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0495: Ultrasound of Neonatal Hip
S68
Ultrasound in Medicine and Biology
Method and Materials: A total of 864 lesions (mean size 1.0cm, range 0.3 - 3.0cm; BI-RADS category 4a /4b /4c /5; 757 / 66 / 28 /13 lesions) in 842 women (mean age 46, range 30-68) who were scheduled to undergo US-guided core biopsy formed our study group. Elastographic images were prospectively classified as positive (abnormal strain) and negative (normal strain) based on the degree of strain induced by light compression. Results: Of the 864 suspicious abnormal lesions, 79 (9.1%) lesions were confirmed as cancers (77 positive, 2 negative at elastography). Of the 224 lesions with negative elastography (216 category 4a, 8 category 4b lesions), 2 lesions (0.9%) proved to be cancers (0.7 and 1.6cm, low grade DCIS). Of the 640 lesions with positive elastography, 77 lesions (12.0%) proved to be cancers (59 invasive ductal carcinomas, 18 DCIS) (p⬍ 0.001). The rate of malignancy for BI-RADS category 4a / 4b / 4c / 5 lesions were 2.6% / 36.4% / 58.6% / 100%, respectively. For the BI-RADS category 4a lesions, 28.5% (216 of 757) had a normal strain and 99.1% (214 of 216) of lesions with normal strain found out to be benign. Conclusion: When a lesion categorized as BI-RADS category 4a has a normal strain on elastography, a biopsy may be averted. 0495 Ultrasound of Neonatal Hip In-One Kim, Seoul National University Hospital, Korea Two major roles of pediatric hip US are diagnos of DDH and joint effusion. In DDH, plain radiography shows relationship of proximal femur and acetabulum and the extent of acetabular coverage, but femoral head is not visible prior to ossification. US shows anatomic details including the cartilage and associated soft tissues without ionizing radiation. US is also useful in screening of high-risk infants and abnormal physical examination. Early diagnosis is important because non-operative treatment is satisfactory in most unstable hip detected before 6-8 months of age. US technique in the diagnosis of DDH includes Coronal scan of Graf technique, and Transverse and Cornal scan with dynamic stress examination. Abnormal position or abnormal mobility of the femoral head with stress, insufficient acetabular depth to accommodate femur head or presence of gap between acetabular cartilage and femoral head suggests DDH. US is also used for the follow-up evaluation during treatment. The main causes of hip joint effusion in pediatric age are transient synovitis and septic arthritis. US alone cannot differentiate between two, but associated bony changes or clinical and laboratory findings can suggests septic hip and aspiration of the effusion is important in the diagnosis of septic hip. Anterior sagittal scan parallel to femoral neck with hip in neutral position shows anterior joint capsule parallel to the anterior cortex of the femoral neck and two layers of the anterior joint capsule composed of fibrous capsule and minute layer of synovial membrane. US easily demonstrates joint effusion accumulated in the anterior recess between two layers. 0496 Sonography of the Gastrointestinal Tract in Pediatrics Alan Daneman, Toronto Children’s Hospital, Canada Sonography is an important modality for evaluation of children with suspected or known disease of the gastrointestinal tract (GIT). In many conditions sonography has come to replace plain radiographs of the abdomen and even contrast examinations of the GIT. Some of these enitities have been dealt with in other presentations at this meeting - eg. intussusception and necrotizing enterocolitis. However the range of disease entities in which sonography plays a pivotal role is wide ranging and also includes hypertrophic pyloric stenosis, appendicitis, inflammatory bowel diseases,
Volume 35, Number 8S, 2009 polyps, Meckels diverticulum and even malrotation. In most of these diseases sonography provides definitive information that the clinicians can use to institute appropriate therapy. However in some cases sonography may have to be followed by other cross sectional modalities such as CT or MR to obtain the definitive information. 