Pilot Study to Show the Feasibility of High-Resolution Sagittal Ultrasound Imaging of the Temporomandibular Joint.

PURPOSE: To show the feasibility of acquiring high-resolution sagittal ultrasound (US) images of the temporomandibular joint (TMJ). PATIENTS AND METHODS: We used commercially available US probes to assess the TMJ via a transoral soft tissue window to acquire sagittal images. Magnetic resonance imaging and clinical correlation were compared with the US findings by the consensus assessment of 2 of the senior investigators. RESULTS: The sample was composed of 10 TMJs (6 participants) with an age range of 34 to 71 years and a male-female ratio of 3:1. The condyle and subcondylar surface were visible in 10 of 10 joints (100%), the disc in 7 of 10 joints (70%), and the pterygoid muscles in 6 of 10 joints (60%). In the 5 joints with magnetic resonance correlation, disc position and configuration were confirmed in all cases. CONCLUSIONS: We show the first sagittal transoral sonograms of the TMJ disc and associated joint components.

Correlation of sonographic features of invasive ductal mammary carcinoma with age, tumor grade, and hormone-receptor status.

PURPOSE: To determine whether presenting sonographic features of invasive ductal carcinomas (IDC) are associated with patient age, tumor histologic grade, and hormonal receptor status. METHODS: Sonographic features of 101 consecutive cases of IDC seen at ultrasound were retrospectively assessed based on the BI-RADS criteria of posterior acoustic appearance, tumor margins, and echogenicity. Associations between sonographic features and tumor characteristics were statistically evaluated with attention to patient age. RESULTS: IDC with shadowing compared with unchanged posterior acoustic appearance were significantly more likely to be of low histologic grade (Odds Ratio [OR] = 5.00; p < 0.05) and estrogen receptor (ER) -positive (OR = 10.00; p < 0.05). Conversely, posterior enhancement was associated with ER-negative status (OR = 4.45; p < 0.01), particularly among patients younger than 60 years of age (OR = 5.36, p < 0.05). Circumscribed tumors were more often high grade, particularly among older women (p < 0.01), and hormone receptor--negative regardless of age group. Among older women, tumors with mixed echogenicity tended to be high grade and progesterone receptor--negative (p values < 0.05). Noncircumscribed borders were observed for all tumors with posterior shadowing, and 97% of such tumors were also ER positive. CONCLUSIONS: Sonographic features were significantly associated with tumor grade and hormone receptor status, with some differences based on patient age. Specifically, the presence of posterior shadowing was associated with lower histologic grade and ER-positive status, especially in older patients. In contrast, we found that posterior acoustic enhancement was more commonly associated with ER-negative status, especially in younger patients.

Current role of ultrasound in chronic liver disease: surveillance, diagnosis and management of hepatic neoplasms.

Ultrasound (US) has been used to evaluate liver disease for many decades. Despite certain inherent limitations in evaluating chronic liver disease on routine gray-scale US, it is still widely used for the initial evaluation in patients suspected of liver disease as well as for hepatocellular carcinoma (HCC) screening in patients with known cirrhosis. Due to recent advances in digital technology and US imaging software, various new computer protocols have been incorporated in the new US equipment. This in turn has resulted in a great improvement in image quality and image resolution. Consequently, the increased ability of US to better characterize the liver texture in general has enabled the sonographers to identify subtle changes in the liver texture and delineate smaller masses in the liver with greater success.

An overview of renal transplantation: current practice and use of ultrasound.

Imaging has played a major role in monitoring the well-being of the renal graft. Ultrasound, in particular, has been extremely helpful for the detection of postoperative complications related to the transplant kidney. From an imaging perspective, the complications of renal transplantation can be categorized into vascular complications, complications related to the collecting systems (urological complications), perinephric fluid collections, and parenchymal complications. Additionally, there are some complications that may occur, secondary to a transplant renal biopsy. To be able to correctly identify the complications associated with renal transplants, one should have a comprehensive understanding of various aspects of the transplant procedure and be familiar with the normal or expected findings after a transplant. This article provides an overview of renal transplantation and discusses the use of various imaging modalities in its evaluation. The various complications associated with renal transplant as well as renal biopsy are elaborated in this article with special emphasis on the use of ultrasound.

Rare breast lesions: correlation of imaging and histologic features with WHO classification.

