Noninvasive diagnosis of cardiac allograft rejection using echocardiography indices of systolic and diastolic function.

BACKGROUND: Limited and conflicting data exist on the diagnosis of cardiac allograft rejection with the use of echocardiography. The purpose of our study was to evaluate various systolic and diastolic indices, including newer tissue Doppler imaging techniques, in diagnosing cardiac allograft rejection. METHODS: We prospectively performed 426 echocardiography studies at the time of endomyocardial biopsy in 54 cardiac transplant patients. We measured left ventricular (LV) systolic and diastolic dimensions, mitral inflow pattern and annular velocities, and the myocardial performance index. Biopsies were assessed for cellular rejection and antibody-mediated rejection (AMR). RESULTS: Mild cellular rejection was diagnosed in 74 biopsy specimens and significant cellular rejection in 10 biopsy specimens. AMR was diagnosed in 30 biopsy specimens. In patients with mild or significant cellular rejection, no significant differences in echocardiographic parameters were observed. In patients with AMR, LV fractional shortening was significantly reduced compared with those with no AMR (mean±SD 31.8±8.9% vs 36.0±7.1%; P=.02). CONCLUSIONS: Although 1 echocardiographic parameter was statistically different in the setting of rejection, lack of consistency and overlap between nonrejection and rejection groups does not permit definitive noninvasive diagnosis of cardiac allograft rejection using this imaging modality.

Contemporary management of amebic liver abscess.

In a retrospective review covering 16 years divided into two time periods, 133 patients with amebic liver abscess were evaluated. Most of the patients were young, Hispanic men, and one-third had coexistent disease. A reliable diagnosis can be established in 24 hours using ultrasound or computed tomography scans. Over the entire time period, antiparasitic therapy was evolved to occupy a primary role and surgery was reserved for management of abscess complications.

Evaluation of women with possible appendicitis using technetium-99m leukocyte scan.

The authors evaluated the use of technetium-99m albumin colloid white blood cell (TAC-WBC) scan in women with possible appendicitis. One hundred and nine women underwent 110 TAC-WBC scans. One woman had a second scan on a separate admission and was considered two individual patients in the analysis. Twenty-six women had appendicitis, 10 of whom had a perforated appendix at surgery. The TAC-WBC scan was indeterminate (abnormal but nondiagnostic for appendicitis) in 52 women (47%), nine of whom had appendicitis. Fifty-eight scans were read as positive or negative for appendiceal pathology. There were 16 true positives, 5 false positives, 36 true negatives, and 1 false negative. The predictive value of a positive scan was 76%, and the predictive value of a negative scan was 97%. The TAC-WBC scan was positive in 62% of patients with appendicitis and negative in 43% of the patients without appendicitis resulting in an overall accuracy of 47% in the 109 women. The main value of TAC-WBC scan in women with possible appendicitis is its high negative predictive value and the main problem with the TAC-WBC scan is its high indeterminate rate.

Accuracy of combined clinical-mammographic-cytologic diagnosis of dominant breast masses. A prospective study.

Excisional biopsy is considered a mandatory part of the workup for patients with dominant breast masses. To evaluate the efficacy of a combined physical, mammographic, and fine-needle aspiration cytologic examination, 113 women were prospectively evaluated. Breast masses were listed as either benign or suspicious/malignant. All patients underwent a subsequent biopsy. Fifty-two (46%) of 113 patients had a malignant mass. The sensitivity and specificity of the individual tests were as follows: 96% and 66% for the physical examination; 94% and 73% for the mammographic examination; 90% and 93% for the fine-needle aspiration cytologic examination. For the 86 patients who underwent all three studies, the 25 patients with benign test results on all three examinations had a benign pathologic result. One (6%) of 18 patients with a single suspicious/malignant test result had cancer, 9 (64%) of 14 patients with two suspicious/malignant test results and 28 (97%) of 29 patients with three suspicious/malignant results also had breast cancer. We conclude that the combined triad of physical, mammographic, and fine-needle aspiration cytologic examinations is highly accurate in the diagnosis of breast masses, and patients in whom all three examination results are benign can be safely observed, obviating the need for an open biopsy.