0497 Doppler in Pulmonary Disease Pedro Unshelm, Instituto Pediatrico La Florida, Venezuela Recently Doppler has been used like prognosis test of pneumonias requiring hospitalization depending on the amount of blood flow in the affected lobe or segment. Ultrasound is an excellent complementary tool to chest x-ray in the diagnosis of pneumonias and pleural effusion. Among the advantages are the fact that there is no ionizing radiation, the use of portable real time equipment so it can be made in the incubator, it is cheap, and no sedation is required. It can be used in lobar or segmental pneumonias and pleural effusions, it is usually performed in cases with poor response to antibiotic therapeutic. The Ultrasound signs are an appereance like liver of the pulmonary parenchyma and the presencie of an air broncho sonogram. The Doppler signal will inform us the kind of the blood flow in the pneunonic segment and, besides it is a predict test, if there is a great amount of blood flow it has a better prognosis than pneumonies with necrotical areas. Ultrasound has higher sensibility than tomography, and has replaced chest x -ray to asses pleural effusions , Ultrasound can be used to guide drainage of effusions. The fluid color sing permits to distinguish if the pleural effusion is free. 0498 Evaluating the Hip Joints’ Blood Flow of Perthes’ Disease with Ultrasonography Xue Mo Quan, Children’ Hospital of Chongqing Medical University, China Kun Zhang, Children’ Hospital of Chongqing Medical University, China Qiao Wang, Children’ Hospital of Chongqing Medical University, China Yi Tang, Children’ Hospital of Chongqing Medical University, China Xiao Juan Ji, Children’ Hospital of Chongqing Medical University Ming Li, Children’ Hospital of Chongqing Medical University Xing Liu, Children’ Hospital of Chongqing Medical University Objective: To investigate the value of ultrasound in evaluation of the hip joints’ blood flow in Perthes’ disease. Methods: 45 hip joints with Perthes’ disease were examined with ultrasound imaging and 45 normal hip joints were assigned into the control group. To study the characterize of hip joints’ blood supply with Color Doppler flow imaging (CDFI),and the articular surface of femoral head and the thickness of membrana synovialis capsulae articularis. Results: The femoral head of Perthes’ disease all showed flatted and broken, with membrana synovialis thickening and articulatio coxae arthroedema in 40 children. Rare blood signal of injured side were detected with CDFI . The flow velocity of the terminal vessel into femoral epiphysis(1.10⫾0.30cm/s) and the lateral ascending cervical arteries (5.30⫾1.20cm/s) were lower than the control group(P ⬍0.01). The hemodynamics between the terminal arteria into femoral epiphysis(1.60⫾0.80 cm/s)and the control group(2.40⫾1.40 cm/s)showed no obviously difference in statistics(P ⬎ 0.05). Conclusion: Ultrasonography could correctly detect lesions and evaluate the blood supply of hip joints.
Ultrasound in Medicine and Biology
Method and Materials: A total of 864 lesions (mean size 1.0cm, range 0.3 - 3.0cm; BI-RADS category 4a /4b /4c /5; 757 / 66 / 28 /13 lesions) in 842 women (mean age 46, range 30-68) who were scheduled to undergo US-guided core biopsy formed our study group. Elastographic images were prospectively classified as positive (abnormal strain) and negative (normal strain) based on the degree of strain induced by light compression. Results: Of the 864 suspicious abnormal lesions, 79 (9.1%) lesions were confirmed as cancers (77 positive, 2 negative at elastography). Of the 224 lesions with negative elastography (216 category 4a, 8 category 4b lesions), 2 lesions (0.9%) proved to be cancers (0.7 and 1.6cm, low grade DCIS). Of the 640 lesions with positive elastography, 77 lesions (12.0%) proved to be cancers (59 invasive ductal carcinomas, 18 DCIS) (p⬍ 0.001). The rate of malignancy for BI-RADS category 4a / 4b / 4c / 5 lesions were 2.6% / 36.4% / 58.6% / 100%, respectively. For the BI-RADS category 4a lesions, 28.5% (216 of 757) had a normal strain and 99.1% (214 of 216) of lesions with normal strain found out to be benign. Conclusion: When a lesion categorized as BI-RADS category 4a has a normal strain on elastography, a biopsy may be averted. 0495 Ultrasound of Neonatal Hip In-One Kim, Seoul National University Hospital, Korea Two major roles of pediatric hip US are diagnos of DDH and joint effusion. In DDH, plain radiography shows relationship of proximal femur and acetabulum and the extent of acetabular coverage, but femoral head is not visible prior to ossification. US shows anatomic details including the cartilage and associated soft tissues without ionizing radiation. US is also useful in screening of high-risk infants and abnormal physical examination. Early diagnosis is important because non-operative treatment is satisfactory in most unstable hip detected before 6-8 months of age. US technique in the diagnosis of DDH includes Coronal scan of Graf technique, and Transverse and Cornal scan with dynamic stress examination. Abnormal position or abnormal mobility of the femoral head with stress, insufficient acetabular depth to accommodate femur head or presence of gap between acetabular cartilage and femoral head suggests DDH. US is also used for the follow-up evaluation during treatment. The main causes of hip joint effusion in pediatric age are transient synovitis and septic arthritis. US alone cannot differentiate between two, but associated bony changes or clinical and laboratory findings can suggests septic hip and aspiration of the effusion is important in the diagnosis of septic hip. Anterior sagittal scan parallel to femoral neck with hip in neutral position shows anterior joint capsule parallel to the anterior cortex of the femoral neck and two layers of the anterior joint capsule composed of fibrous capsule and minute layer of synovial membrane. US easily demonstrates joint effusion accumulated in the anterior recess between two layers. 