Comparison Static and Dynamic Ultrasound Techniques of DDH: The Role of the Patient's Position.

Objectives: The ultrasound examination of the hip joint is performed in the static (Graf) technique in the lateral recumbent position and in the dynamic technique in the supine position. This study compares the two static and dynamic techniques and assesses the role of the patient's position in the examination of DDH. Methods: This cross-sectional study was conducted in 2020-2021 at Akbar Hospital, Mashhad University of Medical Sciences, Iran. 126 patients suspected of having DDH (199 hip) infants were enrolled in the study. All ultrasound examinations were performed with two static and dynamic techniques by a pediatric radiologist. Results: In the static and dynamic ultrasound examinations, the average alpha angle was 51.57 ± 6.41 degrees, and 53.41 ± 6.94 degrees, respectively. These changes were not statistically significant (P = 0.312). The relationship and agreement between instability with dynamic technique and instability with static technique (IIC unstable, D, III, and IV) were investigated. Significant agreement (Kappa=0.77 (95% CI: 0.66-0.87) with excellent clinical significance was obtained between the two ultrasound examination method. Also, in terms of DDH types in the static method with instability types in the dynamic method, a substantial agreement was found between the two examination methods (Kappa =0.67; (95% CI: 0.59-0.75) with good clinical significance. Conclusion: In the ultrasound examination of DDH with static and dynamic techniques, the change in the alpha angle was not statistically significant. Therefore, the hand of the radiologist is open in measuring alpha angles and there is no need to emphasize a specific position. The type of DDH in the static technique completely corresponded to the type of stability or instability in the dynamic technique.

Diagnostic value of colour Doppler ultrasound in differentiating malignant and benign nodules in thyroiditis background.

INTRODUCTION: Differentiating malignant thyroid nodules from benign ones is challenging. Sonography is a non-invasive modality that can be helpful in this regard and is far better than invasive methods like fine needle aspiration (FNA). This study aimed to assess the diagnostic value of colour Doppler ultrasonography in distinguishing malignant and benign nodules of thyroid gland. METHODS: The study involved patients with thyroiditis and thyroid nodules, who underwent sonography. Ultrasound findings were assessed. All the nodules were classified according to the FNA into malignant, follicular nodules and lymphatic. Then, sonography findings were compared between these three groups. RESULTS: There were 216 nodules, including 108 (50%) malignant nodules, 80 (37%) benign and 28 (13%) lymphatic follicles, were evaluated. Micro-calcification was present in 50 (46.3%) malignant cases, 11 (13.7%) benign cases and 2 (2.1%) lymphatic follicles. Decreased or mixed vascularity was reported in 43 (69%) malignant nodules, 4 (5%) benign cases and 7 (25%) lymphatic follicles. Also, 9.7% and 42% of malignant and benign nodules had peripheral circular vascularity, respectively; however, none of the lymphatic follicles had this finding. With 89% specificity, 49% sensitivity and 73.5% accuracy, calcification with or without decreased or mixed vascularity could differentiate benign and malignant nodules. CONCLUSION: Decreased or mixed vascularity with or without calcification shows high sensitivity in differentiating malignant and benign nodules.

Role of ultrasound and inflammatory factors in the management of pediatric hip joint effusion.

BACKGROUND: Septic arthritis is an important differential diagnosis of hip joint pain. Joint aspiration analysis is a necessary diagnostic measure for septic arthritis. In order to reduce the need for joint aspiration, we compared the combination of ultrasound findings and laboratory findings to separate septic arthritis from reactive arthritis. METHODS: Children aged < 14 years who were referred to Akbar pediatric hospital in 2020-2022 with hip pain or limping were included in this longitudinal study. Participants underwent ultrasound examinations of the hip and blood samples were obtained from them. After confirming an effusion, dependent on patient status and clinical diagnosis, one of the following approaches was recommended; the close follow-up, or the ultrasound-guided aspiration of the hip joint effusion, and or arthrotomy. The various ultrasound and laboratory were documented. Data were analyzed and P < 0.001 being considered statistically significant. RESULTS: Overall, 115 patients with a mean age of 3.43 ± 5.76 years, 46 of whom were girls, were studied. The final diagnosis in 23 cases (20.0%) was septic arthritis and 92 (80.0%) had reactive arthritis. C-reactive protein (CRP) and The erythrocyte sedimentation rate (ESR) unlike aspirate volume, effusion volume measured on ultrasound, capsule thickness, total thickness, and recorded capsule-to-effusion ratio were significantly higher in patients with septic arthritis (P < 0.001). There was a significant agreement between the volume of measured fluid in the anterior recess and the volume of aspirated fluid (2.5 times, P < 0.001). Septic arthritis was not observed in any of the patients with effusion volume in anterior recess less than 0.5 cc and ESR less than 40 mm/hr or CRP less than 15 mg/L. CONCLUSION: Since septic arthritis was not observed in any of the patients with effusion volume < 0.5 cc and normal inflammatory factors (ESR or CRP), conservative management and close follow-up can be recommended in these patients instead of joint fluid aspiration.

