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PubMed1999

Interventional endoscopic ultrasonography: current status and future direction.

Although first performed more than 20 years ago, endoscopic ultrasonography (EUS) has only recently been used for interventional/therapeutic purposes. The recognition and application of this versatile procedure by gastroenterologists who perform endoscopy has reached an all-time high, and the demand for symposia and tutorials devoted to EUS rivals that of endoscopic retrograde cholangiopancreatography 20 to 25 years ago. EUS has become an established part of the endoscopic armamentarium for many gastroenterologists. Despite its proved clinical utility for staging gastrointestinal (and lung) cancers, and its use in delineating the nature of "submucosal" tumors of the gastrointestinal tract, EUS has continued to evolve. Within the past 10 years, the safety and efficacy of EUS as a means of guiding tissue acquisition via fine-needle aspiration has been demonstrated, increasing its utility in gastrointestinal oncology. Newer indications currently under clinical investigation include the use of EUS as a delivery mechanism for novel immune-based and viral-based "chemo" therapeutic agents for patients with pancreatic cancer. Finally, the role of EUS as a reliable method to guide therapy to control the often refractory abdominal pain in patients with pancreatic cancer and/or chronic pancreatitis is being verified in clinical trials. The following is a brief overview of the current state-of-the-art in interventional EUS.

Digestive System Diseases↗
PubMed2001

Ultrasound in endourology.

Ultrasonography was first used as a therapeutic aid in endourology in the early 1970s. Since that time, ultrasound has played an important role, and nowadays, interventional ultrasonography is an established procedure in urology. Procedures on the kidney, bladder, and prostate, which require different puncture techniques, are performed under ultrasound guidance. Today, extracorporeal shockwaves for the treatment of stones and Peyronie's disease are applied under ultrasonic control. Furthermore, high-intensity focused ultrasound (HIFU) is used experimentally for the treatment of renal tumors and, clinically, for the treatment of prostate cancer. In urologic emergencies, diagnostic and interventional ultrasonography is an important tool. Interventional ultrasound in urology has become an outstanding tool for the planning and performance of a variety of procedures, and every urologist should be able to use these technologies.

Biopsy, Needle↗
PubMed2005

The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography.

HYPOTHESIS: Incidental thyroid masses identified during carotid duplex ultrasonography may represent clinically significant lesions. DESIGN AND SETTING: Retrospective review of a prospective database in a tertiary care referral center. PATIENTS: A total of 2004 consecutive patients from January, 2000, through January, 2002, undergoing carotid duplex ultrasonography. INTERVENTIONS: After bilateral carotid duplex ultrasonography, selected patients additionally underwent 1 or more of the following: dedicated thyroid ultrasound, fine-needle aspiration biopsy, and/or partial or total thyroidectomy. MAIN OUTCOME MEASURES: The prevalence and type of thyroid abnormalities, correlation with a dedicated thyroid ultrasound, and results of histopathologic diagnosis. RESULTS: One or more thyroid abnormalities were identified in 188 duplexes (9.4%) involving 168 patients. Abnormalities were unilateral in 84 patients (50.6%) and bilateral in 81 patients (49.4%). Seventy-seven abnormalities (47%) were cystic, 72 (43%) were solid, and 16 (10%) were of mixed consistency. Sixty-six of the patients (40%) went on to have formal thyroid ultrasounds. Forty-five patients (70.3%) had masses greater than 1 cm on ultrasound. Based on ultrasound findings, 29 of 66 (44%) underwent fine-needle aspiration biopsy, with 13 of 66 (19.7%) eventually undergoing surgery. Surgical pathology included 5 patients with cancer (3 with papillary cancer, 2 with follicular cancer), 4 patients with a follicular adenoma, and 2 with lymphocytic thyroiditis). Two additional patients were discovered to have parathyroid adenomas following further workup and surgery. Thyroid abnormalities identified during carotid duplex ultrasonography correlated with formal ultrasound in 64 of 66 (97%) patients. Measurement of the thyroid mass by carotid duplex strongly correlated with measurement by formal thyroid ultrasound (r = 0.95, P<.001). Two patients with unilateral masses noted on carotid duplex had a normal thyroid formal ultrasound. CONCLUSIONS: Incidental thyroid abnormalities identified during carotid duplex ultrasound are common and contain clinically significant pathology. A multidisciplinary clinical pathway may facilitate the appropriate evaluation of these abnormalities.

Aged↗
PubMed2003

Transvaginal three-dimensional ultrasonography combined with serum CA 125 level for the diagnosis of pelvic adhesions before laparoscopic surgery.

