Sharon R. Segal

Sonographically guided renal mass biopsy: indications and efficacy.

To review the clinical indications, pathologic results, and success rate of all our sonographically guided solid renal mass biopsies over a 5‐year period.

A Novel Microvascular Flow Technique: Initial Results in Thyroids.

Abstract To evaluate the flow imaging capabilities of a new prototype ultrasound (US) image processing technique (superb micro-vascular imaging [SMI]; Toshiba Medical Systems, Tokyo, Japan) for depiction of microvascular flow in normal thyroid tissue and thyroid nodules compared with standard color and power Doppler US imaging. Ten healthy volunteers and 22 patients, with a total of 25 thyroid nodules, scheduled for US-guided fine needle aspiration were enrolled in this prospective study. Subjects underwent US examination consisting of grayscale, color and power Doppler imaging (CDI and PDI) followed by color and monochrome SMI and pulsed Doppler. SMI is a novel, microvascular flow imaging mode implemented on the Aplio 500 US system (Toshiba). SMI uses advanced clutter suppression to extract flow signals from large to small vessels and depicts this information at high frame rates as a color overlay image or as a monochrome map of flow. Two radiologists independently scored still images and digital clips for overall flow detection, vessel branching details and noise on a visual-analog scale of 1 (worst) to 10 (best). For the volunteers SMI visualized microvasculature with significantly lower velocity than CDI and PDI (P < 0.012). In all thyroid nodules, SMI demonstrated microvascular flow with significantly higher image scores and provided better depiction of the vessel branching details compared with CDI and PDI (P < 0.0001). Clutter noise was significantly higher in monochrome SMI mode than in the other modes, including color SMI (P < 0.001). The novel SMI mode consistently improved the depiction of thyroid microvascular flow compared with standard CDI and PDI.

Laparoscopic liver sonography: preliminary experience in liver metastases compared with CT portography.

This study evaluated the ability of laparoscopic ultrasonography to detect, localize, and characterize focal liver masses. Laparoscopic ultrasonography and CT portography of the liver were performed in 13 patients with known or suspected malignancy. Laparoscopic ultrasonography directly influenced surgical management in four (31%) cases; three by detection of small focal masses and one by exclusion of masses suspected on CT portography. Laparoscopic ultrasonography provided guidance for biopsy or added important anatomic information in three cases. Laparoscopic ultrasonography was complementary to CT portography but added no additional information in three cases, and it failed to provide any information in two cases. Laparoscopic ultrasonography was falsely negative in one case. In this preliminary series, laparoscopic ultrasonography assisted surgeons in critical decision‐making by either providing important new information, clarifying questionable areas, or complementing CT portography.

Intraoperative sonographic localization of breast masses: success with specimen sonography and surgical bed sonography to confirm excision.

To assess the use of intraoperative sonography for localization of breast masses at excisional biopsy, with specimen and surgical bed sonography to confirm excision.

Microvascular blood flow in the thyroid: Preliminary results with a novel imaging technique

Nodules in the thyroid are present in 13-76 % of ultrasound (US) imaging evaluations; although only 4-15 % are malignant. A better understanding of thyroid nodule vascularity might be clinically helpful and the purpose of this study was thus to determine the flow imaging capabilities of a new prototype US image processing technique (SMI; Toshiba Medical Systems, Tokyo, Japan) for the depiction of microvascular flow in normal thyroid tissue and thyroid nodules compared to standard color and power Doppler imaging (CDI and PDI). SMI is a novel, microvascular flow imaging mode implemented on the Aplio 500 scanner (Toshiba). By analyzing clutter motion and using a new adaptive algorithm to identify and remove tissue motion SMI is designed to improve the visualization of microvascular blood flow. SMI depicts this information as a color overlay or as a monochrome map of flow. Ten healthy volunteers and 22 patients, with 25 thyroid nodules, were studied. Subjects underwent a thyroid US examination consisting of grayscale US, CDI and PDI followed by color and monochrome SMI. In the volunteers, pulsed Doppler guided by the 4 flow modes determined the lowest velocity measurable within the normal thyroid. For the patient data, 2 radiologists independently scored overall flow detection, vessel branching and noise on a visual analog scale of 1 (worst) to 10 (best). In the volunteers color and monochrome SMI captured microvasculature with lower velocities than CDI and PDI (2.2 ± 0.35 and 2.1 ± 0.32 cm/s vs. 2.6 ± 0.44 and 2.8 ± 0.77 cm/s; p <; 0.012). For all 25 nodules both readers found that color and monochrome SMI showed more microvascular flow and provided better depiction of the vessel branching compared to CDI and PDI (p <; 0.0001). Clutter noise was significantly higher in the monochrome SMI mode than in the other 3 modes (p <; 0.001). Consequently, initial results indicate that SMI can depict more detailed peri- and intra-nodular thyroid microvascular flow than CDI and PDI.