OBJECTIVE: To provide reference ranges of the fetal gall bladder in the Korean population. MATERIALS AND METHODS: Fetal gall bladder development was evaluated in well-dated, non-anomalous fetuses in the Korean population between February and April 2003 and the visualization rate and reference values were determined from the obtained data. RESULTS: The visualization rate of the fetal gall bladder increased as gestation advanced to a plateau above 90%, which was maintained between 16 and 34 weeks. The measured parameters from the fetal gall bladder had a significant positive relationship with gestational age (p = 0.000 for all cases), and the correlation of length and area with the gestational age (r = 0.741 and r = 0.690, respectively) was better than the correlation of width, height, and volume with gestational age. The repeatability coefficients and coefficients of variation between the two operators were 5.56 mm and 12.9% for the length and 344.11 mm(2) and 33.52% for the area. The median length of the fetal gall bladder in the Korean population was not significantly different from the mean length of gall bladders in the Caucasian and African-American populations (p = 0.915). CONCLUSION: We have provided reference values for the fetal gall bladder throughout the gestation period in the Korean population.
Female ; Gallbladder/*embryology/ultrasonography ; Gestational Age ; Humans ; Korea ; Pregnancy ; Reference Values ; Statistics, Nonparametric ; Ultrasonography, Doppler, Color ; *Ultrasonography, Prenatal

OBJECTIVE: To evaluate the usage of duplex power Doppler ultrasound (PDUS) for the differentiation of benign and malignant thyroid nodules. MATERIALS AND METHODS: We prospectively examined 77 thyroid nodules in 60 patients undergoing ultrasound-guided fine needle aspiration biopsy (FNAB). Each nodule was described according to size, inner structure, borders, parenchymal echogenicity, peripheral halo formation, and the presence of calcification (B-mode ultrasound findings). Vascularity as determined by PDUS imaging was defined as non-vascular, peripheral, central, or of mixed type. For each nodule, the pulsatility index (PI) and resistive index (RI) values were obtained. Results of FNAB and surgical pathological examination (if available) were used as a proof of final diagnosis to categorize all nodules as benign or malignant. A receiver operating characteristic (ROC) curve analysis was performed to establish cut-off, sensitivity, and specificity values associated with RI-PI values. RESULTS: A significant relationship was observed between malignancy and irregular margins, microcalcifications, and hypoechogenicity on ultrasound examination (p < 0.05). The pattern of vascularity as determined by PDUS analysis was not a statistically significant criterion to suggest benign or malignant disease in this study (p > 0.05). The central, peripheral, and mean RI-PI values were higher in malignant nodules when compared to the other cytologies (p < 0.05). CONCLUSION: Vascularity is not a useful parameter for distinguishing malignant from benign thyroid nodules. However, RI and PI values are useful in distinguishing malignant from benign thyroid nodules.
Adult ; Aged ; Biopsy, Fine-Needle ; Chi-Square Distribution ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Statistics, Nonparametric ; Thyroid Neoplasms/pathology/*ultrasonography ; Thyroid Nodule/pathology/*ultrasonography ; *Ultrasonography, Doppler, Duplex ; Ultrasonography, Interventional

OBJECTIVETo study the rates of receiving doppler signal, flow velocity of cerebral artery and the relationship between flow velocity,age and gender in normal adults in China.

METHODSA total of 1500 normal residents at the community level in Guangdong province were examined, using transcranial doppler. Data was gathered and analyzed.

RESULTSWith the increase of age, the rate of receiving signal in cerebral artery gradually decreased. Difference between males and females was noticed. Mean velocity of cerebral artery decreased in both genders but the velocity was faster in females than in males and the pulsate index increased without difference.

CONCLUSIONThe rates of receiving signal and the flow velocity of cerebral artery were related to age and gender and the findings from this study offered criterion for clinical transcranial doppler.

Aged ; Aging ; Cerebral Arteries ; diagnostic imaging ; physiology ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Sex Characteristics ; Ultrasonography, Doppler, Transcranial ; statistics & numerical data

