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0334: Case Studies - Congenital Heart Disease
S44
Ultrasound in Medicine and Biology
Objective: Previous ultrasound studies for infants with diagnosis of antenatal hydronephrosis (ANH) emphazied on the measurement of renal pelvis diameter. No investigation has been attempted to study the bladder function in this group. This study sought to evaluate bladder function in infants with ANH using the dynamic ultrasound protocol in our center. Maximal bladder volume (MaxBV), residual volume (RV) and bladder wall thickness (BWT) were measured and compared with normal controls. Method: 65 consecutive infants (58 males, 7 females, mean age of 0.35 ⫾ 0.30 years) with known history of ANH and 63 age matched normal controls (37 males, 26 females, mean age 0.47 ⫾ 0.37 years) were recruited in this study. MaxBV was determined just before voiding, RV and BWT were measured after spontaneous voiding. Results: Infants with ANH had smaller MaxBV (30.42 vs 42.91 ml), larger RV (2.42 vs 1.51 ml) and larger BWT (4.21 vs 3.68 mm) than normal infants (p⬍0.05, Mann-Whitney test). Conclusion: Bladder dysfunctions were found in infants with ANH. We postulated that “ pacemakers” were present in both renal pelvis and urinary bladder of humans. Immaturity could occur in some infants who presented with simultaneous renal pelvis dilatation and bladder dysfunction. This study showed that dynamic ultrasound protocol could serve as an objective evaluation of bladder function in infants with ANH and might help to understand the relationships between immaturity of both renal pelvis and urinary bladder. 0329 Efficacy of Two Staged Ultrasonography for a Detection of Vesicoureteral Reflux Sook Namkung, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Ji Youn Jang, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Im Kyung Hwang, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Myung Sun Hong, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Heung Cheol Kim, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Purpose: To evaluate the efficacy of two staged ultrasonography obtained on bladder filling (US-F) and post-voiding (US-V) states for a detection of vesicoureteral reflux (VUR) in pediatric patients with urinary tract infection (UTI). Materials and Methods: This study included 50 kidney-ureter-units (KUU) in 25 patients who obtained two staged ultrasonogram without using an echoenhancing contrast material, and conventional voiding cystourethrography (V-CUG). One radiologist evaluated the US images retrospectively. VUR was diagnosed if change of the width of the renal pelvis revealed more than 3 mm between the two staged US images. Another radiologist evaluated the V-CUG and estimated the grade of VUR in accordance with the international system of radiographic VUR grading. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two staged ultrasonography for a detection of VUR were calculated in comparison with V-CUG used as the gold standard. Results: VUR was demonstrated in 10 KUUs (20%) by V-CUG. With two staged ultrasonography, 12 KUUs were diagnosed as VUR including 5 KUUs which were negative at the V-CUG. VUR was missed in 3 KUUs, which revealed Grade I reflux in 1 KUU and Grade II in 2 KUUs. The sensitivity of two staged ultrasonography for a detection of VUR was 58.3%, specificity 92.1%, PPV 70% and NPV 87.5 %. Conclusion: Two staged ultrasonography may be useful as a screening examination with high specificity for the diagnosis of VUR in patients
Volume 35, Number 8S, 2009 with UTI before a precise examinations such as contrast material enhancing US or V-CUG. 0332 Live Scanning Workshop: Polydocinol Techniques Lisa Briggs, Premiere Orthopaedics, Australia This workshop is designed to show delegates how, why and when polidocanol should be used. Tendons are structures that connect muscle to bone. They also carry tensile forces from muscle to bone. They carry comprehensive forces when wrapped around bone like a pulley. Tendon length varies in all major groups and tendon length is practically the discerning factor where muscle size and potential muscle size is concerned. When tendons undergo tendon change such as tendinosis, tendonopathy etc new blood vessels are introduced to repair the damaged region. This tendon injury results from gradual wear and tear to the tendon from overuse and/or ageing. When new blood vessels infiltrate the traumatised region of the tendon, the process of neo-vascularisation begins. Tendons have very low blood supply, as there function is to attach and load muscle