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Aims: Injection therapies play an increasingly decisive role in the treatment of lower back pain. Cumulative studies could show the benefits of ultrasound-guided instillation procedures in the cervical and lumbar spine. We conducted this study to provide a new simple sonographic approach for pararadicular injections of the sacral spinal nerves and to prove the feasibility and accuracy by means of CT and anatomic dissection.Material and Methods: Eight ultrasound-guided injections at four different levels of the sacral spine on a human ethanol-glycerol-embalmed cadaver (S1-S4) were performed. By means of sonography the sacral foramina were identified and the spinal needles were advanced in "in-plane technique" to the medial margin of the respective sacral foramen. Subsequently a solution of blue dye and contrast agent were injected. Then CT scans and anatomic dissection of the cadaver were performed to verify the correct placement of the needle tips and to visualize the dispersion of the injected solution in the respective compartment.Results: Altogether a 100% success rate for a correct injection could be achieved. CT examination confirmed the correct placement of every needle tip within the intended compartment. Also, the anatomic dissections affirmed the appropriate needle positioning. Moreover, the blue dye dispersion was seen in the correct compartments and around the targeted spinal nerves.Conclusions: Although this study was only performed on cadaveric models, this new sonographic approach for pararadicular injections in the sacral spine allows an easy, precise and unerring needle placement within the dorsal sacral foramen. [ABSTRACT FROM AUTHOR]

Aim: To compare ultrasound (US)-guided versus computed tomography (CT)-controlled periradicular injections of the first sacral spinal (S1) nerve in a prospective randomized clinical trial. Materials and methods: Thirty-nine patients with S1-radiculopathy were consecutively enrolled for 40 periradicular injections and assigned to an US or CT guided group. Needle position after US-assisted placement was controlled by a low-dose CT-scan. Accessibility, accuracy, and intervention time were compared. The overall effect on pain was matched evaluating the visual analog scale (VAS) decrease before and one month after the intervention. Results: The mean intervention time was lower in the US-group compared to the CT-group: 4.4±3.46 min (1.3-13.2) vs. 6.5±3.03 min (2.4-12.5). Using CT-controlled infiltration the mean number of needle passes was with 1.15 higher than utilizing US-guidance. The therapeutic effect (mean difference between pre- and post-intervention, VAS scores) for the CT-group was 4.85±2.52 and for the US-group 4.55±2.74 with no significant difference between the two groups (p=0.7). Conclusion: US-controlled infiltrations of the first sacral nerve show a similar therapeutic effect to the time consuming, and ionizing CT-controlled injections and result in a significant reduction of procedure expenditure and avoidance of radiation. [ABSTRACT FROM AUTHOR]

Introduction: The currently accepted pathophysiological concept behind median arcuate ligament syndrome (MALS) is vascular compromise by atypically positioned median arcuate ligament. Despite many articles on MALS, only sparse data on the outcome in general and the rather poor outcome after intervention have been reported and this makes at least questionable the current concepts of the underlying disease. Material and methods: A total of 364 patients with suspected celiac trunk pathology underwent a standardized ultrasound assessment procedure: suspected diagnostic features for MALS such as typically elevated peak flow velocities (PV) in the celiac trunk or atypical celiac trunk deflection-angles (DA) were defined in patients and in 20 matched volunteers. Results: All the 6 retrospectively clearly diagnosed MALS-patients as well as 40% (8/20) of volunteers presented a DA of over 50°. MALS-patients presented a mean inspiratory PV of 172cm/s (± 40.9 cm/s), a mean expiratory PV of 425cm/s (±130.1 cm/s) with a PV-amplitude of 249.1% (±68.9%). Volunteers presented a mean inspiratory PV of 126.9cm/s (±42 cm/s), a mean expiratory PV of 209.9cm/s (±80.1 cm/s) with a PV-amplitude of 169.4% (±54.3%). Conclusions: The combination of a maximum expiratory PV of over350 cm/s and a DA higher than 50° seems to be a most reliable indicator for MALS in this small series of patients. Based on these data we propose that functional ultrasound should be the first line in screening for MALS. However, a clear pathophysiological definition of MALS remains still obscure. [ABSTRACT FROM AUTHOR]

