James Pilcher

Infection after transrectal ultrasonography-guided prostate biopsy: increased relative risks after recent international travel or antibiotic use: RISK FACTORS FOR INFECTION AFTER PROSTATE BIOPSY

Study Type – Prognosis (case series)

Dynamic sentinel lymph node biopsy in patients with invasive squamous cell carcinoma of the penis: a prospective study of the long-term outcome of 500 inguinal basins assessed at a single institution.

BACKGROUND Dynamic sentinel node biopsy (DSNB) in combination with ultrasound scan (USS) has been the technique of choice at our centre since 2004 for the assessment of nonpalpable inguinal lymph nodes (cN0) in patients with squamous cell carcinoma of the penis (SCCp). Sensitivity and false-negative rates may vary depending on whether results are reported per patient or per node basin, and with or without USS. OBJECTIVE To determine the long-term outcome of patients undergoing DSNB and USS-guided fine-needle aspiration cytology (FNAC) in our cohort of newly diagnosed cN0 SCCp patients, as well as to analyse any variation in sensitivity of the procedure. DESIGN, SETTING, AND PARTICIPANTS A series of consecutive patients with newly diagnosed SCCp, over a 6-yr period (2004-2010), were analysed prospectively with a minimum follow-up period of 21 mo. All patients had definitive histology of ≥ T1G2 and nonpalpable nodes in one or both inguinal basins. Patients with persistent or untreated local disease were excluded from the study. INTERVENTION All eligible patients had DSNB and USS with or without FNAC of cN0 groins. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was no nodal disease recurrence on follow-up. The secondary end point was complications after DSNB. Sensitivity of the procedure was calculated per node basin, per patient, with DSNB alone, and with USS with DSNB combined. RESULTS AND LIMITATIONS Five hundred inguinal basins in 264 patients underwent USS with or without FNAC and DSNB. Seventy-three positive inguinal basins (14.6%) in 59 patients (22.3%) were identified. Four inguinal basins in four patients were confirmed false negative at 5, 8, 12, and 18 mo. Two inguinal basins had positive USS and FNAC and negative DSNB results. Sensitivity of DSNB with USS, with and without FNAC, per inguinal basin was 95% and per patient was 94%. Sensitivity of DSNB alone per inguinal basin and per patient was 92% and 91%, respectively. The DSNB morbidity rate was 7.6%. CONCLUSIONS DSNB in combination with USS has excellent performance characteristics to stage patients with cN0 SCCp, with a 5% false-negative rate per node basin and a 6% false-negative rate per patient.

The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy

BackgroundShoulder dysfunction is common and pathology of the rotator cuff tendons and subacromial bursa are considered to be a major cause of pain and morbidity. Although many hypotheses exist there is no definitive understanding as to the origin of the pain arising from these structures. Research investigations from other tendons have placed intra-tendinous neovascularity as a potential mechanism of pain production. The prevalence of neovascularity in patients with a clinical diagnosis of rotator cuff tendinopathy is unknown. As such the primary aim of this pilot study was to investigate if neovascularity could be identified and to determine the prevalence of neovascularity in the rotator cuff tendons and subacromial bursa in subjects with unilateral shoulder pain clinically assessed to be rotator cuff tendinopathy. The secondary aims were to investigate the association between the presence of neovascularity and pain, duration of symptoms, and, neovascularity and shoulder function.MethodsPatients with a clinical diagnosis of unilateral rotator cuff tendinopathy referred for a routine diagnostic ultrasound (US) scan in a major London teaching hospital formed the study population. At referral patients were provided with an information document. On the day of the scan (on average, at least one week later) the patients agreeing to participate were taken through the consent process and underwent an additional clinical examination prior to undergoing a bilateral grey scale and colour Doppler US examination (symptomatic and asymptomatic shoulder) using a Philips HDI 5000 Sono CT US machine. The ultrasound scans were performed by one of two radiologists who recorded their findings and the final assessment was made by a third radiologist blinded both to the clinical examination and the ultrasound examination. The findings of the radiologists who performed the scans and the blinded radiologist were compared and any disagreements were resolved by consensus.ResultsTwenty-six patients agreed to participate and formed the study population. Of these, 6 subjects were not included in the final assessment following the pre-scan clinical investigation. This is because one subject had complete cessation of symptoms between the time of the referral and entry into the trial. Another five had developed bilateral shoulder pain during the same period. The mean age of the 20 subjects forming the study population was 50.2 (range 32-69) years (SD = 10.9) and the mean duration of symptoms was 22.6 (range .75 to 132) months (SD = 40.1). Of the 20 subjects included in the formal analysis, 13 subjects (65%) demonstrated neovascularity in the symptomatic shoulder and 5 subjects (25%) demonstrated neovascularity in the asymptomatic shoulder. The subject withdrawn due to complete cessation of symptoms was not found to have neovascularity in either shoulder and of the 5 withdrawn due to bilateral symptoms; two subjects were found to have signs of bilateral neovascularity, one subject demonstrated neovascularity in one shoulder and two subjects in neither shoulder.ConclusionsThis study demonstrated that neovascularity does occur in subjects with a clinical diagnosis of rotator cuff tendinopathy and to a lesser extent in asymptomatic shoulders. In addition, the findings of this investigation did not identify an association between the presence of neovascularity; and pain, duration of symptoms or shoulder function. Future research is required to determine the relevance of these findings.

