Fast-growing gastric inflammatory pseudotumor: a rare manifestation of peptic ulcer disease.
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Endosonography↗
Biomedical subjects
M Jenett
Publications and source records attributed to M Jenett.
High resolution ultrasound detects a decrease in pannus vascularisation of small finger joints in patients with rheumatoid arthritis receiving treatment with soluble tumour necrosis factor alpha receptor (etanercept).
OBJECTIVE: High resolution ultrasound (HRUS) was used to investigate the effects of tumour necrosis factor alpha (TNFalpha) blockade on pannus formation and vascularisation of small finger joints in patients with active rheumatoid arthritis (RA). METHODS: Five patients with active RA were treated with etanercept, a soluble TNFalpha receptor protein, for one month. Before, during, and after treatment the patients were followed up by clinical rheumatological examination, determination of their subjective pain score, blood chemistry, and by HRUS of the second metacarpophalangeal (MCP) joint of the right hand. RESULTS: One month after treatment with etanercept, rheumatological examination showed a significant decrease in a modified single joint rheumatic disease activity index (from 2.9 (SD 0.2) to 1.2 (0.7); p<0.05) in all patients. Moreover, a significant decrease in the general pain score (from 4.7 (0.4) to 1.8 (0.6); p<0.05) and in C reactive protein (CRP) levels was seen (from 3.02 (0.9) to 0.24 (0.1); p<0.05). Concordantly, HRUS showed a significant reduction in pannus vascularisation of the MCPII joints (from 23,602 (5339) to 2907 (1609) colour signals/region of interest, CS/ROI; p<0.001). Pearson's correlation coefficient between the results obtained by HRUS and the clinical response was 0.85. CONCLUSION: HRUS is promising as an additional useful method in the assessment of RA activity, and probably also in monitoring therapeutic responses.
Aged↗
[Diagnosis of space-occupying lesions of the liver. What is the value of diagnostic imaging?].
Ultrasound in B-mode or tissue harmonic imaging is the procedure of first choice for investigating the liver. If US is employed to screen for metastatic disease, B-mode contrast harmonic imaging should be used in addition to conventional ultrasound. For the diagnosis "space-consuming liver lesion", the echogenicity and clinical aspects determine the further diagnostic procedure. Echogenic liver lesions in patients with known malignant disease, and echo-poor or "echo-complex" lesions always indicate a need for further spiral CT or MRT investigations. In tumour patients, spiral CT offers the advantage of enabling simultaneous evaluation of the parenchyma, and abdominal staging. Primary SPIO-amplified MRT is indicated whenever the primary interest is the detection of space-consuming liver lesions. In the case of echogenic lesions in the absence of underlying malignant disease, US follow-up suffices. Here, differential diagnostic information can be gained from the vascular distribution patterns of a lesion obtained with color-coded duplex US. Hepatic lesions that, after exhausting all diagnostic imaging procedures remain suspicious, require biopsy.
Diagnosis, Differential↗
[Comparison of 3D power doppler ultrasound, color doppler ultrasound and digital subtraction angiography in carotid stenosis].
PURPOSE: To compare easy-to-perform three-dimensional power Doppler ultrasound (3D PDUS) to color Doppler ultrasound (CDUS) and digital subtraction angiography (DSA) in the assessment of internal carotid artery (ICA) stenoses in patients with severe atherosclerosis. METHODS: 26 ICA's (7 without stenosis, 4 low-, 4 middle-, and 11 high-grade stenoses) in 13 patients were examined with DSA, CDUS, and 3D PDUS. CDUS and 3D PDUS were performed with a 7.5 MHz standard transducer and a Sonoline Elegra ultrasound machine. The three methods were performed and interpreted by different persons who were not aware of the diagnoses. RESULTS: Regarding the degree of stenosis correlations between DSA and 3D PDUS were r = 0.98 (p < 0.001), between DSA and CDUS r = 0.97 (p < 0.001), and between CDUS and 3D PDUS r = 0.95 (p < 0.001). Sensitivity and specificity regarding the detection of a high-degree stenosis was 90% and 100% for 3D PDUS, and 100% and 93.3% for CDUS. CONCLUSION: Even in cases with severe atherosclerosis, both sonographic methods reveal similar results comparable to DSA. 3D PDUS does not result in a diagnostic improvement on CDUS, however, it does give the new opportunity for complete data storage, reconstruction, and survey presentations.
