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Transrectal ultrasonography of anorectal diseases: advantages and disadvantages.

Ultrasonography.2015;34(1):19-31. doi:10.14366/usg.14051

Transrectal ultrasonography (TRUS) has been widely accepted as a popular imaging modality for evaluating the lower rectum, anal sphincters, and pelvic floor in patients with various anorectal diseases. It provides excellent visualization of the layers of the rectal wall and of the anatomy of the anal canal. TRUS is an accurate tool for the staging of primary rectal cancer, especially for early stages. Although magnetic resonance imaging is a modality complementary to TRUS with advantages for evaluating the mesorectum, external sphincter, and deep pelvic inflammation, three-dimensional ultrasonography improves the detection and characterization of perianal fistulas and therefore plays a crucial role in optimal treatment planning. The operator should be familiar with the anatomy of the rectum and pelvic structures relevant to the preoperative evaluation of rectal cancer and other anal canal diseases, and should have technical proficiency in the use of TRUS combined with an awareness of its limitations compared to magnetic resonance imaging.
Anal Canal ; Fistula ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Pelvic Floor ; Rectal Neoplasms ; Rectum ; Ultrasonography*

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Contrast-enhanced ultrasonography: advance and current status in abdominal imaging.

Yong Eun CHUNG ; Ki Whang KIM

Ultrasonography.2015;34(1):3-18. doi:10.14366/usg.14034

In the field of contrast-enhanced ultrasonography (US), contrast agents are classified as either first- or second-generation agents depending on the gas within the microbubbles. In the case of first-generation contrast agents, a high-mechanical-index technique is used and only intermittent scanning is possible due to the early destruction of the microbubbles during the scanning. The use of second-generation contrast agents in a low-mechanical-index technique enables continuous scanning. Besides the detection and characterization of focal liver lesions, contrast-enhanced US is helpful in the monitoring of radiofrequency ablation therapy and in the targeting step of an US-guided biopsy. Recently, there has been a demand for new criteria to evaluate the treatment response obtained using anti-angiogenic agents because morphologic criteria alone may not reflect the treatment response of the tumor and contrast-enhanced US can provide quantitative markers of tissue perfusion. In spite of the concerns related to its cost-effectiveness, contrast-enhanced US has the potential to be more widely used as a complimentary tool or to substitute the current imaging modalities in some occasions.
Abdomen ; Biopsy ; Catheter Ablation ; Contrast Media ; Image Enhancement ; Liver ; Microbubbles ; Perfusion ; Ultrasonography*

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ULTRASONOGRAPHY: on the way to becoming an internationally renowned journal.

Jeong Sik YU

Ultrasonography.2015;34(1):1-2. doi:10.14366/usg.14055

No abstract available.
Ultrasonography*

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Papillary thyroid microcarcinoma in a thyroid pyramidal lobe.

Tae Kwun HA ; Dong Wook KIM ; Ha Kyoung PARK ; Soo Jin JUNG

Ultrasonography.2014;33(4):303-306. doi:10.14366/usg.14026

We report an extremely rare case of papillary thyroid microcarcinoma (PTMC) in the thyroid Epub ahead of print pyramidal lobe (TPL). A 48-year-old woman underwent ultrasound-guided fine-needle aspiration for a small thyroid nodule in the right lobe in local clinic, and it revealed a malignant cytology. On preoperative ultrasonography for tumor staging in our hospital, another small suspiciously malignant hypoechoic nodule was detected in the left TPL. Total thyroidectomy and central nodal dissection were performed. Histopathology confirmed PTMCs in the left TPL and both thyroid lobes. Ultrasonography for TPL should be required for complete evaluation of possible multifocality of thyroid malignancy.
Biopsy, Fine-Needle ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Thyroid Gland* ; Thyroid Nodule ; Thyroidectomy ; Ultrasonography

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Aggressive primary thyroid lymphoma: imaging features of two elderly patients.

Eu Hyun KIM ; Jee Young KIM ; Tae Jung KIM

Ultrasonography.2014;33(4):298-302. doi:10.14366/usg.14025

We report two cases of aggressive thyroid lymphoma in elderly patients that presented as Epub ahead of print large infiltrative thyroid masses with extensive invasion to adjacent structures including trachea, esophagus, and common carotid artery. Ultrasonography displayed irregular shaped, heterogeneous hypoechoic mass, mimicking anaplastic carcinoma. Computed tomography showed heterogeneously enhancing mass compared to surrounding muscles without calcification and hemorrhage. After biopsy, the masses were histopathologically diagnosed as lymphoma. Aggressive primary thyroid lymphoma is rare; therefore, here we report its image features, with emphasis on ultrasonographic findings, and discuss its differential diagnosis.
Aged* ; Biopsy ; Carcinoma ; Carotid Artery, Common ; Diagnosis, Differential ; Esophagus ; Hemorrhage ; Humans ; Lymphoma* ; Multidetector Computed Tomography ; Muscles ; Thyroid Gland* ; Trachea ; Ultrasonography

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Conventional papillary thyroid carcinoma: effects of cystic changes visible on ultrasonography on disease prognosis.

