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1054: Clinical Applications of the Color Doppler Twinkling Artifact in Abdominal and Pelvic Sonography: An Illustrative Review
S112
Ultrasound in Medicine and Biology
Methods: Forty-seven cases with pancreatic masses and thirty controls were examined with conventional ultrasonography and second harmonic imaging. Characteristics of gray scale ultrasonography, colour Dopper flow imaging and second harmonic imaging were compared. Results: On second harmonic imaging, different pancreatic masses presented clearer than those on conventional ultrasonography, and color flow signals in and around the pancreatic masses were shown more than those on conventional ultrasonography. Conclusion: It is of clinical value for second harmonic imaging in detecting and diagnosing deeply-located pancreatic masses which is interfered easily bygastric gases.
1052 Ultrasound Manifestation and Evolution of both Side of Ectopectoralis Inflammation and Panniculitis Quan Jiang, Pudong New District Hospital, China Hua Yu Zhao, Pudong New District Hospital, China Odjective: To explore the value of high frequency ultrasound in diagnosing ectopectoralis diseases. Methods: We studied echograms obtained from 20 normal ectopectorali and 1patient suffered from rare ectopectoralis diseases. Results: The ultrasound display unclear echo and contra strong echo mass unevenly. The mass is similar with tumor and has extremely affluent color flow imaging. We eliminate malignant disease because of the imaging recovered by 2months treated. Inflammatory process and fibrosis of tela subcutaneous layer recover difficultly, so it still have ectopectoralis panniculitis. Conclusion: Ultrasonography diagnosis of ectopectoralis diseases is available.
1053 The Onion Skin Sign in the Right Lower Abdomen: Is it a Specific Ultrasonographic Sign for the Diagnosis of Appendiceal Mucocele? Toru Kameda, Japan Fukiko Kawai, Saiseikai Utsunomiya Hospital, Japan Yasuyuki Kobori, Saiseikai Utsunomiya Hospital, Japan Objective: The onion skin sign shows echogenic layers resembling the cross section of an onion in a cystic mass. The sign was reported to be useful for the diagnosis of appendiceal mucocele. The objective of this study was to evaluate the relation of the onion skin sign to appendiceal mucocele. Methods: Between April 2004 and September 2008, 50,550 abdominal ultrasound studies were conducted consecutively at our ultrasound laboratory. In these, five patients had the onion skin sign in the right lower abdomen. We reviewed CT scans, MR images and final diagnoses in these patients. Results: Final diagnosis was appendiceal mucocele in all of the patients. The continuity between the cecum and the cystic mass was not identified with ultrasonography in three patients. CT scanning and MR imaging were performed in five and two patients, respectively. Layered structure like the onion skin sign was not detected on these images. Conclusions: The ultrasonographic onion skin sign in the right lower abdomen is very useful for the diagnosis of appendiceal mucocele, especially when the continuity between the cecum and the mass is not identified.
Volume 35, Number 8S, 2009 1054 Clinical Applications of the Color Doppler Twinkling Artifact in Abdominal and Pelvic Sonography: An Illustrative Review Hyun Cheol Kim, Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung Hee University, Korea Dal Mo Yang, Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung Hee University, Korea Wook Jin, Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung Hee University, Korea Objective: To illustrate the mechanism of the color Doppler twinkling artifact and sonographic machine factors influencing it and to illustrate the various clinical values of the color Doppler twinkling artifact and those pitfalls. Methods: We evaluated the various settings of sonography machineassociated factors that influence artifact appearance. We reviewed the various conditions displaying the color Doppler twinkling artifact and its diagnostic value. We also reviewed the pitfalls associated with the use of the color Doppler twinkling artifact as a diagnostic sign. Results: The color Doppler twinkling artifact was dependent on focal zones, gray scale gains, color write priorities, and pulse repetition frequencies. The color Doppler twinkling artifact was associated with calcified lesions in the liver, gallbladder adenomyomatosis, hepatic bile duct hamartoma, gallstones and choledocholithiasis, chronic pancreatitis, urinary stones, encrusted indwelling urinary stent or catheter, bowel gas, and metallic foreign body. However, some of twinkling artifacts were associated with false negative and false positive results. Conclusions: In our experience, the color Doppler twinkling artifact is an additional useful sonographic sign in the diagnosis of calcified lesions, urinary and biliary stones, gallbladder adenomyomatosis and some miscellaneous conditions. 1055 Image Guided Transvaginal Drainage of Pelvic Abscesses and Fluid Collection Seung Ho Kim, Seoul National University Hospital, Department of Radiology, Korea Seung Hyup Kim, Seoul National University Hospital, Department of Radiology, Korea Jae Young Lee, Seoul National University Hospital, Department of Radiology, Korea Jeong Min Lee, Seoul National University Hospital, Department of Radiology, Korea Joon Koo Han, Seoul National University Hospital, Department of Radiology, Korea Byung Ihn Choi, Seoul National University Hospital, Department of Radiology, Korea Objective: To evaluate the efficacy and the safety of image guided transvaginal drainage of pelvic abscesses and fluid collection using a modified Seldinger technique. Methods: Fifteen patients (mean age, 43 years; range, 24 – 82 years) who underwent transvaginal aspiration (n ⫽ 1), or catheter drainage (n ⫽ 14) guided with ultrasound and fluoroscopy were enrolled in this retrospective study. A small coronal incision was performed to facilitate puncture using an 18 G needle, tract dilation and the insertion of a drainage catheter with the Seldinger technique. Outcome was analyzed with respect to clinical success, technical success, and procedure related complications. Results: The overall clinical success rate was 87% (13/15 cases). The success rate of catheter drainage was 86% (12/14 cases) and the use of aspiration alone was successful in one patient. Technical success was achieved in all patients without procedure related complications.
