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1230
P70
Ultrasound in Medicine and Biology
sound has expanded beyond the imaging realm, with methods and applications extending to novel therapeutic and surgical uses. These applications broadly include: Tissue ablation, acoustocautery, lipoplasty, site-specific and ultrasound mediated drug activity, extracorporeal lithotripsy and the enhancement of natural physiological functions such as wound healing and tissue regeneration. A particularly attractive aspect of this technology is that diagnostic and therapeutic systems can be combined to produce totally noninvasive, image-guided therapy. This general lecture will review a number of these exciting new applications of ultrasound and address some of the basic scientific questions and future challenges in developing these methods and technologies for general use in our society. We shall particularly emphasize the use of high intensity focused ultrasound (HIFU) in the treatment of benign and malignant tumors as well as the introduction of acoustic hemostasis, especially in organs that are difficult to treat using conventional medical and surgical techniques.
DOPPLER US OF CNS AND CAROTID ARTERY 1230 Color Doppler sonographic findings of internal jugular vein and its branches in the neck Chung C-P, Sheng W-Y, Hu H-H, Neurological Institute, Taipei Veteran General Hospital, Taiwan The purpose of this study is to discuss the hemodynamic relationship between the internal jugular vein (IJV) and its branches. We illustrated the color Doppler sonographic findings of the IJV and its branches in normal controls at baseline and during the Valsalva maneuver, respectively. We found that the retrograde flow components in the branches of IJV, which is suggestive of valve insufficiency, were associated with the IJV valve incompetence and a larger flow volume in IJV. The valves insufficiency in these IJV branches may be related to a longterm high IJV venous pressure. Therefore, the reversed flow pattern seen in IJV branches might reflect an elevated IJV pressure. This sonographic finding can be applied in the studies of diseases that are suspected to be related with an increased IJV pressure. Furthermore, we supply an insight into the pathophysiology of venous valve insufficiency.
Volume 32, Number 5S, 2006 that the GI tract is the only abdominal organ(s) in which ultrasound is also used for evaluating the functions.
PEDIATRIC GI AND HEPATOBILIARY US 1232 The sonogram of biliary dilatations in children Lee H-C, Mackay Memorial Hospital, Taiwan We evaluated 211 children who met the criteria for biliary dilatation from 1981 to 2005 to know the accuracy of their sonographic diagnosis. The sonographic definition of biliary dilatation is any of the following: a visible intrahepatic biliary duct in any age; an extrahepatic biliary diameter wider than two mm in infancy, greater than four mm in childhood and greater than seven mm after adolescence. One hundred sixty-three patients were diagnosed with anomalous dilatations of the biliary tree (including 142 choledochal cysts and 21 of biliary atresia with biliary dilatations). Biliary dilatations in the other 48 patients were diagnosed to be secondary or normal variants. All intrahepatic biliary dilatation cases and those with both intra- and extrabiliary dilatations were finally proved to be anomalous. In 161 cases of extrahepatic biliary dilatation only, the mean diameter was widest in choledochal cyst cases (19.9 ⫾ 7.2 mm, compared to cases of biliary atresia with biliary dilatation (9.6 ⫾ 2.0 mm), secondary biliary dilatation (7.9 ⫾ 1.4 mm) and normal variants (4.9 ⫾ 1.6 mm) (p ⬍ .001). Of the 59 infantile biliary dilatation patients, 38 had choledochal cysts and 21 (35.6%) were diagnosed as biliary atresia associated with biliary dilatation (BABD). Excluding biliary atresia associated cases, the accuracy of diagnosing choledochal cysts in extrahepatic biliary dilatation was 84.4% and 97.9% using a cutoff 7 mm and 10 mm as the minimum diameter, respectively. We conclude: the diagnostic criteria of nonbiliary atresia associated extrahepatic choledochal cyst should be ⫾10 mm regardless of age. Lesser degree of extrahepatic biliary dilatation without abnormal laboratory or clinical presentations may be a normal variant. The possibility of BABD must be included in differential diagnosis when a small extrahepatic cyst with prolonged jaundice is found in infancy.