Ja Young KIM ; Eun Kyung KIM ; Hye Sun LEE ; Jin Young KWAK

Ultrasonography.2014;33(4):291-297. doi:10.14366/usg.14028

PURPOSE: To investigate the characteristics of papillary thyroid carcinoma (PTC) with cystic changes visible on ultrasonography (US). METHODS: This study included 553 PTCs in 553 patients between January 2003 and August 2004. One radiologist with 10 years of experience in thyroid imaging retrospectively reviewed the preoperative US images. Two different groups were formed according to two different reference points (group 1, 25%; group 2, 50%) of the cystic component. Patients between the groups were compared according to their clinicopathologic characteristics. Disease-free survival (DFS) was estimated. Cox's multivariate proportional hazards regression model was used to identify the effect of variable factors on the recurrence risk. RESULTS: Fifty-six patients (10.1%) were confirmed to have tumor recurrence within the follow-up period. Thirty-five patients had regional metastasis, one had distant metastasis, eight had multiple site metastases, and 12 had biochemical recurrence. PTC patients with a < or = 50% or PTC patients with a < or = 25% cystic component did not have a statistically significant longer DFS than those with a >50% (hazard ratio [HR], 1.118; 95% confidence interval [CI], 0.255 to 4.910; P=0.883) or those with a >25% cystic component (HR, 0.569; 95% CI, 0.164 to 1.976; P=0.375), respectively. Moreover, independent predictors of recurrence were pathologic size, male gender, and lymph node metastasis, not a >50% or >25% cystic component. CONCLUSION: The proportion of the cystic component in PTCs did not affect DFS.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prognosis* ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroid Nodule ; Ultrasonography*

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Ultrasonographic features of vascular closure devices: initial and 6-month follow-up results.

Hye Jung CHOO ; Hae Woong JEONG ; Jin Young PARK ; Sung Chul JIN ; Sung Tae KIM ; Jung Hwa SEO ; Sun Joo LEE ; Young Mi PARK

Ultrasonography.2014;33(4):283-290. doi:10.14366/usg.14023

PURPOSE: This study aimed to evaluate the ultrasonographic findings for various types of vascular closure devices (VCDs) immediately after the angiographic procedure and at 6-month follow-up. METHODS: We included 18 VCDs including Angio-Seal (n=4), FemoSeal (n=8), ExoSeal (n=3), Perclose (n=2), and StarClose (n=1) in this study. Four patients were implanted with 2 VCDs at the each side of bilateral femoral arteries, while the remaining 8 patients were inserted 1 VCD at the right femoral artery. Ultrasonography was performed within 10 days and at approximately 6 months after the angiographic procedure. Ultrasonographic morphology of the attached VCD and its relationship with the arterial wall were analyzed. RESULTS: Initial ultrasonography revealed the attached VCD as the relevant unique structure with successful deployment and hemostasis. Follow-up ultrasonography demonstrated partial absorption of hemostatic materials in cases of Angio-Seal (n=3), FemoSeal (n=5), and ExoSeal (n=3), changes in the soft tissue surrounding the femoral artery in case of Angio-Seal (n=1), arterial intimal hyperplasia in cases of FemoSeal (n=3), and no gross changes as compared with the initial ultrasonographic findings in cases of Perclose (n=2) and StarClose (n=1). CONCLUSION: Initial ultrasonographic evaluation reflected the unique structure of each VCD, with most of them being easily distinguishable. Follow-up ultrasonography revealed various changes in the affected vessels.
Absorption ; Femoral Artery ; Follow-Up Studies* ; Hemostasis ; Humans ; Hyperplasia ; Ultrasonography ; Vascular Access Devices

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Harmonic ultrasonography for the detection of microlithiasis in the gallbladder.

Chul Soon CHOI ; You Jin KU ; Dae Young YOON ; Eun Joo YUN ; Young Lan SEO ; Kyoung Ja LIM ; Sora BAEK ; Sang Hoon BAE ; Eun Sook NAM