Ultrasound in Medicine and Biology
Methods: Forty-seven cases with pancreatic masses and thirty controls were examined with conventional ultrasonography and second harmonic imaging. Characteristics of gray scale ultrasonography, colour Dopper flow imaging and second harmonic imaging were compared. Results: On second harmonic imaging, different pancreatic masses presented clearer than those on conventional ultrasonography, and color flow signals in and around the pancreatic masses were shown more than those on conventional ultrasonography. Conclusion: It is of clinical value for second harmonic imaging in detecting and diagnosing deeply-located pancreatic masses which is interfered easily bygastric gases.
1052 Ultrasound Manifestation and Evolution of both Side of Ectopectoralis Inflammation and Panniculitis Quan Jiang, Pudong New District Hospital, China Hua Yu Zhao, Pudong New District Hospital, China Odjective: To explore the value of high frequency ultrasound in diagnosing ectopectoralis diseases. Methods: We studied echograms obtained from 20 normal ectopectorali and 1patient suffered from rare ectopectoralis diseases. Results: The ultrasound display unclear echo and contra strong echo mass unevenly. The mass is similar with tumor and has extremely affluent color flow imaging. We eliminate malignant disease because of the imaging recovered by 2months treated. Inflammatory process and fibrosis of tela subcutaneous layer recover difficultly, so it still have ectopectoralis panniculitis. Conclusion: Ultrasonography diagnosis of ectopectoralis diseases is available.
1053 The Onion Skin Sign in the Right Lower Abdomen: Is it a Specific Ultrasonographic Sign for the Diagnosis of Appendiceal Mucocele? Toru Kameda, Japan Fukiko Kawai, Saiseikai Utsunomiya Hospital, Japan Yasuyuki Kobori, Saiseikai Utsunomiya Hospital, Japan Objective: The onion skin sign shows echogenic layers resembling the cross section of an onion in a cystic mass. The sign was reported to be useful for the diagnosis of appendiceal mucocele. The objective of this study was to evaluate the relation of the onion skin sign to appendiceal mucocele. Methods: Between April 2004 and September 2008, 50,550 abdominal ultrasound studies were conducted consecutively at our ultrasound laboratory. In these, five patients had the onion skin sign in the right lower abdomen. We reviewed CT scans, MR images and final diagnoses in these patients. Results: Final diagnosis was appendiceal mucocele in all of the patients. The continuity between the cecum and the cystic mass was not identified with ultrasonography in three patients. CT scanning and MR imaging were performed in five and two patients, respectively. Layered structure like the onion skin sign was not detected on these images. Conclusions: The ultrasonographic onion skin sign in the right lower abdomen is very useful for the diagnosis of appendiceal mucocele, especially when the continuity between the cecum and the mass is not identified.
Volume 35, Number 8S, 2009 1054 Clinical Applications of the Color Doppler Twinkling Artifact in Abdominal and Pelvic Sonography: An Illustrative Review Hyun Cheol Kim, Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung Hee University, Korea Dal Mo Yang, Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung Hee University, Korea Wook Jin, Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung Hee University, Korea Objective: To illustrate the mechanism of the color Doppler twinkling artifact and sonographic machine factors influencing it and to illustrate the various clinical values of the color Doppler twinkling artifact and those pitfalls. Methods: We evaluated the various settings of sonography machineassociated factors that influence artifact appearance. We reviewed the various conditions displaying the color Doppler twinkling artifact and its diagnostic value. We also reviewed the pitfalls associated with the use of the color Doppler twinkling artifact as a diagnostic sign. Results: The color Doppler twinkling artifact was dependent on focal zones, gray scale gains, color write priorities, and pulse repetition frequencies. The color Doppler twinkling artifact was associated with calcified lesions in the liver, gallbladder adenomyomatosis, hepatic bile duct hamartoma, gallstones and choledocholithiasis, chronic pancreatitis, urinary stones, encrusted indwelling urinary stent or catheter, bowel gas, and metallic foreign body. However, some of twinkling artifacts were associated with false negative and false positive results. Conclusions: In our experience, the color Doppler twinkling artifact is an additional useful sonographic sign in the diagnosis of calcified lesions, urinary and biliary stones, gallbladder adenomyomatosis and some miscellaneous conditions. 1055 Image Guided Transvaginal Drainage of Pelvic Abscesses and Fluid Collection Seung Ho Kim, Seoul National University Hospital, Department of Radiology, Korea Seung Hyup Kim, Seoul National University Hospital, Department of Radiology, Korea Jae Young Lee, Seoul National University Hospital, Department of Radiology, Korea Jeong Min Lee, Seoul National University Hospital, Department of Radiology, Korea Joon Koo Han, Seoul National University Hospital, Department of Radiology, Korea Byung Ihn Choi, Seoul National University Hospital, Department of Radiology, Korea Objective: To evaluate the efficacy and the safety of image guided transvaginal drainage of pelvic abscesses and fluid collection using a modified Seldinger technique. Methods: Fifteen patients (mean age, 43 years; range, 24 – 82 years) who underwent transvaginal aspiration (n ⫽ 1), or catheter drainage (n ⫽ 14) guided with ultrasound and fluoroscopy were enrolled in this retrospective study. A small coronal incision was performed to facilitate puncture using an 18 G needle, tract dilation and the insertion of a drainage catheter with the Seldinger technique. Outcome was analyzed with respect to clinical success, technical success, and procedure related complications. Results: The overall clinical success rate was 87% (13/15 cases). The success rate of catheter drainage was 86% (12/14 cases) and the use of aspiration alone was successful in one patient. Technical success was achieved in all patients without procedure related complications.