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US-Elastography of Superficial Organs: Update of Current Knowledge
S242
Ultrasound in Medicine and Biology
the most used tools for diagnosis. Sonographically, meniscus are hyperechogenic triangular structures whose border does not extend beyond the bony joint edges, which are surrounded by hypoechoic lines corresponding to hyaline cartilage. Echographically, the rupture is evidenced as an anechoic or hypoechoic defect, which causes the structure of the meniscus. The meniscal degeneration is evidenced as protrusion or herniation of the meniscus on the articular line; This may or may not be accompanied by rupture. Meniscal lesions, seen by ultrasound, are classified into four grades, depending on the extent of the lesion. Some secondary findings in meniscopathies are: synovitis with or without the presence of pannus and / or joint bodies, hydrartrosis and meniscal cysts. Meniscal cysts consist of collections of mucinous material, most associated with meniscal rupture and myxoid degeneration, may be intrameniscal or parameniscal; they are more frequently located in the outer region. In relation to the ligaments of the knee, they can be sonographically evaluated for acute or chronic injuries, or rupture of the same. The most frequent injury mechanisms would be hyperflexion, valgus with external rotation and hyperextension. The triad of O’Donoghue, also known as an unhappy or unhappy triad, consists of the rupture of the medial collateral ligament, anterior cruciate ligament and meniscal rupture; Often associated with young men and the performance of sports, particularly football. T21-15-IN05 Ultrasound Guided Prolotherapy Hong-Jen Chiou, MD Section of ultrasound and breast imaging, Department of Radiology, Taipei Veterans General Hospital, Taiwan Diagnosis and management of chronic musculoskeletal symptoms related to myofascial pain syndrome had been challenging for clinicians decades. Despite advances in understandings of its underlying pathogenesis and efforts to established practical diagnostic criteria widely accepted by clinicians, a widely accepted consensus for the effective management of such chronic condition had not been established yet. Management of refractory chronic musculoskeletal pain with ultrasound guided injection of dextrose demonstrated promising efficacy recently. However, there is inadequate documentation of positive clinical outcomes treating myofascial pain syndrome with dextrose injection. A variety of physical treatments included mechanical pressure, stretching, ultrasound, low-level laser therapy (LLLT), transcutaneous electrical nerve stimulation (TENS) and repetitive magnetic stimulation (rMS), nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, needle-based interventions were applied, but effect limited. With increasing attention and interests in the clinical application of ultrasound-guided needle injection of bioactive agent as therapeutic alternatives to more invasive treatments for refractory chronic musculoskeletal pain. Dextrose injections, which is most commonly used in Prolotherapy by clinicians for decades, were discussed in the medical literature, including numerous retrospective series and randomized controlled trials. Theoretically dextrose injection leads to local inflammation mimicking the condition of tissue injury and stimulates the proliferation cascade, as observed in experimental animal models. Tissue repair and remodeling follow the transient inflammatory state, which is associated with shortterm or long-term relief of patients chronic musculoskeletal symptoms. From our experience, US-guided high concentration dextrose injection for treating localized musculoskeletal pain syndromes refractory to other alternative treatments showed remarkable effectiveness, significantly reducing symptom intensities in the majority of treated subjects. We are going to demonstrate our experience on the treatment of chronic musculoskeletal pain using US guided prolotherapy.