Pulmonary Invasive Fungal Disease: Ultrasound and Computed Tomography Scan Findings.

OBJECTIVE: The importance of ultrasound in diagnosing pulmonary invasive fungal diseases (IFD) has yet to be assessed. Thus, this study aimed to evaluate the frequency of sonographic findings in patients suspected of an invasive pulmonary fungal infection. MATERIAL AND METHODS: This prospective longitudinal study examined all patients with lung lesions in imaging modalities and suspected IFDs referred to Dr. Sheikh and Akbar pediatric hospitals from 2019 to 2022. Considered variables were the halo sign in the computed tomography (CT) scan; the target sign in the ultrasound and contrast-enhanced CT scan; the cavity; wedge-shaped consoli- dation; and pleuritis and extrapulmonary invasion to the chest wall or subdiaphragmatic invasion in both modalities. All patients who underwent lung CT scans and ultrasounds until the final diagnosis were followed up. The degree of agreement between ultrasound and CT scan findings and the sensitivity, specificity, and diagnostic accuracy of these signs were assessed. RESULTS: This study involved 40 patients with an average age of 7.16 ± 4.23 years. Acute leukemia was the commonest underlying dis- ease detected in 17 (42.5%) cases. The target sign in ultrasound (61.9%) and the halo sign in CT scan (71.4%) had the highest frequency among the variables in patients with IFD. Cohen's kappa coefficient agreement in both modalities was 0.5 for the cavity, with significant relation (P = .02). The Cohen's kappa was less than .17 for other findings (P > .05). The diagnostic criteria in the simultaneous examina- tion of the fungus target in ultrasound and halo in CT scan showed a sensitivity of 82.4% and specificity of 76.5%, respectively. CONCLUSION: Combining the characteristic findings of ultrasound and CT-scan provides a higher value in diagnosing pulmonary invasive fungal disease.

Changes in the thymus gland with age: A sonographic evaluation.

Background: Ultrasound evaluation of normal, ectopic, asymmetric, and hyperplastic thymus and also its differentiation from abnormalities are challenging in children, and few studies have addressed this issue. This study aimed to investigate the thymus sonographic changes with age. Methods: In this cross-sectional study, 118 healthy children were categorised into six age groups. Sonographic features of the thymus, including volume, anatomical position, symmetry, and echo-texture, were recorded. Results: The thymus was visible at all ages from the suprasternal view. In 77.5% of participants, the thymus gland volume in lobes was symmetrical; however, left (21.2%) and right (1.3%) predominance were also found. The most common position of the thymus was in front of the great vessels (100%) with suprasternal extension (97.5%). The mean volume of thymus was 21.3 ± 10.5 (mm). There was no significant difference in the volumes of the thymus between different age groups. The predominant echo-texture of the thymus in different age groups was hypoechoic with thin echogenic septa (liver-like) in below 2-3 years of age, the appearance of echogenic foci and hyperechoic echo-texture (liver-like with starry sky) in 2-14 years, and uniform hyperechoic echo-texture (fatty liver-like) or geographic echo-texture with coarse reticular pattern in above 14 years. Conclusion: In children, the thymus gland is visible in ultrasound examination in all age groups from the suprasternal view; however, the echo-texture of the normal thymus changes with age. There was no significant correlation between age and sex with total thymic volume. The specificity of these appearances has made ultrasound a problem-solving modality in children.

