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Ultrasound-guided infraclavicular brachial plexus block: anatomic requisits and comparison with a nerve stimulator device
Abstracts ing system. Differentiation of benign from malignant lesions may require measurements of applied stress or of a strain standard, and refinement of the mechanical model. Future work will investigate these topics, and establish the repeatability of the strain measurements. 32418 Can power Doppler imaging help in acute ankle tendon pathologies? Rawool NM,* Nazarian LN, Radiology (Ultrasound), Thomas Jefferson University Hospital, Philadelphia, PA Objective: The aim of this study was to determine if power Doppler imaging (PDI) can help diagnose the acute nature of ankle tendon pathologies. Methods: Gray-scale and PDI imaging of the ankle was performed in 41 symptomatic patients with one of the commercially available highend ultrasound scanners using a 10 –13 MHz linear transducer. The tendons of the ankle, namely, the Achilles, posterior tibial (PTT), flexor digitorum, peroneus longus, and brevis and anterior tibial (ATT), were examined first on the symptomatic side and then on the contralateral asymptomatic side. The PDI parameters were optimized for each patient’s symptomatic side and then kept constant for the contralateral side. PDI flow if present was confirmed by pulsed Doppler. Results: In the 41 patients, the abnormal tendons detected were as follows: Achilles (11), PTT (28), and ATT (2). The pathologies seen were tendon tears (23), tendinitis (14), and tenosynovitis (4). In tendinitis, the tendon appeared thickened on gray scale, and the involved portion was heterogeneous and hypoechoic. In tendons with tears, the findings were similar to tendinitis, but in addition discontinuity of the tendon fibers were noted. In tenosynovitis, the tendon itself appeared normal, but the sheath around the tendon was thickened and hypoechoic. In all of the above cases increased blood flow on PDI was noted on the symptomatic side. This increased flow was seen within the tendon in cases of tendinitis and tendon tears and along the tendon sheath in cases of tenosynovitis. None of the corresponding contralateral tendons or tendon sheaths showed increased flow. Also, in five cases on the contralateral (asymptomatic) side, an hypoechoic area was noted within the tendon, but no increased flow was noted on PDI, hence confirming the chronic nature of the pathology. Conclusions: PDI imaging can be a complementary tool in diagnosing ankle tendon pathologies. Since on gray-scale imaging, hypoechoic areas can be noted in acute and chronic cases, PDI can help confirm the acute nature of the pathology. 32421 Ultrasound-guided infraclavicular brachial plexus block: Anatomic requisits and comparison with a nerve stimulator device Bargallo X,2 Sala X,3 Carrera A,1 Bianchi L,2 Bru C,2 1. Radiology, Hospital Clinic, Barcelona, Spain, 2. Anesthesia, Hospital Clinic, Barcelona, Spain, and 3. Anatomy, University of Barcelona, Barcelona, Spain Objective: The aim of this study was to show the normal ultrasound anatomy of the brachial plexus (BP) with anatomic correlation and to evaluate the ultrasonography as a guide to block the BP. Methods: Six patients with hand or wrist trauma requiring surgery were included. We selected an infraclavicular approach to block the BP. Ultrasonography was used to guide and place an insulated needle in contact with the target nerve (the lateral cord of the BP in this case). The needle was connected to a nerve stimulator device, which was used to assess muscle contraction (to a maximum of 2 mA) ensuring a good placement of the needle tip.
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Results: In 5 out of 6 patients, the needle placement was optimum obtaining a good muscular contraction. In the other case, a muscular response could not be obtained, and the anesthetic solution was injected under ultrasound guidance. A successful sensory block was obtained in all patients. No complications were observed. Conclusions: We present our preliminary results, which demonstrate ultrasonography is a safe and good method to guide BP block. Although this is a short series, ultrasonography has had good results with a high level of safety. 32426 Endoscopic ultrasonographic diagnosis of gastric adenoma and superficial elevated type of early gastric cancer Kubo M,1 Masuzawa M,2 Kaneko A,1 Nakama A,1 Fujimoto K,2 Hayashi N,3 1. Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan, 2. Department.of Internal Medicine, Osaka Police Hospital, Osaka, Japan, and 3. Department of Molecular Therapeutic, Osaka University Graduate School, Osaka, Japan Objective: It is often difficult for endoscopic diagnosis to make a differential diagnosis of gastric adenoma and superficial elevated type of early gastric cancer, when the tumor size is less than 20 mm. Therefore, we performed endoscopic ultrasonographic diagnosis for gastric adenoma and early gastric cancer prior to EMR, compared the ultrasonograms and histological finding of the resected specimens of each lesion, and assessed the usefulness of ultrasonographic histological diagnosis of these lesions. Methods: The ultrasonographic diagnostic systems used for this study were SP501 and SP701 (Fujinon) attached with a cable type probe (20 MHz). Forty patients with biopsy diagnosis of gastric adenoma and 59 patients with biopsy diagnosis of early gastric cancer were enrolled in the study. The endoscopic ultrasonographic imaging