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Abnormality detection rates by ultrasound within different racial groups
S46
Abstracts
giography 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.; Al-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 nonspecific or even misleading. Methods: We retrospectively analysed the case records of nine patients (5 men, 4 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–12 years previously. Results: All patients presented with vague nonspecific 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. 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, Wol6erhampton Road, Wol6erhampton WV10 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 (Indian 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 x 2 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 with those of Asian descent 9 – 108 (7%) (P B0.0001). 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 4-D 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. Department of Imaging, Hammersmith Hospital and Royal Postgraduate Medical School, London, Wl2 0HS, UK Introduction: 3-D imaging lends itself to contrast enhanced ultrasound due to its ability to delineate the complete vascular anatomy in normal organs like the liver, kidney and testis. Tumour vessels, which often may be tortuous and lie in many planes in 2-D images, can be seen in their entire extent in a 3-D image. Accurate depiction of tumour vessel characteristics like length, branching patterns, vascular shunts and loops and the possibility of studying tumour perfusion from 4-D datasets are other encouraging possibilities. Aims and Objecti6es: This poster will illustrate with examples the 3-D vascular anatomy in a normal kidney, liver and testis. 3-D vasculature of beast and liver tumours — particularly its advantages over 2-D images, and a brief idea of a 4-D dataset obtained by 3-D reconstructions of tumour vasculature at different time intervals following administration of an ultrasonic contrast agent will be highlighted. Materials and Methods: The image stacks for 3-D reconstruction were obtained using the Acuson 128XP/10 and the ATL HDI 3000 ultrasound equipment. Contrast media used were Levovist (Schering AG, Berlin, Germany) and EchoGen (Sonus Pharmaceuticals, Bothell, USA). 3-D reconstructions were performed on a dedicated workstation (Sun SPARC) and on the ATL equipment with custom built 3-D reconstruction software. Conclusions: Analysis of normal vascular anatomy using 3-D images is a promising adjunct to Doppler imaging due to the added spatial information. Tumour vasculature was also better analysed with 3-D images due to the reasons described above. Moreover, the administration of an ultrasonic contrast agent facilitates detection of regions of low blood flow. The above advantages together with the sensitivity of power
Abstracts
giography 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.; Al-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 nonspecific or even misleading. Methods: We retrospectively analysed the case records of nine patients (5 men, 4 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–12 years previously. Results: All patients presented with vague nonspecific 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. 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, Wol6erhampton Road, Wol6erhampton WV10 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 (Indian 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 x 2 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 with those of Asian descent 9 – 108 (7%) (P B0.0001). 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 4-D 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. Department of Imaging, Hammersmith Hospital and Royal Postgraduate Medical School, London, Wl2 0HS, UK Introduction: 3-D imaging lends itself to contrast enhanced ultrasound due to its ability to delineate the complete vascular anatomy in normal organs like the liver, kidney and testis. Tumour vessels, which often may be tortuous and lie in many planes in 2-D images, can be seen in their entire extent in a 3-D image. Accurate depiction of tumour vessel characteristics like length, branching patterns, vascular shunts and loops and the possibility of studying tumour perfusion from 4-D datasets are other encouraging possibilities. Aims and Objecti6es: This poster will illustrate with examples the 3-D vascular anatomy in a normal kidney, liver and testis. 3-D vasculature of beast and liver tumours — particularly its advantages over 2-D images, and a brief idea of a 4-D dataset obtained by 3-D reconstructions of tumour vasculature at different time intervals following administration of an ultrasonic contrast agent will be highlighted. Materials and Methods: The image stacks for 3-D reconstruction were obtained using the Acuson 128XP/10 and the ATL HDI 3000 ultrasound equipment. Contrast media used were Levovist (Schering AG, Berlin, Germany) and EchoGen (Sonus Pharmaceuticals, Bothell, USA). 3-D reconstructions were performed on a dedicated workstation (Sun SPARC) and on the ATL equipment with custom built 3-D reconstruction software. Conclusions: Analysis of normal vascular anatomy using 3-D images is a promising adjunct to Doppler imaging due to the added spatial information. Tumour vasculature was also better analysed with 3-D images due to the reasons described above. Moreover, the administration of an ultrasonic contrast agent facilitates detection of regions of low blood flow. The above advantages together with the sensitivity of power