Portable ultrasonography and bladder volume accuracy--a comparative study using three-dimensional ultrasonography.

OBJECTIVES To compare the ultrasound bladder volume accuracy and level of agreement between two portable bladder scanners (Bladderscan and Bardscan) and a three-dimensional ultrasound (3D-US) system. METHODS A total of 50 healthy volunteers were scanned using the Bladderscan BVI 3000, Bardscan, and 3D-US system (HDI 4000), in random sequence. The BVI3000 is a dedicated bladder volume calculator, and the Bardscan combines real-time ultrasonography with bladder volume calculation. The ultrasound bladder volumes were compared with the voided volume measurements. The volunteers underwent repeat scanning after voiding, and those with a measurable residual volume were excluded from the final analysis. RESULTS A residual volume was detected in 16 subjects (32%). In the remaining 34 subjects, the mean voided volume +/- standard deviation was 252.9 +/- 167.4 mL (range 33 to 709). A significant correlation (P <0.001) was found between the voided and ultrasound volumes with all three methods (Bardscan, r = 0.97; Bladderscan, r = 0.98; and 3D-US system, r = 0.99). No significant differences were found between the voided volumes and the Bladderscan or 3D-US volumes; however, the Bardscan significantly underestimated the voided volume by a mean of 21.4 mL (t = 2.84, P = 0.0076). The Bland-Altman 95% limit of agreement between the voided and calculated volumes was -64.5 to 107.2 mL, -73.7 to 88.4 mL, and -28.9 to 40.0 mL for the Bardscan, Bladderscan, and 3D-US systems, respectively. CONCLUSIONS The results of our study have shown that although the Bardscan has the advantages of real-time scanning with portability and instantaneous volume calculation, it is not as accurate as the Bladderscan. The accuracy and level of clinical agreement was greatest when using the 3D-US system to calculate the bladder volume.

Small intestinal contrast ultrasonography for the detection of small bowel complications in Crohn's disease: correlation with intraoperative findings and magnetic resonance enterography.

In evaluating small bowel Crohns disease (CD), small intestine contrast‐enhanced ultrasonography (SICUS) is emerging as an alternative to magnetic resonance enterography (MRE). This retrospective study compared the diagnostic accuracy of SICUS and MRE with surgical findings, and their level of agreement.

Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn's disease: Comparative study from the UK

AIM To evaluate the usefulness of small intestine contrast-enhanced ultrasonography (SICUS) using an oral contrast agent in routine clinical practice by assessing the level of agreement with the established techniques, small bowel follow-through (SBFT) and computed tomography (CT), and diagnostic accuracy compared with the final diagnosis in the detection of small bowel Crohns disease (CD) and luminal complications in a regional centre. MATERIALS AND METHODS All symptomatic known or suspected cases of CD who underwent SICUS were retrospectively reviewed. The level of agreement between SICUS and SBFT, CT, histological findings, and C-reactive protein (CRP) level was assessed using kappa (κ) coefficient. Sensitivity was demonstrated using the final diagnosis as the reference standard defined by the outcome of clinical assessment, follow-up, and results of investigations other than SICUS. RESULTS One hundred and forty-three patients underwent SICUS of these 79 (55%) were female. Eighty-six (60%) were known to have CD and 57 (40%) had symptoms suggestive of intestinal disease with no previous diagnosis. Forty-six (55%) of the known CD patients had had at least one previous surgical resection. The sensitivity of SICUS in detecting active small bowel CD in known CD and undiagnosed cases was 93%. The kappa coefficient was 0.88 and 0.91 with SBFT and CT, respectively. SICUS detected nine patients who had one or more small bowel strictures and six patients with a fistula all detected by SBFT or CT. CONCLUSION SICUS is not only comparable to SBFT and CT but avoids radiation exposure and should be more widely adopted in the UK as a primary diagnostic procedure and to monitor disease complications in patients with CD.

Three-dimensional imaging in urology

internal motors that move the ultrasound transducer in a predetermined manner (usually a curved sweep), whilst the probe is kept fixed over the region of interest (e.g. rotational movement during prostatic 3D US). Non-mechanized systems impose no restrictions on probe movement, using acoustic, electromagnetic or optical positional orientation devices to register the coordinates of each US image recorded.

