- Email: [email protected]
2079603 Heterotopic Pregnancy: A Not So Rare Entity
Abstracts searched. Spectral doppler analysis is performed and the cavernosal arteries systolic and diastolic velocities are collected after 5, 10 and 15 minutes after drug induction. After a satisfactory erection, the curvature region must be assessed in order to find focal thickening in albugınea and possible venous leakage. Penile curvature is also measured with a protractor. Results: The cavernosal artery diameter must increase at least 75% after drug injection to indicate a satisfatory response. The outcomes of Doppler analisis: adequated erectile function: Cavernosal artery peak systolic velocity (PSV) . 30 cm/sec and end dyastolic velocity (EDV) , 5 cm/sec; impared erectile function: PSV ,30 cm/sec and/or EDV .5 cm/sec, indicating cavernosal artery insufficiency and VOD respectively. Penile curvature is measured accurately. Conclusions: All patients with PD considered candidates for surgical reconstruction should undergo vascular evaluation to identify if the patients erection function is adequate. DDUS with IVD is reproductible, little invasive and a well accepted method in evaluation of vascular ED. It’s also very precise in identifying number and location of calcified plaques and in measuring penile curvature helping the clinician in the surgery choosing strategy.
2079496 Shoulder pain in long term hemodialytic individuals: Clinical and Sonographic findings in the diagnose of amyloid arthropathy Felipe Carneiro, Igor Fontenele Sousa, Renato Antonio Sernik, Maria Cristina Chammas Radiology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil Objectives: The aim of this educational is to demonstrate clinical and sonographic findings of shoulder amyloid arthropathy, in long term dialytic individuals in order to help clinicians to identify this non very common entity of shoulder pain and choose the best treatment approach. The sonographic evaluation of shoulder pain as the first imaging assessment is also discussed. Methods: Individuals in long term dialysis for chronic renal insufficiency, at least 15 years, presenting with chronic bilateral shoulder pain and weakness. This group of individuals should undergo a targeted orthopedic examination of the shoulders and bilateral ultrasound evaluation of the rotator cuff as the first imaging exam. Results: Shoulder pain worsening while supine, during the evening and through hemodyalisis are common complains in this group of individuals. Bilateral shoulder swelling, motion limitation in passive/active arm elevation and signs of subacromial impingement are the most prevalent physical examination findings. The ultrasound assessment might reveal in different grades: thickening and heterogenity of rotator cuff tendons associated with presence of echogenic amorphous material compatible with amyloid tissue infiltration; bilateral supraespinatus partial tears; bilateral bone erosions of the humeral head, particularly the minor and major tuberculus, with joint space communication. Humeral head erosions filled with echogenic amyloid tissue. Subacromial bursa shows polipoidlike synovial thickening due to amyloid deposit and large anechoic synovial effusion. Conclusions: Sonography is a very effective non-invasive method in the analysis of shoulder pain. Availability, high resolution dynamic evaluation, reliable findings and low cost make it the method of choice for evaluation of different etiologies of shoulder pain. Although the definitive diagnose of amyloid tissue is immunohistologic, the clinical history, physical examination and the sonographic findings listed above allow the diagnose of amyloid deposit, helping the clinician to provide the best treatment option.