diagnosis was carried out 3 weeks after the biopsy when the influence of the biopsy disappeared. Results: The results of ultrasonographic imaging diagnosis for the 99 patients were as follows: among the 40 gastric adenoma patients, gastric adenoma was detected in 19, gastric cancer in 17, and 4 patients were normal; and among the 59 early gastric cancer patients, gastric cancer was detected in 58 and gastric adenoma in 1. All the patients underwent EMR. When the ultrasonographic imaging diagnosis was matched with the histological diagnosis of the resected specimens, both diagnoses corresponded to each other for both diseases. Conclusions: In endoscopic ultrasonographic diagnosis, normal mucosal layer was visualized as two layers, which have different echo levels at 20 MHz. The ultrasonograms of gastric adenoma revealed maintenance of the first layer and the second layer as a lower echo area than the normal lamina propria mucosae. The ultrasonogram of cancer lesion was a rough, low-echo image of higher-brightness than the adenoma, and the first layer disappeared. The above-mentioned findings indicate that the endoscopic ultrasonographic diagnosis is useful for the diagnosis and differential diagnosis of gastric adenoma and superficial elevated type of early gastric cancer. 32435 Is volume rendered image display feasible for three-dimensional ultrasound guidance of interventional radiology procedures? Rose SC,* Nelson TR, Radiology, University of California Medical Center, San Diego, CA Objective: To date, reports of 3D US used for interventional guidance have employed multiplanar reformatted (MPR) image display. If feasible, volume rendered (VR) image display may be more intuitive for the operator. Our goal was to assess the conspicuity of various targets and devices comparing VR display to conventional MPR display.
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Results: In 5 out of 6 patients, the needle placement was optimum obtaining a good muscular contraction. In the other case, a muscular response could not be obtained, and the anesthetic solution was injected under ultrasound guidance. A successful sensory block was obtained in all patients. No complications were observed. Conclusions: We present our preliminary results, which demonstrate ultrasonography is a safe and good method to guide BP block. Although this is a short series, ultrasonography has had good results with a high level of safety. 32426 Endoscopic ultrasonographic diagnosis of gastric adenoma and superficial elevated type of early gastric cancer Kubo M,1 Masuzawa M,2 Kaneko A,1 Nakama A,1 Fujimoto K,2 Hayashi N,3 1. Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan, 2. Department.of Internal Medicine, Osaka Police Hospital, Osaka, Japan, and 3. Department of Molecular Therapeutic, Osaka University Graduate School, Osaka, Japan Objective: It is often difficult for endoscopic diagnosis to make a differential diagnosis of gastric adenoma and superficial elevated type of early gastric cancer, when the tumor size is less than 20 mm. Therefore, we performed endoscopic ultrasonographic diagnosis for gastric adenoma and early gastric cancer prior to EMR, compared the ultrasonograms and histological finding of the resected specimens of each lesion, and assessed the usefulness of ultrasonographic histological diagnosis of these lesions. Methods: The ultrasonographic diagnostic systems used for this study were SP501 and SP701 (Fujinon) attached with a cable type probe (20 MHz). Forty patients with biopsy diagnosis of gastric adenoma and 59 patients with biopsy diagnosis of early gastric cancer were enrolled in the study. The endoscopic ultrasonographic imaging diagnosis was carried out 3 weeks after the biopsy when the influence of the biopsy disappeared. Results: The results of ultrasonographic imaging diagnosis for the 99 patients were as follows: among the 40 gastric adenoma patients, gastric adenoma was detected in 19, gastric cancer in 17, and 4 patients were normal; and among the 59 early gastric cancer patients, gastric cancer was detected in 58 and gastric adenoma in 1. All the patients underwent EMR. When the ultrasonographic imaging diagnosis was matched with the histological diagnosis of the resected specimens, both diagnoses corresponded to each other for both diseases. Conclusions: In endoscopic ultrasonographic diagnosis, normal mucosal layer was visualized as two layers, which have different echo levels at 20 MHz. The ultrasonograms of gastric adenoma revealed maintenance of the first layer and the second layer as a lower echo area than the normal lamina propria mucosae. The ultrasonogram of cancer lesion was a rough, low-echo image of higher-brightness than the adenoma, and the first layer disappeared. The above-mentioned findings indicate that the endoscopic ultrasonographic diagnosis is useful for the diagnosis and differential diagnosis of gastric adenoma and superficial elevated type of early gastric cancer. 32435 Is volume rendered image display feasible for three-dimensional ultrasound guidance of interventional radiology procedures? Rose SC,* Nelson TR, Radiology, University of California Medical Center, San Diego, CA Objective: To date, reports of 3D US used for interventional guidance have employed multiplanar reformatted (MPR) image display. If feasible, volume rendered (VR) image display may be more intuitive for the operator. Our goal was to assess the conspicuity of various targets and devices comparing VR display to conventional MPR display.