Munazza Anis

A Review of Sonographic Evaluation of Renal Transplant Complications

In this article, we present an overview of renal transplantation with its complications and discuss the abilities and limitations of ultrasound in evaluating these complications. We included renal transplants performed at our institution between 1993 and 2006 and gathered data on more than 1,000 patients who developed graft dysfunction. We analyzed the ultrasound findings in different posttransplant complications and compared our findings with those in published literature. We present this review article that elaborates and categorizes various transplant complications from an ultrasound perspective. Based on imaging evaluation, the complications of renal transplantation can be divided into four major categories: peri-renal, renal parenchymal, renal collecting system, and renal vascular complications. Common complications included acute tubular necrosis, graft rejection, drug nephrotoxicity, hematoma, lymphocele, urinoma, hydronephrosis, and vascular complications. Ultrasound has a key role in identification and management of most of these complications. However, some parenchymal complications may only be diagnosed on renal biopsy. Ultrasound is a very powerful screening tool to assess renal transplant dysfunction and has a primary role in early diagnosis and management of structural and vascular complications, which may need surgical intervention to save the graft.

Ovarian Cystic Lesions: A Current Approach to Diagnosis and Management

The primary imaging modality for evaluation of ovarian cystic lesions is pelvic ultrasonography. Most ovarian cysts are benign and demonstrate typical sonographic features that support benignity. However, some ovarian cystic lesions have indeterminate imaging features, and the approach to management varies. This article discusses how to recognize and diagnose different types of ovarian cystic lesions, including an approach to management. The learning objective is to recognize imaging features of ovarian cystic lesions.

Current Role of Ultrasound in Chronic Liver Disease: Surveillance, Diagnosis and Management of Hepatic Neoplasms

Ultrasound (US) has been used to evaluate liver disease for many decades. Despite certain inherent limitations in evaluating chronic liver disease on routine gray-scale US, it is still widely used for the initial evaluation in patients suspected of liver disease as well as for hepatocellular carcinoma (HCC) screening in patients with known cirrhosis. Due to recent advances in digital technology and US imaging software, various new computer protocols have been incorporated in the new US equipment. This in turn has resulted in a great improvement in image quality and image resolution. Consequently, the increased ability of US to better characterize the liver texture in general has enabled the sonographers to identify subtle changes in the liver texture and delineate smaller masses in the liver with greater success.

Imaging of Hepatocellular Carcinoma: Practical Guide to Differential Diagnosis

Hepatocellular carcinoma (HCC) is most commonly seen in patients with cirrhosis. Criteria for diagnosis include arterial-phase enhancement, venous-phase washout, and a capsule on delayed sequences. Tiny HCC are best detected with magnetic resonance imaging using the new hepatocyte-specific gadolinium agents; otherwise, short-term follow up versus biopsy is considered. Diffuse HCC can be difficult to diagnose because of the inherent heterogeneous hepatic parenchyma in cirrhosis, however, portal vein expansion due to thrombosis is a helpful sign.

Role of secretin-enhanced magnetic resonance cholangiopancreatography in the evaluation of patients following pancreatojejunostomy

Objective: This study was conducted to assess the role of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in the evaluation of patients following pancreatico-jejunal anatomosis. Materials and Methods: S-MRCP studies (n = 83) performed at Brigham and Womens Hospital between 1/2005 and 7/2005 were retrospectively reviewed. Among these, there were 13 patients (10 females, 3 males; mean age = 45 years, range = 18-74 years) who were evaluated with S-MRCP following pancreatojejunal anatomosis. Single-shot fast spin-echo T2-weighted thick slab dynamic MRCP images obtained before and every minute (for 10 min) after IV injection of secretin (2 mcg/kg body weight of SecreFloTM IV over 1 min) were reviewed retrospectively and independently by 3 readers. Image analysis included measurement of the main pancreatic duct (MPD) diameter and subjective assessment of the grade of visualization of the MPD remnant. The amount of jejunal fluid and visualization of the pancreatico-jejunal anatomosis pre-and post-secretin were also documented. Direct correlation with endoscopic retrograde cholangiopancreatography (ERCP) finding was available in six of the 13 cases. Results: The MPD diameter and MPD remnant visualization improved post-secretin for 1/3 readers. The number of pancreatico-jejunal anastomoses and the amount of jejunal fillings pre-and post-secretin was seen to improve significantly for 1 of the 3 readers. For Reader 1, the mean MPD diameter in the body of the pancreas, on the pre-and post-secretin image, was 3.2 ± 1.3 mm and 3.8 ± 1.9 mm, respectively. There was no statistical difference in the values pre- and post-secretin in the MPD diameter (P = 0.07), MPD visualization (P = 0.16) and the number of pancreatico-jejunal anastomoses seen (P = 0.125 5/13 pre- and 9/13 post-secretin). Statistical significance was seen in the amount of jejunal filling (P = 0.01) after secretin. For Reader 2, the MPD diameter pre-and post-secretin was 4 ± 2 and 3.9 ± 2.1 mm, respectively (P = 0.89). The MPD visualization (P = 0.19) and degree of jejunal filling (P = 0.7) did not improve significantly. There were 3/13 pancreatico-jejunostomy anastomoses seen pre- and 8/13 seen post-secretin (P = 0.06). The values for Reader 3 reached a statistical significance for the measurement of MPD (P = 0.032). In addition, MPD visualization (P = 0.038), the number of anastomoses seen (P = 0.016) and jejunal filling (P = 0.006) were also significantly improved. Conclusion: The addition of intravenous secretin to an MRCP study in the evaluation of patients following pancreatojejunal anastomosis does not significantly impact the visualization of the pancreatic duct. However, secretin may improve the assessment of the pancreatico-jejunal anastomosis.

