Rong Tu

Role of ultrasound in the diagnosis of common soft tissue lesions of the limbs.

Objective The objective of this study was to investigate the role of ultrasound in the diagnosis of the soft tissue lesions of the limbs. Methods Database of the soft tissue lesions of the limbs were reviewed retrospectively. All lesions had been confirmed by histopathology after surgical removal or biopsy. Ultrasound examination of the patients was performed by 4 sonologists with 9 to 22 years of experience, and the results were reviewed by 2 sonologists in panel. Categories and characteristics of some soft tissue lesions of the limbs were studied. Concordance rate was calculated, and reasons of misdiagnosis were analyzed. Results The patients consisted of 224 males and 173 females, and the age range was 6 months to 74 years (mean, 29.1 ± 27.3 years). The soft tissue lesions of the limbs included granuloma, inflammatory lesions, hematoma, hemangioma, neurofibroma, lipofibromatous hamartoma, fibrosarcoma, lymphangioma, liposarcoma, Baker cyst, epidermoid cyst, angiolipoma, fibrolipoma, malignant schwannoma, dermoid cyst, and intramuscular myoma. Fibrous tumor, lipoma, and hemangioma are of higher proportion. Baker cyst and neurofibroma were more often diagnosed correctly. Malignant lesions liposarcoma and malignant schwannoma were all misdiagnosed. A large number of misdiagnosed lesions were misdiagnosed as fibroma or lipoma. The overall concordance rate of sonographic diagnosis was 57.7%. Conclusions Of the soft tissue lesions of the limbs, Baker cyst and neurofibroma are more often diagnosed correctly, and definitive diagnosis of other lesions is challenging. The overall concordance rate of sonographic diagnosis is not satisfactory.

Impact of variations in fatty liver on sonographic detection of focal hepatic lesions originally identified by CT

Purpose: The aim of this study was to investigate the influence of variations in fatty liver on the ultrasonographic detection of focal liver lesions. Methods: A total of 229 patients with varying degrees of fatty liver and focal liver lesions and 200 patients with focal liver lesions but no fatty liver were randomly selected for inclusion in groups I and II, respectively. Findings of focal liver lesions identified on computed tomography were taken as the reference, and findings on ultrasonography were compared with them. Results: The number of focal liver lesions in groups I and II were 501 and 413, respectively. The ultrasonographic detection rates of focal liver lesions in groups I and II were 86.8% (435/501) and 94.2% (389/413), respectively. Comparison of the detection of the focal lesions between patients with and without fatty liver or different grades of fatty liver were as follows: mild fatty liver (162/177) vs. liver without fat infiltration (389/413) (P=0.277); mild fatty liver (162/177) vs. moderate fatty liver (190/212) (P=0.604); mild fatty liver (162/177) vs. severe fatty liver (83/112) (P<0.001); moderate fatty liver (190/212) vs. liver without fat infiltration (389/413) (P=0.051); moderate fatty liver (190/212) vs. severe fatty liver (83/112) (P<0.001); severe fatty liver (83/112) vs. liver without fat infiltration (389/413) (P<0.001); and fatty liver (435/501) vs. liver without fat infiltration (389/413) (P<0.001). Conclusion: Mild and moderate fatty liver are not significantly associated with the visualization of the lesion, while severe fatty liver usually impairs the detection of focal lesions in the liver. If a patient with severe fatty liver is suspected to have a liver tumor, ultrasonography should only be chosen cautiously in case of a missed diagnosis.

Anatomical variation of the liver with elongated left lobe may be a trap forthe ultrasound detection of focal liver lesion

AIMS The aim of this study was to evaluate the impact of anatomical variations of the elongated left lobe of the liver on the ultrasound detection of focal liver lesions. MATERIALS AND METHODS We evaluated, by ultrasonography (US), 296 patients with elongated left lobe of the liver and 30 patients with focal lesions in the normal length left lobe of the liver. Those patients had undergone prior computed tomography (CT) evaluation. RESULTS Of the 296 patients evaluated, 34 patients had focal lesions (the size range 11- 20 mm) in the distal region of the elongated left lobe of the liver, and none of the lesions was visualized at US examination (p<0.001). All the focal lesions in the normal length left lobe of the liver of the 30 patients were visualized by US without significant difference between the dimensions established by CT and US (p=0.136). CONCLUSION Focal lesions in the distal region of elongated left lobe of the liver are difficult to be detected by conventional US examination and the main reason is the impact of anatomical localization on the examination protocol.