Comparison of Ultrasonographic Findings between Patients with Tethered Cord Syndrome and Healthy Children.

Background: Tethered cord syndrome (TCS) is a type of occult spinal dysraphism, which necessitates early detection as an essential component of patient management in reducing complications. This study aimed to compare the findings of spinal cord ultrasonography between TCS patients and healthy individuals. Methods: The current study is a case-control study of patients who were admitted to the Akbar and Ghaem Hospitals (Mashhad, Iran) in 2019. The study population comprised 30 children with TCS aged under two years old, and the control group included 34 healthy peers of the same age. The maximum distance of the spinal cord from the posterior canal wall was measured in millimeters using ultrasonography. Demographic and sonographic findings of each participant were recorded in checklists, which were then entered into SPSS software. P values less than 0.05 were considered statistically significant. Results: The study included 30 children with TCS and 34 healthy individuals with a mean age of 7.67±6.39 months. TCS patients had a significantly shorter maximum distance of the spinal cord from the posterior wall of the spinal canal than the control group (1.75±0.62 mm vs. 2.79±0.76, P<0.001). After performing corrective surgery, the TCS patients indicated significant improvement in this interval (1.57±0.54 mm to 2.95±0.49 mm, respectively, P=0.001). Conclusion: In comparison to children without TCS, the spinal cord was substantially closer to the posterior canal wall in TCS patients. However, these outcomes were improved significantly in patients after surgery.

Correlation of Sonographic Classification of Neck Adenopathy (A-RADS) and Malignancy.

Introduction: Cervical adenopathy can be involved in various pathological processes. This study aimed to evaluate the ultrasound classification of cervical adenopathy (A-RADS) to choose the appropriate approach. Materials and Methods: This cross-sectional study was conducted among 294 patients with cervical adenopathy at Mashhad University of Medical Sciences during 2020-2021. The data of the long axis diameter, short axis diameter, shape, border, vascular pattern, presence of calcification and changes in cyst/necrosis, cortical echogenicity, hilum visibility, and location of involved lymph nodes were extracted. Lymph nodes was classified into four normal, reactive, suspicious & lymphoid disorders, and metastatic groups, based on ultrasound appearance (Adenopathy-reporting and data system). Diagnostic methods included follow-up, core needle biopsy (CNB), and fine needle aspiration (FNA), and surgical results. After determining the final diagnosis, demographic, sonographic, and pathological data were analyzed at a significance level of p<0.05. Results: Of 294 patients, 185 were benign, and 109 were malignant. There were no significant differences in the location, long axis diameter, shape, cystic or necrotic changes, calcification, and margins of the lymph nodes between the benign and malignant groups. The enlarged short axis diameter, invisible hilum with isoechoic cortex, and non-hilar vascularity were significantly higher in the malignant group (p<0.001). The malignancy rate was 8.7% in reactive cases, 48.5% in lymphoid disorders, and 90% in metastatic nodes. Conclusion: The results of this study shows that cervical lymph nodes can be classified based on short axis diameter, cortex and hilum echo-texture and vascular pattern into normal, reactive, suspicious & lymphoid disorders, and metastatic, which have a high concordance with pathologic results.

Improving data adequacy of ultrasonography reports for non-alcoholic fatty liver disease (NAFLD) through a national structured template.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a prevalent disorder that increases due to lifestyle, the rising rate of obesity, and population ages worldwide. Diagnostic ways, including sonography, do not have an explicit reporting structure. PURPOSE: To create a structure template for NAFLD reporting, investigate its completeness, and assess the specialist opinions of using it in clinical practice. MATERIAL AND METHODS: A structured reporting template (SRT) was designed and implemented in four stages. At first, important features were extracted from a comprehensive literature review and were evaluated by 10 radiologists and gastroenterologists using the Likert scale. Finally, the usefulness of the SRT in comparison with the conventional reporting template (CRT) was judged by 10 gastroenterologists completing the questionnaire. RESULTS: Demographic information and sonography of the liver, gallbladder, and spleen organs were the most critical features. The completeness scores of SRT reports were higher than CRT scores for almost all the factors studied. The difference in the scores was significant for most of the parameters. Moreover, the total completeness score increased from 42% in CRT to 92% in SRT. A comparison of the report adequacy of two reports was seen in all items. The SRT obtained more rates from specialists. CONCLUSION: Introduction of the SRT for NAFLD significantly enhanced the completeness of reporting to reduce variability in the interpretation of the related reports by clinicians. Nevertheless, more studies are needed to generalize the results in real scales for patients with NAFLD.

