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Sonography of sinus tarsi syndrome
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Ultrasound in Medicine and Biology
blood flow in the left uterine artery at 30 weeks of gestation and lower birth weight (P⫽0.01). Conclusions: Thrombophilia does not influence resistance to blood flow in the feto-maternal circulation or birth weight. However, increased resistance to flow in the left uterine artery at 30 gestational weeks may predict lower birth weight.
31967 Impact of ultrasound contrast media in a clinical radiology practice Kono Y,*1 Alton K,1 Rose SC,1 Hassanein TI,2 Choi S,1 Mattrey RF,1 1. Radiology, University of California, San Diego, San Diego, CA, and 2. Internal Medicine, University of California, San Diego, San Diego, CA Objective: The aim of this study was to report on the impact of ultrasound contrast media in radiological clinical practice. Methods: 13 patients were studied between April 2000 and October 2002 at UCSD with one of the ultrasound contrast media (Optison, Definity, and Imagent). All cases were studied because of clinical need. The institutional review board approved the study because of off-label use. The diseases and organs varied. Ultrasound was performed with a Siemens Elegra with multiple injections of contrast media. Images were acquired with wideband gray-scale harmonic using real-time and intermittent imaging. Results: The organs and diseases studied include 7 liver lesions (2 hepatocellular carcinomas, 2 cholangiocarcinomas, 1 nodular regenerative hyperplasia, 1 regenerative nodule, 1 biliary infarction), 4 vascular lesions (1 hepatic artery thrombus, 1 TIPS stenosis, 1 aortic dissection, and 1 patent portal vein), 1 kidney mass, and 1 spleen laceration. The reasons of the US contrast studies varied, but were mostly because the pre-contrast imaging workup was inconclusive. Overall, the US contrast study added important information in all 13 cases, changed the diagnosis in 7/13 (53.8%), and changed patient management in 6/13 (46.2%). No adverse event was observed. Conclusions: There are no US contrast agents approved for noncardiac imaging in the US. This study suggests, although the number of patients is small and highly selected, that CEUS adds critically valuable information without added risk at the bedside affecting patient management in nearly half the cases.
31969 Sonography of sinus tarsi syndrome Shields G,*1 Jacobson J,1 Jamadar D,1 Femino J,2 Hayes C,1 1. Radiology, University of Michigan, Ann Arbor, MI, and 2. Orthopaedics, University of Michigan, Ann Arbor, MI Description of case(s): A 48-year-old woman presented with chronic bilateral hind foot pain. Sonography of bilateral ankles and feet demonstrated abnormal hypoechogenicity within the sinus tarsi.
Volume 29, Number 5S, 2003 The areas had geographic margins and were without anechoic areas or hyperemia on color or power Doppler imaging. There was evidence for prior incomplete injury to the anterior talofibular ligament on the left. Proof of diagnosis: Clinically, the patients’ signs and symptoms were compatible with sinus tarsi syndrome. MR imaging of each foot demonstrated abnormal decreased signal within the sinus tarsi on T1weighted images and increased signal on T2-weighted images consistent with sinus tarsi syndrome. Relevance: Abnormal hypoechogenicity within the sinus tarsi on sonography is compatible with sinus tarsi syndrome. In evaluation of ankle or foot pain with sonography, it is important to evaluate structures beyond the tendons, such as the sinus tarsi. Identification of ligament injury should prompt evaluation of the sinus tarsi, as both may occur with inversion ankle injury.
31977 Evaluation of vascular and enhancement patterns of hepatic focal nodular hyperplasia: Usefulness of dynamic gray scale harmonic ultrasound imaging with a microbubble contrast agent Lim HK, Kim M,* Choi D, Lee WJ, Lim JH, Jang KM, Department of Radiology, Samsung Medical Center, Syunkyunkwan University School of Medicine, Seoul, South Korea Objective: The aim of this study was to assess the usefulness of dynamic gray-scale harmonic ultrasound imaging with a microbubble contrast agent in the evaluation of vascular and enhancement pattern of hepatic focal nodular hyperplasia. Methods: Eleven patients with pathologically proved focal nodular hyperplasia underwent dynamic gray scale harmonic ultrasound imaging with a microbubble contrast agent. All contrast-enhanced ultrasound examinations were performed with Coded Harmonic Angio technique (LogiQ 700 Expert or LogiQ 9, GE Medical Systems, Milwaukee, WI) and SH U 508 A (Levovist, Schering, Berlin, Germany) as a microbubble contrast agent. The vascular pattern was evaluated with a continuous scan between 15–30 seconds after initiation of contrast injection. To assess the enhancement pattern, intermittent acoustic emission imaging was performed with a rapid sweeping technique at the end of the vascular phase (arterial phase), 60 seconds (portal venous phase), and 180 seconds (equilibrium phase) after initiation of contrast injection. The vascular and enhancement patterns of the tumors were analyzed on stored cine images by two experienced radiologists. Results: In 10 of 11 tumors (91%), the continuous scans during arterial phase revealed central arteries of typical spoke-wheel pattern. The remaining one had randomly stippled vascularity within the tumor. On acoustic emission imaging, all tumors were hyperechoic during arterial phase. Hyperechogenicity remained during portal venous phase in 9 tumors and during equilibrium phase in 7 tumors. Other tumors were iso-echoic during either portal venous or equilibrium phase. Conclusions: This preliminary study suggests that dynamic gray scale harmonic ultrasound imaging with a microbubble contrast agent is an
Ultrasound in Medicine and Biology
blood flow in the left uterine artery at 30 weeks of gestation and lower birth weight (P⫽0.01). Conclusions: Thrombophilia does not influence resistance to blood flow in the feto-maternal circulation or birth weight. However, increased resistance to flow in the left uterine artery at 30 gestational weeks may predict lower birth weight.