Focal Fatty Sparing Usually Does Not Arise in Preexisting Nonalcoholic Diffuse Homogeneous Fatty Liver

The purpose of this study was to investigate whether focal fatty sparing can arise in preexisting nonalcoholic diffuse homogeneous fatty liver and its clinical implications.

Hyperechoic and hypoechoic hepatic hemangiomas smaller than 3 cm seldom coexist.

Purpose The purpose of this study was to determine whether hyperechoic and hypoechoic hepatic hemangiomas coexist. Methods Archives of 456 patients with multiple smaller (⩽3 cm) hepatic hemangiomas were reviewed, including sex, age, imaging study (ultrasound [US], computed tomography [CT], and magnetic resonance imaging [MRI]), follow-up, and laboratory test. Patients with chronic liver disease or other malignancy and diameter of lesion larger than 3 cm were excluded. The mean age of the patients was 41.8 ± 13.9 years (range, 18–78 years). The liver was observed with US; undetermined cases were evaluated by using CT and/or MRI. The follow-up time was from 35 to 39 months (mean, 36.3 months). Echo patterns, patterns of enhancement on CT and MRI, and associated findings of the hepatic hemangiomas were studied. Results The number of hemangiomas was from 2 to 6, including 154 patients with 2 lesions, 196 patients with 3 lesions, 78 patients with 4 lesions, 18 patients with 5 lesions, and 10 patients with 6 lesions. Among them, hyperechoic accounts for 71.93% (328/456), hypoechoic 27.85% (127/456), and hyperechoic and hypoechoic coexistence 0.22% (1/456). There were significant differences of distribution between the hyperechoic and hypoechoic coexistence and other echo patterns (all P < 0.001). Diameter of the hemangioma was from 8.6 and 30.0 mm (15.5 ± 4.9 mm). Conclusions Hyperechoic and hypoechoic hemangiomas rarely coexist in the liver. In the event that hypoechoic and hyperechoic lesions are simultaneously found in the liver, CT, MRI, or contrast-enhanced US should be performed for a definitive diagnosis.

Characteristics suggestive of focal Fatty sparing from liver malignancy on ultrasound in liver screening.

Objective The objective of this study was to determine whether there are ultrasound characteristics that can be used to differentiate focal fatty sparing (FFS) from hepatocellular carcinoma and other liver malignancies in liver screening. Methods Data of patients with FFS found at ultrasound were reviewed, 136 patients with FFS were included, and 112 patients with hepatocellular carcinoma and 65 patients with liver metastatic tumor (173 tumors) were selected as control group. Ultrasound and color Doppler characteristics of FFS and liver malignancies were studied. Some characteristics drawn from this study were used as reference to validate the liver malignancies and FFS, and sensitivity, specificity, and positive and negative predictive values were calculated. Results Hyperechogenicity, isoechogenicity, heterogeneous echotexture, posterior acoustic shadowing, halo, hypervasculature presented exclusively in liver malignancies, posterior acoustic enhancement presented predominantly in liver malignancies, irregularly shaped morphology presented exclusively in FFS, arterial velocity, and maximal size of liver malignancies were significantly higher than those of FFS (P < 0.001). Halo presented in 109 of 285 liver malignancies (38.2%), but was absent in FFS (P < 0.001). The overall sensitivity, specificity, and positive and negative predictive values were 94.38%, 90.44%, and 95.39% and 88.49%, respectively. Conclusions Combination of hyperechogenicity, isoechogenicity, heterogeneous echotexture, posterior acoustic shadowing, posterior acoustic enhancement, halo appearance, and hypervascularity with high-speed artery has high sensitivity, specificity, and positive and negative predictive values for distinguishing liver malignancy and FFS.

Findings and Implications of Focal Fatty Sparing of the Liver at Follow-up A Preliminary Study Based on Sonography, Computed Tomography, and Magnetic Resonance Imaging

The purpose of this study was to investigate the stability of focal fatty sparing of the liver and its clinical implications.

Recognition and Application of the Rectangular Sonographic Appearance of the Urinary Bladder

The purpose of this study was to investigate the rectangular sonographic appearance of the urinary bladder and its application.