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Objectives To assess the respective diagnostic value of Sonazoid™ and SonoVue® for characterizing FLLs as benign or malignant and the corresponding safety. Methods This prospective Phase 3 study was conducted at 17 centres in China and Korea (May 2014 to April 2015); 424 patients (20 to 80 years) with at least 1 untreated focal liver lesion (FLL) ( Results Sonazoid-enhanced and SonoVue-enhanced ultrasound provided a statistically significant improvement in specificity for all 3 readers comparing to unenhanced ultrasound (for Sonazoid: p = 0.0093, p = 0.002, 0.03, 0.12, respectively). Difference in accuracy improvement between the 2 groups was within the pre-specified non-inferiority margin of 20% for all 3 readers (6.1%, 95% CI: − 5.0 to 17.2; − 7.5%, 95% CI: − 18.4 to 3.5; − 0.3%, 95% CI: − 11.3 to 10.7). The diagnostic confidence level for all 3 readers increased with post-contrast images relative to pre-contrast images. Both contrast agents were well tolerated. Conclusion Results showed a similar efficacy for Sonazoid™ and SonoVue® in diagnosing FLLs as benign or malignant, and underlined the benefit of CEUS imaging over unenhanced ultrasound imaging in reaching a confident diagnosis without having to refer patients for additional imaging exams.

Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.

Breast tumor ranks fourth among various cancers in terms of mortality rate in Taiwan, and it is also the most commonly prevalent cancer in females. Early detection of any malignant lesions can increase the survival rate and also decline the mortality rate through current advanced medical therapies. Acoustic radiation force impulse (ARFI) is a new imaging technique for distinguishing breast lesions in the early stage based on localized tissue displacement, which is quantitated by virtual touch tissue imaging (VTI). Digital ARFI-VTI is an initial breast imaging modality and appears to be more effective in women aged >30 years. Therefore, image enhancement process is a key technique to enhance a low-contrast image in a region of interest (ROI) for visualizing texture details and morphological features. In this study, two-dimensional (2D) fractional-order convolution, as a 2D sliding filter window (eight filters are selected), is applied to enhance ARFI-VTI images for an accurate extrapolation of lesions in an ROI. Then, the maximum pooling is performed to reduce the dimensions of the feature patterns from 32×32 to 16×16 size. A multilayer machine vision classifier, as a generalized regression neural network (GRNN), is then used to screen subjects with benign or malignant tumors. With a 10fold cross-validation, promising results such as mean recall (%), mean precision (%), mean accuracy (%), and mean F1 score of 92.92±3.43%, 80.42±6.45%, 87.78±2.17%, and 0.8615±0.0495, respectively, are achieved for quantifying the performance of the proposed classifier. Breast tumors visualized on ARFI-VTI images can be useful as digitalized images for rapid screening of malignant from benign lesions by the proposed machine vision classifier.

In China, the majority of patients with hepatocellular carcinoma (HCC) result from long-term infection of hepatitis B. Pathologically, HCC is characterized by rich blood supply, multicentric origins, early vascular invasion and intrahepatic metastasis. Therefore, HCC is not a local disease but a systemic disease at the beginning of its occurrence. For this reason, a comprehensive treatment strategy should be adopted in the management of HCC, including local treatments (such as surgical resection, radiofrequency ablation, microwave ablation, chemical ablation and cryoablation, etc.), organ-level treatments [such as transcatheter arterial infusion of chemotherapy and transcatheter arterial chemoembolization (TACE)], and systemic treatments (such as immunotherapy, antiviral therapy and molecular targeted therapy, etc.). This consensus sets forth the minimally-invasive and multidisciplinary comprehensive guideline of HCC, focusing on the following eight aspects (1) using hepaticarteriography, CT hepatic arteriography (CTHA), CT arterial portography (CTAP), lipiodol CT (Lp-CT), TACE-CT to find the intrahepatic lesion and make precise staging (2) TACE combined with ablation or ablation as the first choice of treatment for early stage or small HCC, while other therapies are considered only when ablation is not applicable (3) infiltrating HCC should be regarded as an independent subtype of HCC (4) minimally-invasive comprehensive treatment could be adopted in treating metastatic lymph nodes (5) multi-level subdivision of M-staging should be used for individualized treatment and predicting prognosis (6) HCC with severe hepatic decompensation is the only candidate criterion for liver transplantation (7) bio-immunotherapy, traditional Chinese medicine therapy, antiviral therapy, and psychosocial and psychopharmacological interventions should be advocated through the whole course of HCC treatment (8) implementation of multicenter randomized controlled trials of minimally-invasive therapy versus surgery for early and intermediate stage HCC is recommended.

Spinal epidural abscess is an uncommon but severe infection affecting the spinal canal with the potential for causing serious complications such as spinal cord compression and infarct with resultant paralysis, if treatment is delayed. Despite advances in medical knowledge and imaging techniques, it is often misdiagnosed at initial presentation due to its insidious onset and nonspecific clinical signs. The classical triad of spinal pain, fever, and neurological deficit is often not present at initial presentation, making the diagnosis based on clinical findings alone challenging. Imaging thus plays a crucial role in the evaluation and early detection of this condition, allowing for prompt treatment to improve prognosis and clinical outcome. This chapter serves to describe the use of various techniques available for imaging pyogenic abscesses in spinal infections, particularly magnetic resonance imaging which is the modality of choice for diagnosis.

Hepatic arterial pseudoaneurysm is a rare but potentially fatal condition that requires prompt management. We report a case of hepatic arterial pseudoaneurysm developed after radiofrequency ablation of a hepatocellular carcinoma. The patient was successfully treated with percutaneous absolute ethanol injection under ultrasound guidance. Follow-up studies with ultrasound and computed tomography for 2 years after treatment revealed no evidence of local recurrence of hepatocellular carcinoma and of the pseudoaneurysm.

Renal cysts are common incidental findings in clinical practice. Most renal cysts detected in medical imaging are benign simple cysts. However, some are complicated by hemorrhage or infection or are associated with calcification. In these instances, difficulties can be encountered distinguishing the complicated cysts from cystic renal tumors such as cystic renal cell carcinoma, multilocular cystic nephroma, and mixed epithelial and stromal tumors. The Bosniak classification is widely used to categorize cystic renal lesions but is used to classify those discovered via computed tomography. Ultrasonography (US) and color Doppler US are the most frequently used imaging techniques for abdominal surveys and long-term follow-up because of their noninvasiveness, relatively low cost, wide availability, and frequently, lack of contrast medium. Herein, we review the features of various cystic lesions of the kidney that can be found using US, discuss differential diagnoses using US, and propose a feature-oriented algorithmic approach to classifying renal cystic lesions using US. Keywords: Bosniak classification, Complex renal cyst, Cystic renal tumor, Renal cystic lesion, Ultrasonography

Choledochal cysts rarely present with acute pancreatitis. We report a patient with type I choledochal cyst(s) who had concomitant acute frank hemorrhagic pancreatitis. A 14-year-old male noted with a history of recurrent abdominal pain, fever and jaundice. Ultrasonography (US) of abdomen at the Emergency Department depicted distended gall bladder with wall thickening. Apparently dilated intrahepatic ducts (IHDs) and fusiform dilatation of the common bile duct (CBD), and mild dilatation of the pancreatic duct were also noted, suggesting a type I choledochal cyst( ). Computed tomography (CT) demonstrated calcifications in the uncinate process of the pancreas in addition to the similar findings on US. He subsequently underwent choledochal cyst excision with a Roux-en-Y hepaticojejunostomy. After surgical treatment, he has been doing well for 3 years.