OBJECTIVE: To validate contrast-enhanced power Doppler ultrasonography (PD US) for the evaluation of synovial vascularity in an arthritic rabbit knee model in correlation with MR and histological findings. MATERIALS AND METHODS: Power Doppler ultrasonography was performed for carrageenin-induced arthritic left knee and control right knee of 13 rabbits, first without and then with sonic contrast agent enhancement (Levovist, Schering, Berlin Germany), followed by gadolinium-enhanced MR imaging. Synovial vascularity was quantitatively assessed by calculating the color pixel area in power Doppler sonography using a computer-aided image analysis program and by grading the enhancement on MR images: grade 1, enhancement of knee joint is less than one-third of the area; grade 2, one-third to two-thirds enhancement; and grade 3, more than two-thirds enhancement. Microvessel density (MVD) was measured on slides stained immunohistochemically for CD31 antigen for histological assessment. RESULTS: The mean area of color pixels in PD US changed from 4.37 to 16.42 mm2 in the arthritic knee after enhancement (p < 0.05), whereas it changed from 0.77 to 2.31 mm2 in the control knee (p < 0.05). Arthritic knees had greater power Doppler signal than control knees both before and after contrast administration (p < 0.05). The average MVD was 88 in arthritic knees and 46 in control knees. MVDs correlated with color pixel areas of contrast-enhanced power Doppler imaging in arthritic knees. In MR grading of arthritic knees, five were grade 2 and eight were grade 3. MVD and PD US revealed no significant difference between grade 2 and 3 arthritic knees (p > 0.05). CONCLUSION: Sonic contrast-enhanced PD US improves the visualization of synovial vascularity and allows quantitative measurement in experimentally induced rabbit arthritic knees.
Animals ; Contrast Media ; Gadolinium DTPA/diagnostic use ; Image Processing, Computer-Assisted ; Immunohistochemistry ; Magnetic Resonance Imaging ; Osteoarthritis, Knee/pathology/*ultrasonography ; Polysaccharides/diagnostic use ; Rabbits ; Statistics, Nonparametric ; Synovial Membrane/*blood supply/pathology/ultrasonography ; *Ultrasonography, Doppler

OBJECTIVE: Logistic regression analysis (LRA), Support Vector Machine (SVM) and a neural network (NN) are commonly used statistical models in computer-aided diagnostic (CAD) systems for breast ultrasonography (US). The aim of this study was to clarify the diagnostic ability of the use of these statistical models for future applications of CAD systems, such as three-dimensional (3D) power Doppler imaging, vascularity evaluation and the differentiation of a solid mass. MATERIALS AND METHODS: A database that contained 3D power Doppler imaging pairs of non-harmonic and tissue harmonic images for 97 benign and 86 malignant solid tumors was utilized. The virtual organ computer-aided analysis-imaging program was used to analyze the stored volumes of the 183 solid breast tumors. LRA, an SVM and NN were employed in comparative analyses for the characterization of benign and malignant solid breast masses from the database. RESULTS: The values of area under receiver operating characteristic (ROC) curve, referred to as Az values for the use of non-harmonic 3D power Doppler US with LRA, SVM and NN were 0.9341, 0.9185 and 0.9086, respectively. The Az values for the use of harmonic 3D power Doppler US with LRA, SVM and NN were 0.9286, 0.8979 and 0.9009, respectively. The Az values of six ROC curves for the use of LRA, SVM and NN for non-harmonic or harmonic 3D power Doppler imaging were similar. CONCLUSION: The diagnostic performances of these three models (LRA, SVM and NN) are not different as demonstrated by ROC curve analysis. Depending on user emphasis for the use of ROC curve findings, the use of LRA appears to provide better sensitivity as compared to the other statistical models.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; *Artificial Intelligence ; Breast Neoplasms/*ultrasonography ; Diagnosis, Computer-Assisted ; Diagnosis, Differential ; Female ; Humans ; Image Interpretation, Computer-Assisted ; Imaging, Three-Dimensional/*statistics & numerical data ; Logistic Models ; Middle Aged ; *Neural Networks (Computer) ; Predictive Value of Tests ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography, Doppler/*statistics & numerical data ; Ultrasonography, Mammary/*statistics & numerical data

PURPOSE: We investigated acute stroke patterns on diffusion weighted images and with doppler ultrasonography studies of ICA and MCA steno-occlusive diseases in order to predict the cerbrovascular reserve (CVR), as was measured by acetazolamide (ACZ)-challenged Tc-99m ECD brain perfusion SPECT. MATERIALS AND METHODS: A retrospective analysis was performed of 76 patients who underwent MRI/MRA, ACZ-challenged Tc-99m ECD brain perfusion SPECT, and carotid and vertebral artery Doppler sonography. After dividing these patients into four groups- MCA and ICA steno-occlusions, we analyzed the relationship between the CVR and topologic MR patterns and the flow volume, as was measured by Doppler sonography. RESULTS: The CVRs were preserved in 26 of 76 patients. The CVRs were impaired in those cases of occlusion that were detected on MRA and also by the pattern of the territorial involvement on the diffusion weighted image (p < 0.05, x2 test). Yet in cases of preserved CVRs, the flow volume of the contralateral ICA, the anterior circulation, and the total cerebral flow volume were increased, as was checked by Doppler sonography (p < 0.05, t-test). As calculated by logistic regression analysis, the accuracy for predicting the preserved CVR by using the statistically significant variables was 78%. CONCLUSION: We believe that the MRI-SPECT correlation study was helpful for understanding the hemodynamics and topographic patterns of ischemia in patients with ICA and MCA steno-occlusive disease, and that the flow volume measurement, which was done by using duplex US, was useful for predicting the CVR.
Acetazolamide ; Brain ; Cerebral Infarction ; Diffusion ; Hemodynamics ; Humans ; Ischemia ; Logistic Models ; Magnetic Resonance Imaging* ; Middle Cerebral Artery ; Perfusion ; Retrospective Studies ; Statistics as Topic ; Stroke ; Tomography, Emission-Computed, Single-Photon ; Ultrasonography, Doppler* ; Vertebral Artery

