- Email: [email protected]
Intestinal Intussusception Determined by a Gastrointestinal Stromal Tumor
S88
Ultrasound in Medicine and Biology
Conclusion: Ultrasonography may provide an accurate modality of evaluating gallbladder disease. Appropriate technique, strict diagnostic criteria, and knowledge of pitfalls are necessary to avoid false diagnosis and potential patient hazard. If there is a diagnostic uncertainty, we should not hesitate to use other diagnostic modalities.
Volume 37, Number 8S, 2011 CT scan confirmed it later. Surgery identified a small tumor in the bowel wall as the cause of intussusception. Conclusion: It was a gastrointestinal stromal tumor (GIST) with low mitotic index. P 046 ee
P 043 se Differential Diagnosis of Gallbladder Polypoid Lesions Assessed with Contrast-Enhanced Ultrasonography M. Hattori,1 M. Katayama,1 M. Tomita,1 M. Yamazaki,2 K. Hara,2 S. Ito,2 H. Hara,2 K. Inui3 1 Gastoroenterology, Yamashita Hospital, Ichinomiya/JP, 2Radiology, Yamashita Hospital, Ichinomiya/JP, 3Internal Medicine, Fujita Health University Second Teaching Hospital, Nagoya/JP Purpose: To investigate the efficacy of differential diagnosis of gallbladder polypoid lesions assessed with contrast-enhanced ultrasonography using perflubutane (SonazoidÒ) (Daiichi-Sankyo, Tokyo). Material & Methods: We treated 76 patients with gallbladder polypoid lesions, including 16 adenocarcinoma, 41 benign polyp, and 19 adenomyomatosis. We used SSA-770A, 790A (Toshiba, Tokyo), or Prosound alpha 10 (ALOKA, Tokyo). The early vascular phase about 30 sec after administration was observed and monitored for approximately 3 min. With the Prosound alpha 10, the region of interest was configured for all the lesions and the histogram of brightness was analyzed. Results: All 16 of the gallbladder cancer lesions showed hypervascular staining and ‘‘eruption sign’’ was apparent. Blood flow imaging revealed irregular size and buckling, including tortuous vessels in 10 cases (62.5%) and erratic blood flow in 8 cases (50%). For gallbladder polyp, staining was scattered within them, and ‘‘flickering sign’’ was observed in 35 cases (85.4%). Blood flow image showed normal vessels without buckling. For adenomyomatosis, staining was scattered and mild flickering signs were observed in all cases. Blood flow at the surface of the prominence and internal Rokitansky-Aschoff sinus was observed clarity. High brightness of the region of interest tended to be sustained in the gallbladder cancer group. Conclusion: Contrast-enhanced ultrasonography using SonazoidÒ can clearly detect hemodynamics, and it is effective to verify the differential diagnosis of gallbladder polypoid lesions.
Abdominal / Gastrointestinal Tract (GI) P 044 se Intestinal Intussusception Determined by a Gastrointestinal Stromal Tumor M. Enache, M. Iriciuc, T. Artenie, C. Jurcut, M. Sotcan, A. Dima, F. Vasilescu Internal Medicine, Central Military Hospital, Bucharest/RO Purpose: Intestinal intussusception, defined as telescoping of a segment of intestine in an immediately adjacent portion, is common in children, in whom it is usually primary and benign, and rare in adults, in this population being almost always secondary to other pathological conditions. Material & Methods: We present a case of a 57-year-old patient, who had episodes of abdominal pain, nausea and vomiting for 4 months, often accompanied by constipation. Prior laboratory data, ultrasound and endoscopic data did not find the cause of these symptoms. Results: At admission in our department, abdominal ultrasound identified a diffuse intestinal distension and a paraumbilical target image (concentric rings with increasing and decreasing echogenicity with a bowel wall which slightly changed its shape with the progression of intestinal peristaltic waves), suggesting intestinal intussusception. The
Diagnosis and Evaluation of Therapeutic Effects on Rectal Varices Using Percutaneous Color Doppler Ultrasonography T. Sato, K. Yamazaki, J. Akaike Gastroenterology, Sapporo Kosei General Hospital, Sapporo/JP Learning Objectives: Rectal varices are an infrequent but potentially serious cause of hematochezia. Here, we report the usefulness of percutaneous color Doppler ultrasonography (CD) in diagnosing and evaluating the therapeutic effects of rectal varices. Background: Ultrasonographic examinations were performed using a color Doppler unit with a 3.5-MHz convex probe. The rectum was observed through the bladder filled with urine by sonography. We examined color flow images and measured the velocity of blood flow in rectal varices using fast-Fourier transform analysis by CD in all 30 patients, before and after treatments. Imaging Findings or Procedure Details: Rectal varices were detected by CD in all 30 patients before treatments. Blood flow velocity in the rectal varices ranged from 5.7 to 36.6 cm/s (mean 11.6 cm/s). Rectal varices were observed in all patients by colonoscopy: enlarged tortuous varices with red color sign in 23, coil-shaped varices in 5, and enlarged tortuous varices without red color in 2. Seven days after treatment, CD showed an extreme decrease in blood flow in all 30 rectal varices, compared to values before treatments. Blood flow velocities in the residual rectal varices were in the range of 0.0-9.6 cm/s (mean 4.0 cm/s) after treatment, with the mean velocity significantly lower in cases after treatment (p , 0.001). Conclusion: CD can be considered a useful tool for diagnosis of rectal varices and is useful for evaluating the therapeutic effects of treatments for rectal varices.