BREAST US DISEASE AND TECHNIQUE 1233
BOWEL AND MISCELLANEOUS 1231 Ultrasonography in gastrointestinal tract Kashida H, Showa University Northern Yokohama Hospital, Japan The GI tract had not been considered very suitable for sonographic diagnosis until about 10 yr ago. With the improvement of the equipments, the situation has changed little by little. Ultrasound is especially useful for making the first tentative diagnosis in so-called “acute abdomen” cases, and deciding the next steps to be taken. Ileus, bowel intussuception, SMA thrombosis or embolization, appendicitis, colon diverticulitis, various kinds of colitis, perforation of the GI tract etc. are lesions that can be diagnosed with ultrasound. The merits of ultrasound are: (1) US is not invasive; (2) US can make a differential diagnosis between the diseases of the GI tract and non-GI tract lesions such as aortic aneurysm, urinary tract stone, cholecystitis etc.; (3) US can not only make the diagnosis, but also evaluate the severity of the disease; (4) US can be done repeatedly and, thus, clinical follow up of the patient is possible. In addition, color Doppler sonography and/or contrast enhanced US can add important information. It is worth noting
Using three-dimensional power Doppler ultrasound to evaluate breast lesions Chang Y-C, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan Three-dimensional (3D) ultrasound (US) enables volumetric evaluation of breast lesions. Power Doppler (PD) of volumetric data provides additional information of nondirectional vascular character of focal breast lesion. The morphologic patterns and vessel distribution can be investigated in multi-slice display (three-dimensional extended imaging, 3DXITM, Medison) and volumetric data can be quantified with VOCAL (virtual organ computer-aided analysis) software histogram. The general criteria of morphologic evaluation of breast lesion with 3D US are similar to 2D images. The main advantage of 3D US is to provide additional oblique or orthogonal views of focal mass or nonmass lesion. Multi-slice display of volumetric data can be used for evaluating the margin of target lesion and possible intraductal tumor invasion, which is not able or difficult to evaluate conventional 2D images. PD US is very sensitive for detecting nondirectional blood flow and, hence, more desirable for assessing tumor vasculature. Several indices can be measured: vascularization index (VI), which describes
Ultrasound in Medicine and Biology
sound has expanded beyond the imaging realm, with methods and applications extending to novel therapeutic and surgical uses. These applications broadly include: Tissue ablation, acoustocautery, lipoplasty, site-specific and ultrasound mediated drug activity, extracorporeal lithotripsy and the enhancement of natural physiological functions such as wound healing and tissue regeneration. A particularly attractive aspect of this technology is that diagnostic and therapeutic systems can be combined to produce totally noninvasive, image-guided therapy. This general lecture will review a number of these exciting new applications of ultrasound and address some of the basic scientific questions and future challenges in developing these methods and technologies for general use in our society. We shall particularly emphasize the use of high intensity focused ultrasound (HIFU) in the treatment of benign and malignant tumors as well as the introduction of acoustic hemostasis, especially in organs that are difficult to treat using conventional medical and surgical techniques.
DOPPLER US OF CNS AND CAROTID ARTERY 1230 Color Doppler sonographic findings of internal jugular vein and its branches in the neck Chung C-P, Sheng W-Y, Hu H-H, Neurological Institute, Taipei Veteran General Hospital, Taiwan The purpose of this study is to discuss the hemodynamic relationship between the internal jugular vein (IJV) and its branches. We illustrated the color Doppler sonographic findings of the IJV and its branches in normal controls at baseline and during the Valsalva maneuver, respectively. We found that the retrograde flow components in the branches of IJV, which is suggestive of valve insufficiency, were associated with the IJV valve incompetence and a larger flow volume in IJV. The valves insufficiency in these IJV branches may be related to a longterm high IJV venous pressure. Therefore, the reversed flow pattern seen in IJV branches might reflect an elevated IJV pressure. This sonographic finding can be applied in the studies of diseases that are suspected to be related with an increased IJV pressure. Furthermore, we supply an insight into the pathophysiology of venous valve insufficiency.
Volume 32, Number 5S, 2006 that the GI tract is the only abdominal organ(s) in which ultrasound is also used for evaluating the functions.