STUDY OBJECTIVE: To investigate the role of transvaginal three-dimensional ultrasonography combined with serum CA 125 level in diagnosing pelvic adhesions before scheduled laparoscopic surgery. DESIGN: Prospective study (Canadian Task Force classification II-1). SETTING: Tertiary care academic hospital. PATIENTS: Fifty-nine women with an adnexal mass diagnosed by two-dimensional transvaginal ultrasonography. INTERVENTION: Preoperative transvaginal three-dimensional ultrasonography and serum CA 125 level, followed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS: Pelvic adhesions were correctly identified by transvaginal three-dimensional ultrasonography in 26 of 32 women in whom the lesions were confirmed at laparoscopy or laparotomy. Mean serum CA125 level in women with adhesions was 70 +/- 73.7 U/ml, which was significantly higher than that in women without adhesions (24 +/- 16.16 U/ml, p = 0.004). The sensitivity of combined transvaginal three-dimensional ultrasonography and serum CA 125 level was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89%. The two methods showed strong agreement with surgical results (kappa = 0.889). Eight scheduled laparoscopies (13.6%) were converted to laparotomy due to severe adhesions. One patient (1.7%) experienced colon injury during laparoscopic adhesiolysis. CONCLUSION: Transvaginal three-dimensional ultrasonography combined with serum CA 125 level is sensitive in detecting pelvic adhesions before laparoscopic surgery. Patients with suspected severe pelvic adhesions should have preoperative bowel preparation to reduce the risk of intraoperative injury.

Adult↗
PubMed1998

Intraoperative thoracic sonography.

In contrast to its use in other surgical disciplines, intraoperative sonography has so far been of minor importance in thoracic surgery. The technique of intrathoracic, intraoperative, ultrasonic examination was applied in 85 patients with different indications: in 61 patients during thoracoscopy, in 24 patients during open thoracic surgery. 6 patients eventually underwent a combination of both procedures. In order to improve the intrathoracic maneuverability of the sonographic probe we developed an electrically controllable handle for the probe. The examinations showed a high sensitivity of thoracoscopic ultrasonography for localization of intrapulmonary tumors. In addition, ultrasound was applied to assess the operability of central tumors. The sound frequency available so far for intraoperative application allows a safe distinction of non-infiltrating tumors from vascular structures; the reliable identification of an infiltration mostly requires a higher resolution. If our experiences are confirmed by further application of the method, explorative thoracotomies will surely be partly replaced by explorative thoracoscopic interventions. Ultrasonography has also proved to be useful in visualisation of mediastinal lymph-nodes and tumors, with the possibility of assessing their size.

Abscess↗
PubMed2002

[Interventional ultrasound in the treatment of acute pancreatitis].

OBJECTIVE: The objective of this study is to evaluate the possibilities of interventional ultrasonography in the treatment of liquid collections created during and after an acute pancreatitis. PATIENTS AND METHODS: Ultra-sound controlled percutaneous drainage of peripancreatic liquid collections was done in 58 patients (44 men and 14 women, average age 47.8 within the span of 15-68) in the period between May 1995 and September 2001. Pseudocystitis of pancreas formed after an acute pancreatitis was drained in 19 cases, abscess collections were drained in 14 cases, and in 25 cases a catheter was entered in peripancreatic liquid collections and steatonecrotic masses in the initial phase of acute haemorrhagic necrotic pancreatitis. Pigtail catheters 5 to 7 F were placed to serve for drainage and instillation of medicaments. RESULTS: In the group of patients to whom a catheter was placed in liquid collections and steatonecrotic masses, two lethal outcomes were recorded. However, they were not the result of the intervention, but of emboly of lungs and coagulopathy. One patient with peripancreatic abscess collections was operated after the intervention. In other patients, ultra-sound controlled percutaneous drainage was successful. Before our intervention 22 patients had been operated, five of them twice and two of them three times. CONCLUSION: Ultra-sound controlled percutaneous drainage gives an important contribution in the treatment of the hardest forms of acute pancreatitis and represents a safe and less aggressive method in the treatment of liquid collections and steatonecroses formed during an acute pancreatitis.

Abscess↗
PubMedDate not supplied

Breast disease: the radiologist's expanding role.

The role of the diagnostic radiologist in breast cancer has expanded during the eight-decade history of breast imaging. The radiologist's role now encompasses both breast cancer diagnosis and treatment. This article traces the expansion of the radiologist's role through the history of mammography. The current roles of the radiologist in breast cancer diagnosis are discussed, including screening mammography in the asymptomatic patient, problem-solving breast imaging, breast ultrasound, and galactography. The radiologist's roles in breast cancer treatment that are discussed include preoperative needle localization, percutaneous breast biopsy, and evaluation of the postoperative breast.