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2079502 ‘‘AMH As An Effective Screening Tool For Ovarian Reserve In Determining Need For Oocyte Cryopreservation’’ Tomer Singer,2 Courtney Griffiths,1,2 Nachum Sicherman,3 Christine Mullin,4 Mina Alikani,4 Hong Yang,4 Avner Hershlag4 1 Touro College of Osteopathic Medicine, New York, NY, United States, 2 Reproductive Endocrinology, Lenox Hill Hospital, New York, NY, United States, 3Columbia University, New York, NY, United States, 4 North Shore LIJ Hospital, New York, NY, Unit Objectives: The goal of our study is to determine whether Antimullerian Hormone (AMH) can be utilized as an effective screening test and to measure its correlation with the degree of ovarian reserve in women of all ages. AMH is expressed by ovarian granulosa cells during reproductive years, and its primary mechanism is such that it inhibits an excess of follicular recruitment by FSH. As a woman ages, their AMH level is known to decline with a significant drop at the age of 41 and above. However, this level can also identify women of younger age who are experiencing premature ovarian failure. In these instances, many women choose to undergo oocyte cryopreservation or ‘‘egg freezing’’ in order to preserve their fertility for a later date depending on their current circumstances. Our main interest and focus of this study is to identify if AMH can be used as a screening tool in general practitioner offices to determine if further fertility workup would be necessary and in the patient’s best interests. Methods: Our study consisted of conducting a retrospective analysis of all patients at the fertility clinic of NorthShore LIJ and Lenox Hill Hospitals from the years of 2012-2014 who wished to undergo elective oocyte cryopreservation. Women of all ages were included in this study ranging from 27-43 years of age. Patients who underwent egg freezing due to medical reasons such as chemotherapy or radiation were not included in this study. All patients were given blood tests during fertility workup to measure their serum AMH levels. Furthermore, data was collected from each patient’s oocyte retrieval and the number of mature oocytes retrieved was noted. This data was then analyzed to determine if a correlation exists between the serum AMH level and number of mature oocytes retrieved. Results: Will be available in 1 week-currently with statistician. Conclusions: Will be available in 1 week.
2079603 Heterotopic Pregnancy: A Not So Rare Entity Artemis Petrides, Sabrina Mahboob, Samia Sayegh Radiology, Winthrop-University Hospital, Mineola, NY, United States Objectives: To discuss two cases of heterotopic pregnancy presentating with characteristic US imaging findings to help familiarize radiologistsin-training with this uncommon diagnosis. Methods: Radiology literature review from 2002 to the present was performed using the following search terms: ectopic pregnancy and heterotopic pregnancy. Results: Heterotopic pregnancy used to be rare however with the advent of assisted reproduction techniques, the overall incidence has increased. This is likely secondary to the high prevalence of tubal damage in this population, the use of overstimulating medications for ovulation and multiple embryo implantations. Heterotopic pregnancy should be suspected in any patient after assisted reproduction presenting with persistent or rising chorionic gonadotropin after dilatation and curettage, a uterine fundus larger than menstrual dates and more than one corpus luteum. Ultrasonographic evaluation is the gold standard for diagnosis, with findings of a second gestational sac or complex mass in addition to the intrauterine pregnancy. Associated findings include pelvic hematoma, hematosalpinx or complex pelvic fluid. Management of heterotopic pregnancy is still evolving and remains controversial. Management can be medical or surgical and is tailored to the specific type of
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pregnancy, patient presentation and desire to preserve intrauterine pregnancy. Conclusions: Heterotopic pregnancy has increased in incidence with the rise in the use of assisted reproduction techniques therefore knowledge of this entity and a high index of suspicion is essential. US is the test of choice for evaluation of a heterotopic pregnancy with knowledge of characteristic findings being essential in prompt diagnosis that will allow for appropriate surgical or medical management.
2079821 Role Of Multiparametric Ultrasonography in Facilitating Testis - Sparing Surgery Dean Huang,1 Eleni Konstantatou,1 Robert Eckersley,2 Maria Sellars,1 Paul Sidhu1 1 Department of Clinical Radiology, King’s College Hospital, London, London, United Kingdom, 2King’s College London, London, United Kingdom Objectives: The availability of scrotal ultrasonography has led to an increasing number of incidentally detected intra-testicular lesions, resulting in a number of unnecessary orchidectomies. Testis-sparing surgery (TSS) is the preferred option when there is a possibility of a benign lesion. We aim to evaluate the role of pre-operative multiparametric ultrasonography (MP-US), which include gray-scale and color Doppler sonography combined with contrast-enhanced ultrasound (CEUS) and real time elastography (RTE), in facilitating case selection for patient selection for testis – sparing surgery. Methods: Consecutive patients undergoing surgery for testicular lesions between 2010 and 2013 were studied. All lesions were assessed with MP-US pre-operatively and consensus imaging and clinical assessments were made at multi-disciplinary meetings for suitability for TSS. Patient demographics, tumour characteristics and histological outcomes were recorded. Oncological outcome in the TSS group was assessed with follow-up ultrasound. Results: 51 patients who had either orchidectomy or TSS were studied. 12 patients (median 39 years, range 24 - 48) underwent TSS for 13 testicular lesions (median size 6 mm, range 3.3 - 15 mm). 38 patients (median age 40 years, range 19-84) underwent orchidectomy for 38 lesions (median size 20.5 mm, range 7-50). All malignancies were correctly identified pre-operatively on MP-US. Histopathological findings for all 13 lesions selected for TSS confirm no malignant features, with final diagnosis including Leydig cell tumours (6), Epidermoid cysts (2), Sertoli cell tumour (1), sarcoidosis (2), focal testicular atrophy (1) and Leydig cell hyperplasia (1). The sensitivity, specitivity, positive predictive value and negative predictive value of MP-US for a benign lesion suitable for TSS are 96.3%, 92%, 92.86% and 95.8% respectively. Oncological follow-up reveals no disease recurrence in all patients in TSS group at 12 months. Conclusions: Our experience suggests that multi-parametric ultrasonography could be a valuable non-invasive investigation to predict benign testicular disease, and improve pre-operative diagnostic confidence to allow testis-sparing surgery to be considered.