Background Acoustic radiation force impulse (ARFI) imaging is a noninvasive imaging modality for quantitative assessment of tissue stiffness. This study utilized ARFI imaging to assess the stiffness of a transplant renal cortex within the first month after renal transplantation and to explore the correlation between the cortical stiffness and arterial resistance of the transplant kidney. Methods Forty renal transplant recipients (male/female = 26/14; mean age: 45.3 years; deceased donor/living related donor = 27/13) were included in this study. ARFI imaging with virtual touch tissue imaging quantification was applied to assess the stiffness of the transplant renal cortex by using a linear ultrasound transducer. Arterial resistance was acquired by spectral Doppler examination of the main artery and intrarenal arteries of the transplant kidney using a curvilinear ultrasound transducer. Results The stiffness of transplant renal cortex was expressed as shear wave velocity (m/s). The mean value of cortical stiffness was 3.19 ± 1.01 m/s (range: 1.55–5.54). The stiffness of transplant renal cortex was positively correlated with the resistance index of the main renal artery ( r = 0.55, P = .001), segmental artery ( r = 0.43, P = .005), and interlobar artery ( r = 0.42, P = .006). Conclusion The stiffness of a transplant renal cortex is positively correlated with the arterial resistance of the renal transplant in the early post-transplant period. This result indicates that, in addition to renal fibrosis, the stiffness of the transplant renal cortex is also influenced by the hemodynamics of the transplant kidney.

Purpose This study aims to evaluate patients with right-sided colonic diverticulitis detected at ultrasonography (US). Methods We retrospectively analyzed 14 patients. Demographic data, clinical features, and US images were documented. Results In the 14 patients, clinical manifestations included right lower abdominal tenderness (93%), leukocytosis (57.1%), and fever (28.6%). Diverticulitis occurred in cecum and ascending colon with a similar frequency (35.7%). US features included diverticular wall thickening (50%), surrounding echogenic fat (50%), intradiverticular echogenic material (50%), adjacent lymph node enlargement (21.4%), intradiverticular or peridiverticular fluid collection (28.6%), and color flow signals on or surrounding the diverticula (14.3%). Two (14.2%) patients suffered from recurrence. Two (14.3%) patients had abscess formation, and one (7.1%) patient had diverticulum perforation. Most (85.7%) patients received conservative treatment only. One (7.1%) patient received computed tomography-guided drainage due to diverticulum perforation and pocket of abscess formation. One patient underwent surgery due to recurrent diverticulitis-related fistula. Conclusion Common US features of diverticulitis include diverticular wall thickening, surrounding echogenic fat, and intradiverticular echogenic material. Proper recognizing of these features helps in differentiating diverticulitis from appendicitis and may obviate an unnecessary emergent surgery.

A 25-year-old man presented with chronic low back pain and occasional radiation to the right lower limb. Magnetic resonance imaging and computed tomography (CT) of the lumbar spine showed an osteolytic expansile lesion with a central sclerotic nidus in the right superior facet of the L5 vertebra and surrounding marrow oedema. The diagnosis of osteoblastoma was made based on imaging findings and confirmed after CT-guided biopsy. Radiofrequency ablation of the lesion was successfully performed. The patient tolerated the procedure well and showed symptomatic relief. The imaging features and management of osteoblastoma are discussed.

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.

Solitary fibrous tumor (SFT) is an uncommon neoplasm of mesenchymal origin, which can be benign or malignant. Most SFTs develop from the pleura, but they can also be found in other sites. There are only few reports of SFT occurring in the breast. We herein report such a rare case. Sonography demonstrated an ovoid lesion mimicking a fibroadenoma, whereas color Doppler imaging showed marked internal vascularity. A brief literature review on imaging features of SFTs is added. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:350-354, 2017.

Spontaneous intrahepatic porto-systemic shunts (IHPSS) can be disclosed with ultrasound (US) and color Doppler ultrasound (CDU). However, direct evidence of the shunt on US or CDU may not be convincing. In this report we demonstrate the presence of IHPSS by ultrasonic contrast portography with intravenous injection of microbubble-based contrast agent (MBCA). With this technique, the MBCA was depicted to enter the hepatic vein through the shunt, and then flowed into the inferior vena cava.

Synovial chondromatosis is a rare, benign, proliferative cartilaginous lesion arising from the synovial tissue, tenosynovium, or bursal lining. We describe the case of a patient who initially presented with multiple axillary masses. Breast ultrasound (US) was requested due to the concern of a breast tumor with axillary lymph node metastases. US study was helpful and provided adequate information to suggest the diagnosis.

Objective The purpose of this study was to determine clinical and ultrasonographic characteristics of male breast tumors. Methods The medical records of male patients with breast lesions were retrieved from an electronic medical record database and a pathology database and retrospectively reviewed. A total of 112 men (125 breast masses) with preoperative breast ultrasonography (US) were included (median age, 59.50 years; age range, 15–96 years). Data extracted included patient age, if the lesions were bilateral, palpable, and tender, and the presence of nipple discharge. Breast lesion features on static US images were reviewed by three experienced radiologists without knowledge of physical examination or pathology results, original breast US image interpretations, or surgical outcomes. The US features were documented according to the BI-RADS (Breast Imaging-Reporting and Data System) US lexicons. A forth radiologist compiled the data for analysis. Results Of the 125 breast masses, palpable tender lumps and bilateral synchronous masses were more likely to be benign than malignant (both, 100% vs 0%, P < 0.05). Advanced age and bloody discharge from nipples were common in malignant lesions (P

The breast section of these Guidelines and Recommendations for Elastography produced under the auspices of the World Federation of Ultrasound in Medicine and Biology (WFUMB) assesses the clinically used applications of all forms of elastography used in breast imaging. The literature on various breast elastography techniques is reviewed, and recommendations are made on evidence-based results. Practical advice is given on how to perform and interpret breast elastography for optimal results, with emphasis placed on avoiding pitfalls. Artifacts are reviewed, and the clinical utility of some artifacts is discussed. Both strain and shear wave techniques have been shown to be highly accurate in characterizing breast lesions as benign or malignant. The relationship between the various techniques is discussed, and recommended interpretation based on a BI-RADS-like malignancy probability scale is provided. This document is intended to be used as a reference and to guide clinical users in a practical way.