Diagnostic Accuracy of Suprasternal Versus Subxiphoid Ultrasonography for Endotracheal Intubation.

Background: Airway management is an important skill for emergency physicians, and confirmation of correct endotracheal tube (ETT) placement is a crucial component of airway management. Objectives: Due to the occurrence of incorrect ETT positioning in emergency departments, the present study aimed to compare the diagnostic sensitivity of ultrasound using suprasternal and subxiphoid methods for confirming the correct placement of ETT compared to capnography. Methods: This cross-sectional study was conducted by examining patients requiring intubation. Ultrasound was performed by two independent emergency medical assistants using two suprasternal and subxiphoid methods to confirm correct ETT placement; the results were then interpreted. To observe the tube passage through the vocal cords, capnography and lung auscultation were applied as the gold standards, and the results of two ultrasound methods were compared. Results: A total of 66 patients, who were intubated in the emergency department, participated in this study. The positive and negative predictive values, sensitivity, and specificity of supernatural ultrasound were 96.72%, 80%, 98.33%, and 66.67%, respectively. Also, positive and negative predictive values, sensitivity, and specificity of subxiphoid ultrasound were 97.95%, 29.41%, 80%, and 83.33%, respectively. The diagnostic odds ratios of suprasternal and subxiphoid ultrasounds were 1.026 and 1.024 compared to capnography, respectively. Conclusions: Ultrasonography using the suprasternal method was feasible. Considering the high sensitivity and specificity of this method in confirming correct ETT placement, it produced reliable results. Overall, this modality can be used as one of the main methods to verify correct ETT placement in emergency departments.

Impact of Chronic Functional Constipation on Lower Urinary Tract System: A Cases - Control Study.

INTRODUCTION: Association of constipation with incomplete bladder emptying, functional bladder outlet un-coordination, urinary tract infection (UTI), and upper urinary tract dilatation has been reported. We designed a study to determine the impact of chronic functional constipation on kidney and bladder ultrasound parameters, the results of the uroflowmetry test, and its association with UTI. METHODS: The study group consisted of 24 cases and 48 controls, who were children between 5 to 18 years-old, from June 2017 to June 2018. The case group included children with chronic functional constipation. The healthy children with urinary continence and regular bowel habits without any history of UTI were considered as the control group. The variables were bladder volume, postvoiding urinary residual volume, full and empty bladder wall thicknesses, uroflowmetry parameters and, UTI prevalence. RESULTS: There were no significant differences in the prevalence of UTI, upper urinary tract dilatation on kidney ultrasound, uroflowmetry and, bladder ultrasound parameters between the case and control groups (P > .05 for all). We found abnormal uroflowmetry curves in 58.3% and 35.4% of the case and control groups, respectively (P > .05) and a higher rate of staccato curves in constipated compared to healthy children. CONCLUSION: the prevalence of UTI and upper urinary tract dilatation on kidney ultrasonography are not significantly different between constipated and healthy children. Moreover, it seems that chronic constipation has no significant impact on the storage and emptying functions of the bladder. The higher frequency of staccato curves in constipated compared to healthy children can indicate that fecal mass causes detrusor sphincter dyssynergia.  DOI: 10.52547/ijkd.6568.

Impact of Intravenous Trehalose Administration in Patients with Niemann-Pick Disease Types A and B.