Volume 43, Number S1, 2017 T21-15-IN06 High Resolution Ultrasound of Brachial Plexus Prof.P. K. Srivastava, M.B.B.S., M.D.(Radiology), FICR, FICMU Professor, Deptt. Of Radiodiagnosis, King George’s Medical University, Lucknow Brachial plexus is a network of spinal nerves which originates in the back of the neck and extend through the axilla and gives rise to nerves to the upper limb. The brachial plexus is formed by the union of portions of the 5th, 6th, 7th and 8th cervical nerves (C5 to C8) and first thoracic nerve all of which come from the spinal cord. This complex nerve formation innervates the muscles, articulations, tegument of the shoulder girdle and upper limb. It is highly vulnerable to trauma due to its large size, superficial location and position between two highly mobile structures neck and upper extremity. The diagnosis of brachial plexus injury is done by clinical, radiological, electrophysiological and MRI. High resolution ultrasound is an excellent modality for evaluation of brachial plexus injury. It can very well visualize the cords of brachial plexus, level of the root avulsion and rupture of the cord by detecting disruption of the nerves and inflammatory chronic neuroma formation around the nerves. HRSG advantage is that it is easily available at bedside of the critically ill patient. Cost effectiveness of the investigation and metallic implants. Short focus, broadband linear transducers from 7 to 12Mhz are used for evaluation of brachial plexus in semi lateral position, coronal oblique position. Color Doppler is used to differentiate the brachial plexus in supraclavicular region from the neck vessels. T21-15-IN07 US-Elastography of Superficial Organs: Update of Current Knowledge Vito Cantisani, MD, PhD EFSUMB, Italy Reported by Hippocrates, palpation is an ancient diagnostic technique used in several fields and especially for thyroid and breast clinical evaluation. A firm or hard nodule consistency is associated with an increased risk of malignancy. A novel, evolving and fast expanding technology – elastography, based on the premise that pathologic processes such as cancer, alter the tissue stiffness, evaluates the mechanical features of tissue elasticity. By assessing hardness as indicator of malignancy, elastography has recently become an additional tool for superficial organs, such as thyroid, breast and salivary glands, in combination with conventional ultrasound (US) and fine-needle aspiration cytology (FNAC). Therefore, the current status of thyroid, breast and salivary gland neoplasm elastography, with regard to the techniques, applications, performance and limitations, will be discussed. US techniques available for breast lesion evaluation and their use in the diagnosis and their limits will be discussed; qualitative elastography with polichromatic score, semi-quantitative strain ratio measurements and shear wave elasticity and velocity measurements will be analysed. Tips and tricks for better results will be showed. Recent EFSUMB, WFUMB guidelines will be discussed. Clinical typical and atypical cases will be presented enhancing Takehome points. T21-15-IN08 Evaluation of Cervical Lymph Nodes (Duplex Scan and Color Doppler US) Maria Christina Chammas Department of Radiology (Division of Ultrasound) – Hospital das Clinicas -School of Medicine – University of Sao Paulo – Brazil Learning Objectives: 1) To become familiar with the normal and abnormal US imaging of cervical lymph nodes
Ultrasound in Medicine and Biology
the most used tools for diagnosis. Sonographically, meniscus are hyperechogenic triangular structures whose border does not extend beyond the bony joint edges, which are surrounded by hypoechoic lines corresponding to hyaline cartilage. Echographically, the rupture is evidenced as an anechoic or hypoechoic defect, which causes the structure of the meniscus. The meniscal degeneration is evidenced as protrusion or herniation of the meniscus on the articular line; This may or may not be accompanied by rupture. Meniscal lesions, seen by ultrasound, are classified into four grades, depending on the extent of the lesion. Some secondary findings in meniscopathies are: synovitis with or without the presence of pannus and / or joint bodies, hydrartrosis and meniscal cysts. Meniscal cysts consist of collections of mucinous material, most associated with meniscal rupture and myxoid degeneration, may be intrameniscal or parameniscal; they are more frequently located in the outer region. In relation to the ligaments of the knee, they can be sonographically evaluated for acute or chronic injuries, or rupture of the same. The most frequent injury mechanisms would be hyperflexion, valgus with external rotation and hyperextension. The triad of O’Donoghue, also known as an unhappy or unhappy triad, consists of the rupture of the medial collateral ligament, anterior cruciate ligament and meniscal rupture; Often associated with young men and the performance of sports, particularly football. T21-15-IN05 Ultrasound Guided Prolotherapy Hong-Jen Chiou, MD Section of ultrasound and breast imaging, Department of Radiology, Taipei Veterans General Hospital, Taiwan Diagnosis and management of chronic musculoskeletal symptoms related to myofascial pain syndrome had been challenging for clinicians decades. Despite advances in understandings of its underlying pathogenesis and efforts to established practical diagnostic criteria widely accepted by clinicians, a widely accepted consensus for the effective management of such chronic condition had not been established yet. Management of refractory chronic musculoskeletal pain with ultrasound guided injection of dextrose demonstrated promising efficacy recently. However, there is inadequate documentation of positive clinical outcomes treating myofascial pain syndrome with dextrose injection. A variety of physical treatments included mechanical pressure, stretching, ultrasound, low-level laser therapy (LLLT), transcutaneous electrical nerve stimulation (TENS) and repetitive magnetic stimulation (rMS), nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, needle-based interventions were applied, but effect limited. With increasing attention and interests in the clinical application of ultrasound-guided needle injection of bioactive agent as therapeutic alternatives to more invasive treatments for refractory chronic musculoskeletal pain. Dextrose injections, which is most commonly used in Prolotherapy by clinicians for decades, were discussed in the medical literature, including numerous retrospective series and randomized controlled trials. Theoretically dextrose injection leads to local inflammation mimicking the condition of tissue injury and stimulates the proliferation cascade, as observed in experimental animal models. Tissue repair and remodeling follow the transient inflammatory state, which is associated with shortterm or long-term relief of patients chronic musculoskeletal symptoms. From our experience, US-guided high concentration dextrose injection for treating localized musculoskeletal pain syndromes refractory to other alternative treatments showed remarkable effectiveness, significantly reducing symptom intensities in the majority of treated subjects. We are going to demonstrate our experience on the treatment of chronic musculoskeletal pain using US guided prolotherapy.