While interpreting routine magnetic resonance imaging (MRI) of the knee joint, a radiologist may encounter various cystic lesions such as ganglion, synovial, and meniscal cysts, among others. In some cases, MRI may demonstrate cystlike lesions around the knee due to fluid distention of normal bursa and recesses, the diagnosis of which should not be difficult if a radiologist is familiar with their characteristic location and MRI appearance. In addition, there are cyst mimickers such as hematomas, abscesses, vascular lesions, and neoplasms around knee joint that may pose a diagnostic challenge on routine MRI. Due to their atypical location and variable morphology, contrast administration is helpful as the enhancement pattern aids to differentiate them from cysts and cystlike lesions. This pictorial essay aims to classify cysts, cystlike lesions, and cyst mimickers in and around the knee joint based on their anatomic location and highlight their characteristic MRI features.

The review demonstrates the unique advantages of ultrasonography in pain control. Several imaging modalities can be used to guide pain control, such as computed tomography, magnetic resonance imaging, and radiography. Ultrasonography has unique advantages over these other modalities in terms of its non-ionizing radiation, real-time imaging, portability, and cost-effectiveness. Ultrasonography with color Doppler and elastography can provide safer guidance to avoid blood vessels and the nerve trunk when using steroid or xylocaine infusions to encase the nerve trunk. This review focuses on the control of chronic pain in the upper limbs, lower limbs, and trunk.

OBJECTIVE. The objective of our study was to discover the types and incidence of artifacts in dual-energy CT (DECT) using datasets of 50 consecutive patients who underwent a four-limb DECT protocol for the evaluation of suspected gout. Identification of artifacts and techniques for artifact reduction are discussed. CONCLUSION. Artifacts commonly occur in DECT performed for gout assessment but are usually readily recognizable. For 90% of the patients in our study who underwent imaging for suspected gout, DECT showed some type of artifact, with nail bed and skin artifacts being the most common.

Objective The goal of this study was to assess the optimum diagnostic cutoff value of maximum outer appendiceal diameter on computed tomography (CT) images in patients with suspected acute appendicitis in the emergency department. Methods A total of 328 patients with clinical suspicion of appendicitis were retrospectively reviewed. Evaluation of CT images, and chart review for clinical, laboratory, surgical, and pathologic findings were performed. Logistic regression was used to identify possible predictive factors influencing diagnosis of acute appendicitis. The receiver operating characteristic (ROC) curve was applied to determine the most suitable diagnostic cutoff value of appendiceal diameter for acute appendicitis. Results In a total of 136 patients (41.5%) the diagnosis of acute appendicitis was made; 192 patients (58.5%) had nonacute appendicitis. Mean appendiceal diameter was 12.68 ± 3.31 mm in patients with acute appendicitis and 6.01 ± 1.50 mm in patients without. The appendiceal diameter had a significantly statistical difference to differentiate the presence from the absence of acute appendicitis with an area under the ROC curve of 0.985 (95% confidence interval, 0.973–0.996). An appendiceal diameter cutoff value of 8.15 mm had a sensitivity of 97%, a specificity of 93.2%, and an accuracy of 94.8%. Appendiceal wall enhancement with intravenous contrast medium also had a significantly statistical difference for discriminating patients with acute appendicitis from those without by logistic regression. Conclusion Detection of maximum outer appendiceal diameter and appendiceal wall enhancement with intravenous contrast medium on CT could help differentiate patients with acute appendicitis from those without. An appendiceal diameter greater than 8.15 mm is particularly useful for diagnosis of acute appendicitis.

Dual‐energy computed tomography (DECT) is a relatively recent development in the imaging of gouty arthritis. Its availability and usage have become increasingly widespread in recent years. DECT is a non‐invasive method for the visualisation, characterisation and quantification of monosodium urate crystal deposits which aids the clinician in the early diagnosis, treatment and follow‐up of this condition. This article aims to give an up to date review and summary of existing literature on the role and accuracy of DECT in the imaging of gout. Techniques in image acquisition, processing and interpretation will be discussed along with pitfalls, artefacts and clinical applications.

Background Metaplastic carcinoma of the breast (MPCB) is a rare breast cancer. We reviewed sonographic findings for MPCB. Methods Grayscale ultrasonography (US), color Doppler US (CDUS), and spectral Doppler US (SDUS) findings for 10 patients with MPCB breast were retrospectively reviewed. Results The prevalence of MPCB was 3.9% among cases of breast cancer in our hospital. All patients had a rapidly growing palpable breast mass. The mean lesion size was 5.7 cm. On US, the lesion shape was most commonly gently lobulated (90%); only one showed an irregular shape (10%). The lesion shape was most commonly circumscribed (90%). Nine tumors had an abrupt boundary and one had an indistinct boundary. Lesion echogenicity was hypoechoic and very hypoechoic (40%), hypoechoic (30%), or very hypoechoic, hypoechoic, and hyperechoic (30%). All our cases had cystic parts with posterior acoustic enhancement, representing necrosis or hemorrhage. CDUS showed peripheral, central and marginal color flow signals. The resistivity index (RI) of tumor vessels in the lesions ranged from 0.7 to 1.3. The axillary lymph nodes were enlarged on US and were positive for metastasis in three cases (30%). Conclusion MPCB is a rare rapidly growing tumor. US findings included gently lobulated, complex mass lesion with cystic parts and posterior acoustic enhancement, representing necrosis or hemorrhage. Increased color flow signals and relative high RI of the feeding arteries were also seen.

To evaluate the clinical implication of splenic volume measured by computed tomography (CT) scan in hepatocellular carcinoma (HCC) patients undergoing percutaneous radiofrequency ablation (RFA).Splenomegaly is an important sign of portal hypertension and poor liver function in patients with advanced liver disease. But whether it could predict the prognosis of patients with HCC is still obscure.We enrolled 161 treatment-naive HCC patients. Splenomegaly was defined as splenic volume300 mL by CT scan and its impact on prognosis was analyzed. Moreover, noninvasive serum markers were validated to predict splenomegaly.A total of 78 patients were with splenomegaly, while the remaining 83 patients had normal splenic volume at the time of receiving RFA. After a median follow-up of 38.1±20.8 months, 41 patients died. The cumulative 5-year survival rates were 54.8% and 77.8% in patients with splenomegaly and in those with normal splenic volume, respectively (P=0.003). By multivariate analysis, age 65 years and older, serum albumin levels ≤3.5 g/dL, and splenic volume300 mL were independent risk factors associated with poor overall survival after RFA. For predicting splenomegaly by noninvasive serum markers, platelet count yielded the highest area under the curve from corresponding receiver operating curves with a level of 0.868 at a cut-off value of 11,7000/mm(3).HCC patients with splenomegaly measured by CT scan have relatively poorer liver functional reserve than those with normal splenic volume. Splenomegaly is an independent risk factor predicting overall survival for patients with small HCC undergoing RFA.