BACKGROUND AND AIMS: Niemann-Pick disease (NPD) types A (NPA) and B (NPB) are caused by deficiency of the acid sphingomyelinase enzyme, which is encoded by the SMPD1 gene, resulting in progressive pathogenic accumulation of lipids in tissues. Trehalose has been suggested as an autophagy inducer with therapeutic neuroprotective effects. We performed a single-arm, open-label pilot study to assess the potential efficacy of trehalose treatment in patients with NPA and NPB patients. METHODS: Five patients with NPD type A and B were enrolled in an open-label, single-arm clinical trial. Trehalose was administrated intravenously (IV) (15 g/week) for three months. The efficacy of trehalose in the management of clinical symptoms was evaluated in patients by assessing the quality of life, serum biomarkers, and high-resolution computed tomography (HRCT) of the lungs at the baseline and end of the interventional trial (day 0 and week 12). RESULTS: The mean of TNO-AZL Preschool children Quality of Life (TAPQOL) scores increased in all patients after intervention at W12 compared to the baseline W0, although the difference was not statistically significant. The serum levels of lyso-SM-509 and lyso-SM were decreased in three and four patients out of five, respectively, compared with baseline. Elevated ALT and AST levels were decreased in all patients after 12 weeks of treatment; however, changes were not statistically significant. Pro-oxidant antioxidant balance (PAB) was also decreased and glutathione peroxidase (GPX) activity was increased in serum of patients at the end of the study. Imaging studies of spleen and lung HRCT showed improvement of symptoms in two patients. CONCLUSIONS: Positive trends in health-related quality of life (HRQoL), serum biomarkers, and organomegaly were observed after 3 months of treatment with trehalose in patients with NPA and NPB. Although not statistically significant, due to the small number of patients enrolled, these results are encouraging and should be further explored.

Diagnostic Values of Kidney Ultrasonography for Vesicoureteral Reflux (VUR) and High Grade VUR.

INTRODUCTION: Vesicoureteral reflux (VUR) is a well-known risk factor for urinary tract infection (UTI). We aim to define diagnostic values of kidney ultrasonography (US) as a predictor of VUR and high grades VUR in children presented by UTI. METHODS: This retrospective study was conducted during October 2003 to 2016. Children aged ≤ 18 years with history of UTI who had underwent kidney US and direct cystography [voiding cystourethrography (VCUG) or radionuclide cystography (RNC)] enrolled in the study. Diagnostic values of hydronephrosis, hydro ureter, renal scaring, hydroureteronephrosis, decreased kidney size and abnormal kidney US for diagnosis of VUR and high grades VUR (grades IV-V) were evaluated. RESULTS: Hydro-ureter, renal scaring, and hydroureteronephrosis were significantly more prevalent in VUR+ versus VUR- cases, also in higher grades compared with lower grades (grades I-III) VUR (P < .05 for all). Additionally, hydronephrosis was more common in VUR+ compared with VUR- patients (P < .0001). As a predictor of VUR and higher grades of VUR, abnormal kidney US had the highest sensitivity (24.87% and 40.84%, respectively), abnormal kidney US and hydro ureter reached the highest NPV (70.42% and 81.27%, respectively), hydroureteronephrosis and hydro ureter showed the highest accuracy (68.51% and 82.21%, respectively) . CONCLUSION: Kidney US is a valuable screening test, abnormal renal US significantly increases the probability of VUR and high grades VUR , but if used as the only screening test , about 2/3 and 1/3 and 20% of VUR , high grades VUR and grade V VURs will be missed. DOI: 10.52547/ijkd.5966.

Necessity of Fine-Needle Aspiration in Probably Benign Sonographic Appearance of Thyroid Nodules.

INTRODUCTION: The management of thyroid nodules has been proposed based on US features and information obtained from Fine-Needle Aspiration Cytology (FNAC). In this study, we checked the diagnostic value of ultrasound in comparison with FNAC in probably benign nodules of thyroid. MATERIALS AND METHODS: Patients with thyroid nodules referred to the Radiology department from 2015 to 2020, were classified into five types based on the American College of Radiology/thyroid imaging reporting and data system (TI-RADS) standards. The patients with TI-RADS III-V were examined by FNA biopsy. Subsequently, the collected data of 535 patients having thyroid nodules with TI-RADS III were statistically analyzed. RESULTS: The mean age of the patients was estimated at 46.57. The analysis of TI-RADS III cases examined by the FNA biopsy revealed that 99.1% of the cases were diagnosed with benign lesions. The mean size of benign and malignant nodules was 27mm and 41mm, respectively. There was no significant correlation between the size of the nodules or patients age, and thyroid malignancy (P-values > 0.05). CONCLUSION: There was a very low chance of malignancy (0.9%) in thyroid nodules with thyroid imaging classification of TI-RADS III. Furthermore, no meaningful correlation was observed between the size of the nodules and their malignancy. Therefore, the use of FNAC, based on the current guidelines, on thyroids for nodules larger than 2.5 cm might need to be revised.

