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Ultrasound strain image data obtained in breast masses: preliminary quantitative analysis
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Ultrasound in Medicine and Biology
32405 The clinical value of color Doppler flow imaging on laryngocarcinoma diagnosis Yi L,* Ji Y, Sun Z, Li Y, Department of Ultrasound, China-Japan Union Hospital of Jilin Prov. P.R. China, Changchun, Jilin Prov., China Objective: The aim of this study was to evaluate the color Doppler flow imaging method on patients with laryngocarcinoma. Methods: 52 patients with laryngocarcinoma were included in this study. Color ultrasonography (ATL Ultrasound Bothell, WA; Transducer: 7.5 MHZ) and laryngo-fiberoscopy were performed before operation, and the findings by ultrasound examination were compared with operative and pathologic results. Results: There were 52 cases in this group, including supraglottic cancer of 30; glottic cancer of 19; and subglottic cancer of 3. The diagnostic accuracy of ultrasonography was 92.3% (48/52), including supraglottic cancer, 90.3% (28/30); glottic cancer, 96.5% (18/19); and subglottic cancer, 66.6% (2/3). Four over 52 were missed by ultrasound. The tumors detected ranged from 0.5 to 4.3 cm in diameter. Twenty cases with metastatic lymph nodes were detected by ultrasound, and 14 cases of the 20 were consistent with pathological results. Six were false positive. Most of the tumors displayed by ultrasound were inhomogeneously hypoechic. The border of the lesions was intense and ill defined. Enhancement and irregularity echogeneous was found when vocal fold was involved. It could be hypokinetic, even akinetic. If there was deep invasion, the echo of vocal fold would not be coherent, and the margins of thyroid cartilage and cricoid cartilage can be discontinuous or unrealed. Color Doppler flow imaging (CDFI) showed there was less blood flow signal in most neoplasmas. If the trachea was moved or stenosed, CDFI can display the location of the trachea by color signal. Conclusions: CDFI can demonstrate the size and location of tumor, and display the depth of invasion and relationship with great vessels. At the same time, it can identify the metastatic lymph nodes. Thus, it can provide important information for surgery and be helpful for the operation treatments. There are still some shortages; for example, it is difficult to detect the lesion that is smaller than 0.5 cm in diameter, and the cancerous ulcer was difficult to indicate. The tumor invaded mucosa and subglottic cannot be revealed in early stage, and need to be further studied. 32411 Microbubble dynamics in liver parenchymal phase of contrast US using Levovist Fujimoto K,*1 Kitade K,2 Maeda T,2 Wada S,1 Oshita M,1 Waki H,2 Kato M,4 Kubo M,3 Masuzawa M,1 Hayashi N,5 1. Department of Internal Medicine, Osaka Police Hospital, Osaka, Japan, 2. Department of Clinical Laboratory, Osaka Police Hospital, Osaka, Japan, 3. Department of Gastroenterology, NTT West Osaka Hospital, Osaka, Japan, 4. Department of Gastroenterology, Osaka National Hospital, Osaka, Japan, and 5. Department of Molecular Therapeutic, Osaka University Graduate School, Suita, Osaka, Japan Objective: In the delayed liver parenchymal phase of contrast ultrasonograhy using Levovist , the dynamics of microbubbles is not clear whether the bubbles are phagocytized by Kupffer cells or attached to the sinusoidal endothelial cells. In this study, we evaluated the dynamics of bubbles by comparing the sensitivity between various imaging modes. Methods: The liver parenchyma was evaluated in 33 patients. The imaging modes were observed as follows: Group 1: coded harmonic angio (GE), pulse inversion harmonics (Philips), extended pure harmonic detection (Aloka); Group 2: ultraharmonic imaging (UHI) (Phil-
Volume 29, Number 5S, 2003 ips). Levovist (300 mg/ml, 8 ml) were given as a bolus injection. Protocol A: Using any of Group 1 images, the opacities of the liver parenchyma (LP), portal vein (PV), hepatic vein (HV), and left ventricle (LV) in the delayed parenchymal phase. Protocol B: Following Protocol A, observation with UHI was carried out every 1 minute on the same cross-sectional plane. Protocol C: Serial imaging according to Protocols A and B was carried out with the UHI mode only. Through these observations, the duration of opacity for LP and PV in groups 1 and 2, and the sensitivity through the number of cases in whom the opacity for LV and HV was confirmed were compared and evaluated. The dynamics of bubbles were also observed in Protocol B. Results: The duration of opacity for LP was 335.8 seconds in Group 1 and 860.9 seconds in Group 2 (p⬍0.01). A similar result was obtained for PV. The number of cases in whom the opacity for LV was confirmed was 23.3% (7/30 cases) in Group 1 as compared with 100% in Group 2 (p⬍0.01). A similar result was obtained for HV. In Protocol B observation, the bubbles were identified in the LP, PV, and HV even after the opacity of the LP with UHI was hardly detected though the bubbles were destroyed. Conclusions: The portal vein and the liver parenchyma were delivered with bubbles of Levovist for a long time as a result of recirculation. These results suggest that a lot of bubbles may continue to be attached to the sinusoidal endothelial cells as well as phagocytized by Kupffer cells. The sensitivity difference between various devices may be responsible for whether or not the phenomenon can be identified. 