2079898 Ultrasound-Guided Fine-Needle Aspiration for Solid Thyroid Nodules Larger than 10 Mm: Correlation Between Sonographic Characteristics at the Needle Tip and Nondiagnostic Results Hong Wu, Department of Ultrasound, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China Objectives: The OBJECTIVES: of this study was to investigate the effect of the ultrasonographic (US) characteristics and ultrasound elastog-
Volume 41, Number 4S, 2015 raphy (UE) patterns on the probability of a nondiagnostic result when performing ultrasound-guided fine-needle aspiration (UG-FNA) cytological sampling of solid thyroid nodules larger than 10 mm, to determine the efficacy of needle tip localization in UG-FNA. Methods: We retrospectively reviewed the cytological results of 710 samples from 355 patients. We compared the US characteristics and UE patterns between nodules with nondiagnostic and diagnostic results, using univariate and multivariate analyses. Results: Among the 710 samples, 81 samples (11.4 %) from 41 patients had nondiagnostic results. According to multivariate analysis, the combinations of hypoechogenicity with avascularity [odds ratio (OR) 5 2.42; 95 % confidence interval (CI) 1.37–3.72; p,0.05], hypoechogenicity with the ‘‘hard pattern’’ (OR 5 2.12; 95 % CI 1.58–4.59;p,0.05), and hypoechogenicity with avascularity and the hard pattern (OR 5 2.61; 95 % CI 1.40–5.21; p,0.05) were risk factors that increased the incidence of nondiagnostic results in UG-FNA. Conclusions: UG-FNA was more likely to yield nondiagnostic results when the needle tip sampling region displayed hypoechogenicity and avascularity in US and the hard pattern in UE.
2079944 Correlation Between The Parameters Of Virtual Organ Computer-Aided Analysis Of Three-Dimensional Ultrasound And Human Epidermalgrowth Factor Receptor-2 Expression Nan Zhou,1 1 Department of Ultrasound, Zhuzhou Central Hospital, Zhu zhou, Hu nan, China Objectives: To investigate the relationship between the parameters of Virtual organ computer-aided analysis(VOCAL) of three-dimensional color power angiography ultrasound(3D-CPA) and Human epidermalgrowth factor receptor-2(HER2) expression. Methods: The parameters of VOCAL by 3D-CPA,such as,vascularization index (VI),flow index (FI) and vascularization-flow index (VFI) for the intra-tumor and for shells with a thickness of 3 mm surrounding the breast tumors, and pathological characteristics of 126 patients with breast carcinoma were collected and were firstly tested with t test. Secondly, analyzed with Logistic regression, and established a regression equation.Finally,the Receiver operating characteristic(ROC) cure was used to assess the accuracy of the regression equation. Results: t test showed that the expression of HER2 was significantly associated with the parameters of vascularization index(VI2),flow index (FI2),and vascularization-flow index (VFI2)of shells with outside thickness of 3mm surrounding the breast tumors.However,only FI2 and VFI2 entered into the Logistic regression equation. Area under the ROC curve of pre-probability p(pnew) generated by the regression equation was 0.927. Conclusions: The parameters of VOCAL, such as FI2 and VFI2, have better predictive value for HER2 expression in patients with breast carcinoma.
