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Abnormality detection rates by ultrasound within different racial groups
Abstracts/European Journal of Ultrasound 5 Suppl. 2 (1997) $1-$18 The role of intravascular ultrasound in the 'difficult to interpret' coronary angiogram Rees M.R.; Wilde P. University of Bristol, Department of
Clinical Radiology, Marlborough Street, Bristol BS2 8HW, UK Introduction: Intravascular ultrasound has developed as a technique which can be used as an adjunct to coronary angiography and coronary angioplasty, however, it has yet to develop a formal clinical role. Materials and methods: We have used intra-coronary ultrasound using fine diameter catheters in four patients with anginal symptoms in whom the coronary angiogram failed to make adequate diagnosis. In all four patients the level of symptoms and other supporting evidence indicated severe coronary disease, however, the degree of disease present on coronary angiography was equivocal. Methods': In all four patients intra-coronary ultrasound catheters were placed into the vessel using standard angioplasty guide catheters. All the intra-coronary ultrasound catheters were of the rapid exchange type. Results: In all four cases intra-coronary ultrasound demonstrated significant coronary disease requiring further interventional surgery. In one patient left main stem coronary disease was diagnosed and in the three other patients, significant coronary stenoses requiring revascularisation was diagnosed. Three patients had uncalcified plaque as diagnosed by intravascular ultrasound and one patient had dense fibre, muscular and calcific plaque in the significant lesion. Conclusions: Coronary intravascular ultrasound demonstrates significant disease not demonstrable on coronary angiography and can be an aid in the diagnosis of the difficult to interpret coronary angiograms. Sonography of delayed complications of splenic trauma Khan A.N.; A1-Khattab Y.S.; Yeung G.J.M.
North Manchester General Hospital, Crumpsall, Manchester M8 6RB, UK Aim: To demonstrate the efficacy of sonography in the
diagnosis of delayed complications of splenic trauma, where clinical presentation may be non-specific or even misleading. Methods: We retrospectively analysed the case records of nine patients (five men, four women age range 20 64 years) admitted to our institution over a 7-year period with delayed complications of splenic trauma. Trauma to the left upper quadrant having occurred 6 months to 12 years previously. Results: All patients presented with vague non-specific left upper quadrant symptoms. History of trauma was not forthcoming at initial workup. Alternative diagnoses were entertained in all. History of trauma was sought and confirmed in all after the ultrasound result was known. In one patient with contained splenic rupture diagnosis was delayed by 3 months the patient having had six consultations with various specialists and had three admissions and treated for pleurisy before the true nature of her problem was revealed by ultrasound. The complications uncovered by ultrasound; three delayed splenic ruptures, four splenic abscesses, one post-traumatic pancreatic tail pseudocyst invading the spleen and one expanding false splenic cyst. Only ultrasound was used to achieve the diagnosis and confirmed at surgery.
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Conclusions: Ultrasound usually achieves diagnosis of delayed complications of splenic trauma in what can be a clinically difficult area and may provide the first clue to causation and lead to the appropriate history being sought. Moreover, it begs the question, how safe is conservative management of splenic trauma. Abnormality detection rates by ultrasound within different racial groups Johnson K.; Powell C.; Pearl L. Department of Radiology, New
Cross Hospital, Wolverhampton Road, Wolverhampton WVIO 02P, UK Introduction: An ultrasound examination is commonly the initial investigation of abdominal pain and it is a service that is widely available to both General Practitioners and Hospital Out-Patient Departments. Within the West Midlands a high proportion of the patients are of Asian (lndian subcontinent) descent. We have investigated the differences in detection of ultrasound abnormalities within different racial groups. Methods: Ultrasound sessions were chosen at random from four West Midland hospitals and outpatients attending for an abdominal ultrasound during these sessions were included in the study. Patients under follow-up and who had a previous ultrasound were excluded. Racial origin was elicited from the patient at the time of their examination. Reports were either classified as: (1) normal; (2) minor abnormality, such as a fatty liver or a simple cyst; (3) significant abnormality, such as gallstones or suspected malignancy. Comparisons were made between the abnormality rates according to race, sex and source of referrals. The data was analysed using the zZ-test. Results: Five-hundred-and-thirteen patients were examined, 354 (69%) were of European descent, 109 (21%) Asian and 53 (7%) other racial origins, predominantly Afro-Caribbean. There was no significant difference in the abnormality detection rate between sexes or between source of referral. There was a significant difference in the detection of significant abnormalities between patients of European descent 114/354 (30%) compared to those of Asian descent 9/108 (7%) (P < 0.0001). Discussion: The Asian population represents a considerable proportion of the work load for abdominal ultrasound examinations, but the detection of abnormalities within this group is significantly lower. This difference suggests that further evaluation of health education and management resources in different ethnic communities is needed to help to improve and rationalise the services offered to people of different racial groups. Contrast enhanced three and four dimensional ultrasound angiography of normal solid organs and tumours - - work in progress Jayaram V.; Cosgrove D.O.; Blomley M.J.K.; Albrecht T.; Humphries K.N.; Pitt T.; Patel N. Dept. oflmaging, Hammer-
smith Hospital and Royal Postgraduate Medical School, London, WI2 0HS, UK Introduction: 3D imaging lends itself to contrast enhanced ultrasound due to its ability to delineate the complete vascular
Clinical Radiology, Marlborough Street, Bristol BS2 8HW, UK Introduction: Intravascular ultrasound has developed as a technique which can be used as an adjunct to coronary angiography and coronary angioplasty, however, it has yet to develop a formal clinical role. Materials and methods: We have used intra-coronary ultrasound using fine diameter catheters in four patients with anginal symptoms in whom the coronary angiogram failed to make adequate diagnosis. In all four patients the level of symptoms and other supporting evidence indicated severe coronary disease, however, the degree of disease present on coronary angiography was equivocal. Methods': In all four patients intra-coronary ultrasound catheters were placed into the vessel using standard angioplasty guide catheters. All the intra-coronary ultrasound catheters were of the rapid exchange type. Results: In all four cases intra-coronary ultrasound demonstrated significant coronary disease requiring further interventional surgery. In one patient left main stem coronary disease was diagnosed and in the three other patients, significant coronary stenoses requiring revascularisation was diagnosed. Three patients had uncalcified plaque as diagnosed by intravascular ultrasound and one patient had dense fibre, muscular and calcific plaque in the significant lesion. Conclusions: Coronary intravascular ultrasound demonstrates significant disease not demonstrable on coronary angiography and can be an aid in the diagnosis of the difficult to interpret coronary angiograms. Sonography of delayed complications of splenic trauma Khan A.N.; A1-Khattab Y.S.; Yeung G.J.M.