To evaluate the impact of age on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (RFA).Whether age plays an important role in the outcomes of HCC after RFA remains controversial.Two hundred fifty-eight consecutive treatment naive HCC patients who underwent RFA were enrolled. Patients aged ≤ 65 years (n = 100) were defined as the younger group and those aged65 years (n = 158) were the elderly group. Their clinicopathologic features and prognosis were compared.Younger patients had a higher male-to-female ratio, higher prevalence of hepatitis B virus, and smaller tumor size than elder patients. After median follow-up of 28.5 ± 18.7 months, 45 patients died. The cumulative 5-year survival rates were 81.3% and 65.4% in younger and elder HCC patients, respectively (P = 0.008). Multivariate analysis disclosed that age65 years, serum albumin level ≤ 3.7 g/dL, prothrombin time international normalized ratio1.1, α-fetoprotein (AFP)20 ng/mL, and no antiviral therapy after RFA were independent risk factors associated with poor overall survival. Besides, there were 163 patients with tumor recurrence after RFA. Multivariate analysis showed that age65 years, platelet count ≤ 10/mm, AFP20 ng/mL, multinodularity, and tumor size2 cm were the independent risk factors predicting recurrence.Both liver functional reserve (serum albumin level, prothrombin time international normalized ratio, platelet count, and antiviral therapy) and tumor factors (tumor size, number, and AFP level) were crucial in determining post-RFA prognosis in HCC patients. Moreover, younger HCC patients have better overall survival and lower recurrence rate after RFA compared with elder patients.

A 21-year-old male patient presented with the symptoms of weakness in both legs, urine and stool incontinence for several months. Neurological examination revealed flaccid bilateral leg. Sonography showed heterogeneously echogenic multilobulated soft-tissue mass with several cystic spaces within it. Magnetic resonance imaging showed iso-signal intensity soft-tissue mass in T1 weighted imaging with many high-signal intensity cystic areas. After intravenous administration of gadolinium contrast agent, the tumor showed moderate contrast enhancement. The most common sarcomatous lesions with cystic degeneration include chondroid tumor (such as chondrosarcoma), liposarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumors. Tumor biopsy showed malignant peripheral nerve sheath tumor. The patient received arterial embolization, radiotherapy, and regular chemotherapy after the diagnostic workup.

To evaluate the role of three-dimensional power Doppler ultrasonography (3D-PDUS) in differential diagnosis of soft tissue masses. 93 patients with palpable soft tissue masses (age range = 14–88 years; mean age = 51.3 years, female:male = 19:74) were scanned with 3D-PDUS. The tumor was traced by the same doctor. The vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were calculated automatically. All tumors were proved by US-guided biopsy or surgical pathology. Wilcoxin Rank Sums test was applied for statistical analysis. There were 25 benign and 67 malignant tumors. Benign tumors included hematoma (2), inflammation (3), hemangioma (1), lymphadenitis (2), and schwannoma (4). Malignant tumors included liposarcoma (2), synovial sarcoma (4), osteosarcoma (3), malignant fibrous histiocytoma (1), lymphoma (2), and metastasis (6). The VI, FI, and VFI were 4.76 ± 5.83, 32.41 ± 7.8, and 1.76 ± 2.39 in benign tumors, and were 5.28 ± 6.37, 33.08 ± 6.18, and 1.97 ± 2.87 in malignant tumors, respectively. There was no significant difference between benign and malignant tumor in VI, FI, and VFI ( p > 0.1). The 3D-PDUS could not be used as a single factor to differentiate the character of soft tissue tumors. Multiparameters in high-resolution ultrasound and color Doppler ultrasound should be considered.

The importance of assessing tumor response during or after treatment with a novel therapy has long been recognized. Several standardized approaches have been proposed and utilized to evaluate tumor response after systemic and/or loco-regional therapy (LRT). Among the LRT modalities, RFA is one of the most widely accepted methods for treating malignant hepatic tumors. Conventional cross-sectional imaging techniques, such as CT and MRI, have traditionally been used primarily to assess tumor response to RFA, however, ultrasound (US) is the most convenient imaging technique during or after treatment. The utility of microbubble contrast agents (MBCA) greatly enhances the ability of US to delineate lesions or structures and therefore provide more information in diagnosis. Imaging technique providing adequate information pre- and during RFA treatment of liver is crucial to achieve optimal therapeutic outcomes. Studies have shown that CEUS with second-generation USCA as a pre-treatment imaging may increase the target lesion conspicuity and enhance the treatment efficacy. In patients with FLL such as HCC and liver metastases not clearly demarcated on conventional US, complete tumor necrosis could be achieved by using a single session of RFA in 94% with US guidance. While complete tumor necrosis rate as high as 98.2% could be achieved in the CEUS-guided group. The tumor size and number are the most important factors related to the complete ablation and tumor recurrence after RFA. With CEUS guidance and monitoring, an RFA procedure can be done optimally. We herein review the methodologies for measuring tumor response and survival, among patients treated with RFA for primary and secondary hepatic malignancies. The learning objectives of this review include spectrum of US/ CEUS techniques and findings during and after RFA of hepatic tumors.

Although examination of the spleen is routinely included in the general abdominal gray-scale ultrasound (US) study, it was considered of limited use in the past and was performed almost only to distinguish between cystic and solid lesions. In the last two decades due to accumulated experience and the introduction of second-generation contrast agents, this technique has been re-evaluated as contrast-enhanced US (CEUS) allows detection and characterization of most focal lesions of the spleen with a high sensitivity and a good specificity. US can provide a correct diagnosis in simple cysts, whereas CEUS is useful when cystic lymphangioma is suspected. US presents a low specificity and relatively low sensitivity in splenic infarctions, while CEUS can achieve a high specificity (up to 100 %). There is a wide spectrum of benign and malignant neoplasms of the spleen. Lymphomas and vascular tumors comprise the most common splenic neoplasms. Splenic hemangiomas and angiosarcomas are the most common mesenchymal tumors in which US and CEUS may show characteristic imaging findings and permit precise diagnosis. US-guided fine needle aspiration and/or biopsy of focal splenic lesions are being increasingly performed to obtain tissue for histopathological characterization. Accurate diagnosis of focal splenic lesions allows institution of optimal patient management. In the study of splenic lesions, the most important problem is to differentiate between angioma, hamartoma, lymphoma, and metastasis. CEUS presents a high specificity in the differentiation of benign and malignant splenic lesions, as hypoenhancement in the parenchymal phase is suggestive of malignancy in 87 % of cases. US, as compared to CT and MRI, has certain advantages, including its ubiquitous availability, lack of ionizing radiation, and low cost, and with additional application of CEUS, can be widely indicated in the study of focal splenic lesions.

