu1, Ji Seon Park1,
So Hee Yoon2, So Young Park2, Wook Jin2
1
2
PURPOSE:
1. To review the pathophysiology, etiologic conditions, clinical manifestations, and natural histories
of superficial thrombophlebitis.
2. To describe the sonographic findings of superficial
thrombophlebitis with some sample cases involving various part of body.
CONTENTS ORGANIZATION:
1. Pathophysiology and underlying etiologic conditions
2. Clinical manifestations (with complications)
3. Diagnosis : the role of sonography and its imaging
findings
- diagnostic confirmation
- extent
- exclusion of deep vein thrombosis
- associated complications
- follow-up
4. Sample cases
5. Differential diagnosis
6. Natural history and prognosis
7. Management
SUMMARY: The superficial thrombophlebitis has
been considered as a benign condition which can be
caused by idiopathic as well as secondary to systemic disease or local trauma. It can accompany
deep vein thrombosis or pulmonary thromboembolism as a complication. The clinical examinations
usually reveal relatively typical appearance of a tender ‘wormlike’ mass deep to the skin with warmness
or redness. The ultrasonography, however, provides
very useful additional information, such as the
283
Scientific Exhibits
PURPOSE: This study was conducted to retrospectively analyze the effectiveness of ultrasound-guided
steroid injection therapy in patients of piriformis
syndrome based on the follow-up records up to
three years.
MATERIALS AND METHODS: The therapeutic
effect was assessed with a total of 67 patients having
clinical piriformis syndrome who were referred to
the Department of Radiology for injection therapy as
outpatients at one tertiary care facility from January
2010 to October 2012, using medical records retrospectively. The ultrasound-guided steroid injection
therapy was performed by laying a patient on a bed
in the prone position, verifying the piriformis muscle, and then puncturing with a 22G-spinal needle
with the guidance of an ultrasonic scope to inject triamcinolon 40 mg. The therapeutic effect was
defined as improvement, partial improvement, and
failure depending on the degree of symptom alleviation within one month. The therapeutic effect was
defined as recurrence when the pain was exacerbated.
RESULTS: Among the 67 patients, 23 patients
(34.3%) had improvement, 18 patients (26.9%) partial improvement and 26 patients (38.8%) failure as
an early therapeutic effect. There was no recurrence. The therapy was performed again with four
of the patients who showed impartial improvement.
When the second therapy was performed within
three years from the first therapy, two patients
showed improvement but the other two patients did
not show any therapeutic effect. According to the
medical records, there was no recurrence for the
second therapy within three years.
Superficial Thrombophlebitis: Sonographic
Features and Clinical Implications
KSUM Open 2014
lesion extent, associated complicated conditions, or
follow-up images of superficial thrombophlebitis as
well as diagnostic confirmation. The recognition of
the clinical implications and sonographic imaging
features of thrombophlebitis involving the various
part of the body may helpful to confirmative diagnosis and clinical management of patients.
SE 108
Variable Ultrasonographic Findings of
Lymphoma in Musculoskeletal System
SeongJin Kim1, Sun Joo Lee1, Hye Jung Choo1,
Young Mi Park1, Hae Woong Jeong1, Kil Ho Cho2,
Sung Moon Lee3, Jae Hyuck Yi4
1
Hospital, Korea
2
Department of Radiology, Yeungnam University
3
Department of Radiology, Keimyung University
Dongsan Medical Center, Korea
4
Department of Radiology, Kyungpook National
PURPOSE: Lymphoma arises in lympho-reticular
tissue anywhere in the body and can involve any
part of musculoskeletal system but it is distinctly
uncommon. The purpose of this exhibit is to illustrate variable US features of lymphoma in the musculoskeletal system and to correlate with other imaging modality and pathologic findings.
reviewed retrospectively gray-scale and color
Doppler US findings of various musculoskeletal lymphoma involving lymph node, muscle, subcutaneous
tissue or peripheral nervous system. And these findings are correlated with other imaging modality such
as CT, MR or PET. All cases were confirmed by needle or excisional biopsy.
RESULTS: Musculoskeletal lymphoma is a heterogeneous disease and can involve more than one
anatomical compartment and not lead to destruction
of an anatomic structure. Thus, imaging manifestations vary among the different modalities. In focal
muscle involvement of lymphoma, US shows
homogenously hypoechoic mass with prominent
vascularity. In diffuse muscle involvement of lym-
284
phoma, US shows diffuse swelling and decreased
echogenicity with preservation of internal muscle
fibers and hypervascularity, which looks like myositis. In subcutaneous panniculitis-like T-cell lymphoma which is rare subtype and often confused
with inflammatory panniculitis, US shows poorly
defined and homogeneous hyperechogenicity in the
subcutaneous fat layer with relative hypervascularity. If patients have persistent symptoms or increased
extent of the lesion despite treatment for myositis or
panniculitis, biopsy should be performed to rule out
lymphoma. In peripheral nerve lymphoma, US
shows diffuse thickening of the peripheral nerve and
a surrounding hypoechoic mass which encases
whole neurovascular bundle with thickening of the
enveloping fascia, and reveals hypervascularity.
CONCLUSION: Through the review of this exhibit,
musculoskeletal lymphoma covers a broad spectrum
of imaging manifestations. Familiarity with US and
the other imaging manifestations of musculoskeletal
lymphoma is important for detecting and characterizing of the lesion and improving diagnostic accuracy.
SE 109
How Many Each Portion of DVT Mimicking
Disease in Patients Who Were Clinically
Suspected DVT?
Dong Joo Kang, Sun Joo Lee, Hye Jung Choo,
Sang Suk Han, Hae Woong Jeong, Yeong-mi Park
Hospital, Korea
PURPOSE: Deep vein thrombosis (DVT) is the formation of a blood clot in deep vein, predominantly
in the legs. DVT is presented by clinical sign, such as
pain, swelling, redness, and etc. However many
other diseases are also presented as clinical signs.
The purpose of this article is to evaluate DVT mimicking disease in clinical practice by using ultrasonography.
MATERIALS AND METHODS: From January
2004 to February 2014, total 652 patients were taken
ultrasound owing to clinically suspected DVT.
Ultrasound was done bilaterally or unilaterally
according to clinical sings. Total 314 patients were
taken bilaterally and 338 patients unilaterally.
Scientific Exhibits
Patients with DVT were evaluated. And other diseases are classified into seven categories: ruptured
baker’s cyst, infection and inflammation, lymphatic
condition, neoplasm, soft-tissue hydrostatic edema
secondary to cardiac and renal failure, hematoma,
and miscellaneous (vasculitis, Klippel-Trenaunay
syndrome, pseudoaneurysm, and etc).
RESULTS: Total 109 patients had DVT by bilateral
ultrasound. Other patients had ruptured baker’s cyst
in 26 (23.9%), lymphatic condition in 25 (22.9%),
soft-tissue hydrostatic edema in 25 (22.9%), infection
and inflammation in 12 (11%), hematoma in 9
(8.3%), neoplasm in 3 (2.8%), and miscellaneous in 9
(8.3%). Total 120 patients were excluded DVT by
unilateral ultrasound. Other patients had infection
and inflammation in 29 (24.2%), lymphatic condition
in 24 (20%), especially lymphedema in 9, hematoma
in 20 (16.7%), ruptured baker's cyst in 15 (12.5%),
soft-tissue hydrostatic edema in 14 (11.7%), neoplasm in 5 (4.7%), and miscellaneous in 13 (10.8%).
CONCLUSION: DVT is suspected by clinical sings.
But many other diseases can be mimicking DVT.
Therefore, it is important to make every effort to
establish a diagnosis when DVT is ruled out. The
key to making a precise diagnosis is recognizing the
characteristics of various diseases on US images.
three times. We evaluated the thickness, morphology
and echogenecity of SCM on grayscale images and
color patterns on elastography. Also, one rehabilitation doctor investigated the degree of head tilting
and limitation of neck rotation through the chart
review and graded the clinical improvements. We
evaluated the correlations between US findings and
clinical findings by statistical analyses.
RESULTS: The month interval of US follow-up was
at least 6 months in each patient. 16 babies had right
SCM torticollis and 9 had left. The difference
between right and left SCM thickness was mean 5.7
mm (1.3-8.6 mm) at initial examination and mean
2.8 mm (0.5-5.8 mm). 20 babies had focal or multifocal thickening of SCM and 5 had diffuse thickening at initial examination and only 4 had focal thickening at 2nd follow-up. All babies showed increased
echogenecities of thicken SCM compared with normal muscular structures at initial examination and
increased echogenecities with variable degrees at
2nd follow-up. The sonoelastography showed mainly
blue color in all patients except two at initial examination and increased green color in all except one.
CONCLUSION: The color pattern of sonoelastography was significantly correlated with clinical
improvement of congenital SCM torticollis
SE 110
SE 111
The Efficacy of Sonoelastography in the
Evaluation of Congenital
Sternocleidomastoid Muscle Torticollis
Is Ultrasound Able to Diagnose Chest Wall
Malignancy: A Two-case Review
You Seon Song , In Sook Lee , Se Kyoung Park
1
Department of Radiology, Pusan National University
Hospital, Korea
2
Department of Radiology, Kosin University Gospel
Hospital, Korea
1
1
2
CASE 1
CLINICAL: A 43-year-old female with stage T1N1
right breast cancer and underwent modified mastectomy plus axillary dissection in November 2003.
Patient had post-surgery chemotherapy lasted 2
years and annual PET-CT for monitoring. Latest
PET/CT (in September 2013) showed a hypermetabolic lesion at anterior 4/5 th right rib. Physical exam
found a tender, protuberant spot on anterior right
chest.
ULTRASOUND: A heterogeneous focus in the
intercostal muscle, 2.01 × 0.9 cm in size. It was ill-
285
Scientific Exhibits
PURPOSE: To evaluate the efficacy of sonoelastography in the evaluation of congenital sternocleidomastoid muscle (SCM) torticollis.
MATERIALS AND METHODS: From November
2012 to February 2014, 25 baby patients (17 male, 8
female; age range, 1 month - 24 months) with congenital SCM torticollis performed ultrasonographic
(US) examinations including elastography. 17 babies
had two times follow-up US examinations and 8 had
Li Song
Department of Radiology, Beijing United Family
Hospital, China
KSUM Open 2014
defined, irregular with microcalcifiations. CDFI
showed scattered color flow signals in the lesion.