North Manchester General Hospital, Crumpsall, Manchester M8 6RB, UK Aim: To demonstrate the efficacy of sonography in the
diagnosis of delayed complications of splenic trauma, where clinical presentation may be non-specific or even misleading. Methods: We retrospectively analysed the case records of nine patients (five men, four women age range 20 64 years) admitted to our institution over a 7-year period with delayed complications of splenic trauma. Trauma to the left upper quadrant having occurred 6 months to 12 years previously. Results: All patients presented with vague non-specific left upper quadrant symptoms. History of trauma was not forthcoming at initial workup. Alternative diagnoses were entertained in all. History of trauma was sought and confirmed in all after the ultrasound result was known. In one patient with contained splenic rupture diagnosis was delayed by 3 months the patient having had six consultations with various specialists and had three admissions and treated for pleurisy before the true nature of her problem was revealed by ultrasound. The complications uncovered by ultrasound; three delayed splenic ruptures, four splenic abscesses, one post-traumatic pancreatic tail pseudocyst invading the spleen and one expanding false splenic cyst. Only ultrasound was used to achieve the diagnosis and confirmed at surgery.
S13
Conclusions: Ultrasound usually achieves diagnosis of delayed complications of splenic trauma in what can be a clinically difficult area and may provide the first clue to causation and lead to the appropriate history being sought. Moreover, it begs the question, how safe is conservative management of splenic trauma. Abnormality detection rates by ultrasound within different racial groups Johnson K.; Powell C.; Pearl L. Department of Radiology, New
Cross Hospital, Wolverhampton Road, Wolverhampton WVIO 02P, UK Introduction: An ultrasound examination is commonly the initial investigation of abdominal pain and it is a service that is widely available to both General Practitioners and Hospital Out-Patient Departments. Within the West Midlands a high proportion of the patients are of Asian (lndian subcontinent) descent. We have investigated the differences in detection of ultrasound abnormalities within different racial groups. Methods: Ultrasound sessions were chosen at random from four West Midland hospitals and outpatients attending for an abdominal ultrasound during these sessions were included in the study. Patients under follow-up and who had a previous ultrasound were excluded. Racial origin was elicited from the patient at the time of their examination. Reports were either classified as: (1) normal; (2) minor abnormality, such as a fatty liver or a simple cyst; (3) significant abnormality, such as gallstones or suspected malignancy. Comparisons were made between the abnormality rates according to race, sex and source of referrals. The data was analysed using the zZ-test. Results: Five-hundred-and-thirteen patients were examined, 354 (69%) were of European descent, 109 (21%) Asian and 53 (7%) other racial origins, predominantly Afro-Caribbean. There was no significant difference in the abnormality detection rate between sexes or between source of referral. There was a significant difference in the detection of significant abnormalities between patients of European descent 114/354 (30%) compared to those of Asian descent 9/108 (7%) (P < 0.0001). Discussion: The Asian population represents a considerable proportion of the work load for abdominal ultrasound examinations, but the detection of abnormalities within this group is significantly lower. This difference suggests that further evaluation of health education and management resources in different ethnic communities is needed to help to improve and rationalise the services offered to people of different racial groups. Contrast enhanced three and four dimensional ultrasound angiography of normal solid organs and tumours - - work in progress Jayaram V.; Cosgrove D.O.; Blomley M.J.K.; Albrecht T.; Humphries K.N.; Pitt T.; Patel N. Dept. oflmaging, Hammer-
smith Hospital and Royal Postgraduate Medical School, London, WI2 0HS, UK Introduction: 3D imaging lends itself to contrast enhanced ultrasound due to its ability to delineate the complete vascular