Ultrasound evaluation of gallbladder dyskinesia: comparison of scintigraphy and dynamic 3D and 4D ultrasound techniques.

OBJECTIVE The purpose of this study was to determine the efficacy of 3D and 4D ultrasound in correlation with hepatoiminodiacetic acid (HIDA) scanning for calculating gallbladder ejection fraction (EF). SUBJECTS AND METHODS A prospective study was conducted with 40 adult patients with suspected gallbladder dyskinesia. Cholecystokinin-provoked (99m)Tc-HIDA scintigraphy was performed, and concurrent 3D and 4D ultrasound images of the gallbladder were obtained before cholecystokinin infusion and 20, 30, and 40 minutes after infusion. The EF values calculated from the ultrasound images and HIDA scan were compared. RESULTS The gallbladder EF values (mean ± standard error of the mean) calculated 20 minutes after cholecystokinin infusion from HIDA scans and 3D and 4D ultrasound images were 54.1% ± 5.0%, 58.9% ± 6.3%, and 62.8% ± 5.5%. Thirty minutes after infusion the EF values were 56.3% ± 4.7%, 56.9% ± 5.7%, and 59.1% ± 4.6%. The numbers of patients with an EF less than 50% were 14, 12, and 13, and the numbers with an EF less than 35% were 10, seven, and eight. For the patients with an EF less than 50%, the kappa agreement between HIDA scanning and 3D ultrasound was 0.89 (95% CI, 0.73-1.00), between HIDA scanning and 4D ultrasound was 0.83 (95% CI, 0.65-1.00), and between 3D and 4D ultrasound was 0.83 (95% CI, 0.64-1.00). CONCLUSION Both 3D and 4D ultrasound techniques correlate well with HIDA scanning for calculating gallbladder EF in patients with suspected biliary dyskinesia.

Can the smallest depth of ascitic fluid on sonograms predict the amount of drainable fluid

To investigate the correlation between the ‘smallest fluid depth’ (SFD) measured on sonography (US) at the ‘paracentesis pocket’ with the amount of fluid drained in patients referred for US‐guided large‐volume paracentesis.

Imaging of Hepatocellular Carcinoma: New Approaches to Diagnosis

The currently accepted major diagnostic criteria for identifying hepatocellular carcinoma (HCC) on dynamic cross-sectional imaging consist of diffuse arterial phase hyperenhancement within the lesion, portal venous or delayed phase washout, and the presence and appearance of a capsule; also included in this criteria is interval threshold growth. Ancillary features such as intralesional fat, blood products, and mosaic architecture also favor a diagnosis of HCC. Tumor in a portal or hepatic vein is a definitive finding for an HCC even if a parenchymal mass is not clearly seen.

Late Occurring Ectopic Pregnancy in a Posthysterectomy Patient

The incidence of ectopic pregnancy after hysterectomy is extremely rare with only 56 cases reported in the medical literature. Due to its rare occurrence, this diagnosis may not be initially considered when such a patient presents with abdominopelvic pain. It is an important diagnosis to keep in mind since a delay in diagnosis may lead to death. The case presented below describes this extremely unusual diagnosis of an ectopic pregnancy which occurred six years after a supracervical hysterectomy.

MRI of Adrenal Masses

The adrenal glands are paired retroperitoneal endocrine glands composed of an outer cortex and an inner medulla.MRI provides comprehensive, reliable evaluation of the adrenal glands.1 It provides excellent soft tissue characterization, in addition to the fact that it does not require ionizing radiation and is not operator dependent. Moreover, rapid breath-hold MR sequences have shortened the examination times, thus improving patient compliance and image quality.MRI (1.5 T or 3 T) with phased array surface coils provides better signal-to-noise and contrast-to-noise ratios, thereby improving lesion detection in comparison with the body coils, which surround the bore of the MR scanner. Surface coil respiratory ghost artifact can be minimized by achieving a tight grip, using breath-hold sequences, or using fat saturation.