PATHOLOGY: Surgical biopsy demonstrated invasive breast carcinoma.
CASE 2
CLINICAL: A 40-year-old male presented with a
hard lump on lateral aspect of left chest for one
month. No history of trauma. Physical exam
revealed a “hard nodule, not fixed to the overlying
skin”.
ULTRASOUND: A hypoechoic nodule in left lateral
chest wall. It located in the intercostal muscle, 2.8×
1.9×1.2 cm in size. It was well defined with homogeneous internal texture and posterior enhancement.
PATHOLOGY: Ultrasound guided biopsy demonstrated nodular fasciitis.
DISCUSSION: Our limited experience showed that:
1) The general differential rules of ultrasound for
breast and thyroid nodules are well known,
including: benign lesions are often well-define,
homogeneous texture, and with posterior
enhancement, where malignant lesions are illdefined, irregular in shape and heterogeneous.
These rules apply in evaluating chest wall lesions
2) The importance of patient's medical history can
never be underestimated.
3) Metastatic lesion often presents the features of its
original tumor - the microcalcifications in lesion
(case 1) raised strong suspicion of malignancy
though mastectomy was completed 10 years ago.
In summary, ultrasound may play an active role in
diagnosing chest wall lesion. To conclude confidently, further investigation is expected in larger case
volume and boarder spectrum of abnormalities.
SE 112
Sonographic Diagnosis of Patellar Clunk
Syndrome a Rare Complication after Total
Knee Replacement
Vince Lau1, PK Chan2
1
Department of Radiology, Queen Mary Hospital,
Hong Kong
2
Department of Orthopedic Surgery, Queen Mary
Hospital, Hong Kong
Patellar clunk syndrome is a rare complication
286
after total knee replacement. It is characterized by
painful, jerky movement of the patella upon knee
extension from a flexed position. The cause of this
symptom is due to the formation of intra-articular
fibrous nodule at the junction between the undersurface of quadriceps tendon and superior pole of the
patella. This presentation illustrates the role of ultrasound in diagnosing the disease.
A 71-year old man had history of bilateral total
knee replacement (press-fit condylar prosthesis) for
one year. After the operation, he complained of persistent right knee pain with jerky patellar movement
on extension at 45 degrees from flexed position.
Sonographic assessment revealed an echogenic
lesion immediately underneath the distal quadriceps
tendon and abutting the proximal pole of the patella.
The overall clinical and sonographic appearances are
compatible with patellar clunk syndrome. The
patient underwent arthroscopy, confirming the diagnosis by discovering a hyperplastic nodule at superomedial part of patella. The nodule was resected and
clinically the patient improved.
Another case of clinically suggestive patellar clunk
syndrome, comparing the diagnosis by MRI and US,
would also be included in the presentation. It
demonstrated that US gives a better assessment of
the size of the fibrous nodule, is more cost-effective,
and has the benefit of real-time functional assessment of the clicking movement.
SE 113
Giant Cell Tumor of the Femur Detected by
Ultrasound: A Case Report
Liem Le Thanh, Hai Phan Thanh
Vietnam
INTRODUCTION: Giant cell tumor of the bone is
an uncommon tumor. This is usually regarded as
benign and detected by radiology. We report the case
of a patient with a giant cell tumor in the femur
detected by ultrasound. We have not found any published cases describe ultrasound images of this type
tumor.
CASE PRESENTATION: A 35-year-old male
patient, left thigh swelling for 6 months.
Scientific Exhibits
Conventional ultrasound (B mode and Doppler,
Aloka System SSD-5000) detected bone lesions at
one third lower left femur, hypoechoic, 10×3×3.6
cm in size, well-defined, osteonecrosis with hypervascular, thin and bulge cortical bone interspersed
with cystic structures, producing images like honeycomb, eccentric, invasive the surrounding soft tissue
with two hypoechoic nodules 16 and 27 mm in the
muscle and subcutaneous layer. Combined with
extended field of view technique, using software
iScape, Mindray system DC-6, creating the image of
the lesion, similar to radiologic images. Radiographic
findings of left femur showed thin and bulge cortical
bone, like honeycomb, clearly limits, eccentric, suggested giant cell tumor. However, unclear invasive
soft tissue images. Bone scan detecting radiation
lesion (Technitium Tc - 99 m) in the one third lower
left femur. MDCT showed thighs hurt third lower
left femur, made lacking the intra-marrow bone
cliques, breaking the bone crust 7×8 cm in size and
infiltrating the soft tissue, limits unknown. There
were calcifications into the bone marrow. Surgical
biopsy was done. The result of histopathology was a
giant cell tumor type II of the femur.
CONCLUSION: This was the first description of
ultrasound findings of a giant cell tumor of the
femur with trespassing on the soft tissue and ultrasound images have characteristics similar to X ray.
REFERENCES: Daniele Vanni, Giant cell tumor of
the distal ulna: a case report, Journal of Medical
Case Reports 2012;6:143.
SE 114
Sparganosis of Upper Extremity in
Subcutaneous and Intramuscular Layers
SE 115
Arm Muscle Injury Finding Correlation
Between US and MR
Dal Soo Park
Department of Radiology, S-Seoul Hospital, Korea
Recently US territory are marked expanded and
now a day US use as a primary diagnostic tool in all
over the medical field. But US was not usually used
in arm muscle evaluation. Recently I have been
experienced exciting US finding about arm lesion
such as transient compartment syndrome in biceps
muscle, triceps muscle, brachialis muscle partial tear
and very extensive olecranon abscess forming bursitis. And I would want to show my US imaging correlation with MR imaging findings. My case will be
helpful and interesting for every day practice US
MSK beginner.
Scientific Exhibits
Sung Hee Park1, Hyo Min Lee2, Yu Mi Jeong2
1
Hospital, Korea
2
Department of Radiology, Gachon University Gil
Hospital, Korea
are definitive hosts. The parasite is typically transmitted to humans by three modes: ingestion of contaminated water, contact with raw snake or tadpoles
or following the topical application of infested flesh
as a poultice. Once humans become infected, the
plerocercoid larvae may migrate to a subcutaneous
location and produce a painful nodular lesion.
Radiological and serological techniques can provide
useful diagnostic clues of sparganosis. We report a
case of repeating sparganosis initially presenting as a
subcutaneous mass but later manifesting as an intramuscular mass in the upper arm. This case showed
the characteristic and distinctive ultrasonographic
findings of sparganosis. Ultrasonographic features of
sparganosis are very characteristic and distinguishable, so ultrasound imaging can be a clue for diagnosis of sparganosis.
Sparganosis is an infection caused by sparganum,
a plerocercoid larva of a cestode belonging to the
genus Spirometra Spargana. Humans are the accidental, second or third intermediate host in the cestode life cycle, while dogs, cats and other mammals
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KSUM Open 2014
SE 116
Imaging Features of Proliferative Myositis:
a Case Report
Pediatric
Donghyun Kim, Hye Jung Choo, Sun Joo Lee,
Young Mi Park, Dong Wook Kim, Yoon Nae Seo,
Sang Suk Han
Hospital, Korea
SE 118
Proliferative myositis is a rare benign inflammatory myopathy characterized by infiltration with
basophilic giant cells and proliferative fibroblasts. It
is classified as pseudosarcomatous myofibroblastic
proliferation along with proliferative fasciitis and
nodular fasciitis. Because of its rapid growth and its
cellularity, the condition can be confused with sarcoma leading to unnecessary, aggressive surgical procedures. Although definite diagnosis can be made by
the pathologic studies, variable radiologic studies
including ultrasonography and magnetic resonance
imaging can aid in the diagnosis. We report a case of
proliferative myositis involving the elbow with the
characteristic imaging features using ultrasonography and magnetic resonance imaging.
SE 117
Compared with Ultrasound and MRI in
Patient with Achilles Tendon Rupture
JoonBum Koo, Sungwon Kim
Department of Radiology, Dongguk University Medical
Center, Korea
Pediatric Cystic Renal Diseases and Tumors:
Focus on the Spectrum
Taeil Han1, Eunkyeol Han2
1
Department of Radiology, University of North Carolina
at Chapel Hill, USA
2
Chapel Hill High School, USA
PURPOSE: To demonstrate the cystic renal diseases
and tumors focused on the spectrum.
1. Autosomal Recessive Polycystic Kidney Medullary sponge kidney: complete/ partial
medullary involvement with/without cortical
involvement
2. UPJ obstruction - Multicystic Dysplatic Kidney
3. Autosomal Recessive Polycystic Kidney Congenital hepatic fibrosis: Ductal plate malformation
4. Cystic Nephroma - Cystic partially differentiated
nephroblastoma - Cystic Wilms tumor
5. Multilocular cystic renal tumor - Pleuropulmonary
blastoma
SUMMARY
This exhibit will review:
1. To understand the spectrum of several cystic renal
diseases.
2. To review ductal plate malformation.
3. To demonstrate the spectrum of cystic renal
tumors.
The Achilles tendon, also known as the tendo
Achilles, tendo calcaneus or calcaneal tendon, is the
longest tendon of the body, formed by the union of
the lower aspect of calf muscles. Achilles tendon
rupture can occur at any age, but most often occurs
in 30-50 year-old recreational athletes. We reviewed
complete or partial rupture of Achilles tendon, tendinosis, gastrocnemius muscle tear, retrocalcacaneal
bursitis, and xanthoma of Achilles tendon.
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Scientific Exhibits
SE 119
Doppler Sonographic Evaluation of
Nutcracker Syndrome in Children:
Comparison Between the Right Flank View
and Anterior Abdominal View
Young Hun Choi, Jung-Eun Cheon,
Hyun-Hae Cho, So Mi Lee, Woo Sun Kim,
In-One Kim
Hospital, Korea
SE 120
Intraoperative Neurosonography Revisited:
an Effective Neuronavigation
Jung-Eun Cheon1, In-One Kim1, Young Hun Choi1,
So Mi Lee1, Hyun Hye Cho1, Seung- Ki Kim2,
Ji Hoon Phi2, Woo Sun Kim1
1
Hospital, Korea
2
Department of Neurosurgery, Seoul National University
Hospital, Korea
Intraoperative real-time ultrasonography of the
brain is a practical and highly effective method of
imaging that can aid the pediatric neurosurgeon by
providing:
1. Guidance for intraventricular catheter placement
2. Localization of juxtacortical lesions
3. Monitoring the surgical field
This review demonstrates representative cases of
intraoperative neurosonography a neuronavigation
for localization of focal cortical dysplasia and juxacortical benign or malignant tumors. We will also
demonstrate several cases of intraventricular
drainage procedures beyond the lateral ventricle.