Biopsy, Needle↗
PubMed2001

Diagnostic and interventional laparoscopy and intraoperative ultrasonography in the management of pancreatic disease.

The laparoscopic management of pancreatic disorders has evolved dramatically from its inception in 1911 and its rediscovery in the 1970s. Although investigators once proclaimed that "it seems unlikely that laparoscopy will have any more than an extremely limited use in the investigation of pancreatic disorders," laparoscopy and LUS now have a well-recognized role in the staging of pancreatic cancer and an increasing part in the management of benign pancreatic disease at many institutions. Although the appropriate role of LS and LUS is debatable, the development and refinement of laparoscopic techniques and instrumentation and the improvement of noninvasive diagnostic modalities will provide new data, increase the rate of resection at laparotomy, and allow surgeons to treat a broader range of pancreatic disease by minimally invasive methods. The value of LS and LUS for benign and malignant pancreatic disorders has been clearly demonstrated, but the inevitable issues of hospital resource, operative expertise, and surgical philosophy will ultimately determine the role of laparoscopy and LUS in clinical practice.

Angiography↗
PubMed2006

Breast interventions: a primer for interventional radiologists.

Breast cancer is the second leading cause of cancer related deaths in the United States. The area of breast interventions has benefited from recent advances in devices and imaging quality. Ultrasound, MRI, and stereotactic guided vacuum assisted and mechanical rotating stick freeze biopsy are the preferred methods for histologic diagnosis of breast lesions. Ablation techniques are available for the treatment of benign and malignant breast disease. The MammoSite balloon catheter can be placed percutaneously for delivering high dose short term brachytherapy. Interventional Radiologists can and should perform all of these procedures to improve the quality of women's health.

Biopsy↗
PubMed1989

Value of antenatal diagnosis of abnormalities of the urinary tract.

OBJECTIVE: To assess the value of antenatal diagnosis of abnormalities of the urinary tract on ultrasonography. DESIGN: Retrospective study. SETTING: Two obstetric units in Glasgow. SUBJECTS: 62 Fetuses in which renal abnormalities were diagnosed on antenatal ultrasonography. INTERVENTIONS: Six fetuses had their bladders aspirated to determine renal function. Fifteen pregnancies were terminated on the basis of the findings on antenatal ultrasonography, and if possible necropsy was performed on the fetuses. In babies who were born alive the final diagnosis was made by postnatal ultrasonography, intravenous urography, radionuclide scanning, cystography, and, in those who died in the early neonatal period, necropsy. Neonates who were referred with a known obstructed kidney had nephrostomy or pyeloplasty. END POINT: Assessment of the value of antenatal diagnosis of renal abnormalities on ultrasonography for babies who had no clinical evidence of disease postnatally. MAIN RESULTS: Eighteen fetuses did not survive birth; the antenatal diagnosis was accurate in all 18. Of the 44 babies born alive, five had normal urinary tracts, in two of whom antenatal ultrasonography had probably indicated a false positive diagnosis. Fourteen babies died during the early neonatal period. Twenty five babies with renal abnormalities were followed up; the antenatal diagnosis was inaccurate for 10 of them, the commonest misdiagnosis being hydronephrosis for multicystic kidney and vice versa, and there was one false positive diagnosis. The initial clinical findings in 14 babies would have led to the early detection of a urological abnormality. In the 30 babies with no clinical evidence of disease the antenatal diagnosis was of definite value in eight, probable value in 15, and marginal value in seven. Overall, an accurate antenatal diagnosis was made in 46 of the 62 cases (74%); in 12 cases renal disease was detected but its specific nature was not determined; and in four cases the diagnosis was misleading. CONCLUSIONS: The overall value of antenatal diagnosis is that it indicates early termination of fetuses with fatal renal disease, prepares parents and medical staff for the likelihood of serious neonatal problems, and shows abnormalities of the urinary tract that may not be detected postnatally.

Abortion, Induced↗
PubMed1994

Ultrasonography in the management of blunt abdominal and thoracic trauma.