Background: The purpose of this study was to report the safety of perfluorobutane (Sonazoid) as a vascular-phase imaging agent in characterizing focal liver lesions (FLLs). Materials and Methods: From May 2014 to April 2015, a total of 54 individuals who received Sonazoid contrast-enhanced ultrasound (CEUS) were enrolled at 5 hospitals of 4 medical centers. All individuals were included in safety evaluation. A prospective study to evaluate the adverse effect (AE) incidences after intravenous administration of Sonazoid. Results: Sonazoid was well tolerated. Treatment-emergent adverse events (TEAEs) representing AE were recorded for 13 (24.1%) patients. The most common AE was abdominal pain (9.3%), followed by heart rate irregularity (5.6%). The majority of these patients (69.2%) experienced TEAEs that were mild in intensity. Sonazoid causes no significant AEs after intravenous injection. The only noteworthy AEs are related to tolerable myalgia (3.7%), abdominal pain (1.9%), and headache (1.9%). None of the 54 patients showed serious adverse effects. Conclusion: Sonazoid shows good safety and tolerance of intravenous use during CEUS of the liver for evaluation of FLLs.

Medial collateral ligament injury is an infrequent occurrence in arm wrestlers. We report here a male patient who injured his left elbow while arm wrestling. Ultrasonography showed a medial collateral ligament tear. We assessed both elbows using ultrasonography at his 3-year follow-up visit. Dynamic ultrasonography showed a decreased gap at the ulnotrochlear joint space in his left elbow. A medial collateral ligament tear in his right elbow was also evident using ultrasonography. This case report shows the advantages of ultrasonography, especially dynamic ultrasonography, in the evaluation of elbow injury. Ultrasonography provides more information than valgus stress radiography, arthrography, and magnetic resonance imaging in the assessment of medial collateral ligament injury. In addition, the contralateral side can readily be assessed for comparison during ultrasonography.

Background We aimed to evaluate the ability of 3-dimensional power Doppler ultrasonography to differentiate soft-tissue masses from blood flow and vascularization with contrast medium. Methods Twenty-five patients (mean age, 44.1 years; range, 12-77 years) with a palpable mass were enrolled in this study. Volume data were acquired using linear and convex 3-dimensional probes and contrast medium injected manually by bolus. Data were stored and traced slice by slice for 12 slices. All patients were scanned by the same senior sonologist. The vascular index (VI), flow index (FI), and vascular-flow index (VFI) were automatically calculated after the tumor was completely traced. All tumors were later confirmed by pathology. Results The study included 8 benign (mean, 36.5 mL; range, 2.4-124 mL) and 17 malignant (mean, 319.4 mL; range, 9.9-1,179.6 mL) tumors. Before contrast medium injection, mean VI, FI and VFI were, respectively, 3.22, 32.26 and 1.07 in benign tumors, and 1.97, 29.33 and 0.67 in malignant tumors. After contrast medium injection, they were, respectively, 20.85, 37.33 and 8.52 in benign tumors, and 40.12, 41.21 and 17.77 in malignant tumors. The mean differences between with and without contrast injection for VI, FI and VFI were, respectively, 17.63, 5.07 and 7.45 in benign tumors, and 38.15, 11.88 and 16.55 in malignant tumors. Tumor volume, VI, FI and VFI were not significantly different between benign and malignant tumors before and after echo-contrast medium injection. However, VI, FI and VFI under self-differentiation (differences between with and without contrast injection) were significantly different between malignant and benign tumors. Conclusion Three-dimensional power Doppler ultrasound is a valuable tool for differential diagnosis of soft-tissue tumors, especially with the injection of an echo-contrast medium.

Background: The risk of post-thrombotic syndrome and pulmonary embolism can be increased if there is failure to diagnose deep venous thrombosis (DVT) promptly. Emergency physicians (EPs) need a quick and readily available test to diagnose, treat and help them decide whether to discharge or admit DVT patients in a timely manner. The aim of this study was to investigate the value of the non-compressibility ratio of thrombosed veins in DVT patients, and give EPs an objective value to aid them in their decision-making with regard to DVT patients in the emergency department. Methods: We reviewed 34 adult patients with DVT diagnosed by sonography in an emergency department. Medical records including demographic data and sonography results were retrospectively reviewed and analyzed. Results: Mean age was 72.9 ± 16.5 years. Group I comprised 14 patients (41.2%) who had DVT in the popliteal and femoral veins. Group II comprised 8 patients (23.5%) who had DVT isolated to the popliteal vein and 12 patients (35.3%) who had DVT isolated to the femoral vein. Group I had a significantly higher non-compressibility ratio than Group II (93.4 ± 6.2% vs. 80.1 ± 19.2%, p < 0.05). The area under the receiver operating characteristic curve of the non-compressibility ratio between discriminating groups was 0.711 (95% confidence interval, 0.527–0.854; p < 0.05). The clinical prognostic score of Group I was significantly higher than that of Group II (6.2 ± 1.8 vs. 4.1 ± 2.6, p < 0.05). There was a significant positive correlation between the non-compressibility ratio of the thrombosed vein and the clinical prognostic score (p = 0.001). Conclusion: The non-compressibility ratio of the thrombosed vein provides EPs with an objective test to evaluate the severity of DVT and to admit patients for consideration of adverse outcomes. [J Chin Med Assoc 2010;73(11):563–567]

Purpose: Breast ultrasound(US) is recently becoming more and more popular for detecting breast lesions. However, screening results in hundreds of USimages for each subject. This magnitude of images can lead to fatigue in radiologist, causing failure in the detection of lesions of a subtle nature. In this study, an image stitching technique is proposed for combining multipass images of the whole breast into a series of full-view images, and a fully automatic screening system that works off these images is also presented. Methods: Using the registration technique based on the simple sum of absolute block-mean difference (SBMD) measure, three-pass images were merged into full-view USimages. An automatic screening system was then developed for detecting tumors from these full-view images. The preprocessing step was used to reduce the tumor detection time of the system and to improve image quality. The gray-level slicing method was then used to divide images into numerous regions. Finally, seven computerized features—darkness, uniformity, width-height ratio, area size, nonpersistence, coronal area size, and region continuity—were defined and used to determine whether or not each region was a part of a tumor. Results: In the experiment, there was a total of 25 experimental cases with 26 lesions, and each case was composed of 252 images (three passes, 84 images/pass). The processing time of the proposed stitching procedure for each case was within 30 s with a Pentium IV 2.0 processor, and the detection sensitivity of the proposed CADsystem was 92.3% with 1.76 false positives per case. Conclusions: The proposed automatic screening system can be applied to the whole breast images stitched together via SBMD-based registration in order to detect tumors.