0496 Sonography of the Gastrointestinal Tract in Pediatrics Alan Daneman, Toronto Children’s Hospital, Canada Sonography is an important modality for evaluation of children with suspected or known disease of the gastrointestinal tract (GIT). In many conditions sonography has come to replace plain radiographs of the abdomen and even contrast examinations of the GIT. Some of these enitities have been dealt with in other presentations at this meeting - eg. intussusception and necrotizing enterocolitis. However the range of disease entities in which sonography plays a pivotal role is wide ranging and also includes hypertrophic pyloric stenosis, appendicitis, inflammatory bowel diseases,
Volume 35, Number 8S, 2009 polyps, Meckels diverticulum and even malrotation. In most of these diseases sonography provides definitive information that the clinicians can use to institute appropriate therapy. However in some cases sonography may have to be followed by other cross sectional modalities such as CT or MR to obtain the definitive information. 0497 Doppler in Pulmonary Disease Pedro Unshelm, Instituto Pediatrico La Florida, Venezuela Recently Doppler has been used like prognosis test of pneumonias requiring hospitalization depending on the amount of blood flow in the affected lobe or segment. Ultrasound is an excellent complementary tool to chest x-ray in the diagnosis of pneumonias and pleural effusion. Among the advantages are the fact that there is no ionizing radiation, the use of portable real time equipment so it can be made in the incubator, it is cheap, and no sedation is required. It can be used in lobar or segmental pneumonias and pleural effusions, it is usually performed in cases with poor response to antibiotic therapeutic. The Ultrasound signs are an appereance like liver of the pulmonary parenchyma and the presencie of an air broncho sonogram. The Doppler signal will inform us the kind of the blood flow in the pneunonic segment and, besides it is a predict test, if there is a great amount of blood flow it has a better prognosis than pneumonies with necrotical areas. Ultrasound has higher sensibility than tomography, and has replaced chest x -ray to asses pleural effusions , Ultrasound can be used to guide drainage of effusions. The fluid color sing permits to distinguish if the pleural effusion is free. 0498 Evaluating the Hip Joints’ Blood Flow of Perthes’ Disease with Ultrasonography Xue Mo Quan, Children’ Hospital of Chongqing Medical University, China Kun Zhang, Children’ Hospital of Chongqing Medical University, China Qiao Wang, Children’ Hospital of Chongqing Medical University, China Yi Tang, Children’ Hospital of Chongqing Medical University, China Xiao Juan Ji, Children’ Hospital of Chongqing Medical University Ming Li, Children’ Hospital of Chongqing Medical University Xing Liu, Children’ Hospital of Chongqing Medical University Objective: To investigate the value of ultrasound in evaluation of the hip joints’ blood flow in Perthes’ disease. Methods: 45 hip joints with Perthes’ disease were examined with ultrasound imaging and 45 normal hip joints were assigned into the control group. To study the characterize of hip joints’ blood supply with Color Doppler flow imaging (CDFI),and the articular surface of femoral head and the thickness of membrana synovialis capsulae articularis. Results: The femoral head of Perthes’ disease all showed flatted and broken, with membrana synovialis thickening and articulatio coxae arthroedema in 40 children. Rare blood signal of injured side were detected with CDFI . The flow velocity of the terminal vessel into femoral epiphysis(1.10⫾0.30cm/s) and the lateral ascending cervical arteries (5.30⫾1.20cm/s) were lower than the control group(P ⬍0.01). The hemodynamics between the terminal arteria into femoral epiphysis(1.60⫾0.80 cm/s)and the control group(2.40⫾1.40 cm/s)showed no obviously difference in statistics(P ⬎ 0.05). Conclusion: Ultrasonography could correctly detect lesions and evaluate the blood supply of hip joints.