OBJECTIVE: To assess the sensitivity, specificity, and predictive value of ultrasonography in patients with blunt abdominal or thoracic trauma in regard to the indication for immediate operation, delayed abdominal exploration, or conservative treatment. DESIGN: A retrospective study was conducted after consecutive sampling of 1151 patients in a nonrandomized control trial. SETTING: The study was conducted at the University Hospital of Innsbruck (Austria), which serves as a general community hospital and a major primary care and referral center. PATIENTS: All patients with blunt abdominal or thoracic trauma with or without polytraumatization were eligible for the study; a total of 1151 patients were observed from 1980 to 1990. According to the ultrasonographic findings, patients were divided into three groups: immediate operation, primary conservative treatment, and conservative treatment (normal ultrasonographic findings). Ultrasonography was repeated when the clinical findings or laboratory test results showed the development of intra-abdominal hemorrhage or signs of organ laceration. INTERVENTION: Ultrasonography in the emergency department or intensive care unit. MAIN OUTCOME MEASURES: Conservative or operative treatment based on ultrasonographic and clinical findings. RESULTS: Ultrasonography showed a sensitivity of 99%, a specificity of 98%, a positive predictive value of 0.97, and a negative predictive value of 0.99 in regard to the indication for surgery in cases of blunt abdominal or thoracic trauma. Ultrasonography is not reliable in patients with intestinal perforation and large retroperitoneal hematomas. CONCLUSION: Ultrasonography saves time and money, can be performed in the emergency department, shows high sensitivity and specificity, and is the method of first choice in the evaluation of blunt trauma.

Abdominal Injuries↗
PubMed2005

A randomized trial of diagnostic strategies after normal proximal vein ultrasonography for suspected deep venous thrombosis: D-dimer testing compared with repeated ultrasonography.

BACKGROUND: With suspected deep venous thrombosis and normal results on proximal vein ultrasonography, a negative d-dimer result may exclude thrombosis and a positive D-dimer result may be an indication for venography. OBJECTIVE: To evaluate and compare the safety of 2 diagnostic strategies for deep venous thrombosis. DESIGN: Randomized, multicenter trial. SETTING: Four university hospitals. PATIENTS: 810 outpatients with suspected deep venous thrombosis and negative results on proximal vein ultrasonography. INTERVENTIONS: Erythrocyte agglutination D-dimer testing followed by no further testing if the result was negative and venography if the result was positive (experimental) or ultrasonography repeated after 1 week in all patients (control). MEASUREMENTS: Symptomatic deep venous thrombosis diagnosed initially and symptomatic venous thromboembolism during 6 months of follow-up. RESULTS: Nineteen of 408 patients (4.7%) in the D-dimer group and 3 of 402 patients (0.7%) in the repeated ultrasonography group initially received a diagnosis of deep venous thrombosis (P < 0.001). During follow-up of patients without a diagnosis of deep venous thrombosis on initial testing, 8 patients (2.1% [95% CI, 0.9% to 4.0%]) in the D-dimer group and 5 patients (1.3% [CI, 0.4% to 2.9%]) in the repeated ultrasonography group developed symptomatic venous thromboembolism (difference, 0.8 percentage point [CI, -1.1 to 2.9 percentage points]; P > 0.2). Venous thromboembolism occurred in 1.0% (CI, 0.2% to 2.8%) of those with a negative D-dimer result. LIMITATIONS: Seventy patients (8.6%) deviated from the diagnostic protocols, and 9 patients (1.1%) had inadequate follow-up. CONCLUSION: In outpatients with suspected deep venous thrombosis who initially had normal results on ultrasonography of the proximal veins, a strategy based on D-dimer testing followed by no further testing if the result was negative and venography if the result was positive had acceptable safety and did not differ from the safety of a strategy based on withholding anticoagulant therapy and routinely repeating ultrasonography after 1 week.

Female↗
PubMed1993

Ovulation inhibition with a combined oral contraceptive containing 1 mg micronized 17 beta-estradiol.

OBJECTIVE: To evaluate ovarian function by ultrasonography and endocrine measurements. DESIGN: Prospective, open study. SETTING: Outpatient clinic of the First Department of Gynaecology and Obstetrics, University of Vienna, Austria. PARTICIPANTS: Twenty healthy women with regular cycles and established ovulation by ultrasonography. INTERVENTION: Treatment with a combination of 1 mg micronized E2 with 150 micrograms desogestrel daily for 21 days, followed by 7 pill-free days. MAIN OUTCOME MEASURES: Transvaginal ultrasonography and estimation of E2 and P at least twice a week for two consecutive cycles, followed by one after treatment cycle. RESULTS: Ovulation inhibition was apparent in all cases and no functional ovarian cysts were observed during treatment. On a few occasions a persistent follicle was noted, but in the majority of cases there was total absence of follicular activity. The bleeding pattern showed a tendency toward prolonged and more heavy bleeding when compared with the before treatment situation. Return of ovulation was prompt in all women but one. CONCLUSIONS: Ultrasonographic observations, accompanied by P and E2 measurements, allow us to conclude that the combination of 1 mg E2 with 150 micrograms desogestrel provides complete ovulation inhibition. However, the bleeding pattern does not show an acceptable profile.

