[Ultrasonographic Features of Pseudomyxoma Peritonei and TheirComparison with Computed Tomographic Findings].

OBJECTIVE: To investigate the value of ultrasound in the diagnosis of pseudomyxoma peritonei (PMP) and summarize the ultrasonographic features of PMP by comparing with computed tomography (CT) findings. METHOD: Ultrasound and CT scan results of 25 patients with PMP confirmed by pathology after surgery were analyzed retrospectively. RESULTS: Among these 25 PMP patients,three were diagnosed by ultrasound and six by CT(P=0.579). The specific ultrasonographic features of PMP were as follows:the dense punctuate echoes or floccules were detected in hydrops abdominis,which seldom or never move with the change of body position. Honeycomb-like lesions were typical. Notches were formed on the surface of liver or spleen due to the mucinous material and/or the mucinous lesions. CONCLUSIONS: Both ultrasound and CT scan have poor detection rate in the diagnosis of PMP. PMP has specific ultrasonographic features,which may make it possible to diagnose most PMP lesions by ultrasound before surgery

[Sonographic features of lymphoma in the abdominal lymph nodes].

OBJECTIVE: To summarize the sonographic features of the lymphoma in the abdominal lymph nodes. METHOD: The clinical data and sonographic findings of 41 lymphoma patients with original appearance of abdominal mass or lymphadenectasis were retrospectively analyzed. RESULTS: Among these 41 cases, the retroperitoneal and mesenteric lymph nodes were most commonly involved.These patients were divided into two types according to sonographic appearances:solitary mass(n=14) and multiple nodules(n=27) .Solitary hypoechoic mass in abdomen was found in the former type, mostly with irregular or lobular shape, and the inner echo was often heterogenous.The typical appearances of the latter type were multiple enlarged lymph nodes, mostly round or oval, with homogeneous inner echo and clear margins.Some other sonographic characteristics were also helpful for the diagnosis of lymphoma, such as cobblestone sign, intranodular reticulation, vessels-embedded sign, and hilar vascularity. CONCLUSION: Ultrasonography can provide useful information in the diagnosis of the lymphoma in the abdominal lymph nodes.

[Ultrasonographic characteristics of ovarian carcinosarcoma].

OBJECTIVE: To summarize the ultrasonographic characteristics of ovarian carcinosarcoma (OCS). METHODS: Totally 12 patients with OCS have been detected in our department. All patients underwent surgical resection and the OCSs were confirmed pathologically. Ultrasound examination was performed before operation. Imaging features were analyzed retrospectively for bilaterality, size, and tumor solidity (cystic or solid). Presence of ascites and other evidence of peritoneal seeding, adjacent organ invasion, and surgical staging were also evaluated. RESULTS: Unilateral OCSs were found in 11 patients and bilateral OCSs in one patient one side was missed by ultrasound). Nine OCSs were solid, and 3 were mixed (solid and cystic). The diameter of the largest dimension was less than 10 cm in 4 cases, 10-20 cm in 7 cases, and larger than 20 cm in one case. Other ultrasonographic findings including peritoneal seeding and direct invasion into the adjacent organs were seen in 8 patients. Surgical stages were International Federation of Gynecology and Obstetrics (FIGO) classification c and b in one patient each, c in 9 patients, and in one patient. CONCLUSION: OCSs usually present as large, hypoechoic, solid, and aggressive tumors, combined with frequent peritoneal seeding and adjacent organ invasion.

Automatic Breast Volume Scanner versus Handheld Ultrasound in Differentiation of Benign and Malignant Breast Lesions: A Systematic Review and Meta-analysis.