Aged↗
Clinical trial on the accuracy of a freehand and sensor-independent three-dimensional power Doppler ultrasound system measuring diameters, volumes and vascularity of malignant primaries of the neck.
AIM: Diameters, volumes and vascularity of malignant primaries of the neck are of substantial importance for staging and prognosis. The purpose of this study was to determine the accuracy of a newly developed freehand and sensor-independent three-dimensional power Doppler ultrasound system (3D PDUS) in the assessment of these parameters. METHOD: 24 patients with squamous cell carcinomas of the neck underwent conventional ultrasound in B- and power Doppler-mode (US), 3D PDUS, and computed tomography (CT). Diameters (sagittal, longitudinal, and transverse) and volumes of the tumours were correlated with hand-segmentated CT images, whereas tumour vascularity was compared with US. RESULTS: 3D PDUS and CT correlated highly regarding diameters and volumes (correlation coefficients r = 0.98/P < 0.001 and r = 0.98/P < 0.001, respectively). 3D PDUS and US correlated highly regarding vascularity (r = 0.92/P < 0.001). CONCLUSION: Although 3D PDUS is based on a freehand and sensorless data acquisition, it appears to be as accurate as CT or US for measurements of diameters, volumes and vascularity of neck malignancies. In spite of the excellent results it has to be mentioned that this technique needs a lot of training and its general use has to be employed with caution.
Adult↗
Colour Doppler ultrasound of the nailbed: an objective tool for monitoring responses to vasodilatory treatment of connective tissue disorders?
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Adolescent↗
Comparison of axial reconstructed ultrasonographic images from three-dimensional data volumes and computed tomographic scans in the documentation and detection of liver lesions.
OBJECTIVE: To compare axial reconstructed ultrasonographic images from three-dimensional data volumes and conventional computed tomographic scans in documentation and detection of liver lesions. METHODS: The livers of 23 patients were examined by a multifrequency curved array transducer to acquire three-dimensional data volumes and by conventional computed tomography The ultrasonographic device was equipped with three-dimensional ultrasonographic technology allowing for real-time parallel movement in every plane within an acquired data volume. Axial ultrasonographic images reconstructed from three-dimensional data volumes were compared with conventional computed tomographic scans. RESULTS: When both methods were taken together, a total of 51 different liver lesions could be detected. Reconstructed ultrasonographic images depicted 44 (86%) of 51 lesions, and computed tomographic scans showed 46 (90%) of 51 lesions. Compared with computed tomography, ultrasonography depicted 5 additional lesions in 3 of the patients (4 hemagiomas and 1 unspecified lesion), whereas 7 lesions were missed in another 4 patients (4 metastases, 2 calcifications, and 1 cyst). The Pearson correlation coefficient between ultrasonography and computed tomography was r = 0.84 (P < .001). CONCLUSIONS: Our study shows that ultrasonographic images can be effectively reconstructed from three-dimensional data volumes. With respect to documentation and detection of liver lesions, the results obtained by three-dimensional ultrasonography appear comparable with those obtained by conventional computed tomography. However, several technical and procedural limitations have to be respected.
Adult↗
Computed tomography after lymphangiography in the diagnosis of intestinal lymphangiectasia with protein-losing enteropathy in Noonan's syndrome.
Noonan's syndrome is a rare congenital disorder that may be associated with abnormalities in the lymphatic drainage. In this case of a 21-year-old man CT after bipedal lymphangiography confirmed the diagnosis of intestinal lymphangiectasy causing protein-losing enteropathy in Noonan's syndrome by showing contrast-enhanced abnormal lymphatic vessels in the mesentery and the intestinal wall. Because of the benefit of diet in case of intestinal involvement, we recommend a thorough documentation of the lymphatic drainage with lymphangiography followed by CT, if clinical signs of lymphatic dysplasia, such as pleural effusions, lymphedema, or hypoproteinemia are present.
