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Pyloric stenosis: The patient's journey
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Ultrasound in Medicine & Biology
Background: Radiofrequency ablation (RFA) is an emerging minimally invasive treatment modality of benign thyroid nodule and limited small papillary thyroid cancer. Among the RFA related complications, the recurrent laryngeal nerve (RLN) damage is one of the most concerned complications. To reduce the RLN injury during RFA, we developed a RFA device with intraoperative neuromonitoring system (IONM) to detect recurrent laryngeal nerve. Furthermore, to avoid a use of EMG tube requiring general anesthesia, we developed an accelerometer sensor that can be attached on the anterior neck skin. In this study, we examined the feasibility of neuromonitoring system to detect RLN during RFA in thyroid gland. Methods: Three beagles (six thyroid glands) underwent the RFA under general anesthesia. Tip of the RF electrode acted as a neurostimulator probe and its location was ultrasonographically monitored. Stimulation current was set based on NIM-Response 3.0 system. During the procedure, nervemonitoring was performed simultaneously using NIMÒ standard EMG reinforced tube, needle electrode and accelerometer. Results: When the tip of the RF electrode was placed near the tracheoesophageal groove, RLN was successfully identified with EMG tube, needle electrode and accelerometer sensor. After RFA near the tracheoesophageal groove, nerve injury was detected in EMG tube, needle electrode and accelerometer sensor. Conclusion: Neuromonitoring system to detect RLN using RF electrode was feasible in the animal study. Like both EMG tube and needle electrode, the accelerometer sensor can detect laryngeal muscle twitching during RLN stimulation. Accelerometer sensor for detecting RLN is expected to make the RFA procedure safer without any invasive monitoring system.
Ultrasound radimoics nomogram for predicting lymph node metastasis in papillary thyroid carcinoma Shi-Chong Zhou, Yunxia Huang, Cai Chang, Yi Guo Shanghai Cancer Center, Xuhui District, Shanghai, China Objective: To establish an ultrasound (US) radimoics nomogram for predicting central neck lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC). Method: A training cohort of 300 patients and validation cohort of 143 patients were established from January to December 2017. US radiomics score was built by using radiomics to analyze ultrasound image of PTC lesion. A nomogram was established by logistic regression from selection of gender, age, thyroglobulin (TG), thyroglobulin antibodies (TGAB), thyroid peroxidase antibody (TPOAB), US radiomics score and US report LNM status. C-index was calculated to evaluate discrimination of this nomogram. Also, calibration curve was drawn to evaluate calibration of it. Results: The positive rates of LNM in two cohorts were 29.7% and 34.6%, respectively. In this study, 23 predictive US radiomics features (26:1) were screened out from 609 cases in the training set, which were nonzero coefficients in the LASSO logistic regression model. US radiomics score yield a C-index of 0.802 (95% CI, 0.791 to 0.815) in training cohort and 0.809 (95% CI, 0.801 to 0.816). Through binary logistic regression, indexes were filtered as age, TPOAB, US radiomics score and US report LNM status. The area under curve, accuracy, sensitivity and specificity of this nomogram was 0.801, 0.812, 0.628 and 0861, respectively, from validation cohort. The C-index was 0.811 (95% CI, 0.804 to 0.818). Conclusion: US radiomics nomogram can predict LNM in PTC effectively.
Volume 45, Number S1, 2019 SESSION 15I: PAEDIATRICS US in appendicitis Lino Piotto Tutor Sonographer, Women’s and Children’s Hospital, Adelaide, SA, Australia Appendicitis may occur at almost any age, though it is most common in the second decade of life. The diagnosis may be difficult, particularly in children as the symptoms and/or signs are similar to many other conditions. The classical presentation is one of central abdominal pain which localises to the right iliac fossa. Early diagnosis is important to avoid perforation which is associated with increased morbidity and likelihood of post-operative complications. For the ultrasound examination a tightly-curved array transducer is recommended. Their sector field of view is useful where access is limited and they allow greater focal pressure to be applied to displace gas and bowel loops. They are also easier to drag across skin and cause less discomfort than a linear array transducer. Identification of the appendix can be confirmed by identifying a tubular, non-peristaltic, blind ending structure arising from the caecum. It is important to note that if the entire length of the appendix has not been visualised then the diagnosis of appendicitis cannot be excluded as appendicitis often involves the distal portion only. The appendix can be very difficult to identify due to its variable location, the presence of overlying gas, and large body habitus. The diagnosis of appendicitis can be made with ultrasound when the appendix has a diameter greater than 6 mm, is hyperaemic, thick walled and non-compressible. However in some cases of appendicitis the appendix is compressible. The mesoappendix is usually swollen, echogenic and hypervascular. Perforation of the appendix can be implied with the presence of a peri-appendiceal or pelvic abscess. A recent study at the Women’s and Children’s Hospital, Adelaide demonstrated that ultrasound was able to identify the appendix in 91.7% (3484/3799) in an unselected study population. Ultrasound was proven to have a sensitivity of 99.5% (98.0-99.9, 95%CI) and a specificity of 98.9% (97.9-99.4, 95%CI) to detect appendicitis. The false positive rate was 0.7% (10/1505 scans) and false negative was 0.1% (2/1505 scans), giving a PPV of 97.3% and an NPV of 99.7%. In patients with a normal appendix, ultrasound demonstrated alternative sonographic findings in 13.0% to account for the presenting signs and symptoms.