31967 Impact of ultrasound contrast media in a clinical radiology practice Kono Y,*1 Alton K,1 Rose SC,1 Hassanein TI,2 Choi S,1 Mattrey RF,1 1. Radiology, University of California, San Diego, San Diego, CA, and 2. Internal Medicine, University of California, San Diego, San Diego, CA Objective: The aim of this study was to report on the impact of ultrasound contrast media in radiological clinical practice. Methods: 13 patients were studied between April 2000 and October 2002 at UCSD with one of the ultrasound contrast media (Optison, Definity, and Imagent). All cases were studied because of clinical need. The institutional review board approved the study because of off-label use. The diseases and organs varied. Ultrasound was performed with a Siemens Elegra with multiple injections of contrast media. Images were acquired with wideband gray-scale harmonic using real-time and intermittent imaging. Results: The organs and diseases studied include 7 liver lesions (2 hepatocellular carcinomas, 2 cholangiocarcinomas, 1 nodular regenerative hyperplasia, 1 regenerative nodule, 1 biliary infarction), 4 vascular lesions (1 hepatic artery thrombus, 1 TIPS stenosis, 1 aortic dissection, and 1 patent portal vein), 1 kidney mass, and 1 spleen laceration. The reasons of the US contrast studies varied, but were mostly because the pre-contrast imaging workup was inconclusive. Overall, the US contrast study added important information in all 13 cases, changed the diagnosis in 7/13 (53.8%), and changed patient management in 6/13 (46.2%). No adverse event was observed. Conclusions: There are no US contrast agents approved for noncardiac imaging in the US. This study suggests, although the number of patients is small and highly selected, that CEUS adds critically valuable information without added risk at the bedside affecting patient management in nearly half the cases.
31969 Sonography of sinus tarsi syndrome Shields G,*1 Jacobson J,1 Jamadar D,1 Femino J,2 Hayes C,1 1. Radiology, University of Michigan, Ann Arbor, MI, and 2. Orthopaedics, University of Michigan, Ann Arbor, MI Description of case(s): A 48-year-old woman presented with chronic bilateral hind foot pain. Sonography of bilateral ankles and feet demonstrated abnormal hypoechogenicity within the sinus tarsi.
Volume 29, Number 5S, 2003 The areas had geographic margins and were without anechoic areas or hyperemia on color or power Doppler imaging. There was evidence for prior incomplete injury to the anterior talofibular ligament on the left. Proof of diagnosis: Clinically, the patients’ signs and symptoms were compatible with sinus tarsi syndrome. MR imaging of each foot demonstrated abnormal decreased signal within the sinus tarsi on T1weighted images and increased signal on T2-weighted images consistent with sinus tarsi syndrome. Relevance: Abnormal hypoechogenicity within the sinus tarsi on sonography is compatible with sinus tarsi syndrome. In evaluation of ankle or foot pain with sonography, it is important to evaluate structures beyond the tendons, such as the sinus tarsi. Identification of ligament injury should prompt evaluation of the sinus tarsi, as both may occur with inversion ankle injury.
31977 Evaluation of vascular and enhancement patterns of hepatic focal nodular hyperplasia: Usefulness of dynamic gray scale harmonic ultrasound imaging with a microbubble contrast agent Lim HK, Kim M,* Choi D, Lee WJ, Lim JH, Jang KM, Department of Radiology, Samsung Medical Center, Syunkyunkwan University School of Medicine, Seoul, South Korea Objective: The aim of this study was to assess the usefulness of dynamic gray-scale harmonic ultrasound imaging with a microbubble contrast agent in the evaluation of vascular and enhancement pattern of hepatic focal nodular hyperplasia. Methods: Eleven patients with pathologically proved focal nodular hyperplasia underwent dynamic gray scale harmonic ultrasound imaging with a microbubble contrast agent. All contrast-enhanced ultrasound examinations were performed with Coded Harmonic Angio technique (LogiQ 700 Expert or LogiQ 9, GE Medical Systems, Milwaukee, WI) and SH U 508 A (Levovist, Schering, Berlin, Germany) as a microbubble contrast agent. The vascular pattern was evaluated with a continuous scan between 15–30 seconds after initiation of contrast injection. To assess the enhancement pattern, intermittent acoustic emission imaging was performed with a rapid sweeping technique at the end of the vascular phase (arterial phase), 60 seconds (portal venous phase), and 180 seconds (equilibrium phase) after initiation of contrast injection. The vascular and enhancement patterns of the tumors were analyzed on stored cine images by two experienced radiologists. Results: In 10 of 11 tumors (91%), the continuous scans during arterial phase revealed central arteries of typical spoke-wheel pattern. The remaining one had randomly stippled vascularity within the tumor. On acoustic emission imaging, all tumors were hyperechoic during arterial phase. Hyperechogenicity remained during portal venous phase in 9 tumors and during equilibrium phase in 7 tumors. Other tumors were iso-echoic during either portal venous or equilibrium phase. Conclusions: This preliminary study suggests that dynamic gray scale harmonic ultrasound imaging with a microbubble contrast agent is an