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0647: Automatic Breast Ultrasound and Computer Aided Diagnosis
S88
Ultrasound in Medicine and Biology
Tendon subluxation Static or dynamic Association with subscapularis tears Transverse ligament rupture Careful medial search for tendon Don’t confuse with long head Infraspinatus tears uncommon in isolation: examine insertion and MTJ Anterior interval Coracohumeral ligament overlies biceps Free edge supraspinatus above/lateral, subscapularis below/medial Coracohumeral ligament thickened in adhesive capsulitis Surrounding synovial mass with blood flow Reduced IR key clinical sign SASD bursa Thickening can be subtle Earliest fluid detected in inferolateral recess Occasional increased blood flow Bunching as positive impingement test but 30% FP and FN Guided anaesthetic better impingement test Glenohumeral joint Effusions best seen posteriorly Minor surface bony irregularity common Welch lesion and PSI possible causes Labrum Can occasional be seen in think individuals but not in entirety No role for US in instability, PSI or SLAP tears Paralabral cysts located in supraglenoid notch .. posterior approach ACJ Anatomical abnormality common poor correlation with symptoms cause of “high-arc” shoulder impingement Dynamic examination Normal ⫽ slight reduction of joint space and acromial elevation Abnormal ⫽ marked reduction and convex upper border Geyser phenomenon due to cuff tear 0643 3D Ultrasound of the Supraspinatus Tendon - A Birds Eye View Le-Anne Grimshaw, Mater Imaging, North Sydney, Australia Where can we take the new technology manufacturers are providing us with? This presentation explores the use of 3D technology in the supraspinatus tendon. I will be discussing the concept of the C-plane, usefulness of data sets and how the volume rendered image can be helpful. I offer a taste of what 3d technology can be used for so that you can go back to your clinic and experiment with all areas of musculoskeletal imaging. 0645 Ultrasound of the Posterior Circumflex Humeral Artery David J Robinson, Symbion Health, The Avenue Hospital, Windsor, Victoria, Australia Paul Marks, Symbion Health, The Avenue Hospital, Windsor, Victoria, Australia Michal Schneider-Kolsky, Dept. of Medical Imaging & Radiation Sciences, Monash University, Australia Objectives: Quadrilateral space syndrome (QSS) is described as compression neuropathy of the axillary neurovascular bundle in the quadrilateral space of the shoulder. This neurovascular bundle includes the posterior circumflex humeral artery (PCHA). The rate of compression of the neurovascular bundle upon abduction and external rotation is unknown in the normal population.
Volume 35, Number 8S, 2009 The diagnosis of QSS is hence challenging and subject to some controversy. The aim of our study was to assess if ultrasound can be used to characterize the heamodynamic properties of the PCHA. Methods: Asymptomatic patients were recruited. All scans were performed on Seimens Sonoline Antares release 5.0 with linear VFX9-4MHz and VFX13-5MHz transducers. Hemodynamic characteristics of the PCHA in neutral position, and in abduction and external rotation were assessed. Outcome measurements included the PSV, EDV, RI and AT. The teres minor muscle was also compared to the adjacent infraspinatus muscle in order to determine presence of fatty infiltration. Results: 26 patients were recruited (mean age 40 ⫾ 12 years). Ultrasound was able to visualize and characterize the PCHA in all cases. Three patients (5.8%) presented with occlusions upon abduction and external rotation. The average PSV was 29.6 (⫾ 9) cm/sec in neutral position, and 27.7 (⫾ 19.8) cm/sec during abduction. None of the patients showed signs of fatty infiltration of the teres minor. Conclusion: Ultrasound is capable of assessing occlusion/stenosis of the PCHA on abduction and external rotation in asymptomatic patients. This modality can be used as the preferred first-line imaging tool for the diagnosis of QSS. 0647 Automatic Breast Ultrasound and Computer Aided Diagnosis Woo Kyung Moon, Seoul National University Hospital, Korea US screening has been performed using hand-held probes that are used to scan the entirety of both breasts. The technique however, requires practice and is generally performed by a physician. Recently, continuing technological advancement has made available whole-breast US scanning using an automated probe, which images wide field of view of breast tissue in three dimension (3D) reconstructed images. From 2007.11-2007.12, 134 bilateral whole breast US was obtained using U-systems in 67 consecutive women who were scheduled to undergo US guided needle biopsy due to 72 suspicious breast masses (24 invasive cancers and 48 benign lesions). Detection rate of malignant nodule (91.7% to 95.8 %) was significantly higher than those of benign nodule (56.2% to 66.7 %) when the 3 radiologists read the 3D breast volume data. In another study, we assessed the performance of 3 radiologists for the detection of breast cancers using 3D ABUS (40 diseased and 37 normal). Almost 95 % of cancers were consistently detected with variable false positive rates (10-40%) by the radiologists. Most of false positive findings were associated with posterior shadowing beneath Cooper’s ligament. Our study suggests that the use of ABUS and interpretation with 3D volume data has the potential to reduce the recall rate for benign masses without missing the malignant masses. Even though substantial degree of cancer detection was achieved by using 3D breast volume data, radiologists’ experience and training are still needed to identify small cancers and to reduce false positive rates. CAD systems may assist the radiologist in the early detection of breast cancer by highlighting suspicious areas seen on ABUS. 0648 Extended Field of View and 3D in the Diagnosis of Breast Pathology Roberto Moncayo, Ecomedica, Ecuador Extended field of view and 3D in the diagnosis of breast pathology is relatively new software in Ultrasonography. It is the ability to collect images from different segments of the human body, while the operator performs a scan with the transducer continuously along the segment of