Adult↗
Technical advances in ultrasound and MR imaging of carpal tunnel syndrome.
The aim of this study was to compare the latest ultrasound-array technology to a conventional "high-resolution" transducer, modified MRI technique, and nerve conduction studies (NCS), in the diagnosis of carpal tunnel syndrome (CTS). In 19 normal wrists and 15 wrists with CTS, US with two different transducers was performed: a conventional linear-array transducer (LA) and a newly developed Multi-D linear-array transducer (MDA) were used. The US images were evaluated determining the swelling and the flattening ratios of the median nerve and correlated to respective findings in MRI (1.5 T) and to NCS. The NCS confirmed CTS in all 15 wrists. Measures of median nerve compression (swelling and flattening ratios) were significantly different in patients with CTS and controls (p < 0.01) with both types of US transducers and MRI. The MDA yielded higher correlation to MRI than the LA. Using critical values of 1.3 for the swelling and 3.4 for the flattening ratio, MRI, and US with the MDA yielded a sensitivity of 100% each. Modern imaging modalities allow for an exact diagnosis of CTS even in cases with only slight median nerve pathology.
Adult↗
Asymptomatic aneurysm of the proximal right subclavian artery: a rare ultrasound diagnosis.
True aneurysms of otherwise normal subclavian arteries are uncommon peripheral vascular anomalies. Most patients with subclavian artery aneurysms are symptomatic by presenting neurologic signs. We report a young woman who had an asymptomatic true aneurysm of the right subclavian artery assumed to be of congenital origin. This case is unique in that the aneurysm was in the extremely rare anatomic location of the right supraclavicular fossa between the origins of the right subclavian artery and the vertebral artery. Aneurysms of the right subclavian artery may represent a potential pitfall in conventional gray-scale ultrasound of the neck particularly the supraclavicular fossa. Differential diagnosis includes cervical cyst, pharyngo-esophageal diverticulum, vascular anomalies, struma, enlarged lymph node, as well benign or malignant neoplasms. Color duplex ultrasound should be performed as the method of choice for further analysis of suspected aneurysms. In this report the role of B-mode ultrasound and color duplex ultrasound is discussed in relation to digital subtraction- and MR angiography in confirmation of the diagnosis.
Adult↗
[Comparison of contrast harmonic imaging in B-mode with stimulated acoustic emission, conventional B-mode US and spiral CT in the detection of focal liver lesions].
PURPOSE: Comparison between contrast harmonic imaging (CHI) in B-mode with stimulated acoustic emission (SAE), conventional B-mode US, and spiral CT in the detection of focal liver lesions. METHODS: In this pilot study 26 patients with liver lesions diagnosed by B-mode US and contrast-enhanced spiral-CT were additionally examined with CHI in B-mode. Each examination started with a bolus injection of 4 g of the US contrast agent Levovist (300 mg/ml) after a delay of at least 5 minutes to ensure liver-specific phase. All examinations were documented on video tapes and analysed by two radiologists. RESULTS: 81 liver lesions were diagnosed with both US examinations and spiral CT. B-mode US detected 66 lesions, CHI with SAE 72 lesions, and spiral CT 73 lesions. Compared to spiral CT 8 lesions in 3 patients could be depicted additionally with both US methods. Metastases and HCC present in CHI with SAE as not-enhancing signal contrast agent areas. Delineation of haemangiomas and FNH was often worse compared to the native examinations. CONCLUSION: The new US method CHI with SAE depicted more lesions than conventional B-mode US and is in some cases superior to spiral CT.
Adult↗
[New possibilities in the diagnosis and documentation using 3D power doppler ultrasound with carcinoma of the floor of the mouth as illustration].
