Fatty liver disease in severe obese patients:Diagnostic value of abdominal ultrasound

AIM:To evaluate the sensitivity and specificity of abdominal ultrasound (US) for the diagnosis of hepatic steatosis in severe obese subjects and its relation to histological grade of steatosis. METHODS: A consecutive series of obese patients, who underwent bariatric surgery from October 2004 to May 2005, was selected. Ultrasonography was performed in all patients as part of routine preoperative time and an intraoperative wedge biopsy was obtained at the beginning of the bariatric surgery. The US and histological findings of steatosis were compared, considering histology as the gold standard. RESULTS: The study included 105 patients. The mean age was 37.2 ± 10.6 years and 75.2% were female. The histological prevalence of steatosis was 89.5%. The sensitivity and specificity of US in the diagnosis of hepatic steatosis were, respectively, 64.9% (95% CI: 54.9-74.3) and 90.9% (95% CI: 57.1-99.5). The positive predictive value and negative predictive value were, respectively, 98.4% (95% CI: 90.2-99.9) and 23.3% (95% CI: 12.3-39.0). The presence of steatosis onUS was associated to advanced grades of steatosis on histology (P = 0.016). CONCLUSION: Preoperative abdominal US in our series has not shown to be an accurate method for the diagnosis of hepatic steatosis in severe obese patients. Until another non-invasive method demonstrates better sensitivity and specificity values, histological evaluation may be recommended to these patients undergoing bariatric surgery.

Ultrasound features of hepatocellular adenoma and the additional value of contrast-enhanced ultrasound

BACKGROUNI）： Hepatocellular adenoma （HCA） is a rare benign tumor of the liver. It is of clinical importance to dif- ferentiate HCA from other liver tumors, especially hepatocel- lular carcinoma （HCC）. This study aimed to evaluate the char- acteristic features of HCA by conventional ultrasound and contrast-enhanced ultrasound （CEUS） findings. METHODS： Twenty-six patients （10 males and 16 females; mean age 36.2＋5.0 years） with 26 histopathologically proven HCAs were retrospectively identified. According to the maxi- mum diameter of HCAs, they were divided into three groups： 〈30 mm, 30-50 mm, and 〉50 mm. Ultrasound examinations were performed with C5-2 broadband curved transducer of Philips iU22 unit （Philips Bothell, WA, USA）. For each lesion, a dose of 2.4 mL SonoVue~ （Bracco Imaging Spa, Milan, Italy） was injected as a quick bolus into the cubital vein. Lesions＇ echogenicity, color-Doppler flow imaging and contrast en- hancement patterns were recorded. RESULTS： Grayscale ultrasound revealed that most of HCAs were hypoechoic （73.1%, 19/26）. Spotty calcifications were detected in 26.9% （7/26） of the lesions. Color-Doppler flow imaging detected centripetal bulky color flow in 46.2% （12/26） of the HCAs. CEUS showed that 73.1% （19/26） of the HCAs displayed as rapid, complete and homogenous enhancement, and 53.8% （14/26） showed decreased contrast enhancement in the late phase. There was no significant difference in enhance- ment patterns among different sizes of HCAs （P〉0.05）. Centripetal enhancement with subcapsular tortuous arteries was common in larger HCAs.

DIAGNOSTIC ULTRASOUND IMAGING OF PAROTID TUMOR

Sonography was performed on 104 cases with parotid tumors. The shape, boundary and internal echoes were related to the malignancy of the tumor. The diagnostic criteria of parotid tumors were proposed. The sonograms of 32 surgical specimens of parotid tumors were compared with histopathologic findings to investigate the pathologic bases of various sonograms. The boundary echoes were related to integrity of the capsule of the tumor. The internal echoes were related to internal structures of the tumor.

Sonographic Diagnosis of Acute Hematogenous Osteomyelitis in the Early Stage

This article presents sonographic diagnosis of acute hematogenous osteomyelitis in early stage.24 clildren with clinically suspected acute hematogtnous osteomyelits were detected to have subptrosteal abscesses by ultrasond during four to fourteen days after onset.The mean length and anteroposterior distance of the subperiosteal abscesses were 86.4 mm and 10.7 mm,respectively.Of 24 cases of subperiosteal atscesses,aspiration performed under ultrasound guidance revealed purulent fluid in al and 23 were verified surgically.The results obtained indicate that ultrasound can be used it diagnosis of actue hematogerous osteomyelitis in the early stage.the earliest case was diagrosed by ultrasound 4 days afttr onset.By use of ultrasound, differentiation diagnosis of acute hematogenous osteomyelitis from other diseases such as cellulitis,soff tissue abscess,acutt septic arthritis and maignant bone tumors is also discussed.