to bone, so when blood supply is increased into a compromised area small nerves also infiltrate this area therefore causing pain. Colour Doppler ultrasound is used to demonstrate these infiltrating vessels. They are identified and consequently sclerosed / obliterated immediately. This is done by guiding the needle, under ultrasound guidance into the “feeder” vessel/s. Polidocanol ( Aethroysklerol® 2% Marcaine ® 0.5% plain , AstraZenica , North Ryde, Australia ) is a sclerosing agent that is used, under ultrasound guidance to sclerose neo-vascularisation within tendons. The main tendons to date that have responded in a positive way to sclerosing techniques are the “loading “tendons. These comprise of the Patellar tendon, Quadriceps tendon ( at the patella insertion) Achilles tendon and Common extensor origin at the lateral epicondyle origin of the elbow. 0334 Case Studies - Congenital Heart Disease Sue Bradley, The Children’s Hospital at Westmead Case study (1) follows a patient initially diagnosed with Transposition of the Great Arteries, a large Ventricular Septal Defect, severe valvar and subvalvar Pulmonary stenosis. Case study (2) follows a patient initially diagnosed with Tricuspid valve atresia. 0336 3D Echocardiography Cheng-Wen Chiang, Cathay General Hospital and Taipei Medical University, Taiwan There has been a tremendous advance in echocardiography over the past decades. Recently, the advent of real-time three-dimensional echocardiography (3-D echo) has opened a new era in medical ultrasound. It greatly reduces the image acquisition and reconstruction times and simplifies the examination. It has several advantages over two-dimensional echocardiography. First, it can show the cardiac structures from any viewing angle. For example, it can provide a “surgeon’s view”, mimicking operative findings. This feature also contributes significantly to the clarification of the complex anatomy in congenital heart diseases, and to the understanding of the mechanism of invasive interventions. Second, it can measure cardiac volumes accurately and reproducibly, without the need of geometric assumptions. Third, some important information (such as strain and strain rate) can be derived in a three-dimensional format, which is very useful for cardiac resynchronization therapy. However, 3-D echo is still immature. Further im-
Ultrasound in Medicine and Biology
Objective: Previous ultrasound studies for infants with diagnosis of antenatal hydronephrosis (ANH) emphazied on the measurement of renal pelvis diameter. No investigation has been attempted to study the bladder function in this group. This study sought to evaluate bladder function in infants with ANH using the dynamic ultrasound protocol in our center. Maximal bladder volume (MaxBV), residual volume (RV) and bladder wall thickness (BWT) were measured and compared with normal controls. Method: 65 consecutive infants (58 males, 7 females, mean age of 0.35 ⫾ 0.30 years) with known history of ANH and 63 age matched normal controls (37 males, 26 females, mean age 0.47 ⫾ 0.37 years) were recruited in this study. MaxBV was determined just before voiding, RV and BWT were measured after spontaneous voiding. Results: Infants with ANH had smaller MaxBV (30.42 vs 42.91 ml), larger RV (2.42 vs 1.51 ml) and larger BWT (4.21 vs 3.68 mm) than normal infants (p⬍0.05, Mann-Whitney test). Conclusion: Bladder dysfunctions were found in infants with ANH. We postulated that “ pacemakers” were present in both renal pelvis and urinary bladder of humans. Immaturity could occur in some infants who presented with simultaneous renal pelvis dilatation and bladder dysfunction. This study showed that dynamic ultrasound protocol could serve as an objective evaluation of bladder function in infants with ANH and might help to understand the relationships between immaturity of both renal pelvis and urinary bladder. 0329 Efficacy of Two Staged Ultrasonography for a Detection of Vesicoureteral Reflux Sook Namkung, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Ji Youn Jang, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Im Kyung Hwang, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Myung Sun Hong, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Heung Cheol Kim, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Purpose: To evaluate the efficacy of two staged ultrasonography obtained on bladder filling (US-F) and post-voiding (US-V) states for a detection of vesicoureteral reflux (VUR) in pediatric patients with urinary tract infection (UTI). Materials and Methods: This study included 50 kidney-ureter-units (KUU) in 25 patients who obtained two staged ultrasonogram without using an echoenhancing contrast material, and conventional voiding cystourethrography (V-CUG). One radiologist evaluated the US images retrospectively. VUR was diagnosed if change of the width of the renal pelvis revealed more than 3 mm between the two staged US images. Another radiologist evaluated the V-CUG and estimated the grade of VUR in accordance with the international system of radiographic VUR grading. