Diagnostic use of superb microvascular imaging in evaluating septic arthritis of the manubriosternal joint:A case report

BACKGROUND Septic arthritis of the manubriosternal joint is a diagnostic challenge due to its rarity and anatomical characteristic.Conventional ultrasound,plain radiographs,and computed tomography are not able to confirm or even suspect arthritis early.Superb microvascular imaging is a new advanced Doppler technique in evaluating low-flow microvascular patterns.The higher sensitivity for increased perisynovial vascularity helps to suspect septic arthritis and forms a methodical approach to using magnetic resonance imaging(MRI).CASE SUMMARY A 34-year-old immunocompetent woman presented with a fever and a dull ache in the chest radiating to the right arm.Traumatic injury and the most common respiratory and cardiac disorders were ruled out.Blood cultures came back positive for Staphylococcus aureus,and sepsis was confirmed.A small lump was noted on the chest during the first week of hospitalization.Superb microvascular imaging was performed and septic arthritis of the manubriosternal joint was detected.MRI confirmed the diagnosis and showed septic arthritis of the manubriosternal joint with several localized abscesses behind the sternum.The patient was treated for three weeks with intravenous antibiotics and the outcome was favorable:Inflammatory markers became normal,and the lump disappeared.Three months later,the patient was examined for a new episode of mild pain in the sternum and was diagnosed with persistent perichondritis by ultrasound in comparison with MRI.CONCLUSION Superb microvascular imaging is a useful tool for the early diagnosis of septic arthritis of the manubriosternal joint and following-up.

Visualizing the hepatic vascular architecture using superb microvascular imaging in patients with hepatitis C virus: A novel technique

AIM: To identify the hepatic vascular architecture of patients with hepatitis C virus (HCV) using superb microvascular imaging (SMI) and investigate the use of SMI in the evaluation of liver fibrosis.METHODS: SMI was performed in 100 HCV patients. SMI images were classified into five types according to the vascular pattern, and these patterns were compared with the fibrosis stage. Moreover, the images were analyzed to examine vascularity by integrating the number of SMI signals in the region of interest ROI [number of vascular trees (VT)]. The number of VT, fibrosis stage, serum parameters of liver function, and CD34 expression were investigated.RESULTS: There was a significant difference between SMI distribution pattern and fibrosis stage (P < 0.001). The mean VT values in each of the fibrosis stages were as follows: 26.69 ± 7.08 in F0, 27.72 ± 9.32 in F1, 36.74 ± 9.23 in F2, 37.36 ± 5.32 in F3, and 58.14 ± 14.08 in F4. The VT showed excellent diagnostic ability for F4 [area under the receiver operator characteristic (AUROC): 0.911]. The VT was significantly correlated with the CD34 labeling index (r = 0.617, P < 0.0001).CONCLUSION: SMI permitted the detailed delineation of the vascular architecture in chronic liver disease. SMI appears to be a reliable tool for noninvasively detecting significant fibrosis or cirrhosis in HCV patients.

Multidisciplinary diagnostic dilemma in differentiating Madelung’s disease—the value of superb microvascular imaging technique:A case report

BACKGROUND Madelung’s disease,also known as multiple symmetrical lipomatosis,is a rare,underrecognized disorder of fat metabolism that results in unusual accumulation of subcutaneous fat deposits around the neck,shoulders,upper arms,trunk,hips,and upper thighs.Our case demonstrates the importance of differential diagnosis and the value of a superb microvascular imaging technique for suspecting and confirming Madelung’s disease.Timely diagnosis and alcohol abstinence could prevent the progression of growing fatty masses and prevent surgery.CASE SUMMARY A 62-year-old male was admitted to the Rheumatology center complaining of symmetric subcutaneous tumors in the area of the parotid and submandibular salivary glands,small soft masses in the occiput and upper third of the forearm,rashes on calves.A high titer of rheumatoid factor and low concentrations of serum complements were detected.The high-end ultrasound and magnetic resonance imaging examinations of all affected areas of the soft tissues showed predominantly adipose tissue(lipomas)without suspicion of liposarcoma.The biopsy from the small salivary gland revealed no pathology.After evaluating the patient’s clinical presentation(symmetrical lipomatosis,cirrhosis,gynecomastia,anemia,hyperuricemia),Madelung’s disease,type I,along with the psoriatic rash and psoriatic arthritis and secondary liver cirrhosis were established.CONCLUSION Madelung’s disease consists of many co-occurring disorders imitating and overlapping with other conditions.Ultrasonography is the first choice for suspecting and confirming symmetrical lipomatosis.

A Review of Clinical Applications for Super-resolution Ultrasound Localization Microscopy

Microvascular structure and hemodynamics are important indicators for the diagnosis and assessment of many diseases and pathologies.The structural and functional imaging of tissue microvasculature in vivo is a clinically significant objective for the development of many imaging modalities.Contrast-enhanced ultrasound(CEUS)is a popular clinical tool for characterizing tissue microvasculature,due to the moderate cost,wide accessibility,and absence of ionizing radiation of ultrasound.