Improving the adherence of urban women to mammography guidelines: strategies for radiologists.

Only 16% of women over 40 years of age are being screened regularly with mammography. To learn what radiologists and technologists can do to increase patient adherence to the screening guidelines of the American Cancer Society, especially by poor, urban women, the authors surveyed patients at a county facility immediately after mammography to document the patients' experiences with technologists and the procedure. Analysis of these data led to the conclusion that the radiologist should encourage an expanded role for the technologist as a breast health educator. By incorporating the use of a well-designed patient brochure, technologists can greatly enhance their effectiveness by decreasing the patient's anxiety and increasing her understanding of the procedure and of the importance of screening. Radiologists need to appreciate the potential of an expanded technologist's role for increasing future referrals.

Perirenal hemangioendothelioma in a newborn: sonograph and MR findings.

This is a case report of perirenal hemangioendothelioma in a newborn and discussion of lesions in the perirenal space in newborns. The findings in this case, high echogenicity on sonographic images and high signal intensity on T2-weighted spin echo magnetic resonance images, mimic those described for hemangiomas in other locations.

Prediction of cesarean section scars with ultrasound imaging during pregnancy.

We sought to determine whether a sonographic examination could identify uterine scars in patients with a history of previous cesarean section and further distinguish patients having previous low transverse from vertical uterine incisions. Forty-six antenatal obstetrical patients with a history of prior cesarean section(s) and 30 control patients without prior uterine surgery underwent sonogram examinations to identify the scar. The researcher who later reviewed the sonogram was blinded as to the presence or type of uterine scar. Of the 47 scars examined, uterine scars were visualized in 13 (27.7%). All scars seen were low transverse; no vertical scars were identified by sonography (p less than .05). No scars were visualized with sonography in the control group and cesarean section scars were seen more easily prior to the third trimester. No information concerning the scar condition (dehiscence) could be obtained with sonography. We conclude it is of benefit to perform sonogram exams in patients with prior cesarean sections of unknown incision to better counsel them as to their risk to rupture. Although vertical cesarean section scars could not be visualized, those patients who had low transverse scars identified could be included in a low-risk vaginal birth population.

Reliability of ultrasound in predicting uterine leiomyoma volume.

Recently ultrasound has been used to size and track individual myoma volumes for patients undergoing medical therapy. However, little is known about the specific performance characteristics and limitations of this technique with respect to volume measurements. We performed and prospectively interpreted serial ultrasound examinations on myoma patients and confirmed the location, size and number of myomas in the surgical specimens. The smallest detectable tumor was 2.7 cm in diameter. The specificity was 94%; reproducibility had a 14% coefficient of variation for tumors with diameters greater than 6 cm. We conclude that ultrasound is suitable for imaging and sizing myomas provided that the diagnosis is otherwise certain and the tumors tracked are large.

Prenatal diagnosis of osteogenesis imperfecta type III.

Ultrasonographic and radiographic evaluation of a fetus at risk for osteogenesis imperfecta (O.I) type III was performed. Real-time ultrasound measurements at 15 weeks gestation were interpreted as normal, but at 20 and 22 weeks of gestation revealed marked shortening of the long bones and deformity of the femurs. The findings were confirmed by fetal radiography at 22 weeks gestation. Radiographic and histologic changes characteristic of O.I. were observed in the aborted fetus. Thus the antenatal manifestations of O.I. type III maybe severe enough to make prenatal diagnosis possible in the second trimester for families at risk for recurrence of this disorder.

Percutaneous drainage of pelvic abscesses: management of the tubo-ovarian abscess.

Percutaneous drainage of 35 pelvic abscesses secondary to pelvic inflammatory salpingitis are reported. Two methods of drainage were used: simple aspiration and catheter drainage. The success rate of aspiration drainage was 94 per cent, while catheter drainage yielded a 77 per cent success rate. The differences between pelvic abscess drainage and other types of percutaneous drainage are presented. The role of percutaneous drainage in the treatment of pelvic inflammatory disease is also discussed.

Cortical sulcal development seen on sonography: relationship to gestational parameters.

