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The Role of Ultrasound in the Evaluation of Peripheral Nerves Abnormalities
S206
Ultrasound in Medicine and Biology
Conclusions: We concluded that the PRF treatment with guidance with US is a very useful treatment technique for patients with refractory sciatic neuropathy. PPT15-013 Sonography for Localized Cutaneous Nodular Amyloidosis in a Patient with Systemic Lupus Erythematosus Chih-Wei Tseng, Kuo-Lung Lai, Hsin-Hua Chen Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan Objectives: Localized cutaneous nodular amyloidosis (LCNA) is the rare manifestation of amyloidosis. The association of LCNA with Sj€ ogren’s syndrome was made in previous reports, but there were fewer cases regarding LCNA in patients with systemic lupus erythematosus (SLE). Herein we reported a patient with underlying SLE with secondary Sjogren’s syndrome who developed localized cutaneous nodular amyloidosis and the cutaneous manifest under ultrasound evaluation. Methods: Case report and literature review. Results: A 60-year-old woman presented with a lump lesion over her left leg developed for a week without erythema or pain. Her medical history was remarkable for SLE for 6 years with initial symptoms/signs including general malaise and Raynaud’s phenomenon, sclerodactyly, digital vasculitis, serositis with pleural effusion and pericardial effusion, positive ANA 1:160. She was hospitalized due to nephrotic syndrome and renal biopsy showed membranous glomerulonephritis. She was regularly followed and was kept with daily prednisolone 5mg, azathioprine 100mg, plaquenil 200mg without major flares, though dsDNA Ab kept rising. There were no apparent skin lesions over her left leg. Sonography showed hypoechoic nodule with ill-defined margins measuring 19.9 x 20 x 9.8 mm in the subcutaneous tissue with posterior acoustic shadow. Bacterial culture was negative. Serum was negative for monoclonal gammopathy. Pathology revealed light chain amyloidosis. No recurrence was noticed at 6 month follow up. Conclusions: This case demonstrated the sonographic findings of the localized cutaneous light chain amyloidosis in SLE. Ultrasound can be useful in diagnosis. PPT15-014 The Role of Ultrasound in the Evaluation of Peripheral Nerves Abnormalities Denise Lau, Chin Chin Ooi, Gaik Mooi Tan, P. Chandra Mohan Department of Diagnostic Radiology, Singapore General Hospital, Singapore Objectives: Abnormalities affecting the peripheral nerves are common in clinical practice. Ultrasound with its high resolution is an excellent modality in imaging of peripheral nerves due to its dynamic capabilities, cost effectiveness and good availability. This didactic exhibit aims to 1. Highlight the usefulness of ultrasound in evaluating peripheral nerves 2. Describe the sonographic appearances of normal and diseased peripheral nerves seen in our institution. Methods: Ultrasound cases of the peripheral nerves that were performed at our institution between January 2009 and January 2017 were retrospectively reviewed. All studies were performed using Philips IU22 machine with a high frequency linear transducer. Where available, correlation with magnetic resonance imaging (MRI) and histopathology will be presented. Results: Pictorial review with actual case illustrations will be presented. The abnormalities presented will include trauma, tumors and entrapment neuropathies. After reviewing this exhibit, reviewers should be able to recognize sonographic appearances of normal peripheral nerve as well as identify and describe the sonographic appearances of various common peripheral nerve abnormalities.