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two staged ultrasonography for a detection of VUR were calculated in comparison with V-CUG used as the gold standard. Results: VUR was demonstrated in 10 KUUs (20%) by V-CUG. With two staged ultrasonography, 12 KUUs were diagnosed as VUR including 5 KUUs which were negative at the V-CUG. VUR was missed in 3 KUUs, which revealed Grade I reflux in 1 KUU and Grade II in 2 KUUs. The sensitivity of two staged ultrasonography for a detection of VUR was 58.3%, specificity 92.1%, PPV 70% and NPV 87.5 %. Conclusion: Two staged ultrasonography may be useful as a screening examination with high specificity for the diagnosis of VUR in patients
Volume 35, Number 8S, 2009 with UTI before a precise examinations such as contrast material enhancing US or V-CUG. 0332 Live Scanning Workshop: Polydocinol Techniques Lisa Briggs, Premiere Orthopaedics, Australia This workshop is designed to show delegates how, why and when polidocanol should be used. Tendons are structures that connect muscle to bone. They also carry tensile forces from muscle to bone. They carry comprehensive forces when wrapped around bone like a pulley. Tendon length varies in all major groups and tendon length is practically the discerning factor where muscle size and potential muscle size is concerned. When tendons undergo tendon change such as tendinosis, tendonopathy etc new blood vessels are introduced to repair the damaged region. This tendon injury results from gradual wear and tear to the tendon from overuse and/or ageing. When new blood vessels infiltrate the traumatised region of the tendon, the process of neo-vascularisation begins. Tendons have very low blood supply, as there function is to attach and load muscle to bone, so when blood supply is increased into a compromised area small nerves also infiltrate this area therefore causing pain. Colour Doppler ultrasound is used to demonstrate these infiltrating vessels. They are identified and consequently sclerosed / obliterated immediately. This is done by guiding the needle, under ultrasound guidance into the “feeder” vessel/s. Polidocanol ( Aethroysklerol® 2% Marcaine ® 0.5% plain , AstraZenica , North Ryde, Australia ) is a sclerosing agent that is used, under ultrasound guidance to sclerose neo-vascularisation within tendons. The main tendons to date that have responded in a positive way to sclerosing techniques are the “loading “tendons. These comprise of the Patellar tendon, Quadriceps tendon ( at the patella insertion) Achilles tendon and Common extensor origin at the lateral epicondyle origin of the elbow. 0334 Case Studies - Congenital Heart Disease Sue Bradley, The Children’s Hospital at Westmead Case study (1) follows a patient initially diagnosed with Transposition of the Great Arteries, a large Ventricular Septal Defect, severe valvar and subvalvar Pulmonary stenosis. Case study (2) follows a patient initially diagnosed with Tricuspid valve atresia. 0336 3D Echocardiography Cheng-Wen Chiang, Cathay General Hospital and Taipei Medical University, Taiwan There has been a tremendous advance in echocardiography over the past decades. Recently, the advent of real-time three-dimensional echocardiography (3-D echo) has opened a new era in medical ultrasound. It greatly reduces the image acquisition and reconstruction times and simplifies the examination. It has several advantages over two-dimensional echocardiography. First, it can show the cardiac structures from any viewing angle. For example, it can provide a “surgeon’s view”, mimicking operative findings. This feature also contributes significantly to the clarification of the complex anatomy in congenital heart diseases, and to the understanding of the mechanism of invasive interventions. Second, it can measure cardiac volumes accurately and reproducibly, without the need of geometric assumptions. Third, some important information (such as strain and strain rate) can be derived in a three-dimensional format, which is very useful for cardiac resynchronization therapy. However, 3-D echo is still immature. Further im-