Sonographic Diagnosis of the Knee Effusion

This paper presents the diagnosis of effusion of the knee by ultrasound. 140patients with pain and swelling of the knee were detected to have suprapatellar effusion by ultrasound. The antero-posterior distances of the suprapatellar effusion were 0. 2-3. 4 cm with a mean of 1. 2 cm. The effusion was revealed as an anechoic fluid-filled area in 121 cases (86. 4 %), as a hypoechoic area in 15 cases (10. 7 %), and as a mixed anechoic fluid-filled area and hypoechoic area in remaining 4 (2. 9 %). Of 140 cases of knee effusion, 126 cases were verified by aspiration or operation. The results obtaineddemonstrate that ultrasound can visualize not only the effusion of the knee, but also theabnormalities in the menisci, synovium, and the popliteal fossa ; This provides an important basis for diagnosis and treatment. Further more, ultrasound is painfree, noninvasive, inexpensive, readily acceptable by patients,and convenient for follow-up studles.

Contrast-enhanced ultrasonography parameters in neural network diagnosis of liver tumors

AIM:To study the role of time-intensity curve(TIC) analysis parameters in a complex system of neural networks designed to classify liver tumors.METHODS:We prospectively included 112 patients with hepatocellular carcinoma(HCC)(n = 41),hypervascular(n = 20) and hypovascular(n = 12) liver metastases,hepatic hemangiomas(n = 16) or focal fatty changes(n = 23) who underwent contrast-enhanced ultrasonography in the Research Center of Gastroenterology and Hepatology,Craiova,Romania.We recorded full length movies of all contrast uptake phases and post-processed them offline by selecting two areas of interest(one for the tumor and one for the healthy surrounding parenchyma) and consecutive TIC analysis.The difference in maximum intensities,the time to reaching them and the aspect of the late/portal phase,as quantified by the neural network and a ratio between median intensities of the central and peripheral areas were analyzed by a feed forward back propagation multi-layer neural network which was trained to classify data into five distinct classes,corresponding to each type of liver lesion.RESULTS:The neural network had 94.45% training accuracy(95% CI:89.31%-97.21%) and 87.12% testing accuracy(95% CI:86.83%-93.17%).The automatic classification process registered 93.2% sensitivity,89.7% specificity,94.42% positive predictive value and 87.57% negative predictive value.The artificial neural networks(ANN) incorrectly classified as hemangyomas three HCC cases and two hypervascular metastases,while in turn misclassifying four liver hemangyomas as HCC(one case) and hypervascular metastases(three cases).Comparatively,human interpretation of TICs showed 94.1% sensitivity,90.7% specificity,95.11% positive predictive value and 88.89% negative predictive value.The accuracy and specificity of the ANN diagnosis system was similar to that of human interpretation of the TICs(P = 0.225 and P = 0.451,respectively).Hepatocellular carcinoma cases showed contrast uptake during the arterial phase followed by wash-out in the portal and first seconds of the late phases.For the hypovascular metastases did not show significant contrast uptake during the arterial phase,which resulted in negative differences between the maximum intensities.We registered wash-out in the late phase for most of the hypervascular metastases.Liver hemangiomas had contrast uptake in the arterial phase without agent wash-out in the portallate phases.The focal fatty changes did not show any differences from surrounding liver parenchyma,resulting in similar TIC patterns and extracted parameters.CONCLUSION:Neural network analysis of contrastenhanced ultrasonography-obtained TICs seems a promising field of development for future techniques,providing fast and reliable diagnostic aid for the clinician.

Fetal Endocardial Fibroelastosis with Coarctation of Aortic Arch: A Case Report

This study describes a 34-year-old pregnant woman who underwent prenatal echocardiography at 24 weeks of gestation and found fetal heart abnormalities. She underwent fetal echocardiography in our hospital. Echocardiography showed complex malformation of fetal heart, thickening and calcification of left ventricular myocardium and tendon, weakening or even flattening of left ventricular wall movement, very severe mitral stenosis, severe mitral regurgitation, aortic stenosis, narrowing of the aortic arch, countercurrent of the ductal arch to aortic arch, small diameter of the oval foramen and significantly increased flow velocity. The patient decided to induce labor after expert consultation, but no autopsy was performed due to his family’s refusal. Color Doppler ultrasound can find the positive signs of endocardial elastofibroplasia earlier, and accurately diagnose patients with neonatal elastofibroplasia. It provides accurate diagnostic information for the clinic and can be used as the first choice. This report has obtained the informed consent of its parents.