The goal of the study described here was to compare the automatic breast volume scanner (ABVS) and handheld ultrasound (HHUS) with respect to diagnostic performance in the differential diagnosis of benign and malignant breast lesions. A literature search of the PubMed, EMBASE and Cochrane Library databases through 30 June 2018 was conducted. Pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratios of the ABVS and HHUS were calculated, and summary receiver operating characteristic (SROC) curves were drawn. A total of nine studies, including 1985 lesions (628 malignant and 1357 benign) from 1774 patients, were analyzed. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for ABVS were 90.8% (95% confidence interval: 88.3%-93.0%), 82.2% (80.0%-84.2%), 5.39 (4.26-6.80), 0.10 (0.06-0.15) and 61.68 (32.31-117.76); those for HHUS were 90.6% (88.1%-92.8%), 81.0% (78.8%-83.0%), 5.22 (3.14-8.67), 0.11 (0.08-0.17) and 52.60 (32.06-86.35), respectively. The areas under the SROC curves in the differentiation of benign and malignant breast lesions were 0.93 and 0.94 for ABVS and HHUS, respectively, which were not significantly different (p = 0.853). In conclusion, based on available evidence in the literature, ABVS the diagnostic performance of the ABVS is similar to that of HHUS in the differentiation of benign and malignant breast lesions.

Evaluation of renal artery stenosis with hemodynamic parameters of Doppler sonography.

OBJECTIVE: The purpose of this study was to determine the values of the hemodynamic parameters of Doppler sonography in the diagnosis of renal artery stenosis (RAS) (diameter reduction >/=50%) and to investigate their possible influencing factors. METHODS: Five Doppler parameters, including renal peak systolic velocity (RPSV), renal-aortic ratio (RAR), renal-renal ratio (RRR), renal-segmental ratio (RSR), and renal-interlobar ratio (RIR), were measured in 81 patients before arteriography. Arteries with >/=50% diameter reduction were considered stenosed at renal arteriography. Receiver operating characteristic curve analysis was performed to determine the optimal parameters. The sensitivity, specificity, positive and negative predictive values, and accuracy at various threshold values were calculated. RESULTS: Sixteen accessory renal arteries (15 normal, one mild stenosis) were identified at arteriography. Of the 153 main renal arteries demonstrated at arteriography, 79 were normal or demonstrated stenosis <50%, 68 demonstrated moderate stenosis (50%-99%), and 6 demonstrated total occlusion. Doppler sonographic examination was technically successful in 91.7% (154/168) of main and accessory renal arteries. The optimal threshold values of RPSV, RAR, RRR, RSR, and RIR were 170 cm/s, 2.3, 2.0, 4.0, and 5.5, respectively. The parameters RPSV, RSR, and RIR showed good diagnostic results with accuracies equal to or greater than 88%, whereas RAR and RRR presented a sensitivity of only 76.47%. The diagnostic accuracies of RPSV, RAR, and RRR were approximately 3% higher after exclusion of the eight patients with abdominal aorta stenosis. CONCLUSION: It should be feasible and necessary to measure three representative hemodynamic parameters (RAR, RPSV, and RIR or RSR) in the diagnosis of >/=50% RAS. The PSVs in the abdominal aorta and renal artery can be affected by factors other than RAS, which may decrease the accuracy of RAR. However, post-PSV ratios are minimally affected by PSV in the abdominal aorta or by an equal proportional change in PSVs in the renal artery trunk and its intrarenal renal arteries; therefore, use of post-PSV ratios dramatically overcomes some limitations of RAR.

[Diagnostic performance of contrast-enhanced ultrasound in liver metastases and its clinical application].

OBJECTIVE: To observe the performance of liver metastases with contrast-enhanced ultrasound (CEUS) and assess its clinical application. METHODS: Twenty-one patients with 21 untreated liver metastases underwent CEUS with low mechanical index imaging. The characteristic appearances of CEUS in different vascular phases were observed. RESULTS: Of 21 metastases, 19 (90.5%) were identified as fast-in and fast-out enhancement pattern. In the arterial phase, all the 21 lesions showed enhancement but with varied appearances: 12 (57.1%) showed early diffuse enhancement, 8 (38.1%) showed ring-like enhancement, and the remaining one lesion of large size showed slowly enhomogenous minor enhancement. In the late phase, sharp defects were found in 20 lesions (95.2%), and more lesions were detected in 3 patients (14.3%). CONCLUSION: CEUS can show the characteristic appearance of liver metastases, and can be used for the screening and diagnosis of liver cancers.