Current Role of Ultrasound in Small Bowel Imaging

Bowel ultrasound is cheap, relatively quick, allows dynamic evaluation of the bowel, has no radiation burden, is well tolerated by patients, and allows repeat imaging. Bowel ultrasound requires a systematic assessment of the entire bowel using high-frequency probes. In addition, hydrosonography and contrast-enhanced ultrasound may be performed. We present the normal sonographic appearances of large and small bowel and the sonographic appearances of acute appendicitis, Crohns disease, celiac disease, intussusception, infectious enteritis, intestinal tuberculosis, small bowel ileus and obstruction, small bowel ischemia, and malignant tumors.

Evaluation of the Accuracy of 3-Dimensional Ultrasonography of the Kidney Using an In Vitro Renal Model

Objective. Three‐dimensional ultrasonography (3DUS) has recently become a reality because of advances in ultrasound probes and machine processing ability. We have developed an anthropomorphic phantom of the human loin to assess both the accuracy of 3DUS of the kidney and its potential usefulness for training in ultrasonographically guided percutaneous renal intervention. Methods. The model was built with easily available and inexpensive materials such as agar and latex with known ultrasonographic properties. The accuracy of 2‐dimensional ultrasonography (2DUS) and 3DUS was assessed by measuring the dimensions of the pelvicalyceal system (PCS) ultrasonographically (pelvis width and calyx diameters) and then comparing these with measurements obtained at the time of construction. Radiology interventional trainees then punctured the PCS with 2DUS and 4‐dimensional ultrasonographic (real‐time/time‐resolved 3DUS) guidance and reported the phantoms performance. Results. The 3‐dimensional nature of the models PCS could be clearly visualized on 2DUS and 3DUS, and the scan characteristics were very similar to those in real life. Measurements using 3DUS proved to be closer to the true dimensions of the models PCS than those using 2DUS. The mean error percentage for 2DUS measurements was −10.2%, and that for 3DUS was −2.2% (P < 0.0001). Interventional trainees were satisfied with the “tissue feel” and level of difficulty posed on puncturing the phantom. Conclusions. Three‐dimensional ultrasonography proved to be more accurate than 2DUS for intrarenal measurements using this in vitro renal model. Three‐dimensional ultrasonography has the potential to ease diagnostic renal scanning with the ability to further scrutinize and postprocess the scanned volumes. The model was realistic in its anthropomorphic properties and simulated human tissue during puncture.

PWE-106 Small Intestine Ultrasonography With Oral Contrast (sicus) For The Detection Of Small Bowel Complications In Crohn’s Disease: Correlation With Intra-operative Findings

Introduction SICUS accurately assesses small bowel lesions in patients with Crohn’s disease (CD) without exposure to diagnostic medical radiation.1 Its role in identifying intra-abdominal complications associated with CD remains to be confirmed. The aim of this retrospective study was to compare the diagnostic sensitivity of SICUS with subsequent surgical findings. Methods Patients with CD evaluated by SICUS who subsequently required bowel resection within 6 months were identified. Radiological findings and operation notes were collated. The accuracy and agreement of SICUS to detect the site and length of strictures, fistulae, abscesses and mucosal thickening, was compared with surgical findings and assessed by kappa (κ) coefficient statistical analysis. Stricture lengths were compared using student’s t-test. CRP and platelet count were recorded within 2 weeks of SICUS and surgery as surrogate markers of disease activity. Results A total of 25 patients (12 male) with a mean age of 29.9 years were included in the study. Mean time from SICUS to respective bowel surgery was 91.5 days (Range 5–176). Ultrasonographic and surgical inter-rater agreement was good for the presence of strictures (κ=0.73, sensitivity and specificity both 88%), their number (κ=0.65, 95% CI: 0.31–0.96) and stricture site (κ =0.72, 95% CI: 0.44–1.00). Stricture length was 7.4 ± 1.5 cm identified at surgery vs. 5.8 ± 1.8 cm by SICUS (NS). Agreement was excellent for the presence of fistulae (κ = 0.82, sensitivity 86%, specificity 94%), location of fistula (κ=0.92, 95% CI: 0.76–1.00), presence of abscess (κ = 0.87, sensitivity 100%, specificity 95%) and its location (κ = 0.87, 95% CI: 0.63–1.00). Agreement was moderate for mucosal wall thickening (κ = 0.51, sensitivity 95%, specificity 50%). Markers of inflammation (CRP and platelet count) showed no significant difference at the time of SICUS and surgery. Conclusion SICUS accurately identifies small bowel complications in CD and offers an alternative in the pre-operative stage of CD complications. Its wider use should be adopted. Reference Chatu S, Pilcher J, Saxena SK, et al. Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn’s disease: comparative study from the UK. Clin Radiol 2012 Jun;67(6):553–9 Disclosure of Interest None Declared.