P 047 se Diagnostic Clues to Colon Cancer with Screening Ultrasound M. Tomizawa,1 F. Shinozaki,2 R. Hasegawa,3 Y. Shirai,3 N. Ichiki,3 T. Sugiyama,4 S. Yamamoto,5 M. Sueishi,4 T. Yoshida6 1 Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 2Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 3Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 4Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 5Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 6Department of Internal Medicine, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP Purpose: Diagnosis of colon cancer with ultrasound is simple with information that a patient has the disease. Conversely, the diagnosis is challenging with screening ultrasound. To establish clues to diagnose colon cancer with screening abdominal ultrasound, we analyzed patient’s characteristics. Material & Methods: Since November 2009 to October 2010, 4 patients showed wall thickness or tumor of the colon with screening ultrasound suggesting colon cancer. Colonoscopy (CF) revealed colon cancers of 2 patients while normal findings of 2 patients. Characteristics of these patients were analyzed. Results: Patient 1 had irregular shaped 3x2 cm low echo lesion in ascending colon with the diameter of 2.0 cm, 10600 /ml of white blood cell (WBC), 2.8 mg/ml of C-reactive protein (CRP), and 9.7 ng/ml of CEA. Patients 2 had a 5x2.5 cm tumor in sigmoid colon, 7500 of
Ultrasound in Medicine and Biology
Conclusion: Ultrasonography may provide an accurate modality of evaluating gallbladder disease. Appropriate technique, strict diagnostic criteria, and knowledge of pitfalls are necessary to avoid false diagnosis and potential patient hazard. If there is a diagnostic uncertainty, we should not hesitate to use other diagnostic modalities.
Volume 37, Number 8S, 2011 CT scan confirmed it later. Surgery identified a small tumor in the bowel wall as the cause of intussusception. Conclusion: It was a gastrointestinal stromal tumor (GIST) with low mitotic index. P 046 ee
P 043 se Differential Diagnosis of Gallbladder Polypoid Lesions Assessed with Contrast-Enhanced Ultrasonography M. Hattori,1 M. Katayama,1 M. Tomita,1 M. Yamazaki,2 K. Hara,2 S. Ito,2 H. Hara,2 K. Inui3 1 Gastoroenterology, Yamashita Hospital, Ichinomiya/JP, 2Radiology, Yamashita Hospital, Ichinomiya/JP, 3Internal Medicine, Fujita Health University Second Teaching Hospital, Nagoya/JP Purpose: To investigate the efficacy of differential diagnosis of gallbladder polypoid lesions assessed with contrast-enhanced ultrasonography using perflubutane (SonazoidÒ) (Daiichi-Sankyo, Tokyo). Material & Methods: We treated 76 patients with gallbladder polypoid lesions, including 16 adenocarcinoma, 41 benign polyp, and 19 adenomyomatosis. We used SSA-770A, 790A (Toshiba, Tokyo), or Prosound alpha 10 (ALOKA, Tokyo). The early vascular phase about 30 sec after administration was observed and monitored for approximately 3 min. With the Prosound alpha 10, the region of interest was configured for all the lesions and the histogram of brightness was analyzed. Results: All 16 of the gallbladder cancer lesions showed hypervascular staining and ‘‘eruption sign’’ was apparent. Blood flow imaging revealed irregular size and buckling, including tortuous vessels in 10 cases (62.5%) and erratic blood flow in 8 cases (50%). For gallbladder polyp, staining was scattered within them, and ‘‘flickering sign’’ was observed in 35 cases (85.4%). Blood flow image showed normal vessels without buckling. For adenomyomatosis, staining was scattered and mild flickering signs were observed in all cases. Blood flow at the surface of the prominence and internal Rokitansky-Aschoff sinus was observed clarity. High brightness of the region of interest tended to be sustained in the gallbladder cancer group. Conclusion: Contrast-enhanced ultrasonography using SonazoidÒ can clearly detect hemodynamics, and it is effective to verify the differential diagnosis of gallbladder polypoid lesions.