Ultrasound characteristics of a glomus jugulare tumor.

A 33-year-old woman presented a chronic headache and sore throat on the right side of her body, continuous pulsatile tinnitus with decreasing hearing in the right ear, and recurrent bleeding from the right ear. Computer tomography and magnetic resonance imaging scan depicted a mass in the external ear canal and an enlarged right jugular bulb, which was revealed on duplex ultrasound in the upper portion of the right internal jugular vein. Surgical dissection of the tumor was performed. Pathological study revealed the mass was glomus jugulare tumor.

Evaluation of the tardus-parvus pattern in patients with atherosclerotic and nonatherosclerotic renal artery stenosis.

OBJECTIVE: The aim of this study was to evaluate the differences in the tardus-parvus pattern between atherosclerotic and nonatherosclerotic renal artery stenosis (RAS) and to explore the causes of these differences. METHODS: In 81 patients, including a nonatherosclerotic group (29 cases of Takayasu arteritis and 22 cases of fibromuscular dysplasia) and an atherosclerotic group (n = 30), RAS was detected by color Doppler sonography and confirmed by renal arteriography. Doppler spectra were obtained at the upper, middle, and lower pole interlobar arteries, and the one with the most prolonged acceleration time (AT) was selected for recording the AT and resistive index (RI). RESULTS: Renal angiography revealed 16 moderate RASs, 80 severe RASs, and 15 occlusions. No statistically significant differences were found in the AT between the atherosclerotic and nonatherosclerotic groups in the mild (P = .24), moderate (P = .63), and severe stenotic (P = .41) subgroups; however, there were statistically significant differences in the RI between the atherosclerotic and nonatherosclerotic groups in the mild (P < .001), moderate (P < .01), and severe (P < .001) subgroups. The RI values in the atherosclerotic group were much higher than those in the nonatherosclerotic group for the 3 stenotic subgroups. CONCLUSIONS: The AT measurement method used widely now cannot differentiate potential differences in pulsus-tardus waveforms between atherosclerotic and nonatherosclerotic RAS; however, it remains a useful approach to detect RAS. Different RI cutoff values should be established according to atherosclerotic and nonatherosclerotic RAS, and consideration of influencing factors for the RI will help reduce misdiagnosis.

Evaluation of renal artery stenosis with velocity parameters of Doppler sonography.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of velocity parameters for the diagnosis of renal artery stenosis (RAS) with color Doppler sonography and to determine the optimal threshold values for these parameters. METHODS: The study group was composed of 187 renal arteries, which were examined by color Doppler sonography and angiography. Four Doppler parameters, including the peak systolic velocities (PSVs) in the renal and interlobar arteries, the renal-aortic ratio, and the renal-interlobar ratio (RIR), were measured. Receiver operating characteristic curve analysis was performed to determine the optimal parameter. The sensitivity, specificity, and negative and positive predictive values at various threshold values were calculated. RESULTS: Doppler sonographic examination was technically successful in 96% of renal arteries (180/187). The RIR was determined to be the best parameter. With threshold values of RIR greater than 5, PSV greater than 150 cm/s in the renal artery, renal-aortic ratio greater than 2, and PSV less than 25 cm/s in the interlobar artery, the sensitivity values were 88%, 81%, 70%, and 74%, respectively. An RIR greater than 5 and PSV less than 15 cm/s in the interlobar artery provided the optimal combination of parameters, with sensitivity and specificity of 91% and 87%, respectively. CONCLUSIONS: The RIR is the best velocity parameter in the detection of RAS (> or =50%), and its best cutoff is 5. Valuing influencing factors of PSV in the renal artery will help reduce misdiagnosis. The combination of RIR greater than 5 and PSV less than 15 cm/s in the interlobar artery provides the best diagnostic efficiency of RAS.