Kazimierz Szopiński

Gray-scale three-dimensional sonography of thyroid nodules: feasibility of the method and preliminary studies

The aim of the study was differential evaluation of new and classical sonographic features of benign thyroid nodules and thyroid cancer with three-dimensional gray-scale sonography and evaluation of the effectiveness of the thin-slice surface rendered images in comparison with multiplanar reformation (MPR) presentation. Fifty-four thyroid nodules were interactively evaluated with thin-slice smooth surface rendering: shape in the c-plane (parallel to the probe) and evaluation of echogenicity, margins and calcification/microcalcification-like echogenic foci in the a-plane (plane of the probe). Evaluation of the level of agreement in readers’ interpretation and between sonographic techniques was performed using the κ statistic. Surface rendering permitted visualization of the shape of the nodule in the c-plane in all cases, in contrast to only up to 48% of cases in MPR evaluation. Lobulated nodule shape in the c-plane was 82–100% sensitive and 47–53% specific in diagnosis of carcinoma. Surface rendered images showed more calcification/microcalcification-like echogenic foci than MPR ones. The level of agreement between the observers in the evaluation of features of thyroid nodules and the agreement between features of thyroid nodules on MPR and surface-rendered images showed at least moderate reproducibility (κ≥0.41). Three-dimensional thin-slice surface rendering sonography appears to be a feasible and effective method for thyroid nodule evaluation.

Value of modern sonography in the assessment of meniscal lesions

The aim of this prospective study was to assess the accuracy of modern ultrasonography in diagnostic imaging of meniscal tears. One hundred and sixty menisci were evaluated in 80 patients (42 females, 38 males, mean age=36.2 years, range=16-70 years). Inclusion criteria for the study were twofold: clinical suspicion of meniscal injury and clinical indication for arthroscopy. Knee examination was performed with the Voluson 730 Expert ultrasound system (General Electric). After sonographic examination, all patients underwent arthroscopic procedures within 1-4 days. The final diagnosis of meniscal tears was taken from surgical reports. The overall sensitivity, specificity, positive predictive value and negative predictive value of sonographic examination in the assessment of meniscal tears amounted to 85.4%, 85.7%, 67.3% and 94.4%, respectively. The statistical parameters were not statistically different in medial and lateral menisci. Age, sex, body mass index (BMI), weight, physical activity, mechanism on injury, and time lapse from injury did not have a statistically significant impact on the usefulness of ultrasonography. The highest sensitivity (>90%) was obtained in medial menisci and in patients with a BMI>25. The highest specificity (>90%) was obtained in lateral menisci, in patients after twisting injuries, in sports injuries, and in recent injuries (time lapse from the injury <1 month). The positive predictive value (PPV) of sonographic examination was higher than 90% only in recent injuries (<1 month), however, the negative predictive value of ultrasound is high, being less than 90% in males with lesions of lateral menisci and in sequelae of sports injuries.

Safety of sonographically guided aspiration of intramuscular, bursal, articular and subcutaneous hematomas

OBJECTIVE To evaluate the safety and efficacy of sonographically guided aspiration of intramuscular, bursal and subcutaneous hematomas. MATERIALS AND METHODS One hundred eleven interventions were performed in 75 patients at a single institution from January 2005 to December 2009. In all cases the target of interest was identified with ultrasonography. RESULTS Ninety-six procedures (87.3%) were successful, 14 procedures (12.7%) were unsuccessful due to excessive density and/or viscosity of the content. No significant complications were encountered during or immediately after any procedure. Clinical follow-up records were available for 73 (75%) procedures in 45 (66%) patients, 30 patients did not return for follow-up after hematoma evacuation. No septic or hemorrhagic complications or cases of neurovascular compromise were recorded. CONCLUSIONS Sonographically guided hematoma evacuation is a safe procedure. However, the proportion of unsuccessful evacuations and hematoma recurrence is substantial.