Chest computed tomography findings of COVID-19 in children younger than 1 year: a systematic review.

BACKGROUND: The aim of this systematic review is to evaluate the chest computed tomography (CT) findings in infants with confirmed COVID-19 infection by providing a comprehensive review of the existing literature. DATA SOURCES: A systematic search was conducted on PubMed and Embase from the onset of the COVID-19 outbreak to October 20, 2020, for studies that discussed the chest CT findings in infants younger than 1 year with COVID-19 infection. RESULTS: A total of 35 studies comprising 70 COVID-19 (58.5% boys) confirmed infants were included. The mean age of the included patients was 4.1 months with a range of 1 day to 12 months. Chest CT scans showed bilateral abnormalities in 34 patients, and unilateral lung involvement in 25 patients. Ground-glass opacities (GGO) (71.43%) were found to be the most prevalent chest CT manifestation, followed by peribronchial thickening (60%), linear or band-shaped opacities (32.8%), consolidation (28.57%), nodule (18.57%), effusion (7.14%) and focal lucency (7.14%). CONCLUSIONS: GGO and peribronchial thickening were the most prevalent findings in the infants' chest CT scans. Linear or band-shaped opacities, consolidation, and pulmonary nodules are more common in infants than in adults. These findings suggest that the disease is more likely to be presented as an atypical pneumonia (peribronchial thickening and linear or band-shaped opacities) in this age group. Other chest CT scan manifestations can be classified as typical COVID-19 infection (peripheral GGO), lobar pneumonia (consolidation) and opportunistic infections (pulmonary nodules).

Ectopic Intrathoracic Kidney Associated with Ipsilateral Ectopic Spleen and Diaphragmatic Hernia in a Pediatric Patient: A Case Report.

Background: Intrathoracic kidney is the rarest form of an ectopic kidney that is usually accompanied by left congenital diaphragmatic hernia (CDH) (Bochdalek hernia), the association of which with other anomalies is rare. Case Presentation: Herein, we describe a case with a diagnosis of an intrathoracic kidney associated with the ectopic spleen and diaphragmatic hernia diagnosed during imaging studies for urinary tract infections (UTIs). This study reports an 11-month-old male case with a history of CDH and several episodes of UTIs. A kidney ultrasound revealed that the left kidney and spleen were located in the thoracic cavity. Despite intrathoracic lying of the left kidney, there was no vesicoureteral reflux. Technetium-99m dimercaptosuccinic acid scan reported a highly positioned left kidney . Conclusion: With the consideration of a pediatric literature review among patients with intrathoracic ectopic kidney, our case was special and notable since it was the first neonate who had an association of intrathoracic spleen and kidney in the same side with a delayed diagnosis. The main point of this case was that radiologists should consider thoracic kidney a differential diagnosis of unilateral renal agenesis when there is a history of diaphragmatic hernia.

Diagnostic Value of Ultrasound in Detecting Causes of Pediatric Chest X-Ray Opacity.

OBJECTIVES: Computed tomography is considered as the diagnostic gold standard for following up the majority of pediatric chest X-ray (CXR) opacities. However, radiation, cost, and waiting times have led to search for diagnostic alternatives. This study was conducted to determine the diagnostic accuracy of the ultrasound (US) in detecting the causes of pediatric CXR opacities. MATERIALS AND METHODS: This study was conducted on the pediatric patients with CXR opacity referring to Dr. Sheikh Hospital in Mashhad, Iran during 2016-2017. After undergoing the US exam, the patients were followed to obtain the final diagnosis based on reference standard (RF). The accuracy of the US was calculated in detection of thoracic lesions. P value <0.05 was considered to be significant. RESULTS: The most common diagnostic cause of CXR opacity based on RF was pneumonia (n=46, 35-38%), thymus (n=37, 28-46%), bone and soft tissue mass (n=12, 9.23%), cystic lesions (n=11, 8.46%), and diaphragmatic lesions (n=10, 7.69%), as well as intrathoracic masses and empyema (n=7, 5.38%). In only four patients (3.07%), the final diagnosis based on RF was inconsistent with the US diagnosis. The diagnostic accuracy of the US was 100% in the diagnosis of bone and soft tissue masses, diaphragmatic lesions, empyema, and normal thymus, and the accuracy was 96.92% for pneumonia, and 99.23% for cystic lesions and intrathoracic masses. CONCLUSION: Regarding the assessed diagnostic accuracy, the US can be a reliable diagnostic tool to differentiate the main cause of pediatric CXR opacity.