SE 121
Ultrasonographic Diagnosis of OvaryContaining Hernias of the Canal of Nuck
Dal Mo Yang, Hyun Cheol Kim, Sang Won Kim
PURPOSE: The purpose of this study is to describe
the ultrasonographic findings of ovary-containing
hernias of the canal of Nuck.
MATERIALS AND METHODS: This was a retrospective analysis of 22 hernia cases of the canal of
Nuck. The following gray scale and color Doppler
ultrasonographic features were analyzed: the site
and the size of hernia, the texture of hernia contents,
and the presence or absence of blood flow of hernia
contents.
RESULTS: All patients had swelling of the right
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Scientific Exhibits
PURPOSE: To evaluate the usefulness of the right
flank view in Doppler sonographic examination of
children with clinically suspected Nutcracker syndrome.
MATERIALS AND METHODS: From June 2013 to
March 2014, renal Doppler ultrasonography was
performed in 37 children with clinically suspected
Nutcracker syndrome. Doppler spectral waveforms
of the left renal vein (LRV) at the aortomesenteric
portion were repeatedly obtained both by the right
flank view (with the transducer placed on the right
flank) and the anterior abdominal view (with the
transducer placed on the right or left subcostal area).
The following values from two views were compared by using a paired t-test; 1) the mean peak
velocity (PV), 2) the standard deviation of the PVs of
LRV at the aortomesenteric portion, 3) the mean
ratio of the PVs between the aortomesenteric and
hilar portion, 4) the mean Doppler angle.
RESULTS: In six patients, obtaining Doppler spectral waveform of LRV from the right flank view was
failed due to bowel gas or large body habitus, while
Doppler spectrum acquisition from the anterior
abdominal view was failed in two children. The
right flank view was associated with the significantly smaller mean PV (111.6±48.0 vs. 71.7±27.9
cm/sec), the smaller standard deviation of the PVs
(23.4±16.8 vs. 5.7±4.9 cm/sec) of LRV at the aortomesenteric portion, the smaller mean PV ratio (5.6
±3.0 vs. 3.6±1.6) and the lower mean Doppler
angle (65.7±5.3 vs. 5.2±4.4º, all p<0.0001).
CONCLUSION: The right flank view yielded smaller, but more consistent PV values of LRV at the aortomesenteric portion with lower Doppler angles,
compared with the classic anterior abdominal view,
even though the right flank view has some limitation
in children with large body habitus.
KSUM Open 2014
inguinal region (n = 10), left inguinal region (n = 8),
or both (n = 2). On ultrasonography, the hernias
appeared as either solid masses (n = 17) or solid
masses containing cysts (n = 5). The mean anteroposterior diameter of the hernia sac of the canal of
Nuck was 9.1 mm (range, 5-18 mm). The mean
anteroposterior diameters of the hernia sac were
11.6 mm (range, 7.6-18 mm) for hernias containing
ovary, and 8.3 mm (range, 5-13 mm) for hernias
containing omental fat. During surgery, among the
17 cases with solid appearing hernia contents on
ultrasonography, omental fat was identified in the
hernia sac in four cases, but no structure was identified in 13 cases. All five cases that appeared as solid
masses containing cysts on ultrasonography contained ovary tissue in the hernia sac. Among the
four cases of ovary-containing hernias, color Doppler
ultrasonography identified blood flow within the
ovary in three cases, but no flow signal was seen in
one case of incarcerated hernia.
CONCLUSION: Ultrasonography may be helpful
for the diagnosis of ovary-containing hernias of the
canal of Nuck by detecting solid masses containing
small cysts.
SE 122
Lumps and Bumps in the Groin in Children
Hee Mang Yoon, Young Ah Cho, Jin Seong Lee,
Hye Kyung Yoon, Ah Young Jung,
Chong Hyun Yoon
Pediatric inguinal swelling occurs mostly from
inguinal hernias, especially in boys. However, various lesions can be found in the inguinal or groin in
boys as well as girls. Therefore, it is important to
consider the different features and characteristics of
masses in the inguinal or groin area to exclude other
causes, such as congenital anomalies, infections, and
neoplasms. Ultrasound is the modality of choice for
initial evaluation of inguinal swelling in children.
Therefore, it is essential for radiologists to be familiar with imaging features of various inguinal lesions.
In this exhibit, we will systematically review diverse
causes of inguinal swelling in boys and girls. We will
illustrate imaging features according to causes of
290
inguinal swelling. Moreover, we will provide radiologists with a practical approach to inguinal swelling,
which differs in boys and girls.
Contents/Outline
1. Anatomy of inguinal area
2. Cause of inguinal swelling in boys and girls
Inguinal hernia/femoral hernia
Inguinal lymphadenopathy or lymphadenitis
Spermatic cord hydrocele
Testes: retractile, ectopic, or undescended
Various tumors: lipoblastoma, lymphangioma,
lymphoma
3. Imaging features according to the causes of
inguinal swelling
4. Summary
SE 123
Abernethy Malformation: One of the Rare
Cause of Hepatopulmonary Syndrome
Vikas Jhanwar, Nitin Mishra, Sunil Agrawal,
Anu Bhandhari, Amrita Maheshwari,
Darshan Koshiya, Rengarajan Rajagopal
Department of Radiology, SMS Medical College, Jaipur
(rajasthan), India
Hepatopulmonary syndrome (HPS) is the clinical relationship between hepatic disease and the
existence of pulmonary vascular pathology, which
can result in a range of arterial oxygenation abnormalities. Abernethy malformation is characterized
by congenital diversion of portal blood away from
the liver, by either end-to-side or side-to-side extra
hepatic porto-systemic shunt. Here, we report a case
of 4-year old-girl who had clubbing since 3 years and
recently developed dyspnea and did not have any
other pulmonary or cardiac signs or symptoms. She
had imperforate anus at birth. Colour Doppler USG
& CT SCAN showed the presence of extra hepatic
portal-venous shunt with absence of intrahepatic
portal vein. We concluded that the patient had
Hepatopulmonary syndrome caused by
Abernethy malformation type Ib. Abernethy
malformation must be included as one of the etiologies of hepatopulmonary syndrome which can be
associated with imperforate anus. These are rare
anomalies and to the best of our knowledge, this is
Scientific Exhibits
the first case reported with both anomalies
associated together. Although Abernethy malformation is a rare anomaly, it must be recognized early
to prevent the consequences of metabolic derangements by appropriate surgical treatment. Imaging
plays a vital role in the diagnosis, determination of
type of shunt and follow up of Abernethy malformation.
Robust Flow Detection in Ultrasound
Color Flow Imaging: a Real-Time GPU-Based
Eigen-Filter Approach
Using our framework, real-time CFI generation
throughputs were realized when it was executed on
a six-GPU array. The throughput results were based
on practical frame sizes (with >10000 pixels) and
slow-time ensemble lengths (16 samples). The
framework was applied to an experimental scenario
an elastic flow phantom model of known operational
behavior (5 MHz frequency; 20 dB clutter-to-blood
signal ratio; 2 mm/s max tissue velocity; 38 cm/s
max flow velocity). Using a receiver operating characteristic analysis approach, we found that our
framework has achieved high flow detection sensitivity (area under curve was always >0.9) when
operating in real-time range. This demonstrates that
real-time robust CFI detection in the presence of tissue motion can be practically realized.
Adrian J. Y. Chee, Billy Y. S. Yiu, Alfred C.H. Yu
Department of Medical Engineering, The University of
Hong Kong, Hong Kong
SE 125
Physics
SE 124
A New Feature-enhanced Speckle Reduction
Method Based on Multiscale Analysis and
Synthesis for Ultrasound B-mode Imaging
Jinbum Kang, Yangmo Yoo
Department of Eletronic Engineering, Sogang University,
Korea
Effective speckle reduction in ultrasound B-mode
imaging is important for improving image quality
and the accuracy in image analysis. While multiscale
analysis-based speckle reduction methods such as
Laplacian pyramid nonlinear diffusion (LPND) and
nonlinear multiscale wavelet diffusion (NMWD)
showed enhanced speckle reduction, they suffer
from excessive blurring and artificial appearance. In
this paper, a new feature-enhanced speckle reduction (FESR) method based on multiscale analysis and
feature enhancement filtering is presented for ultrasound B-mode imaging.
To separate true clinical features (e.g., boundaries
of lesions) from noise, the sub-band images from a
Laplacian pyramid model are firstly generated.
Then, a robust anisotropic diffusion process is
applied to suppress the identified noise and the
extracted features are selectively emphasized by
edge, coherence and contrast enhancement filtering
from fine to coarse scales. In vivo abdominal images
of 30 consecutive frames were captured with a com-
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Scientific Exhibits
In color flow imaging (CFI), eigen-filters with
attenuation response adapted to clutter statistics are
well regarded as powerful techniques for achieving
high flow detection sensitivity even when tissue
motion is present. To put this technical benefit into
practice, it is important to incorporate eigen-filtering
solutions as part of the CFI processing routine on
ultrasound scanners. However, this is not straightforward.
Here, we have formulated a new technical framework that enables fast execution of eigen-filtering in
CFI. It incorporates three principles: (1) pursuing a
parallel computing approach that is becoming
mature with the advent of GPUs; (2) adopting the
single-ensemble (Hankel-SVD) eigen-filter paradigm
that is algorithmically compatible with parallel computing; (3) applying mature eigen-computation algorithms. For each CFI pixel, its flow estimates were
derived by processing the pixel's slow-time ensemble as follows. First, the SVD of the slow-time
ensemble's Hankel matrix was computed using a
GPU algorithm that includes the steps of
Householder Transform, QR decomposition, and
Givens rotation. After that, the power and mean frequency of each eigen-component were estimated in
parallel. Adaptive filter order selection was then
applied to extract the flow eigen-components.
KSUM Open 2014
mercial ultrasound system from the liver area of a
volunteer, and the captured images were transferred
to an external PC for processing.
For quantitative analysis, the performance of the
proposed FESR method was compared with the
LPND and NMWD methods by measuring speckle
signal-to-noise ratio (SSNR) and contrast-to-noise
ratio (CNR). With the FESR method, the mean SSNR
value and the mean CNR value are significantly
higher compared to the LPND and NMWD methods, i.e., 8.06±0.74 vs. 5.69±0.48, 7.14±0.93 and
6.89±0.68 vs. 5.08±0.33, 6.01±0.53, respectively.
