Hsin-Kai Wang

Differentiation of benign and malignant superficial soft-tissue masses using grayscale and color doppler ultrasonography.

Background: This study was performed to evaluate the usefulness of high‐resolution grayscale and color Doppler ultra‐sound to distinguish benign from malignant soft‐tissue masses on the basis of ultrasonographic patterns. Methods: We enrolled 398 female and 420 male patients aged 1–104 years (mean, 49.8 years). All presented with a palpable nodule or mass located superficially in the body. Each lesion was examined by grayscale and color Doppler ultrasonography to assess its echogenicity, margin, shape, composition, acoustic transmission, size and other patterns. Spectral Doppler was applied in lesions with positive color flow signals. The nature of all masses was confirmed by aspiration cytology, biopsy, surgical pathology or long‐term clinical follow‐up. Results: There were a total of 693 benign and 125 malignant masses. Five malignant and 14 benign histologies (including 6 types with inflammation‐related, hematoma or pseudoaneurysm) occurred that had more than 10 subjects with each histology. Eight benign histopathologies included cysts, neoplasms, vascular and miscellaneous. Five malignant histologies included metastases, osteogenic sarcomas, lymphomas, malignant fibrous histiocytomas and liposarcomas. There were significant differences (p < 0.05) between the benign and malignant soft‐tissue tumors in terms of parameters including tumor margin, shape and size. Benign lesions did not have infiltrated margins or a scalloped shape and malignant tumors tended to be large. However, there was no significant difference (p > 0.05) between the benign and malignant soft‐tissue tumors in terms of echogenicity, composition and color Doppler features. Conclusion: Ultrasonography with color Doppler imaging is a good modality for characterizing most soft‐tissue masses, and tumor size > 5 cm and having infiltrated margin highly suggests malignancy.

Ultrasonographic and MR Findings of Alveolar Soft Part Sarcoma

Alveolar soft part sarcoma (ASPS) is a rare soft-tissue sarcoma, commonly occurring in children and adolescents. The tumor mostly involves the lower extremities. The prognosis of the patient depends on whether there is metastasis. We present a 19-year-old female with ASPS in her right lower leg. Grayscale and color Doppler ultrasound showed a well-defined hypoechoic lesion with hypervascularity and very low resistive index (RI). Magnetic resonance imaging revealed iso signal intensity to muscle on T1-weighted images, high signal intensity to muscle on T2-weighted images with signal voids, and good enhancement after gadolinium administration. In a mass with hypervascularity and very low RI on sonography and hypervascularity with flow voids on magnetic resonance imaging, ASPS should be considered.

Chronic Sclerosing Sialadenitis of the Parotid Gland Diagnosis Using Color Doppler Sonography and Sonographically Guided Needle Biopsy

Chronic sclerosing sialadenitis (CSS), or Kuttner tumor, is a benign inflammatory process of the major salivary gland that occurs almost exclusively in the submandibular gland of middle-aged adults. It is rarely reported to involve the parotid gland or to occur in adolescents. 1 Chronic sclerosing sialadenitis is characterized histologically by periductal fibrosis, dense lymphocytic infiltration with lymphoid follicle formation, loss of the acini, and, eventually, marked sclerosis of the salivary gland. 2 , 3 This lesion has been recognized as a distinct clinicopathologic entity in the latest edition of the World Health Organization classification of tumorlike lesions of the salivary glands. 2 Because CSS manifests as a hard mass, it usually raises a strong clinical suspicion of a malignant neoplasm. In recent years, gray scale sonography and color Doppler sonography (CDS) have been widely used in the evaluation of major salivary gland masses, and fine-needle aspiration cytologic examination and needle biopsy have been used increasingly as cost-effective and safe techniques to confirm or evaluate salivary gland lesions.4-6 We report the sonographic and CDS manifestations and sonographically guided needle biopsy histologic features of an adolescent with CSS of the unilateral parotid gland.