The aim of this study was to develop a computer-aided diagnosis (CAD) system in assessing the sonographic morphologic and texture features of soft-tissue tumors.The retrospective study involved 114 pathology proven cases including 73 benign and 41 malignant soft-tissue tumors. The tumor regions were delineated by an experienced radiologist who was unknown to the pathologic result. Then, we applied 10 morphologic features and 6 gray-level co-occurrence matrix texture features to analyze the tumor regions. To classify the tumors as benign or malignant, we used two methods, a linear discriminant analysis with stepwise feature selection and a multilayer neural network with the back-propagation algorithm as classifiers. The classification performances are evaluated by the area A(z) under the receiver operating characteristic. Furthermore, four radiologists provided malignancy grades for all tumors in the comparison of the CAD system.In this analysis, the CAD system based on the combination of morphologic and texture feature sets can give the optimal CAD result by LDA with an accuracy of 89.5%, a sensitivity of 90.2%, a specificity of 89.0%, a positive predictive value (PPV) of 82.2%, negative predictive value (NPV) of 94.2%, and A(z) value of 0.96, and by the multilayer perception with an accuracy of 88.6%, a sensitivity of 90.2%, a specificity of 87.5%, a positive predictive value of 80.4%, negative predictive value of 94.2%, and A(z) value of 0.95. The A(z) values of the four radiologists were ranged between 0.74 and 0.86, and the optimal CAD results were shown the highest A(z) values than the four radiologists' rankings.This study has shown that performing the CAD system with both morphologic and texture features on sonography, can successfully distinguish between benign and malignant soft-tissue tumors. Moreover, it can also provide a second opinion for the tumor diagnosis and avert unnecessary biopsy.

Purpose The purpose of this study is to determine which computed tomography (CT) findings and clinical data can help to diagnose gallbladder perforation in acute cholecystitis. Materials and Methods The medical records and CT findings of patients with surgically proven acute cholecystitis within the last recent 5 years were retrospectively reviewed and compared between 2 groups with and without gallbladder perforation. Results A total of 75 patients with acute cholecystitis were included in the study, and 16 patients were proven to have gallbladder perforation. Higher mortality rate was found in the perforation group (18.8% vs 1.7%; P = .029). Older age (>70 years; P = .004) and higher percentage of segmented neutrophil (>80%; P = .027) were significant clinical factors for predicting gallbladder perforation in acute cholecystitis. The significant CT signs related to gallbladder perforation included visualized gallbladder wall defect ( P = .000), intramural gas ( P = .043), intraluminal gas ( P = .000), intraluminal membrane ( P = .043), pericholecystic abscess or biloma formation ( P = .009), intraperitoneal free air ( P = .001), and presence of ascites in the absence of hypoalbuminemia or other intraabdominal malignancy ( P = .017). In multivariate analysis, visualized gallbladder wall defect was the most significant predicting CT feature for diagnosing gallbladder perforation in acute cholecystitis. Conclusion Elderly patients with higher segmented neutrophil and CT signs of gallbladder wall defect associated with acute cholecystitis may have high possibility of gallbladder rupture.

Portal vein aneurysms are focal dilatation of the portal venous system and have attracted clinical attention in recent years. The most common sites of portal vein aneurysms are the main portal vein and the confluence of the splenic and the superior mesenteric veins. The associated liver cirrhosis and portal hypertension have been thought to be main causes of portal vein aneurysms. We reported on an 86-year-old man with portal vein aneurysm. The imaging findings were presented and the relevant literature was also briefly reviewed.

Objective. The purpose of this study was to verify whether high-resolution and color Doppler ultrasonography could distinguish schwannomas from neurofibromas. Methods. Seventy-six tumors in 71 patients were included in this study. There were 46 patients (50 tumors) with schwannomas and 25 patients (26 tumors) with nondiffuse neurofibromas in the extremities or superficial parts of the body. Ultrasonographic examinations were performed in all patients. The tumor size, shape, location, internal echogenicity, posterior acoustic phenomenon (eg, shadowing or enhancement), capsule, relationship with the adjacent nerve, and presence of cystic components were documented. Color Doppler studies (75 lesions) and spectral Doppler studies (44 lesions) were performed. All data were analyzed with statistical software to check the significance. Results. Both tumors presented as well-defined hypoechoic nodules on ultrasonography. They were oval or lobulated, showed posterior acoustic enhancement, and were hypervascular on color Doppler ultrasonography. There was no significant difference with respect to ultrasonographic morphologic characteristics. The rates of centric, eccentric, and undetermined associations with nerves were 40%, 20%, and 40% in the schwannomas and 46.2%, 0%, and 53.8% in the neurofibromas, respectively, showing a significant difference (P = .032). There was no significant difference in the chance of cystic changes between the schwannomas (30%) and neurofibromas (23%). Conclusions. No ultrasonographic finding (gray scale, color Doppler, or spectral analysis) allows differentiation between neurofibromas and schwannomas of the extremities. A nerve eccentrically entering a mass was seen only in schwannomas, and that may allow differentia

Since the introduction of real-time ultrasonography (US) to the medicine in late 1970s, the unique benefit of the real-time cross-sectional imaging has made US one of the most widely used imaging modalities to guide interventional procedures. Among the intra-abdominal solid organs, the spleen is the least common solid organ considered for interventional procedures. Although splenic puncture for splenoportography was performed as early as the 1950s and has had a low complication rate, traditionally a direct splenic puncture is still avoided due to the risk of hemorrhage or laceration. US-guided percutaneous drainage of splenic abscesses has been used as a safe alternative procedure for more than 20 years, however, only a few series reporting such an interventional procedure have been published. This review describes briefly the usefulness, technique, safety, and the outcome of US-guided interventional procedures of the spleen.