Under visual assessments, the proposed FESR
method clearly depicts boundaries of lesions while
substantially reducing speckle, compared to other
two methods.
These preliminary results demonstrate that the
proposed FESR method can improve the image quality of ultrasound B-mode imaging by enhancing the
visualization of borders and boundaries of lesions
while effectively suppressing speckle.
SE 126
Performance Evaluation of PVDF Single
Element Transducers with Different Backing
Materials
Jun Su Lee, Jin Ho Chang
Department of Electronic Engineering, Sogang
University, Korea
As a molecular imaging modality, photoacoustic
microscopy (PAM) imaging uses acoustic waves generated inside the absorbers of incident laser energy.
An ultrasound transducer detects the laser-induced
acoustic waves, i.e., photoacoustic signals. The spatial resolution of photoacoustic microscopy (PAM)
images is typically determined by the ultrasound
transducer. Therefore, we selected a polyvinylidene
fluoride (PVDF) single element transducer. PVDF
has a relatively high receiving constant (g33), low
acoustic impedance, and low dielectric constant. In
fabrication of a PVDF transducer, a matter of great
importance is the selection of backing material. If
backing material has acoustic impedance larger than
PVDF, it presented the downshift of center frequency and the lowering of bandwidth. In this paper, the
292
suitable the backing layer material properties are
experimentally investigated to solve the problems.
The PAM transducer is preferred to have the center frequency, the -6 dB bandwidth, and the receive
sensitivity as high as possible. For this, we selected
three backing layer materials (EPO-TEK 301, E-SOLDER 3022, and RTV). The pulse-echo characteristics
of the PAM transducers were measured in order to
evaluate their performance. A commercial
pulse/receiver system (UT340, UTEX Scientific
Instruments Inc) excited the transducer and received
ultrasound reflected signals from the focal point.
The received signal was stored using an oscilloscope
(TDS5054, Tektronics Inc).
RTV material property was due to the rubber that
is weak role of the backing layer. RTV backing layer
has lower attenuation coefficient in the materials.
So, the center frequency and -6 dB bandwidth were
higher than other transducers. However, the pulseecho signal magnitude of the RTV backing layer
transducer was the smallest one. Consequently,
EPO-TEK 301 backing layer is the best material for a
PAM transducer that is a key element to improve a
pulse-echo signal magnitude, center frequency, -6
dB bandwidth characteristics.
SE 127
Quantitative Image Quality Evaluation of
Ultrasound Imaging Systems
Hyeongmin Jin, Jong Hyo Kim, Myung Eun Lee
Hospital, Korea
Ultrasound imaging is known to be a powerful tool
with non-invasive and non-ionizing radiation in diagnosis, but objective criteria have not yet been fully
developed in image quality assessment. This study
presents a quantitative metric for assessing the
image quality and compares the results in three different ultrasound imaging systems. A Gammex
403GS LE multi-purpose: phantom (Gammex RMI,
Middleton, WI) was scanned with three different
ultrasound systems (iU22 xMATRIX, Philips, Aplio
XG, Toshiba, E-CUBE 15, Alpinion) at base band
mode and harmonic mode. The Fourier metrics of
modulation transfer function (MTF) and noise power
Scientific Exhibits
spectrum (NPS), indicating spatial resolution and
noise, respectively, were used for the image quality
evaluation. 2D MTF, which represents axial and lateral resolutions, was measured on the beads located
in the axial direction. 2D NPS was computed from
the 2D Fourier transform on two background ROIs,
one is for near field and the other is for far field, to
determine the different noise patterns depending on
depth. For vendor A, the spatial resolution was preserved at the far field as well as near field in harmonic mode. For other two systems, the 2D MTF
graphs were degraded in high frequency, especially
lateral resolution, at the far field. For vendor B, the
band of NPS was the narrowest in the 3 vendors and
the noise magnitude showed lower up to 70% in
base band mode. Our study represents the feasibility
for an objective metric on clinical evaluation of
ultrasound image quality and compares the results
of three different ultrasound imaging systems. The
objective metrics could improve the accuracy of
image quality prediction in ultrasound imaging.
SE 128
A New Smart Probe System for a Tablet
PC-based Point-of-Care Ultrasound Imaging
System: Feasibility Study
Yeongnam Lee1, Jeeun Gang1, Sunmi Yeo1,
Jaejin Lee1, Gi-Duck Kim2, Yangmo Yoo1,
Tai-Kyong Song1
1
University, Korea
2
Sogang Institute of Advanced Technology, Sogang
University Research Foundation, Korea
SE 129
Selective Thermal Therapeutic of Deep-lying
Tissue by Combining Laser and Ultrasound
Energies
Heamin Kim1, Jin Ho Chang2
1
Interdisciplinary Program of Integrated Biotechnology,
2
Sogang Institute of Advanced Technology, Sogang
University, Korea
Photothermal therapy is performed by converting
laser radiation into heat owing to the absorption of
the photons in tissue chromophores. While laser
radiation passes through a medium, the laser energy
decreases due to the absorption and scattering of the
laser in tissue. This causes the limitation of penetration depth and ineffective thermal therapy. To over-
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Scientific Exhibits
There is a growing interest in a smart ultrasound
probe system wirelessly connected to a mobile
device (e.g., smartphone and tablet PC) for point-ofcare ultrasound imaging due to its enhanced accessibility. In this paper, the feasibility of a smart ultrasound probe system, in which transmit and receive
modules along with a digital receive beamformer are
embedded, is demonstrated. In the smart probe, two
eight-channel high-voltage pulsers with transmit/
receive switch (MAX14808, Maxim Integrated, San
Jose, CA, USA) and two analog-to-digital converter
(AFE5808, Texas Instruments, Dallas, TX, USA) are
embedded. The transmit/receive beamforming and
mid processing blocks are implemented on a single
low-cost field programmable gate array chip (Spartan
6 LX150, Xilinx Inc., San Jose, CA, USA). The complex base-band data after quadrature demodulation
are transferred to the commercial tablet PC (ATIV
Smart PC, Samsung Electronics, Seoul, Korea) via
the USB 3.0 interface. The tablet PC handles ultrasound back-end processing (i.e., envelope detection,
log compression, image filtering, and digital scanline
conversion) and image display with graphical user
interface (GUI). To evaluate the performance of the
proposed smart probe system, the phantom study
with a commercial linear array probe (L5-13IS,
Samsung Medison, Seoul, Korea) and a phantom
(ATS539. ATS Laboratories, Inc., Bridgeport, CT,
USA), was conducted. The developed smart probe
system with the size of 150 mm× 50 mm× 10 mm,
the weight of 100 g and total power consumption of
7 W can support 32-channel dynamic receive beamforming with an extended aperture technique while
providing the frame rates of 11 Hz for the 4-cm
imaging depth with 128 scanlines. These results indicate that the developed smart probe system connected to a general tablet PC can support point-of-care
ultrasound imaging. The further evaluation of the
developed system, e.g., wireless communication, is
under investigation.
KSUM Open 2014
come the limitation, we propose a dual thermal therapeutic method in which both laser and ultrasound
(US) energies are simultaneously transmitted for
selective treatment of deep-lying tissue. In the proposed method, the US energy plays a role in increasing the local temperature of the treatment area, but
the temperature rise is limited to the threshold level
for tissue damage. Under this condition, laser energy
is delivered into the treatment area, thus causing the
temperature to surpass the threshold for coagulation
necrosis only within the tissue chromophores.
Effects of dual thermal therapy were ascertained
using a tissue mimicking phantom consisting of scattering and absorbing sections. US energy was produced using an 1.1 MHz single element transducer
with 62.5 mm focal depth and 20 mm central opening. Laser energy was delivered by Nd:YAG laser
system: 1064 nm wavelength, 10 nm pulse length,
and 10 Hz PRF.
Through this study, it was verified that the depth of
lesion formation was increased by 1.6 mm in the
case of simultaneous delivery of both laser energy of
73.5 mJ/cm2 and US energy of 200 W/cm2, compared
with the laser energy alone. Also, it was ascertained
that the US energy allowed more laser influence to
pass through the phantom. The results demonstrate
that, because two energies are complementary in
elevation of tissue temperature, the therapeutic
depth by the laser energy increases under US exposure. Its penetration depth also increases in conjunction with US, which is beneficial for photodynamic
therapy using photosensitizers.
the 3D Cartesian coordinate system. These 3D SC
methods can visualize an arbitrary plane for 3D
ultrasound volume data. However, they suffer from
blurring and blocking artifacts due to resampling
during SC. In this paper, a new multi-planar reconstruction method based on voxel based beamforming
(VBF) is proposed for reducing blurring and blocking
artifacts. In VBF, unlike direct and separable 3D SC,
each voxel on an arbitrary imaging plane is directly
reconstructed by applying the focusing delay to
radio-frequency (RF) data. To evaluate the proposed
VBF method, pre-beamformed RF data were captured by a 7.5-MHz linear array transducer connected to the commercial ultrasound system from a tissue mimicking phantom (Model 050, CIRS Inc.,
Norfolk, VA, USA). The linear transducer was linearly translated by the motion-controlled motion stage.
The direct 3D SC and VBF methods were implemented on GPU by using CUDA programming. The
proposed VBF method shows the higher contrast
and less blurring compared to the separable and
direct 3D SC methods. This result is consistent with
the measured information entropy contrast (IEC) values, i.e., 98.9 vs. 42.0 vs. 47.9, respectively. The execution times for the VBF and direct 3D SC methods
are 1633.3 ms and 1631.4 ms, which are I/O bounded. These results indicate that the proposed VBF
method can improve image quality of 3D ultrasound
B-mode imaging by removing blurring and blocking
artifacts associated with 3D scan conversion.
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SE 130
A New Multi-planar Reconstruction Method
Using Voxel Based Beamforming for 3D
Ultrasound Imaging
Hyun Seok Ju1, Jae Hee Song2, Yangmo Yoo1
1
Department of Electronic, Sogang University, Korea
2
2Medical Solutions Institute, Sogang Advanced Institute
Technology, Korea
For multi-planar reconstruction in 3D ultrasound
imaging, direct and separable 3D scan conversion
(SC) have been used for transforming the ultrasound
data acquired in the 3D polar coordinate system to
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Color Twinkling Enhanced by a Controlled
External Mechanical Excitation
Jeonghwa Yang1, Gwansuk Kang2, Minjoo Choi2
1
Department of Radiotechnology, Cheju Halla University,
Korea
2
Department of Biomedical Engineering, Jeju National
University, Korea
Color twinkling, a rapidly changing mixture of red
and blue colors, often appear in the color Doppler
mode of ultrasonography, for a hyper-echogenic target, even if it is stationary. It has been revealed that
the color twinkling has clinical potential in confirming various pathological sites associated with calculi,
Scientific Exhibits
calcifications, cacinoses and fibroses which are
inconclusive in conventional grayscale sonograms.