Comparison of the analgesic effect of xylocaine only with xylocaine and corticosteroid injection after ultrasonographically-guided percutaneous treatment for rotator cuff calcific tendonosis

Background The analgesic effect of xylocaine alone versus xylocaine with corticosteroid injection after ultrasonographically (US)‐guided treatment of rotator cuff calcific tendonosis has not been described in English literature. The aim of this study was to compare the analgesic effect of xylocaine only with xylocaine and corticosteroid following US‐guided percutaneous treatment of rotator cuff calcific tendonosis. Methods This prospective study enrolled 88 patients who were given different analgesic treatments [xylocaine only, n = 23; xylocaine with corticosteroid, n = 44; control (no xylocaine or corticosteroid), n = 21]. The assessment of a patients painful symptoms was recorded before treatment, and 1 day, 1 week, 1 month and 3 months after treatment using the visual analogue scale (VAS). Results There were no significant differences in age, sex, calcification size before and after treatment, and amount of calcification decrease after treatment, but there was a significant difference in calcification morphology among the groups (p = 0.010). General linear model analysis indicated that the three groups had no difference in pain prior to treatment. After treatment, the xylocaine only and the xylocaine with corticosteroid groups had less pain than the control group at 1 day, 1 week, and 1 month after treatment. At 3 months after treatment, the xylocaine only group had less pain than the control group (p = 0.039), and the xylocaine with corticosteroid and control groups had similar levels of pain. Conclusion Injection of xylocaine alone after US‐guided treatment of rotator cuff calcific tendonosis provided a longer pain relief period than that of a mixture of xylocaine with corticosteroid.

Evolutionary magnetic resonance appearance of renal cell carcinoma after percutaneous cryoablation

Objective: To determine the evolutionary MRI appearance of renal cell carcinoma (RCC) following cryoablation. Methods: For this institution review board-approved study, we recruited patients with biopsy-proven RCC and treated them with percutaneous cryoablation between November 2009 and October 2014. Two radiologists retrospectively reviewed the pre-procedural and follow-up MRI. The findings included tumour sizes, signal intensities on T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), diffusion-weighted imaging, apparent diffusion coefficient (ADC) map and contrast enhancement patterns. The ADC values of the tumours before and after treatment were measured. Results: A total of 26 patients were enrolled. The ablated tumours exhibited predominantly high signals on T1WI at 1–9-month follow-up (47.1% strong hyperintense at 3 months) and subsequently returned to being isointense. In T2WI, the signals of the ablated tumours were highly variable during the first 3 months and became strikingly hypointense after 6 months (58.3% strong hypointense at 6 months). Diffusion restriction was prominent during the first 3 months (lowest ADC: 0.62u2009±u20090.29u2009×u200910−3u2009mm2u2009s−1 at 1 month). Contrast enhancement persisted up to 6 months after the procedure. The residual enhancement gradually increased in the dynamic scan and was most prominent in the delay phase. Conclusion: The MRI of the cryoablated renal tumour follows a typical evolutionary pattern. Advances in knowledge: Familiarity of practitioners with the normal post-cryoablation change of RCC on MRI can enable the early detection and prevention of tumour recurrence.

Management of rotator cuff calcific tendinosis guided by ultrasound elastography.

Background Ultrasound (US) elastography can provide information about the hardness of calcification and might help decide treatment strategy. The purpose of this study was to evaluate the hardness of the calcific area within rotator cuffs by US elastography as an aid for the selection of aspiration or fine‐needle repeated puncture for the treatment of rotator cuff calcific tendinosis. Methods This prospective study included 39 patients (32 males, 7 females; mean age, 52.9 years) who received US elastography and gray‐scale ultrasonography before US‐guided treatment for rotator cuff calcific tendinosis. The morphology of the calcifications was classified as arc, fragmented, nodular, and cystic types. US elastography using virtual touch imaging (acoustic radiation force impulse) technique was performed to examine the calcified region to obtain an elastogram that was graded dark, intermediate, or bright. The hardness of the calcifications were recorded, and graded as hard, sand‐like, or fluid‐like tactile patterns during the US‐guided treatment, and the tactile patterns were compared with the results of US elastography and gray‐scale ultrasonography. Results Though the morphologies of the calcifications were significantly related to the tactile pattern of the needle punctures (p < 0.001), gray‐scale US could not accurately demonstrate the hardness of the calcifications. With the aid of elastography, the fluid‐like tactile pattern could be predicted well as a nondark pattern by elastography (p < 0.001). Conclusion Ultrasound elastography is a useful modality for evaluation of rotator cuff calcific tendinosis, and as an aid to guide management. If elastography shows the calcified area as a non‐dark pattern, then fine‐needle aspiration should be performed.

Soft-tissue Tumor Differentiation Using 3D Power Doppler Ultrasonography With Echo-contrast Medium Injection

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.

Imaging Spectrum after Pancreas Transplantation with Enteric Drainage

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.

Sonographic presentations of metaplastic breast cancers

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.

Chronic musculoskeletal pain: Ultrasound guided pain control

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.