2080417 Ectopic Thyroid Tissue In The Head And Neck: A Pictorial Review Osmar Cassio Saito, Maria Cristina Chammas, Sandra Tochetto, Giovanni Guido Cerri Radiology University of Sao Paulo, Inrad, Sao Paulo, Sao Paulo, Brazil Objectives: The purpose of this educational exhibit is describe the imaging findings of ectopic thyroid tissue in head and neck, emphasizing the differential diagnosis with others cervical mass and correlating with anatomopathology. Methods: (1) to review the embryological thyroid pathway and common and uncommon sites of ectopic thyroid tissue; (2) to illustrate imaging findings (by ultrasound, CT and scintigraphy) of ectopic thyroid
2079496 Shoulder pain in long term hemodialytic individuals: Clinical and Sonographic findings in the diagnose of amyloid arthropathy Felipe Carneiro, Igor Fontenele Sousa, Renato Antonio Sernik, Maria Cristina Chammas Radiology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil Objectives: The aim of this educational is to demonstrate clinical and sonographic findings of shoulder amyloid arthropathy, in long term dialytic individuals in order to help clinicians to identify this non very common entity of shoulder pain and choose the best treatment approach. The sonographic evaluation of shoulder pain as the first imaging assessment is also discussed. Methods: Individuals in long term dialysis for chronic renal insufficiency, at least 15 years, presenting with chronic bilateral shoulder pain and weakness. This group of individuals should undergo a targeted orthopedic examination of the shoulders and bilateral ultrasound evaluation of the rotator cuff as the first imaging exam. Results: Shoulder pain worsening while supine, during the evening and through hemodyalisis are common complains in this group of individuals. Bilateral shoulder swelling, motion limitation in passive/active arm elevation and signs of subacromial impingement are the most prevalent physical examination findings. The ultrasound assessment might reveal in different grades: thickening and heterogenity of rotator cuff tendons associated with presence of echogenic amorphous material compatible with amyloid tissue infiltration; bilateral supraespinatus partial tears; bilateral bone erosions of the humeral head, particularly the minor and major tuberculus, with joint space communication. Humeral head erosions filled with echogenic amyloid tissue. Subacromial bursa shows polipoidlike synovial thickening due to amyloid deposit and large anechoic synovial effusion. Conclusions: Sonography is a very effective non-invasive method in the analysis of shoulder pain. Availability, high resolution dynamic evaluation, reliable findings and low cost make it the method of choice for evaluation of different etiologies of shoulder pain. Although the definitive diagnose of amyloid tissue is immunohistologic, the clinical history, physical examination and the sonographic findings listed above allow the diagnose of amyloid deposit, helping the clinician to provide the best treatment option.
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2079502 ‘‘AMH As An Effective Screening Tool For Ovarian Reserve In Determining Need For Oocyte Cryopreservation’’ Tomer Singer,2 Courtney Griffiths,1,2 Nachum Sicherman,3 Christine Mullin,4 Mina Alikani,4 Hong Yang,4 Avner Hershlag4 1 Touro College of Osteopathic Medicine, New York, NY, United States, 2 Reproductive Endocrinology, Lenox Hill Hospital, New York, NY, United States, 3Columbia University, New York, NY, United States, 4 North Shore LIJ Hospital, New York, NY, Unit Objectives: The goal of our study is to determine whether Antimullerian Hormone (AMH) can be utilized as an effective screening test and to measure its correlation with the degree of ovarian reserve in women of all ages. AMH is expressed by ovarian granulosa cells during reproductive years, and its primary mechanism is such that it inhibits an excess of follicular recruitment by FSH. As a woman ages, their AMH level is known to decline with a significant drop at the age of 41 and above. However, this level can also identify women of younger age who are experiencing premature ovarian failure. In these instances, many women choose to undergo oocyte cryopreservation or ‘‘egg freezing’’ in order to preserve their fertility for a later date depending on their current circumstances. Our main interest and focus of this study is to identify if AMH can be used as a screening tool in general practitioner offices to determine if further fertility workup would be necessary and in the patient’s best interests. Methods: Our study consisted of conducting a retrospective analysis of all patients at the fertility clinic of NorthShore LIJ and Lenox Hill Hospitals from the years of 2012-2014 who wished to undergo elective oocyte cryopreservation. Women of all ages were included in this study ranging from 27-43 years of age. Patients who underwent egg freezing due to medical reasons such as chemotherapy or radiation were not included in this study. All patients were given blood tests during fertility workup to measure their serum AMH levels. Furthermore, data was collected from each patient’s oocyte retrieval and the number of mature oocytes retrieved was noted. This data was then analyzed to determine if a correlation exists between the serum AMH level and number of mature oocytes retrieved. Results: Will be available in 1 week-currently with statistician. Conclusions: Will be available in 1 week.
