Michael S. Cronan

Ultrasonographic evaluation of diaphragmatic motion.

To evaluate the technical feasibility and utility of ultrasonography in the study of diaphragmatic motion at our institution.

Appearance of Solid Organ Injury with Contrast-Enhanced Sonography in Blunt Abdominal Trauma: Preliminary Experience

OBJECTIVE The purpose of this study was to compare the detection rate of injury and characterize imaging findings of contrast-enhanced sonography and non-contrast-enhanced sonography in the setting of confirmed solid organ injury. SUBJECTS AND METHODS This prospective study involved identifying hepatic, splenic, and renal injuries on contrast-enhanced CT. After injury identification, both non-contrast-enhanced sonography and contrast-enhanced sonography were performed to identify the possible injury and to analyze the appearance of the injury. The sonographic appearance of hepatic, splenic, and renal injuries was then analyzed, and the conspicuity of the injuries was graded on a scale from 0 (nonvisualization) to 3 (high visualization). RESULTS Non-contrast-enhanced sonography revealed 11 (50%) of 22 injuries, whereas contrast-enhanced sonography depicted 20 (91%) of 22 injuries. The average grade for conspicuity of injuries was increased from 0.67 to 2.33 for spleen injuries and from 1.0 to 2.2 for liver injuries comparing non-contrast-enhanced with contrast-enhanced sonography, respectively, on a scale from 0, being nonvisualization, to 3, being high visualization. The splenic injuries appeared hypoechoic with occasional areas of normal enhancing splenic tissue within the laceration with contrast-enhanced sonography. Different patterns were observed in liver injuries including a central hypoechoic region. In some liver injuries there was a surrounding hyperechoic region. CONCLUSION Contrast-enhanced sonography greatly enhances visualization of liver and spleen injuries compared with non-contrast-enhanced sonography. Solid organ injuries usually appeared hypoechoic on contrast-enhanced sonography, but often a hyperechoic region surrounding the injury also was identified with liver injuries.

Spinal Sonography and Magnetic Resonance Imaging in Patients with Repaired Myelomeningocele: Comparison of Modalities

The goals of this study were to evaluate the feasibility of using ultrasonography of the spine in the follow‐up evaluation of patients with repaired myelomeningocele at birth and to compare sonography with the accepted modality of magnetic resonance imaging. Over a period of 4 years we performed 165 sonographic studies in 101 patients; 107 sonographic studies had MR imaging results for comparison. We collected our data prospectively. The quality of the sonograms was good in 110 of 129 studies, acceptable in 17 of 129, and poor in two of 129. The sonographic examinations failed in 33 of 165 studies (20%). Concordant information was obtained between ultrasonography and magnetic resonance imaging in the following percentage of studies: level of the distal end of the cord in 82%, position of the cord in the canal in 59%, presence of hydromyelia in 63%, cord duplication in 96%, adhesions in 16%, intradural mass in 37%, cord measurements in 85%, and dural sac measurements in 83%. At the lumbosacral level, we saw no cord pulsation in 57% of the studies in patients with cord adhesions and in 20% of those without adhesions. At the lower thoracic level, we saw no pulsation in 35% of the studies in patients with cord adhesions and in 7% of those without adhesions. Postoperative studies of cord release surgery in eight patients showed varied findings. We conclude that in those patients who have a spinal defect or interlaminar space allowing proper visualization of the lumbosacral spinal canal, ultrasound can provide fairly similar information to that obtained with magnetic resonance imaging of that area with no need for sedation and at a reduced cost. Ultrasonography seems more sensitive than magnetic resonance imaging in the detection of cord adhesions, which is particularly relevant in the diagnosis of tethering.

A New Ultrasound Technique to Visualize the Proximal Fetal Cerebral Ventricle

In routine obstetric scanning of the fetal cranium, the near or proximal portion of the fetal cerebrum is obscured by reverberation caused by overlying cranium. A new technique is described in which the ultrasound probe is angled in relation to the bony calvarium to allow visualization of the more proximal fetal cerebrum, cerebral ventricle, and choroid plexus.

Reliability Assessment of Various Sonographic Techniques for Evaluating Carpal Tunnel Syndrome

The aim of this study was to determine the intra‐ and inter‐rater reliability of sonographic measurements of the median nerve cross‐sectional area in individuals with carpal tunnel syndrome and healthy control participants.

Ultrasonography: Not useful in detecting susceptibility to malignant hyperthermia

MH is a rare, potentially fatal complication of general anesthesia. Halothane‐caffeine contracture testing of a muscle biopsy is the only accepted diagnostic test for MH. A previous report indicated that ultrasonography may aid in diagnosis of MH. Using sonographic examination of the thigh and calf, we evaluated eight patients with proved susceptibility to MH and eight control patients. Two radiologists independently evaluated the sonograms for echogenicity and definition of fascial planes. We detected no consistent and reliable differences between control and MH patients. We conclude that, in our hands, ultrasonography is not useful in differentiating patients with MH from normal persons.

Practical Utility of Color Doppler Sonography in the Evaluation of Endometrial Pathology

The sonographic findings and corresponding pathology reports of 83 premenopausal and 55 postmenopausal women were retrospectively reviewed to evaluate the significance of color Doppler imaging in the evaluation of the endometrium. Premenopausal women had flow noted in the single malignancy case and in 16 of 21 (76%) polyps, with 7 polyps (33%) presenting as a vascular pedicle. In postmenopausal women, flow was seen in 3 of 5 (60%) malignancies and 5 of 9 (56%) polyps, with 2 polyps (22%) presenting as a vascular pedicle. Postmenopausal women with thin endometria had flow in 1 of 2 (50%) polyps, while those with thicker endometria had flow in 4 of 7 (56%) polyps and 3 of 5 (60%) malignancies. The data showed that color Doppler imaging was useful in detecting vascular pedicles in endometrial polyps, but it was not otherwise helpful as an independent predictor of malignancy.