32416 Ultrasound strain image data obtained in breast masses: Preliminary quantitative analysis Hangiandreou NJ,*1 Meixner DM,1 Hesley GK,1 Farrell MA,1 Morton MJ,1 Charboneau JW,1 Hall TJ,2 Zhu Y,2 Spalding C,2 1. Radiology, Mayo Clinic, Rochester, MN, and 2. Radiology, University of Kansas Medical Center, Kansas City, KS Objective: The aim of this study was to apply a prototype system for performing real-time freehand ultrasound (US) strain imaging of breast masses, and make an initial evaluation of the strain data obtained. Methods: US strain images were obtained using a prototype algorithm on a commercial Siemens Elegra US system. Radio-frequency (RF) data were stored during strain imaging of 16 lesions (9 malignant, 7 benign). Stored RF sequences were selected based on real-time review of strain images during acquisition. Two regions of interest (ROIs) were defined for each strain image sequence, one over the lesion, and one over normal breast tissue. Strain images exhibiting appreciable noise were excluded from the analysis. Mean ROI pixel values were computed, resulting in a sequence of paired lesion and normal tissue strain measurements, which were plotted against one another, and fitted to a line. The slope of the line represents a measure of the relative lesion strain compared to normal tissue and, assuming uniform stress and linear mechanical properties, is a measure of the relative tissue stiffness. Results: The fits included ⱖ 50 frames in 14/16 cases. The correlation coefficients (r) were ⬎ 0.85 in 15/16 cases, and r ⬎ 0.90 in 9/16 cases. The y-intercepts were all within 2 standard deviations (SDs) of zero. All slopes were ⬍ 1, indicating the lesions were stiffer than normal tissue. Slope SDs ranged from 2–12%, and in 14 cases slope SDs were ⱕ 10%. Slopes for malignant lesions ranged from 0.10 – 0.87, while benign lesion slopes ranged from 0.18 – 0.41. The overlap of the relative strains for benign and malignant lesions may be due to a range of stiffness of normal breast tissue, which has been previously reported. Methods to overcome normal tissue variability would include measuring applied stress, or measuring the strain of a known standard. Conclusions: Our preliminary study suggests that strain data of good quality may be obtained using the prototype freehand US strain imag-
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.
S179
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.
Ultrasound in Medicine and Biology
32405 The clinical value of color Doppler flow imaging on laryngocarcinoma diagnosis Yi L,* Ji Y, Sun Z, Li Y, Department of Ultrasound, China-Japan Union Hospital of Jilin Prov. P.R. China, Changchun, Jilin Prov., China Objective: The aim of this study was to evaluate the color Doppler flow imaging method on patients with laryngocarcinoma. Methods: 52 patients with laryngocarcinoma were included in this study. Color ultrasonography (ATL Ultrasound Bothell, WA; Transducer: 7.5 MHZ) and laryngo-fiberoscopy were performed before operation, and the findings by ultrasound examination were compared with operative and pathologic results. Results: There were 52 cases in this group, including supraglottic cancer of 30; glottic cancer of 19; and subglottic cancer of 3. The diagnostic accuracy of ultrasonography was 92.3% (48/52), including supraglottic cancer, 90.3% (28/30); glottic cancer, 96.5% (18/19); and subglottic cancer, 66.6% (2/3). Four over 52 were missed by ultrasound. The tumors detected ranged from 0.5 to 4.3 cm in diameter. Twenty cases with metastatic lymph nodes were detected by ultrasound, and 14 cases of the 20 were consistent with pathological results. Six were false positive. Most of the tumors displayed by ultrasound were inhomogeneously hypoechic. The border of the lesions was intense and ill defined. Enhancement and irregularity echogeneous was found when vocal fold was involved. It could be hypokinetic, even akinetic. If there was deep invasion, the echo of vocal fold would not be coherent, and the margins of thyroid cartilage and cricoid cartilage can be discontinuous or unrealed. Color Doppler flow imaging (CDFI) showed there was less blood flow signal in most neoplasmas. If the trachea was moved or stenosed, CDFI can display the location of the trachea by color signal. Conclusions: CDFI can demonstrate the size and location of tumor, and display the depth of invasion and relationship with great vessels. At the same time, it can identify the metastatic lymph nodes. Thus, it can provide important information for surgery and be helpful for the operation treatments. There are still some shortages; for example, it is difficult to detect the lesion that is smaller than 0.5 cm in diameter, and the cancerous ulcer was difficult to indicate. The tumor invaded mucosa and subglottic cannot be revealed in early stage, and need to be further studied. 