2079603 Heterotopic Pregnancy: A Not So Rare Entity Artemis Petrides, Sabrina Mahboob, Samia Sayegh Radiology, Winthrop-University Hospital, Mineola, NY, United States Objectives: To discuss two cases of heterotopic pregnancy presentating with characteristic US imaging findings to help familiarize radiologistsin-training with this uncommon diagnosis. Methods: Radiology literature review from 2002 to the present was performed using the following search terms: ectopic pregnancy and heterotopic pregnancy. Results: Heterotopic pregnancy used to be rare however with the advent of assisted reproduction techniques, the overall incidence has increased. This is likely secondary to the high prevalence of tubal damage in this population, the use of overstimulating medications for ovulation and multiple embryo implantations. Heterotopic pregnancy should be suspected in any patient after assisted reproduction presenting with persistent or rising chorionic gonadotropin after dilatation and curettage, a uterine fundus larger than menstrual dates and more than one corpus luteum. Ultrasonographic evaluation is the gold standard for diagnosis, with findings of a second gestational sac or complex mass in addition to the intrauterine pregnancy. Associated findings include pelvic hematoma, hematosalpinx or complex pelvic fluid. Management of heterotopic pregnancy is still evolving and remains controversial. Management can be medical or surgical and is tailored to the specific type of
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pregnancy, patient presentation and desire to preserve intrauterine pregnancy. Conclusions: Heterotopic pregnancy has increased in incidence with the rise in the use of assisted reproduction techniques therefore knowledge of this entity and a high index of suspicion is essential. US is the test of choice for evaluation of a heterotopic pregnancy with knowledge of characteristic findings being essential in prompt diagnosis that will allow for appropriate surgical or medical management.
2079821 Role Of Multiparametric Ultrasonography in Facilitating Testis - Sparing Surgery Dean Huang,1 Eleni Konstantatou,1 Robert Eckersley,2 Maria Sellars,1 Paul Sidhu1 1 Department of Clinical Radiology, King’s College Hospital, London, London, United Kingdom, 2King’s College London, London, United Kingdom Objectives: The availability of scrotal ultrasonography has led to an increasing number of incidentally detected intra-testicular lesions, resulting in a number of unnecessary orchidectomies. Testis-sparing surgery (TSS) is the preferred option when there is a possibility of a benign lesion. We aim to evaluate the role of pre-operative multiparametric ultrasonography (MP-US), which include gray-scale and color Doppler sonography combined with contrast-enhanced ultrasound (CEUS) and real time elastography (RTE), in facilitating case selection for patient selection for testis – sparing surgery. Methods: Consecutive patients undergoing surgery for testicular lesions between 2010 and 2013 were studied. All lesions were assessed with MP-US pre-operatively and consensus imaging and clinical assessments were made at multi-disciplinary meetings for suitability for TSS. Patient demographics, tumour characteristics and histological outcomes were recorded. Oncological outcome in the TSS group was assessed with follow-up ultrasound. Results: 51 patients who had either orchidectomy or TSS were studied. 12 patients (median 39 years, range 24 - 48) underwent TSS for 13 testicular lesions (median size 6 mm, range 3.3 - 15 mm). 38 patients (median age 40 years, range 19-84) underwent orchidectomy for 38 lesions (median size 20.5 mm, range 7-50). All malignancies were correctly identified pre-operatively on MP-US. Histopathological findings for all 13 lesions selected for TSS confirm no malignant features, with final diagnosis including Leydig cell tumours (6), Epidermoid cysts (2), Sertoli cell tumour (1), sarcoidosis (2), focal testicular atrophy (1) and Leydig cell hyperplasia (1). The sensitivity, specitivity, positive predictive value and negative predictive value of MP-US for a benign lesion suitable for TSS are 96.3%, 92%, 92.86% and 95.8% respectively. Oncological follow-up reveals no disease recurrence in all patients in TSS group at 12 months. Conclusions: Our experience suggests that multi-parametric ultrasonography could be a valuable non-invasive investigation to predict benign testicular disease, and improve pre-operative diagnostic confidence to allow testis-sparing surgery to be considered.