This study proposes a technique to enhance the contrast of the color twinkling.
The technique involves the capture of a serious of
images throughout an external minor impact to a target. In this study, color Doppler images were
obtained for a stationary echogenic circular contrast
(+15dB, +6, and +3dB) targets (LCS, Model 551
Small parts phantom, ATS Lab. Inc., USA), with a
clinical ultrasonic scanner (GE Voluson-e with 12L
linear probe, GE Medical, USA). The color twinkling
was observed to be sparse before the target was
excited by an impact hammer (2302-100, Meggitt
sensing system, USA) attached with an accelerometer (3109 front-end, B & K, Denmark). However, the
image was entirely occupied by colors twinkling at
the moment of impact, and was gradually recovered
back. The color disappearance was much faster on
the background than the target +15dB. There is a
time for observation at which the contrast in twinkling colors for the target is maximized is subject to
the mechanical excitation.
This finding suggests that well controlled mechanical excitation to either a target or an ultrasonic probe
and freezing image at an observation time may significantly enhance the contrast twinkling colors,
when color twinkling is clinically informative.
SE 132
running on a smart mobile device with high-performance mobile central processing units (CPUs) and
graphics processing units (GPUs) is demonstrated
for point-of-care ultrasound imaging where automation of user control is critical. For real-time realization of the ADRA method on a high-end smartphone, the OpenGL ES cross-platform graphics
application processing interface was used. To accelerate the performance of the mobile GPU embedded
in the mobile device, ultrasound core mid and backend processing tasks, including ADRA, are divided
into multiple software pipelines and the load operation for accessing the frame buffer by the mobile
CPU is minimized. 200 frames of in vivo abdominal
data were acquired with a 3.5-MHz convex array
transducer from with a commercial ultrasound scanner equipped with a research package (Accuvix V10,
Samsung Medison, Seoul, Korea).
The performance of the real-time ADRA method
on the smart phone was evaluated by measuring the
contrast-to-noise ratio (CNR) and frame rates. The
ADRA method showed the improved image quality
compared to the conventional method (CON) with a
fixed 60 dB DR value. The CNR values of the CON
and ADRA methods were 3.35±0.89 vs. 3.89±0.71,
respectively. In addition, the frame rates of the CON
and ADRA methods were 74.12±24.7 Hz vs. 60.51
±11.51 Hz, respectively. These results indicate that
the ADRA method can be incorporated in the smartphone-based point-of-care ultrasound imaging system while providing enhanced image quality and
lowered user dependency.
A Real-time Realization of an Automatic
Dynamic Range Adjustment Method on
a Smart Mobile Device for Point-of-Care
Ultrasound Imaging
SE 133
Jeehoo Kim, Yeonhwa Lee, Yangmo Yoo
Phantom and In Vivo Evaluation of Sound
Speed Estimation Methods: Preliminary
Results
Sound speed is the essential parameter that affects
image quality in ultrasound B-mode imaging. The
constant sound speed corresponding to soft tissues
(e.g., 1540 m/s) is typically used, but its performance
degrades because of the disparity in sound speed
295
Scientific Exhibits
In ultrasound imaging, dynamic range (DR) is the
essential parameter that affects image quality and
feature representation. Previously, the automatic DR
adjustment (ADRA) method, in which DR value is
adaptively adjusts based on the analysis of reference
and input image, was proposed for improved clinical
productivity and lowered user dependency. In this
paper, the feasibility of a real-time ADRA method
Sooah Cho, Jeeun Kang, Yangmo Yoo
KSUM Open 2014
between soft tissue and fatty layers. Various sound
speed estimation (SSE) methods were proposed, but
these methods have not been extensively evaluated.
In this paper, five different SSE methods were evaluated with tissue mimicking phantom and in vivo
breast studies. The five SSE methods, i.e., coherent
factor (CF), minimum average phase variance
(MAPV), minimum average sum of the absolute difference (MASAD), focus quality spectra (FQS) and
edge conspicuity using modified nonlinear
anisotropic diffusion (MNAD), were implemented
on MATLAB (Mathworks Inc., Natick, MA, USA).
For quantitative evaluation, pre-beamformed radiofrequency data were acquired from a tissue mimicking phantom (ATS549, ATS Laboratories Inc.,
Bridgeport, CT, USA) with the mean sound speed of
1450 m/s and from a patient with breast lesions by a
7.5-MHz linear array transducer connected to the
ultrasound research platform (SonixTouch,
Ultrasonix, Vancouver, BC, Canada). The five SSE
methods show the comparable performance with
the tissue mimicking phantom (i.e., 1450 ± 25 m/s).
The CF and FQS methods also show the lower
errors with the in vivo breast data, but, the MAPV,
MASAD and MNAD methods have difficulty in estimating the optimal sound speed in image quality
(i.e., 1530 m/s) i.e., 25.0 ± 12.9 and 20.0 ± 8.2 vs.
72.5 ± 45.0, 72.5 ± 41.9, 52.5 ± 28.7, respectively.
These results indicate that the previously-proposed
CF and FQS methods can robustly determine the
optimal sound speed for the phantom and heterogeneous tissues (e.g., breast). The further evaluation
with breast in vivo data is under investigation.
transducers, however, an unrealistic for HIFU transducers because it needs at least thousands of elements due to the large aperture size. Therefore a
random sparse array (RSA) is widely used as a HIFU
transducer. Although RSAs have shown good performance in GL suppression, it has limitations in element size and inter-element separation due to random distribution of elements. In this paper, we proposed a 2D circular sparse array (CSA) in which elements are distributed on the center of a circular
aperture and concentric circles with radii which
equally divide the radius of an aperture into equal
distances. On each circle, the first element is placed
randomly and other elements are distributed around
the center of a circular aperture in concentric circles
with radii which divide the radius of aperture with
equal distance. The sidelobe and grating lobe of
beams produced with CSA can be separately controlled to have desired levels by adjusting the radial
and circular element spacings (i.e., RES and CES).
For the performance evaluation, three kinds of 2D
transducers (i.e., uniform array, RSA and CSA) with
same number of elements (566) and aperture size (40
mm diameter) were designed and then their field
patterns and resultant temperature distributions
were compared through simulation. Undesirable
heating by GLs are observed when UA is used. On
the contrary in CSA as well as RSA, only target area
was heated over 60℃ since GLs were effectively
suppressed. From results, it was shown that GL suppression of CSA was comparable to RSA. Moreover,
element size and inter-element distance of CSA can
be controlled more freely than those of RSA, leading
to an optimized beam profile.
SE 134
A 2-D Circular Sparse Array for HIFU
Transducer
Jae Hee Song1, Tai-Kyong Song2
1
Medical Solutions Institute, Sogang Institute of
Advanced Technology, Korea
2
The half wavelength element spacing requirement
must be satisfied to be free of high grating lobes
(GLs). This criterion can be met easily for imaging
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Scientific Exhibits
SE 135
A New Phase Rotation Beamforming (PRBF)
Based on a Polyphase Delay Filter:
Preliminary Results
Gunho Lee1, Jongho Park1, Jeeun Kang1,
Jaejin Lee1, Yangmo Yoo2, Tai-kyong Song1
1
Department of Electronic Engineering, Signal
Processing & System Lab, Medical Solutions Institute,
2
Interdicsiplinary Program of Integrated Biotechnology,
Medical Solutions Institute,
SE 136
Adaptive Sound Speed Correction for
Medical Ultrasound Imaging:
Preliminary Results
Sewoong Ahn1, Jeeun Kang1, Tai-Kyong Song1,
Yangmo Yoo2
1
University, Korea
2
Department of Interdisciplinary Program of Integrated
Biotechnology, Sogang University, Korea
In examining obese patients, spatial and contrast
resolutions of ultrasound imaging are severely deteriorated when a constant sound speed corresponding
to soft tissues (1540 m/s) is applied due to phase
aberration. To overcome phase aberration, for a single region-of-interest (ROI), various sound-speed-correction (SSC) methods have been proposed.
However, the improvement in image quality from
the SSC methods with a single ROI is still limited. In
this paper, a new adaptive-SSC (ASSC) method with
a bilayer-tissue model is presented for transabdominal imaging of obese patients.
In the ASSC method, two ROIs in the lower layer
are pre-determined, and the two sound speeds are
estimated by an iterative approach. The optimal
speed in the lower layer is determined by considering the sound speeds and distance ratio between
ROIs. Then, the sound speed in the upper layer is
independently estimated with a single ROI. The
upper and lower images are reconstructed with the
estimated sound speed and these images are blended. For quantitative evaluation, radio-frequency data
were obtained by a commercial US-research package
(SonixRouch, Ultrasonix Corp., Canada) and a linear
probe (L14-5/38) from a gel-pad (Parker Lab. Inc.,
USA)-stacked, tissue-mimicking phantom (ATS
Laboratories Inc., USA). The sound speeds of the gel
pad and the phantom are 1610 m/s and 1450 m/s,
297
Scientific Exhibits
Dynamic receive beamforming (DRBF) is important for improving spatial resolution and SNR in US
imaging. To enhance time delay accuracy in DRBF,
interpolation and phase rotation are widely used
(IBF and PRBF, respectively). Compared to IBF, the
PRBF has a potential to substantially reduce the
hardware complexity by lowering the data rate close
to f0. However, it suffers from the degraded spatial
resolution due to the wide bandwidth of the
received signals. In this paper, a new PRBF method
based on a polyphase-delay-filter (PRBF-PDF) is presented for ultrasound imaging.