AIM: To evaluate a novel 3D power Doppler ultrasound-technique (3D PDUS) in the diagnosis and documentation of tumours of the floor of the mouth. METHOD: 22 patients with tumours of the floor of the mouth (2 T1-, 5 T2-, 6 T3- and 9 T4-carcinomas) prospectively underwent conventional grey-scale ultrasound combined with power Doppler ultrasound and 3D PDUS (3-Scape). All examinations were performed with the "Sonoline Elegra Advanced" in combination with a 7.5 MHz transducer. Two independent observers compared the results regarding clear tumour margins, midline crossing, infiltration of the mylohyoid muscle, infrahyoidal tumour, contact to the mandible, contact to major vessels (such as the lingual, submental and/or facial artery), intra- and peritumoural vascularisation and judged the value of the 3D reconstruction method for documentation purpose. RESULTS: All parameters relevant for therapy could be gathered from the 3D data (agreement: 98.2%) almost without loss of information; results of both observers were identical (kappa value: 1.0). In the comparison to conventional ultrasound, 3D PDUS also allows for the reconstruction of axial images of the floor of the mouth similar to CT-images, and a 3D image of tumour vascularisation can be obtained. Acquisition and reconstruction of the 3D data only takes a couple of minutes. CONCLUSIONS: "3-Scape" is a novel easy-to-perform method allowing the complete acquisition of 3D data of the entire floor of the mouth, and providing the possibility to digitally store and/or transfer examination results without loss of information. Reconstruction of ultrasound-images in any desirable plane and/or as a 3D presentation is possible. Thus, in the future, additional software will facilitate the determination of the volume and the degree of vascularisation of tumours.
Adult↗
[3D power Doppler ultrasound: new possibilities in the diagnosis and documentation of tumors of the base of the tongue].
BACKGROUND: To evaluate a novel 3-D power Doppler ultrasound technique (3-D PDUS) in the diagnosis and documentation of tumors of the base of the tongue. PATIENTS AND METHODS: Twenty patients with tumors of the base of the tongue (2T1, 6T2, 6T3, and 6T4 carcinomas) prospectively underwent two-dimensional gray scale and power Doppler ultrasound and 3-D PDUS (3-Scape). All examinations were performed with a 7.5 MHz transducer and the Sonoline Elegra Advanced. Two independent observers compared the examinations regarding clear tumor margins, maximal diameter of the tumor, midline crossing, infiltration of the mylohyoid muscle, infrahyoidal tumor, contact to the lingual artery, vascularization in the tumor and in surrounding tissue, and evaluated the documentary use of the 3-D reconstruction. RESULTS: All relevant pretreatment parameters were accessible in the 3-D data; results of both observers were almost identical. An acquisition and reconstruction of the 3-D data takes only a couple of minutes. In addition to two-dimensional ultrasound 3-D PDUS allows reconstruction of axial images of the base of the tongue similar to CT images and a 3-D visualization of tumor vascularization. CONCLUSIONS: 3-Scape is a novel user-friendly method that allows uninterrupted acquisition of large 3-D volumes, and digital storage and transmission of ultrasound studies without loss of information. US images can be reconstructed in any desired plane or visualized in 3-D. In the future, additional software will permit exact determination of the volume and degree of vascularization of tumors.
Adult↗
Assessment of microvascular changes in Raynaud's phenomenon and connective tissue disease using colour doppler ultrasound.
OBJECTIVE: We used colour Doppler ultrasound (CDU) to differentiate primary from secondary Raynaud's phenomenon (pRP and sRP, respectively) and to assess digital vascular damage in patients with connective tissue disease (CTD). METHODS: Vascularity in the nailbeds of 15 healthy controls and 35 patients with CTD (systemic sclerosis or systemic lupus erythematosus) was quantified using a multi-D array transducer before and after cold and warm challenge, respectively. The results were compared with the clinically evaluated initial skin lesions. Vascularity was compared similarly between 10 pRP and 22 sRP patients. RESULTS: Vascularity at ambient temperature differed between healthy subjects and sRP patients as well as between healthy subjects and CTD patients without initial skin lesions. Patients with pRP had normal vascularity at ambient temperature but differed from healthy controls in response to a dynamic temperature challenge. CDU confirmed the clinical evaluation in 89.4% of the patients with RP and in 78.0% of the skin lesions. CONCLUSION: The novel CDU technique presented here makes it possible to discriminate between pRP and sRP and to quantify vascular changes in CTD patients.
Adult↗
Enlarged lymph nodes of the neck: evaluation with parallel extended field-of-view sonographic sequences.