Pyloric stenosis: The patient’s journey Joanne Tang Sonographer & Radiographer, Royal Children’s Hospital, Melbourne, VIC, Australia Pyloric stenosis is the most common surgically treated cause of vomiting in the early infancy. It affects 2-5 children per 1000 births, with symptoms typically presenting between 2-12 weeks with a peak at the 5th week of life. Gradual thickening and elongation of the pyloric circular muscle results in an acquired obstruction of the gastric outlet. This produces the typical symptom of progressively worsening non-bilious projectile vomiting after feeds, with increased force and frequency. If left untreated or undiagnosed, severe dehydration, metabolic alkalosis and ultimately, death, results. Although clinical investigation is approximately 80% accurate with an experienced clinician, the sensitivity and specificity of diagnosis with sonographic investigation approaches 100%. This presentation will cover anatomy, sonographic findings of a normal and abnormal pylorus, confounders and management. The aim is to
Abstracts provide an overview of the patient’s journey from initial presentation, imaging, clinical investigations, peri-operative management, non-surgical management and complications.
Super-cali-fragilistic-hyperbili-rubin-aemia! Clinical and sonographic presentation of biliary atresia Sara Kernick, Chelsea Russell Royal Children’s Hospital, Melbourne, VIC, Australia Biliary atresia is a serious condition that has extreme and often life limiting sequellae. The clinical presentation can be ambiguous and relies heavily on ultrasound. Accurate and definitive diagnosis can be made with a combination of sonographic signs. Knowledge of these
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signs and their importance to biliary atresia and other pathologies is vital to the long term outcome of these delicate patients.
The role of ultrasound and MRI in adolescent and paediatric gynaecology Kate Stone,1 Natalie Yang2 1 Consultant Sonologist, Mercy Hospital for Women, Heidelberg, VIC, Australia, 2 Acting Medical Director, Radiology, Austin Health, Heidelberg, VIC, Australia How these imaging modalities can work together to maximise diagnostic capabilities in this group of of patients. Indications for MRI and how to use it in conjunction with ultrasound will be discussed.
Ultrasound in Medicine & Biology
Background: Radiofrequency ablation (RFA) is an emerging minimally invasive treatment modality of benign thyroid nodule and limited small papillary thyroid cancer. Among the RFA related complications, the recurrent laryngeal nerve (RLN) damage is one of the most concerned complications. To reduce the RLN injury during RFA, we developed a RFA device with intraoperative neuromonitoring system (IONM) to detect recurrent laryngeal nerve. Furthermore, to avoid a use of EMG tube requiring general anesthesia, we developed an accelerometer sensor that can be attached on the anterior neck skin. In this study, we examined the feasibility of neuromonitoring system to detect RLN during RFA in thyroid gland. Methods: Three beagles (six thyroid glands) underwent the RFA under general anesthesia. Tip of the RF electrode acted as a neurostimulator probe and its location was ultrasonographically monitored. Stimulation current was set based on NIM-Response 3.0 system. During the procedure, nervemonitoring was performed simultaneously using NIMÒ standard EMG reinforced tube, needle electrode and accelerometer. Results: When the tip of the RF electrode was placed near the tracheoesophageal groove, RLN was successfully identified with EMG tube, needle electrode and accelerometer sensor. After RFA near the tracheoesophageal groove, nerve injury was detected in EMG tube, needle electrode and accelerometer sensor. Conclusion: Neuromonitoring system to detect RLN using RF electrode was feasible in the animal study. Like both EMG tube and needle electrode, the accelerometer sensor can detect laryngeal muscle twitching during RLN stimulation. Accelerometer sensor for detecting RLN is expected to make the RFA procedure safer without any invasive monitoring system.
Ultrasound radimoics nomogram for predicting lymph node metastasis in papillary thyroid carcinoma Shi-Chong Zhou, Yunxia Huang, Cai Chang, Yi Guo Shanghai Cancer Center, Xuhui District, Shanghai, China Objective: To establish an ultrasound (US) radimoics nomogram for predicting central neck lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC). Method: A training cohort of 300 patients and validation cohort of 143 patients were established from January to December 2017. US radiomics score was built by using radiomics to analyze ultrasound image of PTC lesion. A nomogram was established by logistic regression from selection of gender, age, thyroglobulin (TG), thyroglobulin antibodies (TGAB), thyroid peroxidase antibody (TPOAB), US radiomics score and US report LNM status. C-index was calculated to evaluate discrimination of this nomogram. Also, calibration curve was drawn to evaluate calibration of it. Results: The positive rates of LNM in two cohorts were 29.7% and 34.6%, respectively. In this study, 23 predictive US radiomics features (26:1) were screened out from 609 cases in the training set, which were nonzero coefficients in the LASSO logistic regression model. US radiomics score yield a C-index of 0.802 (95% CI, 0.791 to 0.815) in training cohort and 0.809 (95% CI, 0.801 to 0.816). Through binary logistic regression, indexes were filtered as age, TPOAB, US radiomics score and US report LNM status. The area under curve, accuracy, sensitivity and specificity of this nomogram was 0.801, 0.812, 0.628 and 0861, respectively, from validation cohort. The C-index was 0.811 (95% CI, 0.804 to 0.818). Conclusion: US radiomics nomogram can predict LNM in PTC effectively.