The prevalence of pulp stones in historical populations from the middle euphrates valley (Syria)

There are many reports in the literature concerning pulp stones in contemporary living populations, but there are no descriptions of cases of pulp stones and their prevalence in populations of the past. Here we present a study of pulp stones in a series of archaeologically derived samples from the Middle Euphrates Valley (Syria) obtained from two sites: Terqa and Tell Masaikh. The specimens were assigned to five periods: Early Bronze (2650-2350 BC); Middle Bronze (2200-1700 BC); late Roman (AD 200-400); Islamic (AD 600-1200); and Modern Islamic (AD 1850-1950). A total of 529 teeth representing 117 adult individuals of both sexes were examined. Pulp stones were identified by X-ray and 10 selected specimens were sectioned for histological study. Pulp stones were found in 99 of 117 individuals (85%) and in 271 of 529 (51%) teeth. Pulp stone prevalence was found to increase with age, for individuals of older age classes have more pulp stones than younger individuals. Intriguingly, the prevalence of single pulp stones was higher among older individuals (36-45, >46), while younger individuals (17-25, 26-35) more often possessed multiple stones. Individuals with moderate to highly advanced dental wear have pulp stones significantly more often than individuals whose tooth wear is limited to invisible or very small facets. Though there is no statistical significance in the prevalence of pulp stones across chronological periods, it appears that a high level of calcium in the diet is accompanied by a greater prevalence of pulp stones.

Adrenal ganglioneuroblastoma in pregnant woman: Diagnosis with three-dimensional ultrasound

Abstract. The diagnostic approach for evaluation of adrenal tumour in pregnant women is a problem. This article presents the multifactorial diagnosis of rare, incidentally detected massive adrenal tumour with 2D and 3D US. Grey-scale 2D and 3D US with tissue harmonic imaging showed inhomogeneous, encapsulated, solid tumour of the right adrenal region. Three-dimensional colour Doppler and power Doppler studies showed ample neovascularization in the tumour and the adrenal vein draining to the inferior vena cava similarly to angiographic studies performed in the past.

Visibility of dental pulp spaces in dental ultrasound.

The purpose of this study was to assess the feasibility of dental ultrasound with conventional sonographic equipment. The teeth of three adult volunteers who had cone beam CT examinations performed previously with clinical indications and one extracted tooth were examined using linear and compact (hockey stick) sonographic probes. The sonographic images were compared with cone beam CT images reconstructed accordingly. Dental pulp spaces were demonstrated in all teeth not covered with prosthetic crowns. The dentin and pulp were best visualized at the level of the neck of the teeth. The dentin was hypoechoic, and the superficial layer comprising the cementum and the pulp spaces were hyperechoic. Dental ultrasound is feasible with general purpose sonographic machines. The buccal surfaces of all teeth are accessible with a compact (hockey stick) probe. Visualization and differentiation of dental pulp spaces, dentin and the superficial layer comprising cementum is possible in the portions of teeth not covered by the alveolar bone or prosthetic crowns. The dental pulp spaces are best seen at the level of the tooth neck. Pulp and endodontic fillings can be distinguished on ultrasound.

Traumatic detachment of the inferior angle of the scapula in a 5-year-old boy—a sonographic diagnosis

A complete slip of the cartilage of the inferior angle of the scapula was diagnosed in a 5-year-old boy who fell inside a wooden construction at a kindergarten playground. Radiographs of the scapula were normal, and ultrasound demonstrated complete cartilage detachment, which was displaced deep and laterally. Computed tomography (CT) additionally demonstrated a thin rim of bone displaced along with the detached cartilage. Radiologic findings were confirmed during surgery. We report what we believe to be the first published case of traumatic detachment of the cartilaginous lower angle of the scapula in a child demonstrated by ultrasound.

Interposition of the transverse ligament of the knee into a fracture of the tibial plateau: a case report

Interposition of the transverse ligament of the knee between fragments of an intercondylar eminence fracture was diagnosed using magnetic resonance imaging (MRI) in a 11-year-old boy after a sports injury. The interposition was confirmed and corrected during arthroscopy. We report what we believe to be the first published case of isolated interposition of the transverse ligament in a minimally displaced fracture of the tibial eminence.

Stroke Tissue Pattern Recognition Based on CT Texture Analysis

The main objective of this paper is a texture-based solution to the problem of acute stroke tissue recognition on computed tomography images. Our proposed method of early stroke indication was based on two fundamental steps: (i) segmentation of potential areas with distorted brain tissue (selection of regions of interest), and (ii) acute stroke tissue recognition by extracting and then classifying a set of well-differentiating features. The proposed solution used various numerical image descriptors determined in several image transformation domains: 2D Fourier domain, polar 2D Fourier domain, and multiscale domains (i.e., wavelet, complex wavelet, and contourlet domain). The obtained results indicate the possibility of relatively effective detection of early stroke symptoms in CT images. Selected normal or pathological blocks were classified by LogitBoost with the accuracy close to 75 % with the use of our adjusted cross-validation procedure.