1343: Usefulness of High Frequency Ultrasonography in Dermatological Examination

Abstracts criteria for differentiating pilomatricomas from other subcutaneous tumors. 1340 Imaging Findings of Intravascular Papillary Endothelial Hyperplasia Presenting as Soft Tissue Masses in Extremities Sun Joo Lee, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Young Mi Park, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Jae Ryange Juhn, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Choong Ki Eun, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Sung Hwan Hong, Department of Radiology, College of Medicine, Seoul National University Hospital, Korea Ji Young Hwang, Department of Radiology, College of Medicine, Ewha Womans University Mokdong Hospital, Korea In Sook Lee, Department of Radiology, College of Medicine, Pusan National University Hospital, Korea Young Jin Park, Ulsan Boram Hospital, Korea Purpose: To describe the ultrasonography (US) and Magnetic resonance imaging (MRI) findings of IPEH (intravascular papillary endothelial hyperplasia) in extremities. Materials: The six patients were selected during a period of 4 years (from January 2003 through January 2007) from the archives of four institutions. Results: The ultrasonographic findings revealed that pure form occurred most commonly on the finger and hypoechoic soft tissue masses in the subcutis, mixed form were found intramuscularly and showed slightly hyperechoic septum-like structures and central core in the mass corresponding to endothelial papillary proliferative tissue. The papillary endothelial hyperplastic tissues were seen well correlation with hypervascularity on color Doppler US. In the most cases, MRI showed isointense on T1WI and hyperintense on T2WI with enhancement corresponded to the endothelial papillary proliferative tissue in peripheral, septal, and central core. And the hyperintense on T1WI and T2WI were consistent with subacute hemorrhage. Especially in the mixed form of IPEH, The masses looked like a section of an orange on T1WI with gadolinium enhancement due to isointense mass with enhancement in peripheral, septal, and central core. Conclusions: The mixed type of IPEH should be considered as a possible diagnosis when a well defined intramuscular mass showed slightly hyperechoic septum-like structures and central core with hypervascularity on ultrasonography and high signal intensity on T1WI and hyperintense with iso or low signal intensity on T2WI with peripheral, septal and central core enhancement on MRI. The masses looked like a section of an orange on ultrasonography and T1WI with gadolinium enhancement. 1341 Pictorial Essay of Ultrasound Evaluation of Neurogenic Tumors: Head to Toe Asif A Momin, Prince Aly Khan Hospital, Mumbai, India US is first investigation of choice for any palpable lump or bump anywhere in the body. We encountered various such SOL’s during US examinations. The sites include Orbit, Neck in carotid sheath as well as brachial plexus, Post-op nueroma, posterior mediastinal, peripheral extremities, ankle, foot, palmer aspect of hand, abdominal para spinal area,