Ultrasonography.2014;33(4):275-282. doi:10.14366/usg.14024

PURPOSE: To validate the use of harmonic ultrasonography (US) in the detection of gallbladder microlithiasis. METHODS: From November 30, 2012, to January 18, 2014, fundamental US (FUS) and harmonic US with a high background noise (HUS-N) were performed for evaluation of gallbladder during the routine abdomen US. During the US, a dot-like stone (or stones) with Brownian motion was regarded as a positive finding of microlithiasis. Fifty-five patients with microlithiasis in the gallbladder detected on US were enrolled as the subjects of a retrospective review. With respect to the obtained images, two abdominal radiologists independently scored the conspicuity of gallbladder microlithiasis on FUS and HUS-N by using a 4-grade scale. The statistical analysis employed a kappa test and a Wilcoxon rank-sum test. RESULTS: For FUS, the conspicuity grades of gallbladder microlithiasis were G1 in 25 and 37, G2 in 21 and 9, G3 in 6 and 6, G4 in 3 and 3 patients, while HUS-N showed G1 in 0 and 0, G2 in 3 and 2, G3 in 12 and 15, and G4 in 40 and 38 patients, respectively, by each of the two radiologists. The kappa value was 0.633 for FUS between the two radiologists and 0.708 for HUS-N. HUS-N showed better conspicuity of gallbladder microlithiasis than FUS with significant P-values of less than 0.001 and 0.001 for the two radiologists, respectively. CONCLUSION: Compared with FUS, HUS-N enables better detection of microlithiasis in the gallbladder.
Abdomen ; Cholecystolithiasis ; Gallbladder* ; Humans ; Noise ; Retrospective Studies ; Ultrasonography*

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Ultrasonographic findings of type IIIa biliary atresia.

Seung Seob KIM ; Myung Joon KIM ; Mi Jung LEE ; Choon Sik YOON ; Seok Joo HAN ; Hong KOH

Ultrasonography.2014;33(4):267-274. doi:10.14366/usg.14016

PURPOSE: To describe the ultrasonographic (US) findings of type IIIa biliary atresia. METHODS: We retrospectively reviewed a medical database of patients pathologically confirmed to have biliary atresia, Kasai type IIIa, between January 2002 and May 2013 (n=18). We evaluated US findings including the visible common bile duct (CBD), triangular cord thickness, gallbladder size and shape, and subcapsular flow on color Doppler US; laboratory data; and pathological hepatic fibrosis grades. We divided them into two groups-those with visible (group A) and invisible (group B) CBD on US-and compared all parameters between the two groups. RESULTS: CBD was visible on US in five cases (27.8%; group A) and invisible in 13 cases (72.2%; group B). US was performed at an earlier age in group A than in group B (median, 27 days vs. 60 days; P=0.027) with the maximal age of 51 days. A comparison of the US findings revealed that the triangular cord thickness was smaller (4.1 mm vs. 4.9 mm; P=0.004) and the gallbladder length was larger (20.0 mm vs. 11.7 mm; P=0.021) in group A. The gallbladder shape did not differ between the two groups, and the subcapsular flow was positive in all cases of both groups. There was no significant difference in the laboratory data between the two groups. Upon pathological analysis, group A showed low-grade and group B showed low- to high-grade hepatic fibrosis. CONCLUSION: When CBD is visible on US in patients diagnosed with type IIIa biliary atresia, other US features could have a false negative status. A subcapsular flow on the color Doppler US would be noted in the type IIIa biliary atresia patients.
Biliary Atresia* ; Common Bile Duct ; Fibrosis ; Gallbladder ; Humans ; Retrospective Studies ; Ultrasonography

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Vacuum-assisted breast biopsy under ultrasonographic guidance: analysis of a 10-year experience.

Seung Hyun LEE ; Eun Kyung KIM ; Min Jung KIM ; Hee Jung MOON ; Jung Hyun YOON

Ultrasonography.2014;33(4):259-266. doi:10.14366/usg.14020

PURPOSE: To determine the indications and the diagnostic accuracy of vacuum-assisted breast biopsy (VABB) under ultrasonographic (US) guidance based on a 10-year period of clinical use. METHODS: This was a retrospective analysis of 2,920 breast lesions in 2,477 consecutive patients who underwent US-guided VABB between February 2002 and December 2011. The proportions of each indication for VABB were analyzed as well as the trend of its use over divided time periods. Histopathological diagnosis and the malignancy rate of the lesions with VABB were analyzed. A comparison of the pathological diagnosis of VABB and the gold standard diagnosis revealed the false negative rate, the underestimation rate, and the agreement rate. RESULTS: Palpable lesions (44.4%), low-suspicion lesions (15.7%), high-risk lesions (12.4%), and calcifications (10.3%) were the most common indications for US-guided VABB. The malignancy rate of lesions submitted to VABB was 5.4%. The false negative rate was only 0.1%, while the underestimation rate of high-risk lesions and ductal carcinoma in situ was 3.1% and 13.8%, respectively, with a 98.7% agreement rate. Among 1,512 therapeutic VABB cases, 84.9% showed no residual or recurrent lesions on long term follow-up US for more than a year. Complications occurred in 1% of the patients without need for surgical intervention. CONCLUSION: US-guided VABB is an accurate and safe method that can help decision-making in the diagnostic process and can be an alternative for excisional surgery in some therapeutic circumstances.
Biopsy* ; Breast Neoplasms ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Follow-Up Studies ; Humans ; Image-Guided Biopsy ; Retrospective Studies ; Ultrasonography

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