Ultrasound in Medicine and Biology
Tendon subluxation Static or dynamic Association with subscapularis tears Transverse ligament rupture Careful medial search for tendon Don’t confuse with long head Infraspinatus tears uncommon in isolation: examine insertion and MTJ Anterior interval Coracohumeral ligament overlies biceps Free edge supraspinatus above/lateral, subscapularis below/medial Coracohumeral ligament thickened in adhesive capsulitis Surrounding synovial mass with blood flow Reduced IR key clinical sign SASD bursa Thickening can be subtle Earliest fluid detected in inferolateral recess Occasional increased blood flow Bunching as positive impingement test but 30% FP and FN Guided anaesthetic better impingement test Glenohumeral joint Effusions best seen posteriorly Minor surface bony irregularity common Welch lesion and PSI possible causes Labrum Can occasional be seen in think individuals but not in entirety No role for US in instability, PSI or SLAP tears Paralabral cysts located in supraglenoid notch .. posterior approach ACJ Anatomical abnormality common poor correlation with symptoms cause of “high-arc” shoulder impingement Dynamic examination Normal ⫽ slight reduction of joint space and acromial elevation Abnormal ⫽ marked reduction and convex upper border Geyser phenomenon due to cuff tear 0643 3D Ultrasound of the Supraspinatus Tendon - A Birds Eye View Le-Anne Grimshaw, Mater Imaging, North Sydney, Australia Where can we take the new technology manufacturers are providing us with? This presentation explores the use of 3D technology in the supraspinatus tendon. I will be discussing the concept of the C-plane, usefulness of data sets and how the volume rendered image can be helpful. I offer a taste of what 3d technology can be used for so that you can go back to your clinic and experiment with all areas of musculoskeletal imaging. 0645 Ultrasound of the Posterior Circumflex Humeral Artery David J Robinson, Symbion Health, The Avenue Hospital, Windsor, Victoria, Australia Paul Marks, Symbion Health, The Avenue Hospital, Windsor, Victoria, Australia Michal Schneider-Kolsky, Dept. of Medical Imaging & Radiation Sciences, Monash University, Australia Objectives: Quadrilateral space syndrome (QSS) is described as compression neuropathy of the axillary neurovascular bundle in the quadrilateral space of the shoulder. This neurovascular bundle includes the posterior circumflex humeral artery (PCHA). The rate of compression of the neurovascular bundle upon abduction and external rotation is unknown in the normal population.
Volume 35, Number 8S, 2009 The diagnosis of QSS is hence challenging and subject to some controversy. The aim of our study was to assess if ultrasound can be used to characterize the heamodynamic properties of the PCHA. Methods: Asymptomatic patients were recruited. All scans were performed on Seimens Sonoline Antares release 5.0 with linear VFX9-4MHz and VFX13-5MHz transducers. Hemodynamic characteristics of the PCHA in neutral position, and in abduction and external rotation were assessed. Outcome measurements included the PSV, EDV, RI and AT. The teres minor muscle was also compared to the adjacent infraspinatus muscle in order to determine presence of fatty infiltration. Results: 26 patients were recruited (mean age 40 ⫾ 12 years). Ultrasound was able to visualize and characterize the PCHA in all cases. Three patients (5.8%) presented with occlusions upon abduction and external rotation. The average PSV was 29.6 (⫾ 9) cm/sec in neutral position, and 27.7 (⫾ 19.8) cm/sec during abduction. None of the patients showed signs of fatty infiltration of the teres minor. Conclusion: Ultrasound is capable of assessing occlusion/stenosis of the PCHA on abduction and external rotation in asymptomatic patients. This modality can be used as the preferred first-line imaging tool for the diagnosis of QSS. 0647 Automatic Breast Ultrasound and Computer Aided Diagnosis Woo Kyung Moon, Seoul National University Hospital, Korea US screening has been performed using hand-held probes that are used to scan the entirety of both breasts. The technique however, requires practice and is generally performed by a physician. Recently, continuing technological advancement has made available whole-breast US scanning using an automated probe, which images wide field of view of breast tissue in three dimension (3D) reconstructed images. From 2007.11-2007.12, 134 bilateral whole breast US was obtained using U-systems in 67 consecutive women who were scheduled to undergo US guided needle biopsy due to 72 suspicious breast masses (24 invasive cancers and 48 benign lesions). Detection rate of malignant nodule (91.7% to 95.8 %) was significantly higher than those of benign nodule (56.2% to 66.7 %) when the 3 radiologists read the 3D breast volume data. In another study, we assessed the performance of 3 radiologists for the detection of breast cancers using 3D ABUS (40 diseased and 37 normal). Almost 95 % of cancers were consistently detected with variable false positive rates (10-40%) by the radiologists. Most of false positive findings were associated with posterior shadowing beneath Cooper’s ligament. Our study suggests that the use of ABUS and interpretation with 3D volume data has the potential to reduce the recall rate for benign masses without missing the malignant masses. Even though substantial degree of cancer detection was achieved by using 3D breast volume data, radiologists’ experience and training are still needed to identify small cancers and to reduce false positive rates. CAD systems may assist the radiologist in the early detection of breast cancer by highlighting suspicious areas seen on ABUS. 0648 Extended Field of View and 3D in the Diagnosis of Breast Pathology Roberto Moncayo, Ecomedica, Ecuador Extended field of view and 3D in the diagnosis of breast pathology is relatively new software in Ultrasonography. It is the ability to collect images from different segments of the human body, while the operator performs a scan with the transducer continuously along the segment of