The proposed PRBF-PDF method utilizes the
polyphase-delay-filter to increase the accuracy in
focusing delay computation by 4 f0, compared to f0
in PRBF-CON without increasing the data rate. Also,
with phase rotation, the total delay accuracy
becomes 16 f0. To evaluate the proposed PRDF-PDF
method, the Field II simulation was conducted with
an 8.0-MHz linear transducer. The complex baseband data (i.e., inphase and quadrature components)
were generated with the sampling frequency of 40
MHz and the 128 channels. The point spread functions are obtained by the IBF, PRBF-CON and PRBFPDF methods for the wire target located at 25 mm
of five wire targets were positioned from 15 mm to
55 mm. For quantitative evaluation, -6-dB lateral resolutions for the PRBF-CON and PRBF-PDF methods
were compared with the reference, i.e., IBF. This
result indicate that the proposed PRBF-PDF method
shows the comparable image quality with the IBF
method. On the other hand, the PRBF-CON method
suffers from the degraded spatial resolution. Unlike
PRBF-CON, the proposed PRBF-PDF method pro-
vided the comparable lateral resolution to the IBF
method after the transmit focal point at 25 mm.
These results indicate that the proposed PRBF-PDF
method can provide comparable image quality to the
IBF method while substantially reducing the hardware complexity.
KSUM Open 2014
respectively.
Under visual assessments, the ASSC method
shows the improvement in image quality for all
three wire targets. It is consistent with the measured
lateral resolutions. For example, the lateral resolution from the ASSC method is 0.60 mm compared to
the conventional and SSC methods, i.e., 0.75 mm
and 0.86 mm, respectively, for the wire target at 12
mm. These results indicate that the ASSC method
can improve image quality in a bilayer-tissue model.
The further evaluation of the ASSC method is still
under investigation with in vivo abdominal data.
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ZBF-LI, ZBF-NLI) while varying the allowance error
from 0.25 to 1.0. the proposed ZBF-NLI method provides the fewer zones for each allowance error than
that of the ZBF-LI method (e.g., 136 vs. 2048 zones
for 0.25). The proposed ZBF-NLI method shows the
more comparable image quality with the CON
method than ZBF-LI method, which is consistent
with the PSNR (i.e., 13.7 dB vs. 21.4 dB for ZBF-LI
and ZBF-NLI). Also, the proposed ZBF-NLI method
only requires 6.9% of memory needed in the ZBF-LI
method. These results indicate that the proposed
ZBF-NLI method can improve image quality in the
zone-based method while substantially lowering the
hardware complexity (i.e., memory size) for point-ofcare ultrasound imaging.
A New Nonlinear Zone-based Beamforming
Method for Point-of-Care Ultrasound Imaging
Pilsu Kim1, Jeeun Kang1, Jaejin Lee1, Gi-Duck Kim2,
Yangmo Yoo1, Tai-kyong Song1
1
2
Sogang Institute of Advanced Technology, Korea
It is important for reducing the hardware complexity of an ultrasound dynamic receive beamformer
for point-of-care ultrasound imaging systems. While
the previously-proposed linear zone-based beamforming (ZBF-LI) method that piecewisely interpolates receive delays between predetermined zones
can substantially lower the complexity, it degrades
image quality in the near field. In this paper, a new
nonlinear zone-based beamforming (ZBF-NLI)
method, which can decrease delay errors in the near
field while reducing the hardware complexity, is proposed. In the proposed ZBF-NLI method, the optimal length of each zone is dynamically determined
to limit the delay error below the allowance error
(i.e., 0.25 for 16 f0 delay resolution at 4 f0 sampling).
The ZBF-NLI method was implemented on the lowcost FPGA (Spartan 6, Xilinx Inc.). To evaluate the
proposed ZBF-NLI method, the Field II simulation
was conducted by considering the system specification of the portable US imaging system (i.e., 7.5MHz linear array with 40-MHz sampling). The peak
signal-to-noise ratio (PSNR) was measured for the
conventional dynamic receive focusing (CON) and
the linear and nonlinear zone-based methods (i.e.,
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Thyroid
SE 138
Infiltrative Pathologies of Thyroid Gland:
Hard to Ignore-difficult to Diagnose
Shenaz Momin1, Asif Momin2, Roshni Chinoy3,
Avinash Gutte4
1
Department of Radiology, Nair Hospital and T N
Medical College, India
2
Department of Radiology, Prince Aly Khan Hospital,
India
3
Department of Pathology, Prince Aly Khan Hospital,
India
4
Department of Radiology, Grant Medical College and
J J Group of Hospitals, India
The purpose of this study is to familiarize with
unusual specific infiltrative thyroid abnormalities
which could be mistaken for routine subacute nonspecific thyroiditis or its sequalae. In a head and
neck imaging unit ultrasound of thyroid and adjacent neck nodes was done; multiple unusual thyroid
infiltrative abnormalities were identified which
posed as an initial diagnostic challenge. These were
evaluated using biopsy, FNAC and other corroborative imaging studies like CT, MR or radiographs as
and when required to understand the extent and distant associated abnormalities.
Various specific abnormalities were histologically
proven as Langerhans cell histiocytosis, Non
Scientific Exhibits
Hodgkin's lymphoma of thyroid, Riedel's thyroiditis,
thyroid abscess following extension of Ludwig's
angina in a known diabetic and intrinsic and extrinsic tuberculous thyroid involvement. All these cases
in retrospect have specific imaging clues but were
difficult to diagnose without histological help. Hence
to conclude thyroid imaging is incomplete without
considering specific uncommon infiltrative and
infective abnormalities which could be mistaken and
treated as nonspecific form of thyroiditis. Ultrasound guided biopsy and FNA play definitive diagnostic role.
roid nodules.
CONCLUSION: ARFI can be performed in thyroid
nodule with reliable results. The combination of
VTQ and VTI might give a better differentiation of
benign and malignant thyroid nodules. Larger studies are awaited.
SE 140
Benign Lesions That Mimic Thyroid
Malignancy on Ultrasound
Dong Wook Kim
Hospital, Korea
SE 139
Acoustic Radiation Force Impulse Imaging of
Thyroid Nodules at Medic Medical Center,
Ho Chi Minh City
Khanh Vo, Hung Nguyen
Vietnam
SE 141
Ultrasound-based T Staging in Preoperative
Papillary Thyroid Microcarcinoma Patients
Dong Wook Kim, Sun Jeong Moon
Hospital, Korea
PURPOSE: This study aimed to assess the diagnostic accuracy of ultrasound (US)-based T staging of
papillary thyroid microcarcinoma (PTMC).
MATERIALS AND METHODS: From January
2013 to June 2013, a total of 185 patients underwent
preoperative thyroid US for the treatment of thyroid
malignancy. A single radiologist immediately determined sonographic T staging for PTMC under realtime US examination. The diagnostic accuracy of
sonographic T staging for PTMC and the difference
in the frequency of level VI node metastasis accord-
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Scientific Exhibits
PURPOSE: The aim of the present study was to
evaluate the VTQ of normal thyroid tissues, benign
and malignant thyroid nodules. Besides, VTI (Virtual
Touch Tissue Imaging) of ARFI-Imaging was
assessed in these objects as well.
MATERIALS AND METHODS: One hundred and
thirty nodules underwent conventional ultrasound,
including Color Doppler ultrasound using a 7.5 MHz
linear transducer. Next, nodule stiffness were measured and assessed by VTQ and VTI of ARFIImaging (Acuson Siemens S2000). FNAC (Fine needle aspiration cytology) under ultrasound guide was
used as reference method for the diagnosis of benign
and malignant thyroid nodules.
RESULTS: 103 benign and 27 malignant thyroid
nodules. The median velocity of ARFI-imaging in the
normal tissue as well as in benign and malignant
nodules was 1.51 m/s (range 0.84-3.00 m/s), 2.15
m/s (range 0.8-4.04 m/s), 3.21m/s (range 0.9-9.22
m/s), respectively. At the cut-off of 2.16 m/s, the sensibility and specificity in differentiation of benign
and malignant thyroid nodules were 79.4% and
53.7% (AUROC =0.731, p<0.0001). Chi-square statistic showed there was a relationship between VTI
and the differentiation of benign and malignant thy-
Ultrasound (US)-guided fine-needle aspiration (USFNA) is widely used for the diagnosis of thyroid
nodules. However, US-FNA and other biopsies are
unnecessary or should be avoided in some cases.
These lesions that can mimic malignancies on US
can be classified into the following categories: (1)
inflammatory thyroid abnormalities, (2) non-pathologic thyroid or perithyroidal abnormalities, (3)
fibrotic collapse of benign cystic or solid thyroid
nodules, and (4) abnormal perithyroidal structures.
Awareness about these lesions, facilitates the choice
of the most appropriate diagnostic tool.
KSUM Open 2014
ing to the T stage of PTMC were evaluated.
RESULTS: Among 185 patients, 105 cases of PTMC
(57.1%) were found. The preoperative sonographic
diagnoses of the 105 PTMC cases included intraglandular location (n=35), subcapsular location (n=30),
mild capsule abutment (n=7), moderate capsule
abutment (n=19), and perithyroidal invasion without adjacent strap muscle invasion (n=14). The
histopathological results of all PTMC cases revealed
intraglandular confinement (n=66), only capsule
invasion (n=13), and extrathyroidal fat invasion
(n=26). When the sonographic T stages were compared with histopathological results, all the sonographic categories showed a high specificity and low
sensitivity. There was no significant relationship
between level VI node metastasis and histopathological T stage (p = 0.2631).
CONCLUSION: The present sonographic T staging
may be useful for preoperative evaluation in PTMC
patients.
SE 142
Shear Wave Elastography of Thyroid Nodules
in a Large Scale Study: Is it a Predictor of
Thyroid Malignancy?
Ah Young Park , Eun Ju Son , Kyunghwa Han ,
Ji Hyun Youk1, Jeong-Ah Kim1, Cheong Soo Park3
1
Department of Radiology, Gangnam Severance
Hospital, Korea
2
2Biostatistics Collaboration Unit, Gangnam Medical
Research Center, Gangnam Severance Hospital, Korea
3
Department of Surgery, Gangnam Severance Hospital,
Korea
1
1
2
PURPOSE: To validate the usefulness of shear wave
elastography (SWE) in predicting thyroid malignancy
with a large-scale quantitative SWE data.
MATERIALS AND METHODS: This was an institutional review board-approved retrospective study
with waiver of informed consent. 476 thyroid nodules in 453 patients who underwent gray-scale US
and SWE before US-guided fine-needle aspiration
biopsy (US-FNA) or surgical excision were included.