2079898 Ultrasound-Guided Fine-Needle Aspiration for Solid Thyroid Nodules Larger than 10 Mm: Correlation Between Sonographic Characteristics at the Needle Tip and Nondiagnostic Results Hong Wu, Department of Ultrasound, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China Objectives: The OBJECTIVES: of this study was to investigate the effect of the ultrasonographic (US) characteristics and ultrasound elastog-
Volume 41, Number 4S, 2015 raphy (UE) patterns on the probability of a nondiagnostic result when performing ultrasound-guided fine-needle aspiration (UG-FNA) cytological sampling of solid thyroid nodules larger than 10 mm, to determine the efficacy of needle tip localization in UG-FNA. Methods: We retrospectively reviewed the cytological results of 710 samples from 355 patients. We compared the US characteristics and UE patterns between nodules with nondiagnostic and diagnostic results, using univariate and multivariate analyses. Results: Among the 710 samples, 81 samples (11.4 %) from 41 patients had nondiagnostic results. According to multivariate analysis, the combinations of hypoechogenicity with avascularity [odds ratio (OR) 5 2.42; 95 % confidence interval (CI) 1.37–3.72; p,0.05], hypoechogenicity with the ‘‘hard pattern’’ (OR 5 2.12; 95 % CI 1.58–4.59;p,0.05), and hypoechogenicity with avascularity and the hard pattern (OR 5 2.61; 95 % CI 1.40–5.21; p,0.05) were risk factors that increased the incidence of nondiagnostic results in UG-FNA. Conclusions: UG-FNA was more likely to yield nondiagnostic results when the needle tip sampling region displayed hypoechogenicity and avascularity in US and the hard pattern in UE.
2079944 Correlation Between The Parameters Of Virtual Organ Computer-Aided Analysis Of Three-Dimensional Ultrasound And Human Epidermalgrowth Factor Receptor-2 Expression Nan Zhou,1 1 Department of Ultrasound, Zhuzhou Central Hospital, Zhu zhou, Hu nan, China Objectives: To investigate the relationship between the parameters of Virtual organ computer-aided analysis(VOCAL) of three-dimensional color power angiography ultrasound(3D-CPA) and Human epidermalgrowth factor receptor-2(HER2) expression. Methods: The parameters of VOCAL by 3D-CPA,such as,vascularization index (VI),flow index (FI) and vascularization-flow index (VFI) for the intra-tumor and for shells with a thickness of 3 mm surrounding the breast tumors, and pathological characteristics of 126 patients with breast carcinoma were collected and were firstly tested with t test. Secondly, analyzed with Logistic regression, and established a regression equation.Finally,the Receiver operating characteristic(ROC) cure was used to assess the accuracy of the regression equation. Results: t test showed that the expression of HER2 was significantly associated with the parameters of vascularization index(VI2),flow index (FI2),and vascularization-flow index (VFI2)of shells with outside thickness of 3mm surrounding the breast tumors.However,only FI2 and VFI2 entered into the Logistic regression equation. Area under the ROC curve of pre-probability p(pnew) generated by the regression equation was 0.927. Conclusions: The parameters of VOCAL, such as FI2 and VFI2, have better predictive value for HER2 expression in patients with breast carcinoma.
2080417 Ectopic Thyroid Tissue In The Head And Neck: A Pictorial Review Osmar Cassio Saito, Maria Cristina Chammas, Sandra Tochetto, Giovanni Guido Cerri Radiology University of Sao Paulo, Inrad, Sao Paulo, Sao Paulo, Brazil Objectives: The purpose of this educational exhibit is describe the imaging findings of ectopic thyroid tissue in head and neck, emphasizing the differential diagnosis with others cervical mass and correlating with anatomopathology. Methods: (1) to review the embryological thyroid pathway and common and uncommon sites of ectopic thyroid tissue; (2) to illustrate imaging findings (by ultrasound, CT and scintigraphy) of ectopic thyroid