Adult↗
PubMed1997

Historical development of Croatian radiology.

The history of the development of Croatian radiology is described, from the first beginnings to the present. Very soon after Roentgen's discovery in 1895, not only communications and informative lectures, but also the first x-ray device appeared in Zagreb and then in many other towns in Croatia. The first specialists in roentgenology and x-ray technician were educated at Professor Holzknecht's Roentgenology Institute in Vienna. After the opening of the University School of Medicine in Zagreb in 1917/1918, the Chair of Roentgenology, headed by Professor L. Popović, was founded as early as 1922. Here the first specialization for physicians was organized. After the second world war, with the foundation of Medical Schools in Rijeka, Osijek and Split, Croatian radiology steadily progressed. Autonomous departments and institutes for diagnostic and therapeutic radiology were organized at all large medical centers. Thanks to gynecologists, ultrasound has not only developed at radiologic units, but also at departments of gastroenterology, orthopedics, pediatrics and others. Today, there are many units for interventional ultrasonography throughout Croatia. Radioisotope units have also been organized, but only in the main medical centers, rarely in small ones. At present, there are five radiotherapy and oncology institutions in Zagreb, and one in Rijeka, Split and Osijek. Interventional radiology has been well organized since the 80s, and the First Congress of Diagnostic and interventional Radiology was held in Rijeka in 1994. In conclusion, there is no doubt that the Croatian radiology keeps pace with the international advances in the field.

Croatia↗
PubMed2003

Ultrasonography of the acute abdomen.

For many years, ultrasonography has been considered to be one of the most valuable imaging techniques for evaluation of the abdominal cavity and its organs. In most cases, abdominal ultrasonography helps obtain information that leads to a definitive diagnosis. Ultrasonography is also valuable to narrow the list of differential diagnoses obtained with other diagnostic techniques. This article discusses the role of ultrasound for the diagnosis of the most common diseases that can produce clinical signs of acute abdominal pain. Abdominal organs that can be evaluated using ultrasound include the liver, biliary system, pancreas, stomach, small intestine, kidney, urinary bladder, uterus, and prostate. Pathologies of the abdominal cavity and retroperitoneal space can be also diagnosed with ultrasonography. Interventional ultrasound techniques are useful to either assist in getting the definitive diagnosis or to treat certain pathologic conditions.

Abdomen, Acute↗
PubMed1998

The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis.

BACKGROUND: Ultrasonography using vein compression accurately detects proximal deep venous thrombosis in symptomatic outpatients. Repeated testing is required for patients with normal results at presentation, but the optimal management of such patients is uncertain. OBJECTIVE: To test the safety of withholding anticoagulation in outpatients suspected of having first-episode deep venous thrombosis who have normal results on simplified compression ultrasonography at presentation and on a single repeated test done 5 to 7 days later. DESIGN: Prospective cohort study. SETTING: Noninvasive vascular laboratories at a university teaching hospital and a Veterans Administration medical center. PATIENTS: 405 consecutive outpatients suspected of having first-episode deep venous thrombosis. INTERVENTION: Ultrasonography was performed at presentation. The common femoral and popliteal veins were assessed for compressibility. If the result was normal, anti-coagulation was withheld and testing was repeated 5 to 7 days later. Anticoagulation was withheld from all patients whose results remained normal according to compression ultrasonography, regardless of their symptoms. The safety of this approach was tested by follow-up lasting 3 months. MEASUREMENTS: Objective testing was done during follow-up in all patients with symptoms or signs of venous thromboembolism. The outcome measure was symptomatic venous thrombosis or pulmonary embolism during follow-up, confirmed by objective testing. RESULTS: Ultrasonography had normal results in 335 patients (83%) and abnormal results in 70 (17%). None of the patients with normal results died of pulmonary embolism. Venous thromboembolism occurred during follow-up in 2 patients with normal ultrasonographic results (0.6% [95% CI, 0.07% to 2.14%]) and in 4 patients with abnormal results (5.7% [CI, 1.58% to 13.99%]) (P = 0.009). CONCLUSIONS: It is safe to withhold anticoagulation in outpatients suspected of having first-episode deep venous thrombosis if results of simplified compression ultrasonography are normal at presentation and on a single repeated test done 5 to 7 days later.

Adolescent↗