Ultrasonography (US) has been used as an important adjunct to mammography (MG) for about 20 years, and during this period the diagnostic accuracy of US has increased remarkably. A conventional 2-dimensional MG only detects a summation of the X-ray opacity of the whole thickness of breast tissue over the entire breast, while US can separately detect the sonographic properties of the breast tissue in a fashion of contiguous slices. Automated full-field breast US (AFBUS) scanners were originally designed to effectively examine the breast in its entirety. Basically, AFBUS scanners are either prone or supine types. The old generation prone-type scanner consists of a large water-filled tank with the transducers mounted at the base. The patient is prone with the breast freely suspended in the warm water bath. The first prone-type AFBUS scanner (Octoson, 3 to 4.5 MHz; Ultrasound Institute, Sydney, Australia) was used from the late 1970s to late 1980s. It was a specially designed scanner comprising eight transducers immersed at the base of a large water tank. When used for breast scanning, a combination of three to four transducers was usually utilized to obtain an optimal compound image of the breast. The Labsonics scanner, a representative scanner of old-generation supine type, was a simple B-mode single-crystal high-resolution automated unit (7.5 MHz; Labsonics, Indianapolis, IN, USA) that was used from the mid-1980s to mid-1990s. The scanner provided multiple static images of the breast. The patient was supine and a water bag technique was used for sound wave transmission to the breast. With the rapid development of computer technologies, volumetric ultrasound can now be applied for the breasts. Volumetric ultrasound scanning of the breast has been proposed as a complimentary modality for breast cancer screening. There are two types: compression and suspension; the latter is not commercially available outside Japan (ASU-1004, Aloka, Japan). The compression type consists of two major designs: upright and supine types. In the upright-type compression method, the breast is placed and compressed between a film sheet and a compression plate. The new supine-type compression AFBUS scanning apparatus comprises a rigid and substantially stationary frame and a compressive membrane (a polyester film sheet). By manually pushing the frame to contact firmly with the relatively soft breast, the transducer can optimally scan the breast if a sufficient amount of gel is evenly applied on the breast surface, leaving minimal or no contact artifacts. It was originally hoped that AFBUS would rival MG as a screening procedure in asymptomatic women. However, the images obtained from the automated scanners of the old generation were of inferior quality to those generated by hand-held real-time scanners. Nevertheless, the current automated scanners equipped with high-frequency broadband transducers are still significantly competing with hand-held instruments. The current high-resolution AFBUS scanners can provide better demonstration of the breast anatomy and proper orientation and documentation of the lesions detected, and therefore better reproducibility and are good for follow-up studies. The volumetric data obtained can provide potential information for computer-aided detection and diagnosis of breast lesions. With current volumetric technologies, the AFBUS system can provide even higher detection rate of lesions including solid lesions and carcinomas. Interpretation of the imaging results from the volumetric AFBUS should be based on all the imaging data obtained. The current AFBUS scanners are easy to use and need only a short period of training, and the examination technique is especially suitable for technologists or sonographers to perform the whole scanning procedure. AFBUS may be used as an adjunct to MG or as baseline US examination of the breast and can play an important role in screening nonpalpable tumors in women with dense breasts. However, AFBUS in its current form cannot replace MG in detecting malignancy presenting as only microcalcifications.

Conventional diagnostic ultrasound images of the anatomy (as opposed to blood flow) reveal differences in the acoustic properties of soft tissues (mainly echogenicity but also, to some extent, attenuation), whereas ultrasound-based elasticity images are able to reveal the differences in the elastic properties of soft tissues (e.g., elasticity and viscosity). The benefit of elasticity imaging lies in the fact that many soft tissues can share similar ultrasonic echogenicities but may have different mechanical properties that can be used to clearly visualize normal anatomy and delineate pathologic lesions. Typically, all elasticity measurement and imaging methods introduce a mechanical excitation and monitor the resulting tissue response. Some of the most widely available commercial elasticity imaging methods are ‘quasi-static’ and use external tissue compression to generate images of the resulting tissue strain (or deformation). In addition, many manufacturers now provide shear wave imaging and measurement methods, which deliver stiffness images based upon the shear wave propagation speed. The goal of this review is to describe the fundamental physics and the associated terminology underlying these technologies. We have included a questions and answers section, an extensive appendix, and a glossary of terms in this manuscript. We have also endeavored to ensure that the terminology and descriptions, although not identical, are broadly compatible across the WFUMB and EFSUMB sets of guidelines on elastography (Bamber et al. 2013; Cosgrove et al. 2013).

The development of a carcinoma in a fibroadenoma is a rare occurrence. 1-3 Carcinomas arising within a fibroadenoma have the same biological behavior as those arising independently. Treatment of this particular entity is therefore generally considered the same as that of the usual breast cancers. They usually are incidental pathologic findings after excision of the fibroadenoma. 3,4 To the best of our knowledge, there have been no previous reports on preoperative sonographic diagnosis of a ductal carcinoma in situ (DCIS) that developed in a fibroadenoma. Here we report such a case, in which the correct diagnosis was made on the basis of the follow-up color Doppler sonography and sonographically guided fine-needle aspiration cytologic examination.

We evaluated superficial soft-tissue lymphomas on high-resolution ultrasonography (HRUS) in 43 patients (17 women, 26 men; mean, 59.7 y; range, 12 to 90 y), with 1- to 97-month follow-up. Clinical presentations, tumor location and morphology, echogenicity on HRUS and color-encoding grades on Doppler ultrasonography (CDUS) were assessed. Clinical presentations did not significantly differ with tumor location or morphology. Types of lymphoma did not significantly differ in echogenicity, although most were hypoechogenic. On CDUS, most lymphomas were hypervascular, but grades did not significantly depend on the type of tumor. On Kaplan-Meier analysis with log-rank testing, survival did not differ by age (divided at 65 y), sex, tumor location or size (cut-off, 5 cm), CDUS grade or pathology. Survival was significantly related to clinical presentation (p < 0.0095) and tumor morphology (p < 0.0354). HRUS and CDUS were good modalities to detect the masses and provided important pretreatment information.

Mucin-producing carcinoma of the gallbladder is rare, and its imaging features have not been well documented. Its symptoms and signs are nonspecific and the prognosis of the disease is poor. We present a 73-year-old male with mucin-producing carcinoma of the gallbladder, emphasizing its imaging features on ultrasound, computed tomography and magnetic resonance imaging. The tumor usually presents as a cauliflower-like soft tissue mass with small calcified spots in the gallbladder wall and some laminated high viscosity fluid inside the gallbladder cavity. Recognition of these features can provide clues to the diagnosis of mucin-producing carcinoma of the gallbladder.