Volume 43, Number S1, 2017 Conclusions: Ultrasound with its high resolution and dynamic capabilities is useful in the evaluation of peripheral nerves abnormalities. Knowledge of sonographic appearances of normal and common peripheral nerves abnormalities is essential for accurate diagnosis. PPT15-015 The Use of Ultrasonography and Nerve Conduction Study to Assess Outcomes and Prognostic Indicators in Carpal Tunnel Syndrome: A Study in Patients Treated with Night Splinting Lin-Yi Wang, Mei-Yun Liaw, Yu-Chi Huang, Hsiao-Lan Chen, Yiu-Chung Lau, Ya-Ping Pong Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hopsital, Taiwan Objectives: To investigate the value of ultrasonography (US) and nerve conduction study (NCS) in evaluating outcomes and prognosis for carpal tunnel syndrome (CTS) treated with night splinting. Methods: Fifty-eight hands with mild to moderate CTS were prospectively enrolled; 42 diseased hands completed the study. Satisfaction rating, symptom severity score (SSS), functional status score (FSS), NCS data, and US data were evaluated as outcome variables before and after 3 and 6 months of night splinting. On an intent-to-treat basis, a binary logistic regression analysis was used to determine prognostic indicators of subjective satisfaction and receiver operating characteristic (ROC) curves were plotted. Results: After 6 months of splinting, 29 hands had good subjective outcomes and 13 had poor subjective outcomes. SSS, FSS, sensory conduction velocity (SCV) on NCS, and the cross-sectional area of the median nerve at the pisiform bone level (PCSA) on US improved significantly in hands with good satisfaction but not in hands with poor satisfaction. On an intent-to-treat basis, 29 hands were categorized as good or poor subjective outcomes respectively. According to regression model and the ROC curves, SCV and PCSA were independent prognostic indicators, and the optimal cut-off values of SCV and PCSA for good subjective outcome were $40m/s and #11.35 mm2 respectively. Conclusions: US and NCS are appropriate tools for assessing outcome variables and prognostic indicators of night splinting for CTS. PPT15-016 Ultrasono Guide Mr Arthrography: How Can Do and Success Rate Dal Su Park Department of Radiology, S-Seoul Hospital, South Korea Objectives: This study was showing capabiliy and sucess rate of doing us guide MR arthrography without fluoroscopy. Methods: Between march 2014 and november 2015, a total of 9 consecutive patient for MR arhtrography were prospectively include in this study. This study were performed by single center non randomized and one radiologist. 3 case were shoulder joint, 6 case were hip joint.Shouder 2 cases were performed by classic ant.approach method and another one was doing by post. approach method. All case were perfomed by free hand us guide method. Shoulder joint US guide were performed by 7MHZ linear transducer hip joint us guide were perfomed by 3.5MHZ Curved linea transduce. Results: There are many limitation factor exist but sucess rate are 100%. Conclusions: Us guide arthrogrphy are many pros such as avoid harmful radiation and not used fluoroguide contrast media. Cons are no much experenced and contrast delivery into joint space conviction are weak than fluroscopic guide.
Ultrasound in Medicine and Biology
Conclusions: We concluded that the PRF treatment with guidance with US is a very useful treatment technique for patients with refractory sciatic neuropathy. PPT15-013 Sonography for Localized Cutaneous Nodular Amyloidosis in a Patient with Systemic Lupus Erythematosus Chih-Wei Tseng, Kuo-Lung Lai, Hsin-Hua Chen Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan Objectives: Localized cutaneous nodular amyloidosis (LCNA) is the rare manifestation of amyloidosis. The association of LCNA with Sj€ ogren’s syndrome was made in previous reports, but there were fewer cases regarding LCNA in patients with systemic lupus erythematosus (SLE). Herein we reported a patient with underlying SLE with secondary Sjogren’s syndrome who developed localized cutaneous nodular amyloidosis and the cutaneous manifest under ultrasound evaluation. Methods: Case report and literature review. Results: A 60-year-old woman presented with a lump lesion over her left leg developed for a week without erythema or pain. Her medical history was remarkable for SLE for 6 years with initial symptoms/signs including general malaise and Raynaud’s phenomenon, sclerodactyly, digital vasculitis, serositis with pleural effusion and pericardial effusion, positive ANA 1:160. She was hospitalized due to nephrotic syndrome and renal biopsy showed membranous glomerulonephritis. She was regularly followed and was kept with daily prednisolone 5mg, azathioprine 100mg, plaquenil 200mg without major flares, though dsDNA Ab kept rising. There were no apparent skin lesions over her left leg. Sonography showed hypoechoic nodule with ill-defined margins measuring 19.9 x 20 x 9.8 mm in the subcutaneous tissue with posterior acoustic shadow. Bacterial culture was negative. Serum was negative for monoclonal gammopathy. Pathology revealed light chain amyloidosis. No recurrence was noticed at 6 month follow up. Conclusions: This case demonstrated the sonographic findings of the localized cutaneous light chain amyloidosis in SLE. Ultrasound can be useful in diagnosis. PPT15-014 The Role of Ultrasound in the Evaluation of Peripheral Nerves Abnormalities Denise Lau, Chin Chin Ooi, Gaik Mooi Tan, P. Chandra Mohan Department of Diagnostic Radiology, Singapore General Hospital, Singapore Objectives: Abnormalities affecting the peripheral nerves are common in clinical practice. Ultrasound with its high resolution is an excellent modality in imaging of peripheral nerves due to its dynamic capabilities, cost effectiveness and good availability. This didactic exhibit aims to 1. Highlight the usefulness of ultrasound in evaluating peripheral nerves 2. Describe the sonographic appearances of normal and diseased peripheral nerves seen in our institution. Methods: Ultrasound cases of the peripheral nerves that were performed at our institution between January 2009 and January 2017 were retrospectively reviewed. All studies were performed using Philips IU22 machine with a high frequency linear transducer. Where available, correlation with magnetic resonance imaging (MRI) and histopathology will be presented. Results: Pictorial review with actual case illustrations will be presented. The abnormalities presented will include trauma, tumors and entrapment neuropathies. After reviewing this exhibit, reviewers should be able to recognize sonographic appearances of normal peripheral nerve as well as identify and describe the sonographic appearances of various common peripheral nerve abnormalities.