A standardized extended field-of-view sonographic examination technique of the neck is evaluated. In a prospective study we screened 50 patients suspected of having carcinoma or lymphoma for enlarged cervical lymph nodes. After conventional CT of the neck, extended field-of-view sonography was performed using defined axial parallel scanning sequences. The results were interpreted separately by two radiologists. Of 245 lymph nodes (diameter 1 cm or greater) diagnosed with conventional CT, 218 were correctly identified by extended field-of-view ultrasonography. With respect to the entire neck, the sensitivity of extended field-of-view sonography was 92%, and the correlation coefficient between the methods was r = 0.98 (P < 0.001). Fifteen of 17 false-negative lymph nodes were located in the mandibular angle region. False-positive results (N = 10) were caused by misinterpretation of primary tumors, blood vessels, lobulated salivary glands, and double imaged lymph nodes. Our results indicate that extended field-of-view sonography in parallel scanning sequences represents a reliable method for the detection of cervical lymphadenopathy.
Adult↗
Evaluation of pannus and vascularization of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis by high-resolution ultrasound (multidimensional linear array).
OBJECTIVE: To evaluate the extent of intraarticular vascularization and pannus formation in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of patients with rheumatoid arthritis (RA) by high-resolution ultrasound (US). METHODS: A newly developed, high-resolution multidimensional linear array US was utilized to obtain longitudinal and transverse scans of joints with active RA (n = 21), moderately active RA (n = 39), or inactive RA (n = 93), and of joints from healthy controls (n = 120). RESULTS: Healthy joints had no detectable pannus, whereas pannus could be detected in 52% of the joints with active RA, 82% of the joints with moderately active RA, and 67% of the joints with inactive RA. There was a significant difference in vascularization in the joints of all subgroups of RA patients and those of healthy subjects (P < 0.001). Moreover, vascularization differed significantly among the RA subgroups: inactive versus moderately active RA (P < 0.02) and inactive versus active RA (P < 0.05). Both pannus and vascularization appeared to be localized preferentially on the radial side of the joints. CONCLUSION: Evaluation of pannus and the extent of vascularization within the joints of patients with RA by high-resolution US might be helpful in the assessment of disease activity, and thus influence therapeutic strategies.
Adult↗
[SieScape panorama imaging in radiologic diagnosis].
Through high-performance computer processing it has become possible to realize a new ultrasound imaging process: SieScape imaging. This method provides extended field of view images in real time using successive ultrasound images obtained when a standard transducer is scanned over a distance of up to 60 cm without any position sensor. SieScape offers new possibilities to view topographical anatomy. It is especially advantageous for scanning extended and tubular structures as well as large and enlarged organs and big pathologic volumes. Parallel scanning sequences allow documentation comparable to that of computed tomography. In addition, just as in magnetic resonance, variable imaging planes can be realized. The following describes the results obtained with SieScape in a multitude of clinical applications, especially in examinations of throat, thoracic and abdominal walls, breast, and intraabdominal organs as well as the soft tissues and small vessels of the extremities. The experience gathered with SieScape imaging--its advantages as well as its potential limitations, such as the formation of artefacts--is described.
Equipment Design↗
[In vitro studies to determine the degree of stenosis using spiral CT angiography].
UNLABELLED: Aim of the study was to evaluate the influence of different spiral-CT parameters for the visualisation of vascular stenoses, especially of the renal arteries. MATERIAL AND METHODS: Models with a density equivalent to that of fat, filled with diluted contrast agent, and an inner lumen of 4, 6, 8 mm were scanned in x-, y- and z-direction. Data were acquired in up to 24 second long spiral-CT scans using different spiral-CT parameters (collimation, table speed, reconstruction algorithm, tube current). Detection of the degree of stenosis was achieved by assessment of the axial images and 3D reconstructions. RESULTS: The best correlation between real and measured degree of stenosis was seen by using a small collimation, a low table increment and assessment of the axial images reconstructed in standard algorithm. The stenosis degrees of models directed in x- and y-direction were overestimated and those in z-direction were underestimated depending on the spiral-CT parameters. CONCLUSION: For optimal imaging of renal artery stenoses, collimation of 2 mm (pitch = 1-2 and a reconstruction interval of 1 mm is recommended.
Algorithms↗