Cranial sonograms are now routine for the evaluation of neonates for intracranial hemorrhage and other pathology. In this study, normal gyral development of the neonatal brain is reviewed and gyral pattern is correlated to gestational parameters. The value of this information for the sonographer is discussed.

Sonographic demonstration of the progression of meconium peritonitis.

A case of meconium peritonitis that was diagnosed ultrasonographically in the early third trimester in a patient with acute polyhydramnios is presented. The pathophysiologic progression of this condition is demonstrated by serial ultrasound examinations. Neonatal radiologic confirmation of the diagnosis is also presented. The obstetric and neonatal implications of meconium peritonitis and the importance of serial ultrasonography in those pregnancies in which this diagnosis is made are discussed.

Septate uterus: sonographic diagnosis and obstetric complications.

The present study is a report of the authors' sonographic and obstetric experience in seven cases with anatomically confirmed partial uterine septa. Emphasis is placed on the sonographic appearance and the differential diagnosis of a uterine septum. New sonographic findings are described that can resemble the appearance of a uterine septum during pregnancy, including uterine contractions, cystic masses adjacent to the uterine fundus, and a full urinary bladder. Obstetric complications are compared with previous studies. The authors observed one major obstetric complication of fetal malpresentation.

Amebic liver abscess. The surgeon's role in management.

Hepatic amebic abscess presented as an acute abdominal illness in 71 patients seen at the Harbor-UCLA Medical Center during the past 10 years. Most of the patients were young, Mexican and male, and half had coexistent medical diseases. The correct diagnosis was made by ultrasonography in 27 patients, laparotomy in 6, and radionuclide scan in 38. More than half (38 patients) were diagnosed accurately within 24 hours of admission. Sixty-seven abscesses were located in the right or both lobes; only 4 were limited to the left lobe, all of which had caused perforation. Operative findings in 20 patients were ruptured abscess in 12 and unruptured abscess in 2; abscesses were missed during exploration in 6 patients, one of whom had acute cholecystitis and another, a small bowel infarction. Other complications were intrathoracic rupture in four and intrapericardial rupture in one. Metronidazole was successful as initial drug therapy in 64 patients. Ultrasonographically-guided percutaneous drainage was used as a diagnostic and therapeutic adjunct to management in 15 patients. In a metropolitan population, the surgeon must consider amebic abscess in the evaluation of a febrile patient with right upper quadrant illness. With ultrasonography or radionuclide scanning, he can establish a reliable diagnosis in 24 hours. Although medical therapy is effective, surgery is required in 20 percent of patients for drainage of the ruptured abscess or treatment of a coexistent surgical condition. An unruptured abscess should be sought in an apparently negative exploration. A solitary abscess of the left lobe is rare but has a particular propensity to cause perforation.

The use of computerized tomography scanning to localize the impalpable testis.

To determine the usefulness of computerized tomography scanning in the preoperative localization of the impalpable undescended testis 5 patients with 8 impalpable testes were studied. In 2 patients the scan correctly outlined 3 impalpable testes inside the internal inguinal ring, in 2 patients the scan correctly localized 4 impalpable testes at or just inside the external inguinal ring and in 1 patient the scan failed to demonstrate a testis, a finding corroborated at an operation. These results suggest that computerized tomography scanning appears to be an effective, simple and less hazardous method to localize impalpable undescended testes than other currently available techniques.

Normal pancreatic echogenicity: relation to age and body fat.

Normal pancreatic sonograms of 161 patients were evaluated by three experienced sonographers for pancreatic echogenicity. Sonograms were given a grade for pancreatic echogenicity based on its echogenicity compared with the liver's echogenicity. Grade I was given when the pancreas equaled the liver, grade II slightly greater than the liver, grade III definitely greater than the liver, and grade IV when the pancreas was as echogenic as the retroperitoneal fat. Pancreatic echogenicity was correlated with the patient's age and subcutaneous fat. Statistical analysis by computer methods indicated that both age and body fat deposition are determinants of increasing echogenicity and that they function independently. A formula is given for the expected pancreatic echogenicity (PE) as a function of age and subcutaneous fat: PE = 0.788 + (age) (0.021 +/- 0.003) + (skin thickness) (0.48 +/- 0.08).