Assessment of Ultrasound / Radio-guided Occult Lesion Localization in Non-palpable Breast Lesions.

OBJECTIVES: Controversy exists about the localization of non-palpable breast lesions. In many countries, the gold standard for the diagnosis of these lesions is needle localization due to its accuracy. This study sought to compare the ultrasound- and radio-guided occult lesion localization (ROLL) as a simple method with the conventional procedures in terms of their diagnostic power. METHODS: This study was conducted on 94 patients with non-palpable breast lesions detected by ultrasonography and localized by the combination of ultrasonography and using radiopharmaceuticals. One to ten hours prior to surgery, 0.1-0.2 ml (equivalent to 0.5-1 mCi) of Tc-99m-phytate was injected to the lesion under the guidance of ultrasonography. Then, the lesion was localized using a hand-held gamma probe, and excision of the lesion was performed according to its radioactivity signal. Data analysis was performed using SPSS, version 16. RESULTS: Benign and malignant pathologic results were observed in 77 (81.9%) and 17(18.1%) of the patients, respectively, and the mean volume of the excised tissue was 26.29±27 mm³. 79 patients had a solitary lesion (84%), 55 in the left breast (58.5%) and 39 in superolateral quadrant (41.5%). The mean size of the lesions was 15.7 mm in diameter (ranging from 4 to 34 mm). Additionally, there was a need to secondary surgery in 3 (3.2%) patients and inappropriate localization in 6 (6.4%) patients (subcutaneous or intra-ductal spread of radiodrug). CONCLUSION: Combination of ultrasound- and radio-guided localization methods for localizing non-palpable breast lesions is a simple and acceptable method for localization with no significant complications. For radio-drug spread and subsequent excessive excised tissue volume, subcutaneous and intra-ductal lesions are not suitable indication for ROLL.

Diagnostic value of ultrasonography in spinal abnormalities among children with neurogenic bladder.

BACKGROUND: Nowadays, magnetic resonance imaging (MRI) is the gold standard for evaluation and diagnosis of spinal cord abnormalities, which are considered among the leading causes of neurogenic bladder; however, MRI is a costly imaging method and is not available at all health centers. Sporadic studies have shown the alignment of MRI with ultrasonography results in diagnosis of spinal abnormalities; although none of these studies has expressed the diagnostic value of ultrasonography. OBJECTIVE: The aim of this study was to evaluate the diagnostic value of ultrasonography in detection of spinal abnormalities in children with neurogenic bladder. METHODS: This is a cross-sectional study carried out from January 2014 to November 2015 on patients with neurogenic bladder referred to Department of Radiology, Dr. Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. All patients underwent sonography of the spinal cord and soft-tissue masses; also, a spinal MRI scan was performed. The existence of spina bifida, sacral agenesis, posterior vertebral arch defects, mass, tethered cord, myelomeningocele, lipoma and fatty infiltration, dural ectasia, hydromyelia and syringomyelia, and diastomatomyelia was recorded during each imaging scan. Chi-square and Fisher's tests were used for data analysis using SPSS 19.0 software, and the sensitivity and specificity of ultrasonography findings were calculated by MedCale 26 software. RESULTS: Forty patients with neurogenic bladder (22 males/18 females), with an average of 25.73±19.15 months, were enrolled. The most common abnormality was found in patients' MRI was tethered cord syndrome (70%). There was a significant relationship between ultrasonographic and MRI findings in spina bifida abnormalities (p=0.016), sacral agenesis (p=0.00), tethered cord (p=0.00), myelomeningocele (p=0.00), and lipoma and fatty infiltration (p=0.01). Ultrasonography had a sensitivity of 20.0%-100% and a specificity of 85.7%-100% depending on the detected type of abnormality. CONCLUSION: It seems that ultrasonography has an acceptable and desirable sensitivity and specificity in the diagnosis of most of the spinal cord abnormalities in children with a neurogenic bladder.