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sub hepatic region, pelvic cavity along the sciatic notch, vaginal wall and even scrotal sac. All these lesion share features like shape, echogenicity, consistency, vascularity and the course of lesion. Some variable findings were recorded. This article will highlight the value of visual impression in the diagnosis of nuerogenic SOL’s even in an unusual locations. 1342 Disgnostic Yield of US-Guided Gun Biopsy in Mulculoskeletal Mass Lesions Myungjin Shin, Asan Medical Center, Korea Heywon Chung, Asan Medical Center, Korea Sanghoon Lee, Asan Medical Center, Korea Shinwoo Lee, Asan Medical Center, Korea Minjung Seo, Asan Medical Center, Korea Minjee Kim, Asan Medical Center, Korea Jinhee Park, Asan Medical Center, Korea Purpose: To evaluate the diagnostic yield of US-guided gun biopsy in various musculoskeletal mass or mass like lesions. Materials and Methods: 47 consecutive cases of US-guided gun biopsy patients were included in this study. The US-guided gun biopsy procedures were performed using 14G, 16G or 18G gun biopsy needle with coaxial technique according to the size and location of the lesion. The number of needle pass was 3 or 4 times and obtained specimens were grossly confirmed. Pathological reports including post-surgical biopsy reports were reviewed to evaluate the diagnostic yield. Results: There was no case of inadequate specimen in pathologic reports. Two cases out of seven malignant tumors (sarcomatous tumors) were not able to determine its subtype. Four out of eight subcutaneous mass or mass-like lesions were reported as non-specific findings. Two cases out of three chondrosarcoma were confirmed as osteosarcoma in post-surgical specimen. Conclusion: Overall diagnostic yield of US-guided gun biopsy in various musculoskeletal mass or mass like lesions is excellent. However, it is good to understand that the specimen from gun biopsy could be difficult in determining the subtype in sarcomatous lesion or differentiating between chondrosarcoma and osteosarcoma or making confirmative pathological diagnosis in subcutaneous lesions. 1343 Usefulness of High Frequency Ultrasonography in Dermatological Examination Elzbieta Szymanska, Department of Dermatology, CSK MSWiA, Poland Magdalena Majsterek, Department of Dermatology, CSK MSWiA, Poland Malgorzata Maj, Department of Dermatology, CSK MSWiA, Poland Wojciech Secomski, Polish Academy of Sciences, Poland Andrzej Nowicki, Polish Academy of Sciences, Poland Lidia Rudnicka, Department of Dermatology, CSK MSWiA, Poland The aim of the study was the assessment of high frequency ultrasonography in dermatologic diagnostics. Examination was performed with 30 MHz ultrasound transducer with 0,1mm resolution and 7mm penetration. We examined patients with neoplasms, cicatrical alopecia, morphea and nail psoriasis. Most of small skin neoplasmatic lesions were hypoechogenic and homogeneous on examination. Extensive lesions were multicomponent with normo, hypo and anechogenic structures. The assessment of lesion’s boarders allows sometimes to conclude the invasiveness of the lesion.

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Ultrasound in Medicine and Biology

Areas of skin with clinically visible atrophy showed diffuse increasing of echogenicity. In early lesions, without accomplished fibrosis, diffuse decreasing of echogenicity can be observed, that is probably caused by inflammatory infiltration. Ultrasonographic image of healthy individual’s nail reveals the presence of 3 layers: both external layers (surface and bottom) are hyperechogenic and the inner layer is hypoechogenic. Matrix, in longitudinal section, is triangular shape, anechoic or with few internal echoes. These internal echoes are more intense in toes than in fingers. Nail bed can not be distinguished as a separate layer – it’s thickness can be measured indirectly, by assessing the distance from nail plate to the surface of phalanx. The thickness and the vasculature of nail fold can also be easily measured. The ultrasonographic image of psoriatic nails reveals many statistically important differences from image of healthy nails, within nail plate, matrix and nail fold. Above data suggest that ultrasonographic examination may be a valuable dermatologic diagnostic tool that completes classical dermatologic diagnostics and helps to plan the treatment.

Volume 35, Number 8S, 2009 1345 Ultrasonography of the Neonatal Kidney: A Pictorial Review Gye Yeon Lim, The Catholic University of Korea, St. Mary’s Hospital, Korea Soo Ah Ah Im, The Catholic University of Korea, St. Mary’s Hospital, Korea Ultrasonography has become modality of choice for the evaluation of the neonatal kidney. It has major advantage over other modalities is portability, real time observation, and circumvention of sedation in neonatal age. Congenital and acquired renal disease during neonatal period may be classified according to their sonographic characteristics: 1) diffusely hyperechoic cortex 2) diffusely hyperechoic renal pyramid 3) diffusely echogenic renal parenchyme 4) multiple large cysts 5) renal mass. High resolution US (with Doppler US) along with clinical parameters will allow the radiologist to offer likely underlying pathologic conditions and differential diagnostic possibilities in neonatal age. 1346