Volume 45, Number S1, 2019 SESSION 15I: PAEDIATRICS US in appendicitis Lino Piotto Tutor Sonographer, Women’s and Children’s Hospital, Adelaide, SA, Australia Appendicitis may occur at almost any age, though it is most common in the second decade of life. The diagnosis may be difficult, particularly in children as the symptoms and/or signs are similar to many other conditions. The classical presentation is one of central abdominal pain which localises to the right iliac fossa. Early diagnosis is important to avoid perforation which is associated with increased morbidity and likelihood of post-operative complications. For the ultrasound examination a tightly-curved array transducer is recommended. Their sector field of view is useful where access is limited and they allow greater focal pressure to be applied to displace gas and bowel loops. They are also easier to drag across skin and cause less discomfort than a linear array transducer. Identification of the appendix can be confirmed by identifying a tubular, non-peristaltic, blind ending structure arising from the caecum. It is important to note that if the entire length of the appendix has not been visualised then the diagnosis of appendicitis cannot be excluded as appendicitis often involves the distal portion only. The appendix can be very difficult to identify due to its variable location, the presence of overlying gas, and large body habitus. The diagnosis of appendicitis can be made with ultrasound when the appendix has a diameter greater than 6 mm, is hyperaemic, thick walled and non-compressible. However in some cases of appendicitis the appendix is compressible. The mesoappendix is usually swollen, echogenic and hypervascular. Perforation of the appendix can be implied with the presence of a peri-appendiceal or pelvic abscess. A recent study at the Women’s and Children’s Hospital, Adelaide demonstrated that ultrasound was able to identify the appendix in 91.7% (3484/3799) in an unselected study population. Ultrasound was proven to have a sensitivity of 99.5% (98.0-99.9, 95%CI) and a specificity of 98.9% (97.9-99.4, 95%CI) to detect appendicitis. The false positive rate was 0.7% (10/1505 scans) and false negative was 0.1% (2/1505 scans), giving a PPV of 97.3% and an NPV of 99.7%. In patients with a normal appendix, ultrasound demonstrated alternative sonographic findings in 13.0% to account for the presenting signs and symptoms.
Pyloric stenosis: The patient’s journey Joanne Tang Sonographer & Radiographer, Royal Children’s Hospital, Melbourne, VIC, Australia Pyloric stenosis is the most common surgically treated cause of vomiting in the early infancy. It affects 2-5 children per 1000 births, with symptoms typically presenting between 2-12 weeks with a peak at the 5th week of life. Gradual thickening and elongation of the pyloric circular muscle results in an acquired obstruction of the gastric outlet. This produces the typical symptom of progressively worsening non-bilious projectile vomiting after feeds, with increased force and frequency. If left untreated or undiagnosed, severe dehydration, metabolic alkalosis and ultimately, death, results. Although clinical investigation is approximately 80% accurate with an experienced clinician, the sensitivity and specificity of diagnosis with sonographic investigation approaches 100%. This presentation will cover anatomy, sonographic findings of a normal and abnormal pylorus, confounders and management. The aim is to
Abstracts provide an overview of the patient’s journey from initial presentation, imaging, clinical investigations, peri-operative management, non-surgical management and complications.
Super-cali-fragilistic-hyperbili-rubin-aemia! Clinical and sonographic presentation of biliary atresia Sara Kernick, Chelsea Russell Royal Children’s Hospital, Melbourne, VIC, Australia Biliary atresia is a serious condition that has extreme and often life limiting sequellae. The clinical presentation can be ambiguous and relies heavily on ultrasound. Accurate and definitive diagnosis can be made with a combination of sonographic signs. Knowledge of these
S79
signs and their importance to biliary atresia and other pathologies is vital to the long term outcome of these delicate patients.
The role of ultrasound and MRI in adolescent and paediatric gynaecology Kate Stone,1 Natalie Yang2 1 Consultant Sonologist, Mercy Hospital for Women, Heidelberg, VIC, Australia, 2 Acting Medical Director, Radiology, Austin Health, Heidelberg, VIC, Australia How these imaging modalities can work together to maximise diagnostic capabilities in this group of of patients. Indications for MRI and how to use it in conjunction with ultrasound will be discussed.