Mammographers occasionally are surprised by the diagnosis of a rare lesion at breast biopsy. The imaging features of some breast lesions are unfamiliar because they are rarely seen in routine mammographic practice and they are not well described or well documented in the radiologic literature. Moreover, there may be wide variation in the appearances of rare breast lesions at mammography and ultrasonography (US). In addition, although a few rare breast lesions have a typical imaging appearance, most have mammographic and US features similar to those of breast carcinomas, and a needle biopsy is almost always necessary to obtain a diagnosis. However, even when a rare breast lesion is diagnosed on the basis of a needle biopsy, knowledge of the imaging features of such lesions may help the radiologist decide whether the results of pathologic analysis concur with the imaging findings and whether surgical excision is necessary. It is therefore important that radiologists be familiar with the broad spectrum of imaging features of rare breast lesions as well as with the correlation between their histopathologic features and their current classification according to the World Health Organization classification system.

Characterization of sonographic and mammographic features of granular cell tumors of the breast and estimation of their incidence.

OBJECTIVE: The purpose of this series was to review the spectrum of sonographic and mammographic features of granular cell tumors (GCTs) of the breast and to compare their frequency relative to breast carcinoma. METHODS: Ten cases of a breast GCT diagnosed during the last 13 years were analyzed for the imaging characteristics and clinical features. Sonographic images were reviewed for location, size, echogenicity, margins, height-width ratio, and sound transmission. Mammograms were reviewed for tumor size, location, margin characteristics, spiculations, and calcifications. The frequency of GCTs was compared with that of breast carcinoma during the same study period. RESULTS: Of 10 GCT cases, 9 tumors occurred in female patients, and 1 occurred in a male patient. The mean patient age was 51.8 years, and the mean lesion size was 1.57 cm. All 7 tumors visualized on sonography were hypoechoic masses. Posterior enhancement was noted in 3 of 7 cases, and posterior shadowing was noted in 2 of 7 cases. Two of 7 did not show any posterior enhancement or shadowing. Two of 7 masses were taller than wide. Of 8 tumors visualized on mammography, 5 were spiculated, and 3 were well circumscribed. Calcifications were not visualized in any tumor. During the same period, 1482 cases of breast carcinoma were diagnosed, making the frequency of GCTs of the breast about 6.7 per thousand breast carcinomas. CONCLUSIONS: Granular cell tumors of the breast are rare neoplasms with a relative frequency of 6.7 per thousand breast carcinomas in our series, which was higher than reported in literature. Spiculations are a common imaging feature and mimic carcinoma when present.

Mammographic surveillance after MammoSite breast brachytherapy: analysis of architectural patterns and additional interventions.

PURPOSE: To report the post-treatment mammographic findings of patients who received MammoSite brachytherapy at the Medical University of South Carolina (MUSC). MATERIALS AND METHODS: A total of 126 mammograms from a cohort of 38 patients who underwent MammoSite breast brachytherapy and post-treatment mammographic follow-up exclusively at MUSC are the subject of this analysis. Surveillance mammography commenced at 6 months after completion of brachytherapy and was repeated every 6 to 12 months thereafter, depending on Breast Imaging Reporting and Data System (BI-RADS) classification and further testing recommendations. Patients were clinically assessed at least every 3 months and all available data were reviewed for documentation of mammographic findings and subsequent interventions. The minimum and median follow-up was 6 and 28 months, respectively. RESULTS: Of the 126 mammograms analyzed, 22 (17%) were classified as BI-RADS category 2, 93 (74%) as category 3, 10 (8%) as category 4, and 1 (0.8%) as category 5. Further descriptions of the BI-RADS 3 studies were: 61 (65%) "surgical changes," 30 (32%) seromas, and 2 (2%) dystrophic calcifications. Additional interventions followed 10 (11%) of BI-RADS 3 studies, all revealing benign findings. All BI-RADS 4 or 5 studies led to needle aspiration (3) or breast biopsy (8). Two biopsies were positive for malignancy, and both were classified as elsewhere breast failures. CONCLUSION: Mammographic architectural patterns observed after partial breast irradiation and potential differences with respect to those traditionally seen following whole breast radiotherapy have yet to be well characterized. Our experience may be of clinical utility in the counseling of patients until data from randomized trials becomes available.