Gray-scale findings and SWE elasticity indices (EIs)
were retrospectively reviewed and compared
between benign and malignant thyroid nodules. The
300
optimal cut-off values of EIs for predicting malignancy were determined. The diagnostic performances of
gray-scale US and SWE for predicting malignancy
were analyzed and compared between the gray-scale
US findings only and the combined use of gray-scale
US findings with SWEs.
RESULTS: All EIs of malignant thyroid nodules
were significantly higher than those of benign (P ≤
.001). The optimal cut-off values of each EI for predicting malignancy were Emean: 85.2 kPa, Emax: 94.0
kPa, Emin: 54.0 kPa. Emean (OR3.071, P=.005) or Emax
(OR3.015, P=.003) were the independent predictors
of thyroid malignancy. Combined use of gray-scale
US findings and each EI showed elevated sensitivity
(95.0% to 95.5% vs. 92.9%, P≤.005) and AUC (0.820
to 0.834 vs. 0.769, P≤.005) for predicting malignancy, compared with the use of gray-scale US findings
only.
CONCLUSION: Quantitative parameters of SWE
were predictive factors of thyroid malignancy and
SWE evaluation combined with gray-scale US was
adjunctive to the diagnostic performance of grayscale US for predicting thyroid malignancy.
SE 143
US Findings of Thyroid Metastasis in
a Patient with Hepatocellular Carcinoma
Mimicking Liver Abscess: a Case Report
Noh Hyuck Park1, Tae Youn Rho2
1
Department of Radiology, Myongji Hospital, Korea
2
Department of Radiology, Inha international Medical
Center, Korea
53-year-old man who was diagnosed as a liver
abscess 3 years ago, presented tumor thrombosis in
the right hepatic vein and intrahepatic segment of
IVC by direct invasion of mass which was considered as a liver abscess.
On physical examination, multiple palpable masses were found in anterior and left lateral neck along
internal jugular chain.
Ultrasonography which was performed to evaluate
neck masses, revealed multiple variable sized hypoechoic solid masses in thyroid gland and enlarged
lymph nodes along the left internal jugular chain.
The masses in the thyroid gland showed echo fea-
Scientific Exhibits
tures with heterogeneous hypoechoic solid echogenecity without necrosis or calcification. The
lymph nodes showed same nature with thyroid
masses. No significant increase of intratumoral or
intranodal vascularity was found on color Doppler
study.
We underwent US guided 18G core needle biopsy
for the left thyroid mass and a pathologic lymph
node at the left level 3 and these were confirmed as
metastasis from hepatocelluar carcinoma.
SE 144
Ultrasound Elastography Using Carotid
Artery Pulsation in Differential Diagnosis of
Sonographically Indeterminate
Thyroid Nodules
Woo Jung Choi1, Jeong Seon Park2,
Hye Ryoung Koo2, Soo-Yeon Kim3,
Min Sung Chung4, Kyung Tae5
1
2
Department of Radiology, Hanyang University Medical
Center, Korea
3
Department of Radiology, Hanyang University Guri
Hospital, Korea
4
Department of Surgery, Hanyang University Medical
Center, Korea
5
Department of Otorhinolaryngology, Hanyang University
SE 145
Hyalinizing Trabecular Tumor of the Thyroid
Gland: Ultrasonography Features and
the Role of Core-needle Biopsy
Woo Jung Choi1, Jung Hwan Baek1, Eun Ju Ha2,
Young Jun Choi1, Dong Eun Song3, Jin Yong Sung4,
Hyun Ju Yoo5, So Lyung Jung6, Ha Young Lee7,
Jeong Hyun Lee1
1
2
Department of Radiology, Ajou University Medical
Center, Korea
3
Department of Pathology, Asan Medical Center, Korea
4
Department of Radiology, Daerim St. Marys Hospital,
Korea
5
Department of Pathology, Daerim St. Marys Hospital,
Korea
6
Korea, Seoul St. Mary's Hospital, Korea
7
Department of Radiology, Inha University Hospital,
Korea
OBJECTIVES: The purpose of this study was to
evaluate the ultrasonography (US) findings and the
role of core-needle biopsy (CNB) for hyalinizing trabecular tumor (HTT).
301
Scientific Exhibits
PURPOSE: The purpose of this study was to evaluate the diagnostic performance of gray-scale ultrasound (US) and a new method of thyroid US elastography using carotid artery pulsation in the differential diagnosis of sonographically indeterminate thyroid nodules.
MATERIALS AND METHODS: A total of 102 thyroid nodules with indeterminate gray-scale US features from 102 patients (20 men and 82 women; age
range, 16-74 years, mean age: 51 years) were included. Gray-scale US images were reviewed and scored
from 1 (low) to 5 (high) according to the possibility
of malignancy. US elastography was performed
using carotid pulsation as a compression source. The
elasticity contrast index (ECI), which quantifies local
strain contrast within a nodule, was automatically
calculated. The radiologist reassessed scores after
concurrently reviewing gray-scale US and elastography. Receiver operating characteristic curve analysis
was used to evaluate the diagnostic performances of
each data set and to compare the Az values of grayscale scoring, ECI, and combined assessment scoring.
RESULTS: Malignant thyroid nodules were more
hypoechoic than benign nodules. The ECI was significantly higher in malignant nodules than in
benign thyroid nodules. The Az values of each data
set were 0.755 (95% CI, 0.660-0.835) for gray-scale,
0.835 (95% CI, 0.748-0.901) for ECI, and 0.853 (95%
CI, 0.769-0.915) for combined assessment. The Az
value for the combined assessment of gray-scale and
ECI was significantly higher than for gray-scale
alone (p = 0.022).
CONCLUSION: Combined assessment with grayscale US and elastography using carotid artery pulsation is helpful for differentiating sonographically
indeterminate thyroid nodules.
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MATERIALS AND METHODS: We retrospectively analyzed 24 patients (3 males and 21 females; age
range, 23-58 years, mean age: 52 years) between
January 2000 and May 2013 who had histopathological diagnosis of HTT. The US findings were categorized according to shape, margin, orientation,
echogenicity, composition, calcification, and vascularity. The cytohistology of fine-needle aspiration
(FNA) and CNB, and histopathology of surgery were
reviewed.
RESULTS: The US features were oval-to-round
shape (24/24), smooth margin (21/24), hypoechoic or
marked hypoechogenicity (18/24), solid (22/24) and
peri- and/or intranodular vascularity (17/17). Of
these, seven patients had malignant US tumor features such as marked hypoechogenicity (n=7) and a
spiculated margin (n=3). 19 patients underwent
FNA and all were misdiagnosed, including 12 malignancies and five atypia of undetermined significance. Four patients underwent CNB and all were
correctly diagnosed as HTT. Histological results of
CNB specimens suggested HTT, which was confirmed by immunostaining of MIB-1. Final confirmation was done by surgery in 22 patients and by CNB
in two.
CONCLUSION: HTTs can be suggested when the
cytological diagnosis is PTC on FNA and without
malignant US features. CNB showed the possibility
of a correct diagnosis of HTTs in this study.
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SE 146
Ultrasonography-Guided Ethanol Ablation of
Cystic and Predominantly Cystic Nodules:
Factors Related with Outcome
Diagnosis of Thyroid Follicular Neoplasm:
Fine-needle Aspiration Versus Core-needle
Biopsy
Ra Gyoung Yoon1, Jung Hwan Baek1,
Jeong Hyun Lee1, Young Jun Choi1,
Dong Eun Song1, Jae Kyun Kim2
1
2
Hospital, Korea
PURPOSE: To evaluate the diagnostic role of coreneedle biopsy (CNB) for thyroid nodules with follicular neoplasm (FN), compared with fine-needle aspiration (FNA).
MATERIALS AND METHODS: From October
302
2008 to December 2013, 107 patients (24 men, 83
women; mean age, 47.4 years) from 231 FNAs and
107 patients (29 men, 78 women; mean age, 46.3
years) from 180 CNBs with FN readings, all of
whom underwent surgery, were retrospectively analyzed. The false positive rate, unnecessary surgery
rate, and malignancy rate of FNA and CNB, according to the final diagnosis following surgery, were
evaluated.
RESULTS: CNB showed a significantly lower falsepositive and unnecessary surgery rate than FNA
(4.7% versus 30.8%, 3.7% versus 26.2%, P< 0.001,
respectively). In the FNA group, 33 patients (30.8%)
had non-neoplasms, including nodular hyperplasia
(n=32) and chronic lymphocytic thyroiditis (n=1).
In the CNB group, five patients (4.7%) had non-neoplasms, including nodular hyperplasia (n=5).
Moreover, CNB showed a significantly higher malignancy rate than FNA (57.9% versus 28%, P< 0.001).
CONCLUSION: Our study demonstrated that CNB
showed a significantly lower falsepositive rate and a
higher malignancy rate than those of FNA for diagnosing FN. Therefore, CNB could minimize unnecessary surgery as well as leading to surgery performed with diagnostic confidence in patients with
FN.
Mirinae Seo, Soo Jin Kim, Sung Hee Park,
Hye Shin Ahn
Hospital, Korea
PURPOSE: The aim of our study was to evaluate
the outcome in ultrasonography (US) guided ethanol
ablation (EA) of cystic and predominantly cystic
nodules and to assess the factors that predict outcome.
MATERIALS AND METHODS: Between March
2010 and October 2013, 28 cystic and predominantly cystic nodules in 26 patients were enrolled. EA
outcome in treating cystic and predominantly cystic
nodules was compared; and factors related with out-
Scientific Exhibits
come, including lesion location, initial nodule volume, aspirated fluid volume, aspirated fluid nature,
cystic component, vascularity, and echogenicity of
solid component, were evaluated.
RESULTS: Mean nodule volume decreased from
13.5±13.4 ml to 2.1±5.3 ml (mean volume reduction, 88.5±13.0%) and the therapeutic success rate
was 100% on last follow-up US. Seventeen nodules
showed an excellent response (90% or greater
decrease in volume) and 11 nodules showed a good
response (50-90% decrease in volume). Mean initial
nodule volume of the excellent response group was
smaller than the good response group without statistical significance (12.1±10.8 vs. 15.7±17.2,
p>0.05). Nodules with viscous cystic content tended
to be associated with the good response group
(p=0.05). There is no significant difference between
the excellent response group and the good response
group in lesion location, initial nodule volume, aspirated fluid volume, cystic component, vascularity,
and echogenicity of solid component.
CONCLUSION: The success rate of EA of cystic
and predominantly cystic nodules was 100%, and
aspirated fluid nature was useful in predicting the
outcome of EA.