1344 US Diagnosis in Differentiation of Benign from Malignant Soft Tissue Musculoskeletal Lesions Compared with CT and MR V Vasilevska, University Surgical Clinic “St. Naum Ohridski”, Macedonia A Gligorievski, University Clinic for Radiology, Mediacal Faculty, Macedonia N Kirjas, University Clinic for Radiology, Mediacal Faculty, Macedonia G Zafiroski, Orthopedic Clinic, Mediacal Faculty, Macedonia V Janevska, Institute of Pathology, Mediacal Faculty, Macedonia K Gjorevski, University Clinic for Radiology, Mediacal Faculty, Macedonia Tolevska, University Surgical Clinic”St. Naum Ohridski”Mediacal Faculty, Macedonia Purpose: The purpose of this prospective study was to assess value of imaging diagnosis in differentiation of benign from malignant softtissue lesions, ability to make accurate preoperative staging and to make diagnostic algorithm. Material and Methods: One hundred consecutive patients (53 male, 47 female, median age 51 years) with musculoskeletal soft tissue mass underwent ultrasonography(US), computed tomography(CT) and magnetic resonance(MRI). Benign lesions were 70(53 benign tumors and 17 tumor-like lesions) and 30 were malignant lesions (26 malignant tumors and 4 metastases). Fifteen imaging parameters on US, CT and MR were evaluated. The diagnosis was based on histopathologic findings from core needle biopsy and surgical specimens. Multivariate logistic regression analysis was used to identify the best combination of imaging parameters in all used methods, predicting malignancy. Results: For predicting primary malignant soft tissue musculoskeletal tumor, US had sensitivity 80,8%, specificity 77% and accuracy 78%. For benign tumors the accuracy was 94%. The correlation between imaging preoperative staging of malignant tumors was 63,6%. Following US parameters for predicting malignancy showed statistically significant difference(p⬍0,01): partial capsule or uncapsulated lesions, inhomogeneous structure, presence of necrosis and contact with vascular structures. Conclusion: US had satisfactory contribution, but MRI had highest accuracy in imaging diagnosis of musculoskeletal lesions. A combination of individual parameters improved the differentiation between benign and malignant soft-tissue musculoskeletal lesions. Imaging diagnostic algorithm gives direction to evaluate musculoskeletal lesions in order not to make unnecessary examinations as well as not to miss malignant ones.

The Prenatal Ultrasonography of Pulmonary Stenosis and Atresla with Intact Ventricular Septum Guorong Lv, Department of Ultrasound, the Second Affilicated Hospital of Fujian Medical University, China LI Tang, China Shaohui Li, China Objective: To evaluate the fetus of Pulmonary stenosis(PS) and atresia(PA) with intact ventricular septum(IVS) by echocardiography. Methods: By reviewing the records of all the cases at our institutions between 2002 and 2008, all cases were diagnosed PS/IVS and PA/IVS by postnatal echocardiography or/and surgery, or autopsy. Results: In all of PS/IVS cases,2 were mild, 2 were moderate and 4 were severe. On the four-chamber view, there were 9 fetus with abnormal dyssymmetric four-chamber view and all of them were moderate and severe PS/IVS or PA/IVS. In all of cases, there were 7 fetus with enlarged right atrium, 3 fetus with enlarged, 2 fetus with normal, 4 fetus with hypoplastic of right ventricle and 10 fetus with hypertrophic of right ventricular wall. In cases with hypoplasia of the pulmonary artery trunk, 2 were mild, 2 were moderate, and 2 were severe. There were 5 fetus with reversed flow in the ductus arteriosus, and 6 fetus with tricuspid regurgitation. Conclusions: Abnormal dyssymmetric four-chamber view and disproportion of pulmonary artery to arteriae aorta is the clue and condition of prenatal diagnose of the PS/IVS and PA/IVS. There were significantly correlation between prognosis of fetus and reversed flow in ductus arteriosus with PS/IVS or PA/IVS. 1347 Ductus Venosus Measurements in the Near-Term Hircine Fetus After Intermittent Umbilical Cord Occlusion Shao-Zheng He, the Second Affilicated Hospital of Fujian Medical Umiversity, China Guo-Rong Lv, the Second Affilicated Hospital of Fujian Medical Umiversity, China Bo-Yi Li, the Second Affilicated Hospital of Fujian Medical Umiversity, China Qiu-Yue Chen, the Second Affilicated Hospital of Fujian Medical Umiversity, China Rui-Juan Su, the Second Affilicated Hospital of Fujian Medical Umiversity, China Peng Jin, the Second Affilicated Hospital of Fujian Medical Umiversity, China