Volume 43, Number S1, 2017 Conclusions: Ultrasound with its high resolution and dynamic capabilities is useful in the evaluation of peripheral nerves abnormalities. Knowledge of sonographic appearances of normal and common peripheral nerves abnormalities is essential for accurate diagnosis. PPT15-015 The Use of Ultrasonography and Nerve Conduction Study to Assess Outcomes and Prognostic Indicators in Carpal Tunnel Syndrome: A Study in Patients Treated with Night Splinting Lin-Yi Wang, Mei-Yun Liaw, Yu-Chi Huang, Hsiao-Lan Chen, Yiu-Chung Lau, Ya-Ping Pong Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hopsital, Taiwan Objectives: To investigate the value of ultrasonography (US) and nerve conduction study (NCS) in evaluating outcomes and prognosis for carpal tunnel syndrome (CTS) treated with night splinting. Methods: Fifty-eight hands with mild to moderate CTS were prospectively enrolled; 42 diseased hands completed the study. Satisfaction rating, symptom severity score (SSS), functional status score (FSS), NCS data, and US data were evaluated as outcome variables before and after 3 and 6 months of night splinting. On an intent-to-treat basis, a binary logistic regression analysis was used to determine prognostic indicators of subjective satisfaction and receiver operating characteristic (ROC) curves were plotted. Results: After 6 months of splinting, 29 hands had good subjective outcomes and 13 had poor subjective outcomes. SSS, FSS, sensory conduction velocity (SCV) on NCS, and the cross-sectional area of the median nerve at the pisiform bone level (PCSA) on US improved significantly in hands with good satisfaction but not in hands with poor satisfaction. On an intent-to-treat basis, 29 hands were categorized as good or poor subjective outcomes respectively. According to regression model and the ROC curves, SCV and PCSA were independent prognostic indicators, and the optimal cut-off values of SCV and PCSA for good subjective outcome were $40m/s and #11.35 mm2 respectively. Conclusions: US and NCS are appropriate tools for assessing outcome variables and prognostic indicators of night splinting for CTS. PPT15-016 Ultrasono Guide Mr Arthrography: How Can Do and Success Rate Dal Su Park Department of Radiology, S-Seoul Hospital, South Korea Objectives: This study was showing capabiliy and sucess rate of doing us guide MR arthrography without fluoroscopy. Methods: Between march 2014 and november 2015, a total of 9 consecutive patient for MR arhtrography were prospectively include in this study. This study were performed by single center non randomized and one radiologist. 3 case were shoulder joint, 6 case were hip joint.Shouder 2 cases were performed by classic ant.approach method and another one was doing by post. approach method. All case were perfomed by free hand us guide method. Shoulder joint US guide were performed by 7MHZ linear transducer hip joint us guide were perfomed by 3.5MHZ Curved linea transduce. Results: There are many limitation factor exist but sucess rate are 100%. Conclusions: Us guide arthrogrphy are many pros such as avoid harmful radiation and not used fluoroguide contrast media. Cons are no much experenced and contrast delivery into joint space conviction are weak than fluroscopic guide.