INTRODUCTIONHaemodynamic monitoring is an essential element in the management of critically ill patients in the intensive care unit (ICU). However, there have been increasing concerns about the clinical utility and safety profile of the invasive pulmonary artery catheter (PAC). Oesophageal Doppler (ED) monitoring has emerged recently as a safer and less invasive tool which can be used by the intensivist to estimate cardiac output in the critically ill patient. Validation studies have thus far only been performed in surgical patients perioperatively and in mixed surgical/medical ICU patients. Currently, minimal data are available in any sizeable Asian population or in patients with severe sepsis. The assumption that these normograms and data hold true for our local medical ICU patients may not be valid due to differences in body habitus.

MATERIALS AND METHODSOur primary aim is to validate the oesophageal Doppler as a reliable measure of cardiac index, systemic vascular resistance (SVR) and preload in our local Asian population of patients with severe sepsis and septic shock in the medical ICU. This was a prospective pilot study on 12 consecutive mechanically ventilated patients in our medical ICU with the diagnosis of septic shock as defined by SCCM/ESICM/ACCP/ATS/SIS International Sepsis definitions Conference-Critical Care Medicine 2003 and required PAC haemodynamic monitoring as indicated by Medical Intensive Care Unit attending.

RESULTSNinety-seven paired cardiac output measurements were made. Cardiac output ranged from 2.87 to 11.0 L/ min (calculated cardiac index ranging from 1.73 to 6.36 L/min/m2) when measured using the PAC with thermodilution technique and from 2.0 to 12.1 L/min (calculated cardiac index of 1.2 to 7.2 L/min/m2) using the trans-oesophageal Doppler. There was moderately good correlation between CIpac and CIed (correlation coefficient, r = 0.762 with PCA = 58%). The mean bias was 0.26 L/min/m2 (P <0.07), while the limit of agreement was +/- 1.44 L/min/m2.

CONCLUSIONED has good correlation with PAC in measuring cardiac index in Asians with septic shock but is an unreliable measure of both pre-load and SVR.

Cardiac Output ; Critical Care ; Critical Illness ; Echocardiography, Transesophageal ; Esophagus ; diagnostic imaging ; Female ; Hemodynamics ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Pulmonary Artery ; Reproducibility of Results ; Shock, Septic ; diagnostic imaging ; Statistics as Topic ; Ultrasonography, Doppler

OBJECTIVE: This study aims to evaluate the degree of inter- and intraobserver agreement when characterizing breast abnormalities using the Breast Imaging Reporting and Data System (BI-RADS)-ultrasound (US) lexicon, as defined by the American College of Radiology (ACR). MATERIALS AND METHODS: Two hundred ninety three female patients with 314 lesions underwent US-guided biopsies at one facility during a two-year period. Static sonographic images of each breast lesion were acquired and reviewed by four radiologists with expertise in breast imaging. Each radiologist independently evaluated all cases and described the mass according to BI-RADS-US. To assess intraobserver variability, one of the four radiologists reassessed all of the cases one month after the initial evaluation. Inter- and intraobserver variabilities were determined using Cohen's kappa (k) statistics. RESULTS: The greatest degree of reliability for a descriptor was found for mass orientation (k = 0.61) and the least concordance of fair was found for the mass margin (k = 0.32) and echo pattern (k = 0.36). Others descriptive terms: shape, lesion boundary and posterior features (k = 0.42, k = 0.55 and k = 0.53, respectively) and the final assessment (k = 0.51) demonstrated only moderate levels of agreement. A substantial degree of intraobserver agreement was found when classifying all morphologic features: shape, orientation, margin, lesion boundary, echo pattern and posterior feature (k = 0.73, k = 0.68, k = 0.64, 0.68, k = 0.65 and k = 0.64, respectively) and rendering final assessments (k = 0.65). CONCLUSION: Although BI-RADS-US was created to achieve a consensus among radiologists when describing breast abnormalities, our study shows substantial intraobserver agreement but only moderate interobserver agreement in the mass description and final assessment of breast abnormalities according to its use. A better agreement will ultimately require specialized education, as well as self-auditing practice tests.
Adenocarcinoma/classification/*diagnosis ; Adenocarcinoma, Mucinous/classification/*diagnosis ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; Breast Neoplasms/classification/*diagnosis ; Carcinoma, Ductal, Breast/classification/*diagnosis ; Carcinoma, Intraductal, Noninfiltrating/classification/*diagnosis ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Observer Variation ; Predictive Value of Tests ; Radiology ; Reproducibility of Results ; Sensitivity and Specificity ; Societies, Medical ; Terminology as Topic ; Ultrasonography, Doppler, Color/statistics & numerical data ; Ultrasonography, Mammary/*statistics & numerical data