Objectives: A prospective randomized clinical trial was conducted to evaluate accuracy, time-saving, radiation doses and pain relief of ultrasound-guided (US) facet joint injections versus Computed Tomography (CT)-controlled interventions in the cervical spine. Material and methods: Forty adult patients were consecutively enrolled and randomly assigned to the US- or CT group. US-guided facet joint injections were performed on a standard ultrasound device using a broadband linear-array transducer. The corresponding comparison group underwent CT-guided instillations which were performed under standardized procedures using the CT-positioning laser function. Results: The accuracy of ultrasound-guided interventions was 100%. The mean time (min:sec) to final needle placement in the US group was 04:46 versus 11:12 (p<0.05) in the CT group for one injected level, and 05:49 in the US group versus 14:32 (p<0.05) in the CT group for two injected levels. The mean dose-length product (DLP, mGy*cm) radiation dose, including CT confirmation for study purposes only, was 27.6 for the US group versus 88.2 in the CT group (p<0.05) for one injected level, and 32.5 in the US group versus 205.0 in the CT group (p<0.05) for two injected levels. Both groups showed the same significant visual-analog-scale (VAS) relief in pain (p<0.05), without any "intermethodic" differences (p>0.05). Conclusions: US-guided intra-articular injections show the same therapeutic effect as CTguided intra-articular injections and result in a significant reduction of procedure duration without any exposure to radiation. [ABSTRACT FROM AUTHOR]

Peliosis hepatis is a rare benign disorder of the liver, histologically characterized by blood-filled cystic cavities of various sizes and irregular shapes, communicating with the hepatic sinusoids. Only a few cases of peliosis hepatis have been described using contrast enhanced ultrasound showing admittedly various dynamic enhancement patterns. We present a case of peliosis hepatis with a typical target-sign enhancement depicted by means of contrast enhanced ultrasound. [ABSTRACT FROM AUTHOR]

Injection therapies play a major role in the treatment of cervical pain and are becoming integral parts of a multidisciplinary approach in treatment and rehabilitation of such patients. Pararadicular- and facet-joint injections in the cervical spine are preferentially performed under computed tomography (CT) or fluoroscopy-guidance. In this article we present an alternative, simple and easy to learn step by step US-guided technique for injection therapy in the cervical spine. [ABSTRACT FROM AUTHOR]

Aim: To assess technical and lesion related factors affecting the quality of ultrasound guided core needle biopsy (CNB) of musculoskeletal soft tissue tumors. Materials and Methods: Data of 223 CNBs were evaluated in a retrospective study. Diagnostic yield was calculated for all lesions on the basis of lesion location (extremity/torso), examiner, biopsy needle gauge/length and number of acquired samples. Diagnostic accuracy was calculated for surgical lesions (n= 113) based on final specimen histology. Chi-square test based Phi-coefficient calculations were performed to search for associations between each factor and diagnostic yield. Results: Overall diagnostic yield was 94.6%. There was no significant difference in diagnostic yield between specialist biopsies (96.8%) and resident biopsies (93.1%), between lesions located in the extremities (94.9%) and lesions in the torso (93.8%) and on the basis of needle gauge or number of acquired cores. Diagnostic accuracy was 100% for surgical lesions. The only factor influencing the quality of CNB was lesion composition (repeat biopsies in myxoid and/or inhomogeneous lesions). Conclusion: The most important aspects to achieve constant high quality results with ultrasound guided CNBs in the work-up of musculoskeletal soft tissue tumors are expertise concerning identification and targeting of viable tumor components and strict adherence to a quality controlled biopsy procedure. Once this is achieved, technical factors have almost no effect on the quality of CNB. [ABSTRACT FROM AUTHOR]

Immunologic reactions in transplanted organs are in more or less all allograft patients detectable: clear parameters exist as e.g. in renal transplants where the clearance power reduces by rejection. On the contrary, in composite tissue allografts clear and objective indicators stating a rejection episode lack. We present the case of a hand-transplanted subject with signs of acute transplant rejection diagnosed by means of Duplex Ultrasound and confirmed by biopsy. [ABSTRACT FROM AUTHOR]