Volume 43, Number S1, 2017 T21-15-IN06 High Resolution Ultrasound of Brachial Plexus Prof.P. K. Srivastava, M.B.B.S., M.D.(Radiology), FICR, FICMU Professor, Deptt. Of Radiodiagnosis, King George’s Medical University, Lucknow Brachial plexus is a network of spinal nerves which originates in the back of the neck and extend through the axilla and gives rise to nerves to the upper limb. The brachial plexus is formed by the union of portions of the 5th, 6th, 7th and 8th cervical nerves (C5 to C8) and first thoracic nerve all of which come from the spinal cord. This complex nerve formation innervates the muscles, articulations, tegument of the shoulder girdle and upper limb. It is highly vulnerable to trauma due to its large size, superficial location and position between two highly mobile structures neck and upper extremity. The diagnosis of brachial plexus injury is done by clinical, radiological, electrophysiological and MRI. High resolution ultrasound is an excellent modality for evaluation of brachial plexus injury. It can very well visualize the cords of brachial plexus, level of the root avulsion and rupture of the cord by detecting disruption of the nerves and inflammatory chronic neuroma formation around the nerves. HRSG advantage is that it is easily available at bedside of the critically ill patient. Cost effectiveness of the investigation and metallic implants. Short focus, broadband linear transducers from 7 to 12Mhz are used for evaluation of brachial plexus in semi lateral position, coronal oblique position. Color Doppler is used to differentiate the brachial plexus in supraclavicular region from the neck vessels. T21-15-IN07 US-Elastography of Superficial Organs: Update of Current Knowledge Vito Cantisani, MD, PhD EFSUMB, Italy Reported by Hippocrates, palpation is an ancient diagnostic technique used in several fields and especially for thyroid and breast clinical evaluation. A firm or hard nodule consistency is associated with an increased risk of malignancy. A novel, evolving and fast expanding technology – elastography, based on the premise that pathologic processes such as cancer, alter the tissue stiffness, evaluates the mechanical features of tissue elasticity. By assessing hardness as indicator of malignancy, elastography has recently become an additional tool for superficial organs, such as thyroid, breast and salivary glands, in combination with conventional ultrasound (US) and fine-needle aspiration cytology (FNAC). Therefore, the current status of thyroid, breast and salivary gland neoplasm elastography, with regard to the techniques, applications, performance and limitations, will be discussed. US techniques available for breast lesion evaluation and their use in the diagnosis and their limits will be discussed; qualitative elastography with polichromatic score, semi-quantitative strain ratio measurements and shear wave elasticity and velocity measurements will be analysed. Tips and tricks for better results will be showed. Recent EFSUMB, WFUMB guidelines will be discussed. Clinical typical and atypical cases will be presented enhancing Takehome points. T21-15-IN08 Evaluation of Cervical Lymph Nodes (Duplex Scan and Color Doppler US) Maria Christina Chammas Department of Radiology (Division of Ultrasound) – Hospital das Clinicas -School of Medicine – University of Sao Paulo – Brazil Learning Objectives: 1) To become familiar with the normal and abnormal US imaging of cervical lymph nodes