See-Ying Chiou

High-resolution Ultrasonography in Superficial Soft Tissue Tumors

Surgical removal and clinical follow-up of soft tissue masses are easily managed in clinical practice but are dependent on the experience of the clinician. Occasionally, however, a patient is referred from a local clinician to our clinic with an inoperable mass following a surgical procedure. We consider it important to fully understand the nature of the mass prior to surgery, thus avoiding unnecessary surgery in some cases. High-resolution ultrasonography has been widely applied in the musculoskeletal system over the past two decades and is very useful in evaluating the nature of superficial soft tissue masses. It enables the differentiation of benign and malignant masses and the detection of many different types of histology in superficial soft tissue masses. The purpose of this review is to demonstrate the characteristic findings of high-resolution ultrasonography and color Doppler ultrasonography in superficial soft tissue tumors.

Evaluation of Cortical Perfusion in Renal Transplants: Application of Quantified Power Doppler Ultrasonography

Perfusion of renal transplants may be altered by various pathological conditions. This study assessed cortical perfusion of renal transplants during acute rejection episodes using power Doppler quantification. Forty-eight renal transplant patients with clinical indications for biopsy were included in this study. Power Doppler ultrasonography (US) of these renal transplants was performed prior to biopsy. Power Doppler image intensity in the proximal outer cortex of renal transplants was quantified by image analysis software. The results of power Doppler quantification were compared with the clinical data and histological findings. Biopsies were classified into three groups based on Banff diagnostic categories: group 1 (no acute rejection; 26 patients), group 2 (acute cell-mediated rejection alone; 12 patients), and group 3 (acute antibody-mediated rejection with/or without acute cell-mediated rejection; 10 patients). The power Doppler intensity of the outer renal cortex was 1.98 +/- 1.50 dB for group 1, 1.38 +/- 0.86 dB for group 2, and 0.81 +/- 0.66 dB for group 3. Statistically, there was a significant difference between group 1 and group 3 (1.98 vs 0.81 dB, P = .01) but not between group 1 and group 2 (1.98 vs 1.38 dB, P = .34). In conclusion, the status of cortical perfusion of renal transplants can be determined noninvasively by quantified power Doppler US. Accordingly, acute antibody-mediated rejection is associated with significantly decreased cortical perfusion, which, we propose, is due to this distinct pathological process.

Clinical Significance of Ductal Dilatation on Breast Ultrasonogram

Background With the advent of high-resolution ultrasound (US), dilatation of the lactiferous ducts can be easily demonstrated at routine breast US examination. The purpose of this study was to prospectively evaluate the clinical significance of ductal dilatation detected on breast US study. Patients and Methods During a period of 12 months, we examined 16,336 nonlactating women referred for breast US; about 2.5% of them had a known history of nipple discharge. Routine whole breast US examinations were performed by using high-resolution US scanners. More attention was paid to detect and document the dilated ducts in the breasts. Among the 16,336 nonlactating women, 478 (2.9%) had duct dilatation (defined as duct diameter > 2.0 mm). Patients with dilated ducts were either followed-up for at least 2 years or were aspirated or biopsied according to their US findings. Results Of the 478 women with duct dilatation, 387 (81.0%) had no significant internal echoes in the dilated ducts, 48 (10.0%) had low-level internal echoes inside the ducts, and 39 (8.2%) had medium-level to relatively high-level internal echoes. Solid nodules in the ducts were demonstrated in 26 (5.4%) women, and calcified material in five (1.0%). For patients with intraductal echoes, US-guided aspiration or biopsy was performed to determine the duct contents; 18 of 26 intraductal nodules were shown to be intraductal papilloma cytologically and/or histopathologically, two were shown to be intraductal carcinoma in situ , and five were epithelial hyperplasia or atypical ductal hyperplasia. The majority of the other 61 women with internal echoes were found to have inspissated secretions (50/61, 82.0%), while the remaining 11 showed no cellular component inside, but the findings were inconclusive. Conclusion Multiple dilated ducts depicted on US are rarely associated with intraductal tumors ( p

Liposarcoma of the Spermatic Cord: A Report of Two Cases and a Review of the Literature

Extratesticular neoplasms, though rare, are clinically significant lesions that affect patients of all ages. Although ultrasound (US) is currently the imaging modality of choice for the detection and evaluation of intrascrotal tumor, there are only limited reports on the imaging findings, particularly on the US appearance of the intrascrotal liposarcoma. We report on the US features of two cases of spermatic cord liposarcoma, and discuss the role of US and other imaging modalities in the demonstration and diagnosis of this entity. The literature on spermatic cord liposarcoma was also reviewed.

B-flow Ultrasonography of Peripheral Vascular Diseases

B-flow ultrasonography (US) is a new US technology, which has recently been utilized for the investigation of vascular diseases. In this pictorial essay, we demonstrate the B-flow US imaging presentations of various peripheral vascular diseases, including diseases of the carotid artery, peripheral artery, peripheral vein, and hemodialysis fistula. B-flow US is superior in the depiction of complex hemodynamics in the blood spaces of peripheral vascular diseases. Discrimination between flowing blood and surrounding stationary structures (vessel wall, thrombus, hematoma, intimal flap, venous valve) can be made without difficulty by using B-flow US. Our experiences show that B-flow US is a useful technique in the diagnosis of peripheral vascular diseases.

Ultrasonography-guided Percutaneous Interventional Procedures of the Spleen

Since the introduction of real-time ultrasonography (US) to the medicine in late 1970s, the unique benefit of the real-time cross-sectional imaging has made US one of the most widely used imaging modalities to guide interventional procedures. Among the intra-abdominal solid organs, the spleen is the least common solid organ considered for interventional procedures. Although splenic puncture for splenoportography was performed as early as the 1950s and has had a low complication rate, traditionally a direct splenic puncture is still avoided due to the risk of hemorrhage or laceration. US-guided percutaneous drainage of splenic abscesses has been used as a safe alternative procedure for more than 20 years, however, only a few series reporting such an interventional procedure have been published. This review describes briefly the usefulness, technique, safety, and the outcome of US-guided interventional procedures of the spleen.

Demonstration of Ductal Carcinoma in situ with Microcalcifications in a Patient with Augmentation Mammoplasty by Free Silicone Injection

Free liquid silicone injections were used for breast augmentation in the 1950s and 1960s. Patients who received these breast silicone injections are now at the age of high breast cancer risk, but breast masses in such patients are difficult to detect by clinical examination and imaging studies. Ultrasonography may be affected by silicones, but lesions superficial to the silicones can still be detected. Here, we report one patient who received silicone injection 35 years ago when she was 18 years old. Ductal carcinoma in situ with clustered multiple microcalcifications was noted on ultrasound and confirmed by histopathologic examination. Surgery was performed and there was no evidence of recurrence 20 months after operation.

Osler-Weber-Rendu Disease: Transhepatic Portography Using Ultrasonic Contrast Agents to Demonstrate Intrahepatic Porto-systemic Shunts

While shunts between portal and hepatic veins in Osler-Weber-Rendu disease have rarely been demonstrated in the liver, these portohepatic venous shunts (PHVS) may be revealed by ultrasound. However, direct evidence of PHVS on ultrasound may not be convincing. In this report, we demonstrate PHVS using ultrasound-guided percutaneous transhepatic portography with ultrasonic contrast agent (USCA) injection. With this technique, the microbubble-based USCA was depicted to enter the hepatic vein by way of the shunts and then flow into the inferior vena cava. The shunts were confirmed by iodinated contrast venography via the same sheathed needle.