32411 Microbubble dynamics in liver parenchymal phase of contrast US using Levovist Fujimoto K,*1 Kitade K,2 Maeda T,2 Wada S,1 Oshita M,1 Waki H,2 Kato M,4 Kubo M,3 Masuzawa M,1 Hayashi N,5 1. Department of Internal Medicine, Osaka Police Hospital, Osaka, Japan, 2. Department of Clinical Laboratory, Osaka Police Hospital, Osaka, Japan, 3. Department of Gastroenterology, NTT West Osaka Hospital, Osaka, Japan, 4. Department of Gastroenterology, Osaka National Hospital, Osaka, Japan, and 5. Department of Molecular Therapeutic, Osaka University Graduate School, Suita, Osaka, Japan Objective: In the delayed liver parenchymal phase of contrast ultrasonograhy using Levovist , the dynamics of microbubbles is not clear whether the bubbles are phagocytized by Kupffer cells or attached to the sinusoidal endothelial cells. In this study, we evaluated the dynamics of bubbles by comparing the sensitivity between various imaging modes. Methods: The liver parenchyma was evaluated in 33 patients. The imaging modes were observed as follows: Group 1: coded harmonic angio (GE), pulse inversion harmonics (Philips), extended pure harmonic detection (Aloka); Group 2: ultraharmonic imaging (UHI) (Phil-
Volume 29, Number 5S, 2003 ips). Levovist (300 mg/ml, 8 ml) were given as a bolus injection. Protocol A: Using any of Group 1 images, the opacities of the liver parenchyma (LP), portal vein (PV), hepatic vein (HV), and left ventricle (LV) in the delayed parenchymal phase. Protocol B: Following Protocol A, observation with UHI was carried out every 1 minute on the same cross-sectional plane. Protocol C: Serial imaging according to Protocols A and B was carried out with the UHI mode only. Through these observations, the duration of opacity for LP and PV in groups 1 and 2, and the sensitivity through the number of cases in whom the opacity for LV and HV was confirmed were compared and evaluated. The dynamics of bubbles were also observed in Protocol B. Results: The duration of opacity for LP was 335.8 seconds in Group 1 and 860.9 seconds in Group 2 (p⬍0.01). A similar result was obtained for PV. The number of cases in whom the opacity for LV was confirmed was 23.3% (7/30 cases) in Group 1 as compared with 100% in Group 2 (p⬍0.01). A similar result was obtained for HV. In Protocol B observation, the bubbles were identified in the LP, PV, and HV even after the opacity of the LP with UHI was hardly detected though the bubbles were destroyed. Conclusions: The portal vein and the liver parenchyma were delivered with bubbles of Levovist for a long time as a result of recirculation. These results suggest that a lot of bubbles may continue to be attached to the sinusoidal endothelial cells as well as phagocytized by Kupffer cells. The sensitivity difference between various devices may be responsible for whether or not the phenomenon can be identified. 32416 Ultrasound strain image data obtained in breast masses: Preliminary quantitative analysis Hangiandreou NJ,*1 Meixner DM,1 Hesley GK,1 Farrell MA,1 Morton MJ,1 Charboneau JW,1 Hall TJ,2 Zhu Y,2 Spalding C,2 1. Radiology, Mayo Clinic, Rochester, MN, and 2. Radiology, University of Kansas Medical Center, Kansas City, KS Objective: The aim of this study was to apply a prototype system for performing real-time freehand ultrasound (US) strain imaging of breast masses, and make an initial evaluation of the strain data obtained. Methods: US strain images were obtained using a prototype algorithm on a commercial Siemens Elegra US system. Radio-frequency (RF) data were stored during strain imaging of 16 lesions (9 malignant, 7 benign). Stored RF sequences were selected based on real-time review of strain images during acquisition. Two regions of interest (ROIs) were defined for each strain image sequence, one over the lesion, and one over normal breast tissue. Strain images exhibiting appreciable noise were excluded from the analysis. Mean ROI pixel values were computed, resulting in a sequence of paired lesion and normal tissue strain measurements, which were plotted against one another, and fitted to a line. The slope of the line represents a measure of the relative lesion strain compared to normal tissue and, assuming uniform stress and linear mechanical properties, is a measure of the relative tissue stiffness. Results: The fits included ⱖ 50 frames in 14/16 cases. The correlation coefficients (r) were ⬎ 0.85 in 15/16 cases, and r ⬎ 0.90 in 9/16 cases. The y-intercepts were all within 2 standard deviations (SDs) of zero. All slopes were ⬍ 1, indicating the lesions were stiffer than normal tissue. Slope SDs ranged from 2–12%, and in 14 cases slope SDs were ⱕ 10%. Slopes for malignant lesions ranged from 0.10 – 0.87, while benign lesion slopes ranged from 0.18 – 0.41. The overlap of the relative strains for benign and malignant lesions may be due to a range of stiffness of normal breast tissue, which has been previously reported. Methods to overcome normal tissue variability would include measuring applied stress, or measuring the strain of a known standard. Conclusions: Our preliminary study suggests that strain data of good quality may be obtained using the prototype freehand US strain imag-
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.
S179
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.