SE 148
Thyroid Nodules with Initially Nondiagnostic, Fine-needle Aspiration Results:
Comparison of Core-needle Biopsy and
Repeated Fine-needle Aspiration
1
PURPOSE: To evaluate the role of core-needle biopsy (CNB) by comparing the results of CNB and
repeated fine-needle aspiration (FNA) for thyroid
SE 149
Virtual Touch Tissue Quantification (VTQ) in
the Differential Diagnosis of Benign and
Malignant Thyroid Nodules
Seung Mi Ha, Seong Whi Cho, Sam Soo Kim
Department of Radiology, Kangwon National University
Hospital, Korea
PURPOSE: The aim of this study was to evaluate
the diagnostic ability of Virtual Touch tissue quantification (VTQ) technology for differentiating
between benign and malignant thyroid nodules.
MATERIALS AND METHODS: A total of 198 nodules (168 benign nodules and 30 malignant nodules)
in 186 patients (169 females and 29 males) with
available share wave velocity (SWV) results and
pathologic diagnosis were included in this study.
303
Scientific Exhibits
Sang Hyun Choi , Jung Hwan Baek ,
Jeong Hyun Lee1, Young Jun Choi1, Min Ji Hong1,
Dong Eun Song2, Jae Kyun Kim3, Jong Ho Yoon4,
Won Bae Kim5
1
2
Department of Pathology, Asan Medical Center, Korea
3
Hospital, Korea
4
Department of Surgery, Asan Medical Center, Korea
5
Department of Internal Medicine-Endocrine, Asan
1
nodules with initially non-diagnostic FNA results.
MATERIALS AND METHODS: From October
2008 to December 2011, 360 nodules, consecutive
180 repeated FNAs and 180 CNBs, from 360 patients
(83 men, 277 women; mean age, 54.4 years) with initially non-diagnostic FNA results, were analyzed retrospectively. The incidences of non-diagnostic
results, inconclusive results, diagnostic surgery, and
diagnostic performance of repeated FNA and CNB
were assessed. The factors affecting second nondiagnostic results were evaluated.
RESULTS: CNB achieved a significantly lower nondiagnostic and inconclusive rate than repeated FNA
(1.1% versus 40.0%, P<0.001; 7.2% versus 72.0%,
P<0.001). All diagnostic performances with CNB
were higher than repeated FNA. The diagnostic
surgery rate was lower with CNB than with repeated FNA (3.6% versus 16.7%, P=0.047). Multivariate
logistic regression analysis showed that repeated
FNA was the most important factor for second nondiagnostic results (OR=56.06, P<0.001) and followed by nodules with rim calcification (OR = 7.46,
P = 0.003).
CONCLUSION: CNB is more useful than repeated
FNA for reducing non-diagnostic and inconclusive
results and preventing unnecessary diagnostic
surgery for thyroid nodules with initially non-diagnostic FNA results.
KSUM Open 2014
SWV of nodules and adjacent thyroid tissue were
examined by using Acuson S2000 ultrasound system
(Siemens Medical Solutions) and statistically analyzed by Student's t-test.
RESULTS: Malignant nodules had significantly
higher SWV values (3.057 ± 1.0350 m/s) than those
of benign nodules (2.404 ± 0.8458 m/s) (P=0.002).
SWV values of adjacent thyroid parenchyma showed
no significant difference between malignant and
benign groups. The best cutoff point was 2.380 m/s
for accurate differentiation between benign and
malignant thyroid nodules. The sensitivity, specificity, positive predictive value, negative predictive
value were 86.7%, 49.4%, 13.4%, and 82.6%,
respectively. The area under the receiver operating
characteristic curve was 0.716.
CONCLUSION: VTQ provides quantitative information about tissue hardness, which is helpful in the
differentiation of malignant and benign thyroid nodules. Diagnostic accuracy of VTQ is relatively fair.
VTQ can be used as a supplement diagnostic tool
with high negative predictive value.
dicting nondiagnostic result (NDR). Of 753 nodules,
526 nodules, proven histologic result by operation or
unchanged for two years, were included for assessing diagnostic performance of three methods.
Receiver operator characteristic (ROC) curves were
calculated for each preparation methods.
RESULTS: NDR was higher in inexperienced performers, <1 cm, solid, and calcified nodules (P
<0.05) in all methods. Mixed composition was more
prevent in NDR using CC than LC (P =0.004).
Nondiagnostic rate was 26.9%, 18.2% and 15.8% in
CC, LC and combination, respectively. Sensitivity
(92.3% vs. 91.5% vs. 92.3%), specificity (60.2% vs.
66.4% vs. 70.1%), positive predictive value (46.1% vs.
50.1% vs. 53.2%) and negative predictive value
(95.5% vs. 95.5% vs. 96.1%) were similar. Area under
curve (AUC) was 0.762, 0.790 and 0.821, respectively.
CONCLUSION: LC is more effective in reducing
repeat FNA with better diagnostic performance than
CC. LC may be preferred in a mixed thyroid nodule
for reducing NDR than CC.
SE 150
SE 151
Comparisons of Liquid-based Cytology and
Conventional Cytology on Thyroid Nodules:
Prospective Study with Imaging-cytologic
Correlations According to Bethesda System
Head Rotation Technique in Thyroid
Ultrasonography: Focusing on Case Reviews
Chang Un Lee1, Soo Jin Kim1, Sung Hee Park1,
Semin Chong1, Mirinae Seo1, Hye Shin Ahn1,
Han Suk Ryu2
1
Hospital, Korea
2
Department of Pathology, Seoul National University
Hospital, Korea
PURPOSE: We compared sonographic (US) features
predicting nondiagnostic result and diagnostic performance between LC and CC on thyroid nodule.
MATERIALS AND METHODS: From September
to December 2011, this prospective study included
753 nodules in consecutive 601 patients underwent
US-guided FNAB prepared into LC and CC simultaneously. A pathologist reviewed each method (CC,
LC and combination) with a month interval. We
evaluated US differences between LC and CC in pre-
304
Chanyeong Park, Kwanseop Lee,
Kyoon Soon Jung, Jin Hee Moon, Ju Yeon Jung
Department of Radiology, Hallym University Sacred
Heart Hospital, Korea
In this exhibition, a simple head rotation technique using SCM as a sonic window to improve
image quality in thyroid ultrasonography (USG) is
introduced. The advantages of head rotation technique during thyroid USG are as follows:
1. Avoidance of muscle interface shadowing
Muscle interface shadowing is a problem because
it often mimics an ill-defined hypoechoic lesion,
leading to unnecessary fine needle aspiration (FNA).
Therefore, SCM muscle has been considered to be
an obstacle on thyroid USG by making muscle interface shadowing. However, better visualization and
accurate evaluation is possible by rotating the head
and making muscle interface away from suspected
lesion, providing an opportunity to hold unnecessary
Scientific Exhibits
FNA.
2. Eliminating side lobe artifacts
Side lobe artifact is one of well-known artifacts,
especially on gallbladder as a mimicker of sludge
material. Anechoic cyst can be affected by this artifact also on the thyroid, masquerading as a solid
nodule. In the displayed case, we were able to reveal
its true internal anechoic nature by taking SCM in
front of the nodule. This was probably due to
absorption of side lobe with low-amplitude by SCM.
3. Movement difference between superficial and
deep portion of the thyroid
According to the author's observation, the superficial portion of one thyroid lobe moves as ipsilateral
SCM moves medially, while the deep portion of it
moves less. This results in slight twisting of the thyroid lobe in anteroposterior plane. This might be
useful in certain circumstances. This concept is supported by a displayed case, which is about a previously undetected thyroid nodule due to posterior
acoustic shadowing generated by another calcified
one.
In conclusion, head rotation for using SCM as a
sonic window may be a useful technique for improving image quality of thyroid USG.
SE 152
Antenatal Diagnosis of Fetal Goiter Due to
Hypothyroidism - A Rare Cause of
Polyhydramnios
Vikas Jhanwar, Nitin Mishra, Sunil Kumar Agrawal,
Amrita Maheshwari, Meenu Bagarhatta,
Darshan Koshiya, Rengarajan Rajagopal
Department of Radiology, SMS Medical College, Jaipur
(rajasthan), India
SE 153
Thyroid Hemangiomas Diagnosed on
Sonography
Sung Hee Park1, Soo Jin Kim1, Hyun Kyung Jung2,
Hye Shin Ahn1, Mirinae Seo1
1
Hospital, Korea
2
Primary thyroid hemangiomas are extremely rare,
and only a few cases have been previously reported.
Primary hemangiomas are developmental anomalies
resulting from the inability of the angioblastic mesenchyme to form canals. Thyroid hemangiomas are
generally considered difficult to diagnose preoperatively because of their low incidence and nonspecific
imaging findings. Here we report two cases of thyroid hemangiomas that were diagnosed correctly on
preoperative sonography. Our cases showed similar
sonographic findings, such as well-circumscribed
hypoechoic lesions with internal channel-like linear
lines, and bloody content was aspirated during fineneedle aspirations. Our report shows that thyroid
hemangiomas can be diagnosed correctly by sonography with or without confirmation of bloody content in the lesions by fine-needle aspiration.
305
Scientific Exhibits
Fetal goiter is a rare but potentially serious disorder that occurs in 0.2% of pregnancies, usually associated with maternal thyroid disease. Antenatal diagnosis of fetal goiter and its cause (hypothyroidism or
hyperthyroidism) is crucial for the immediate postpartum management of these neonates. Previously
cordocentesis which is an invasive method was solely used to differentiate between hyper and hypothyroidism, but now ultrasonography(USG) can noninvasively diagnose fetal goiter and its cause
(hypothyroidism or hyperthyroidism) on the basis of
USG scoring system which includes gland vascularity, fetal heart rate, bone maturation and fetal movements. We are presenting a case report of a 23 year
old pregnant female patient who presented with
complaints of polyhydramnios and abdominal discomfort. On antenatal ultrasound examination, we
found an anterior neck mass in 32 weeks fetus. On
the basis of imaging characteristics and USG scoring
system we gave the probable diagnosis of fetal goiter
due to hypothyroidism which was exerting pressure
over oesophagus and causing polyhydramnios.
Appropriate measures were taken on the basis of
diagnosis and no prenatal and postnatal complication occurred. On postnatal clinical examination,
diagnosis of fetal goiter was confirmed and biochemical examination showed hormonal assessment in
favour of hypothyroidism.

Abdomen

Transcription

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