Abdominal / Gastrointestinal Tract (GI) P 044 se Intestinal Intussusception Determined by a Gastrointestinal Stromal Tumor M. Enache, M. Iriciuc, T. Artenie, C. Jurcut, M. Sotcan, A. Dima, F. Vasilescu Internal Medicine, Central Military Hospital, Bucharest/RO Purpose: Intestinal intussusception, defined as telescoping of a segment of intestine in an immediately adjacent portion, is common in children, in whom it is usually primary and benign, and rare in adults, in this population being almost always secondary to other pathological conditions. Material & Methods: We present a case of a 57-year-old patient, who had episodes of abdominal pain, nausea and vomiting for 4 months, often accompanied by constipation. Prior laboratory data, ultrasound and endoscopic data did not find the cause of these symptoms. Results: At admission in our department, abdominal ultrasound identified a diffuse intestinal distension and a paraumbilical target image (concentric rings with increasing and decreasing echogenicity with a bowel wall which slightly changed its shape with the progression of intestinal peristaltic waves), suggesting intestinal intussusception. The
Diagnosis and Evaluation of Therapeutic Effects on Rectal Varices Using Percutaneous Color Doppler Ultrasonography T. Sato, K. Yamazaki, J. Akaike Gastroenterology, Sapporo Kosei General Hospital, Sapporo/JP Learning Objectives: Rectal varices are an infrequent but potentially serious cause of hematochezia. Here, we report the usefulness of percutaneous color Doppler ultrasonography (CD) in diagnosing and evaluating the therapeutic effects of rectal varices. Background: Ultrasonographic examinations were performed using a color Doppler unit with a 3.5-MHz convex probe. The rectum was observed through the bladder filled with urine by sonography. We examined color flow images and measured the velocity of blood flow in rectal varices using fast-Fourier transform analysis by CD in all 30 patients, before and after treatments. Imaging Findings or Procedure Details: Rectal varices were detected by CD in all 30 patients before treatments. Blood flow velocity in the rectal varices ranged from 5.7 to 36.6 cm/s (mean 11.6 cm/s). Rectal varices were observed in all patients by colonoscopy: enlarged tortuous varices with red color sign in 23, coil-shaped varices in 5, and enlarged tortuous varices without red color in 2. Seven days after treatment, CD showed an extreme decrease in blood flow in all 30 rectal varices, compared to values before treatments. Blood flow velocities in the residual rectal varices were in the range of 0.0-9.6 cm/s (mean 4.0 cm/s) after treatment, with the mean velocity significantly lower in cases after treatment (p , 0.001). Conclusion: CD can be considered a useful tool for diagnosis of rectal varices and is useful for evaluating the therapeutic effects of treatments for rectal varices.
P 047 se Diagnostic Clues to Colon Cancer with Screening Ultrasound M. Tomizawa,1 F. Shinozaki,2 R. Hasegawa,3 Y. Shirai,3 N. Ichiki,3 T. Sugiyama,4 S. Yamamoto,5 M. Sueishi,4 T. Yoshida6 1 Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 2Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 3Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 4Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 5Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP, 6Department of Internal Medicine, National Hospital Organization Shimoshizu Hospital, Yotsukaido City/JP Purpose: Diagnosis of colon cancer with ultrasound is simple with information that a patient has the disease. Conversely, the diagnosis is challenging with screening ultrasound. To establish clues to diagnose colon cancer with screening abdominal ultrasound, we analyzed patient’s characteristics. Material & Methods: Since November 2009 to October 2010, 4 patients showed wall thickness or tumor of the colon with screening ultrasound suggesting colon cancer. Colonoscopy (CF) revealed colon cancers of 2 patients while normal findings of 2 patients. Characteristics of these patients were analyzed. Results: Patient 1 had irregular shaped 3x2 cm low echo lesion in ascending colon with the diameter of 2.0 cm, 10600 /ml of white blood cell (WBC), 2.8 mg/ml of C-reactive protein (CRP), and 9.7 ng/ml of CEA. Patients 2 had a 5x2.5 cm tumor in sigmoid colon, 7500 of