Editorial

In this issue of Ultrasound we present a review article, an article on original scientific technique, three articles under the category of original research and two interesting case reports. Besides these we have the usual section on ‘Echoes' written by Hazel Edwards.

Dendas and colleagues present what appears to be the largest review of cases of heterotopic interstitial pregnancy. The trigger for their review seems to be their own encounter with a similar case. Their review once again identifies the difficulty in diagnosing interstitial pregnancy particularly when associated simultaneously with another pregnancy. More than a third of such cases in their review came to light following rupture of uterine cornu. Presence of historical risk factors reminds us of the value of good history taking and being ‘ectopic minded’ in order to consider a diagnosis of ectopic gestation. In such cases, both the pregnancies are at risk of being lost, although luckily Dendas's case resulted in live birth of the intra-uterine pregnancy.

Paquette et al. elucidate the role of a nerve phantom model to assess its longitudinal excursion in their original work carried out in vitro. They reasoned that quantitative ultrasound imaging (QUI) may be used in clinical settings to measure the neuro-mechanical properties of the peripheral nerves such as their capability to glide in response to body segment movement. They refer to evidence which suggests that impaired median nerve longitudinal excursion is associated with carpal tunnel syndrome. Comparing QUI system with a 3D motion analysis system, Paquette’s team found satisfactory association and agreement between the two methods. They conclude that QUI is an accurate method to assess the longitudinal excursion of an in vitro nerve phantom model. For in vivo application and practical implementation, their method should form a basis for future research protocols investigating the neuro-mechanical properties of peripheral nerves.

Turkay and colleagues report on their original work utilising the relatively new technology of shear wave elastography (SWE) in the diagnosis of erectile dysfunction of penis. They compare their findings in a group of healthy volunteers with a group with erectile dysfunction. Comparison of SWE measurements in the two groups revealed statistically significant difference and demonstrated a specificity of over 94% in the diagnosis of erectile dysfunction. It is important to note that the difference in age among the two groups were not statistically significant. Although in this study histological confirmation was not available for those with erectile dysfunction, this new technique seems to hold promise as an important adjunct in the investigative work up for erectile dysfunction.

Fagerquist’s team of researchers report on a new technique of calculating fetal urinary bladder volume utilising 3D ultrasound scan images. Implementing their method of sum-of-cylinders and comparing it with a more traditional method, they demonstrate that the sum-of-cylinders method produced a much lower standard deviation amongst a series of volumes calculated by the same observer, implying consistency of their method. They mention the limitations of their study which includes an upper limit of applicability of the fetal bladder volume which is lower than in previously reported study. Bladder volume is a function of urine production by the fetus and is related to the amount of blood flow in the renal arteries which in turn is a function of fetal well-being. This work by Fagerquist should pave the way for a bigger trial with larger number of fetuses at each and varying gestational ages through pregnancy to see whether this promising new method is useful in practice.

Alerhand et al. reviewed 1411 cases of children affected with appendicitis with a view to exploring the utility of an initial ultrasound scan in diagnosing appendiceal perforation. They compared, ultrasound scan (USS) as the initial investigation versus computerised tomography (CT) scan as the initial investigation and also USS only versus USS followed by CT. They found that an initial USS does not confer any disadvantage due to increased risk of appendiceal perforation. In the backdrop of modern day trends of using CT scan for such problems, Alerhand’s study reminds us that apart from avoiding ionizing radiation USS when used judiciously, especially in younger age group may be as good as CT scan in diagnosing appendiceal perforation. However, we need to remember that all the associated drawbacks of a retrospective review may apply to their study.

We include two unusual case reports in this issue. Neufeld and colleagues report an interesting case of detection of splenic tissue in a previously splenectomised woman’s kidney. This is likely to have resulted from autotransplantation instigated by her previous surgical operation. Secondly, in a case of polyorchidism, Rafailidis et al. highlight the role of contrast-enhanced ultrasonography in diagnosis. The colour photograph included here brings to life the findings in this case.

We also include a book review in this issue. The editorial responsibility for this book review was carried out by former editor-in-chief, Kevin Martin and I remain thankful to him for this work.