PEDIATRIC GI AND HEPATOBILIARY US 1232 The sonogram of biliary dilatations in children Lee H-C, Mackay Memorial Hospital, Taiwan We evaluated 211 children who met the criteria for biliary dilatation from 1981 to 2005 to know the accuracy of their sonographic diagnosis. The sonographic definition of biliary dilatation is any of the following: a visible intrahepatic biliary duct in any age; an extrahepatic biliary diameter wider than two mm in infancy, greater than four mm in childhood and greater than seven mm after adolescence. One hundred sixty-three patients were diagnosed with anomalous dilatations of the biliary tree (including 142 choledochal cysts and 21 of biliary atresia with biliary dilatations). Biliary dilatations in the other 48 patients were diagnosed to be secondary or normal variants. All intrahepatic biliary dilatation cases and those with both intra- and extrabiliary dilatations were finally proved to be anomalous. In 161 cases of extrahepatic biliary dilatation only, the mean diameter was widest in choledochal cyst cases (19.9 ⫾ 7.2 mm, compared to cases of biliary atresia with biliary dilatation (9.6 ⫾ 2.0 mm), secondary biliary dilatation (7.9 ⫾ 1.4 mm) and normal variants (4.9 ⫾ 1.6 mm) (p ⬍ .001). Of the 59 infantile biliary dilatation patients, 38 had choledochal cysts and 21 (35.6%) were diagnosed as biliary atresia associated with biliary dilatation (BABD). Excluding biliary atresia associated cases, the accuracy of diagnosing choledochal cysts in extrahepatic biliary dilatation was 84.4% and 97.9% using a cutoff 7 mm and 10 mm as the minimum diameter, respectively. We conclude: the diagnostic criteria of nonbiliary atresia associated extrahepatic choledochal cyst should be ⫾10 mm regardless of age. Lesser degree of extrahepatic biliary dilatation without abnormal laboratory or clinical presentations may be a normal variant. The possibility of BABD must be included in differential diagnosis when a small extrahepatic cyst with prolonged jaundice is found in infancy.
BREAST US DISEASE AND TECHNIQUE 1233
BOWEL AND MISCELLANEOUS 1231 Ultrasonography in gastrointestinal tract Kashida H, Showa University Northern Yokohama Hospital, Japan The GI tract had not been considered very suitable for sonographic diagnosis until about 10 yr ago. With the improvement of the equipments, the situation has changed little by little. Ultrasound is especially useful for making the first tentative diagnosis in so-called “acute abdomen” cases, and deciding the next steps to be taken. Ileus, bowel intussuception, SMA thrombosis or embolization, appendicitis, colon diverticulitis, various kinds of colitis, perforation of the GI tract etc. are lesions that can be diagnosed with ultrasound. The merits of ultrasound are: (1) US is not invasive; (2) US can make a differential diagnosis between the diseases of the GI tract and non-GI tract lesions such as aortic aneurysm, urinary tract stone, cholecystitis etc.; (3) US can not only make the diagnosis, but also evaluate the severity of the disease; (4) US can be done repeatedly and, thus, clinical follow up of the patient is possible. In addition, color Doppler sonography and/or contrast enhanced US can add important information. It is worth noting
Using three-dimensional power Doppler ultrasound to evaluate breast lesions Chang Y-C, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan Three-dimensional (3D) ultrasound (US) enables volumetric evaluation of breast lesions. Power Doppler (PD) of volumetric data provides additional information of nondirectional vascular character of focal breast lesion. The morphologic patterns and vessel distribution can be investigated in multi-slice display (three-dimensional extended imaging, 3DXITM, Medison) and volumetric data can be quantified with VOCAL (virtual organ computer-aided analysis) software histogram. The general criteria of morphologic evaluation of breast lesion with 3D US are similar to 2D images. The main advantage of 3D US is to provide additional oblique or orthogonal views of focal mass or nonmass lesion. Multi-slice display of volumetric data can be used for evaluating the margin of target lesion and possible intraductal tumor invasion, which is not able or difficult to evaluate conventional 2D images. PD US is very sensitive for detecting nondirectional blood flow and, hence, more desirable for assessing tumor vasculature. Several indices can be measured: vascularization index (VI), which describes