Background: The purpose of this study was to establish practical diagnostic criteria to differentiate colonic diverticulitis from colon cancer by computed tomography (CT) in the emergency department (ER). Methods: Helical CT scans of 40 patients admitted to the ER with the clinical diagnosis of diverticulitis and 14 patients diagnosed with colon cancer were retrospectively reviewed. In total, 18 imaging parameters were analyzed and were compared between the 2 groups of patients. Results: Thirteen parameters were found to be statistically significant for the diagnosis of colonic diverticulitis in excluding colon cancer: pericolic infiltration (p < 0.001); presence of lymph nodes (p < 0.001); inflamed diverticula (p = 0.001); non-inflamed diverticula (p = 0.001); degree of enhancement (p = 0.001); intestinal obstruction (p = 0.001); involved wall thickness (p = 0.005); lymph node size (p = 0.007); fascial thickening (p = 0.009); pattern of enhancement (p = 0.012); involved length (p = 0.014); free air (p = 0.035); and abscess formation (p = 0.042). Among these parameters, the most valuable imaging findings for diverticulitis were the presence of non-inflamed diverticulum, inflamed diverticulum, mild degree of enhancement, and small lymph node size. Three were found to have high specificity but low sensitivity: target enhancement pattern; abscess formation; and free air. When colonic obstruction is present, colon cancer is more likely than diverticulitis. Conclusion: Specific CT criteria help to differentiate colonic diverticulitis from colon cancer. CT scan with intravenous contrast administration would be the best noninvasive imaging modality in the ER for the accurate diagnosis and appropriate management of such disease. (J Chin Med Assoc 2005;68(9):411-418)

Taiwan is nearly free from hydatid disease. We report a case of hydatid cyst of the liver in a 37-year-old man who originally lived in India and had migrated to Taiwan 2 years earlier. He presented with right upper quadrant pain and intermittent low-grade fever. Both sonography and computed tomography (CT) demonstrated a cystic lesion with vesicles at its periphery in segments 6 and 7 of the liver. A hydatid cyst was diagnosed. The patient underwent radical excision of the cyst with total removal without opening the wall. He also received pre- and postoperative oral mebendazole. Pathology showed a hydatid cyst consisting of three layers: the inner single nucleated geminal layer, the middle acellular laminated layer, and the outer pericyst originating from inflammatory and hepatic cells. This case highlights that accurate preoperative diagnosis of hydatid disease can be made from personal history, typical sonography and CT study in non-endemic areas.

Background Preliminary data regarding the use of percutaneous radiofrequency ablation (RFA) for the treatment of renal cell carcinoma (RCC) are encouraging, and show the technique to be associated with minimal morbidity. Thus, the current study was designed to evaluate the clinical applications, treatment efficacy, and complications of percutaneous RFA in RCC. Methods From February 2003 to February 2004, 12 consecutive patients with histopathologically proven RCC underwent imaging-guided percutaneous RFA. The mean age of the patients (8 men and 4 women) was 76 years (range, 56-87 years), and mean tumor diameter was 3.7 cm (range, 2.2-8.0 cm). The efficacy of RFA was evaluated with contrast-enhanced, dynamic computed tomography (CT) performed 1 month after treatment, and then every 3 months. A Radionics device with an internally cooled electrode was used in 7 patients, and a radiofrequency interstitial tissue ablation (RITA) device with an expandable needle electrode was used in 5. Complete necrosis was defined as a lack of contrast enhancement in the treated region on follow-up CT studies. Results Overall, 16 sessions of RFA were performed for 12 solitary renal tumors in 12 patients: 8 patients underwent a single RFA session, whereas 4 had 2 sessions. Dynamic CT after RFA showed complete necrosis in 9 of 12 tumors. In 3 patients with tumors of 4.5-8.0 cm in diameter, enhancement of residual tissue was observed after RFA treatment, thus indicating residual tumor. Complete tumor necrosis was seen in all 5 tumors (100%) of diameter = 3.0 cm; 3 of 4 tumors (75%) of diameter 3.1-5.0 cm; and 1 of 3 tumors (33%) of diameter > 5.0 cm. A big subcapsular hematoma, which was found in 1 patient after RFA, resolved completely within 10 months without treatment; no serious complications occurred in the other 11 patients. Conclusion Percutaneous RFA is effective in the treatment of RCC. It is most successful for tumors not larger than 3 cm in diameter, and has a satisfactory success rate in tumors of 3-5 cm in diameter. The rate of serious complications of RFA is low. Further studies are necessary to determine the long-term efficacy of RFA in RCC.

BackgroundThe goals of this study were to evaluate the specific computed tomography (CT) features of internal hernia (IH), and to verify CT features useful for the differential diagnosis of IH from adhesive small bowel obstruction (ASBO), and for the early detection of intestinal strangulation.MethodsCT findings for 28 patients with surgically proven IH were retrospectively reviewed and compared with those for 50 patients with surgically proven ASBO.ResultsCT features most suggestive of IH versus ASBO included the following: a cluster of small bowel segments (100% vs 4% of patients; p < 0.0001); crowding and convergence of mesenteric vessels (79% vs 4%; p < 0.0001); mesenteric vessel engorgement (79% vs 26%; p = 0.0002); and mass effect to the surrounding bowels (82% vs 44%; p = 0.002). In addition, intestinal strangulation, the most severe complication, occurred more in IH than ASBO (39% vs 10%; p = 0.002), whereas proximal small bowel dilation (46% vs 100%; p < 0.0001) and small-bowel feces sign (0% vs 26%; p = 0.0029) were less common in IH than ASBO. The CT features indicative of intestinal strangulation were localized mesenteric fluid (p < 0.0001), mesenteric infiltrates (p = 0.0005), bowel wall thickening (p = 0.003), intramural hemorrhage (p = 0.005), mesenteric vessel engorgement (p = 0.03), and abnormal bowel wall enhancement (p = 0.008); the first 4 of these features were noted more in patients with IH than ASBO.ConclusionThe most specific CT criteria for the diagnosis of IH, rather than ASBO, were engorged mesenteric vessels, mass effect to surrounding organs, and bowel wall thickening. When associated mesenteric infiltrates were found, intestinal strangulation was highly suspected.

Thrombophlebitis of the superficial veins of the breast, also referred to as Mondor's disease, is a rare disease entity. Mondor reported the first superficial venous thrombosis of the chest wall in 1939. The major clinical manifestation is palpable and painful cord-like lesion in the breast. This condition is usually a benign, self-limiting process and requires only symptomatic treatment. The etiologic factors include trauma, surgery, infection, excessive physical activity, arthritis or breast carcinoma. Laboratory data are not helpful and biopsy is usually not advised. The use of grayscale and color Doppler ultrasound can aid in the diagnosis of Mondor's disease by its specific findings. Here, we present three women with Mondor's disease.

Free liquid silicone injections were used for breast augmentation in the 1950s and 1960s. Patients who received these breast silicone injections are now at the age of high breast cancer risk, but breast masses in such patients are difficult to detect by clinical examination and imaging studies. Ultrasonography may be affected by silicones, but lesions superficial to the silicones can still be detected. Here, we report one patient who received silicone injection 35 years ago when she was 18 years old. Ductal carcinoma in situ with clustered multiple microcalcifications was noted on ultrasound and confirmed by histopathologic examination. Surgery was performed and there was no evidence of recurrence 20 months after operation.