Journal of Diagnostic Medical Sonography

Prostate cancer is a common cause of cancer-related death of men in the United States. The purpose of this review is to compare the validity of transrectal ultrasound–guided systemic biopsy with contrast-enhanced transrectal ultrasound–guided systemic biopsy and transrectal elastography–guided systemic biopsy for the detection of prostate cancer. Adding contrast-enhanced or transrectal elastography core targeting to transrectal ultrasound–guided biopsy is a feasible approach to increase detection rates of higher-grade prostate cancers. Because contrast-enhanced imaging of the prostate is not approved for use in the United States, elastography is the most effective sonographic solution to improve prostate cancer detection with current screening techniques.

Tissue Doppler imaging, left ventricular color M-mode velocity propagation, and deformation imaging techniques from the medical literature were critically reviewed. The review was undertaken to evaluate the accuracy, reproducibility, and clinical efficiency of echocardiographic technologies for image acquisition and data analysis in assessing pediatric diastolic function. Tissue Doppler imaging, velocity propagation, and deformation imaging all show low variability and high reproducibility and specificity. Age, growth, heart rate, morphology, and sonographic technique affect some pediatric echocardiographic indices more than others; therefore, each should not be solely relied on. Their complementary diagnostic information should be evaluated collectively as a complete echocardiographic examination by expertly trained medical professionals.

The objective of this study was to determine if a relationship exists between sonographic pathological findings of the ankle/foot and self-reported ankle/foot pain. Symptomatic and asymptomatic participants were recruited and evaluated using sonographic imaging of the ankle and foot bilaterally. Participants also completed the Short Form<@150>12 (SF-12, a national physical and mental health scoring system), a visual analog scale (VAS) for pain, and the Victorian Institute of Sports Assessment–Achilles (VISA-A, a scoring system for Achilles tendon abnormalities), as well as provided a health history and demographic information. Twenty-five participants were evaluated. Symptomatic participants had below average physical SF-12 scores (mean [SD], 48.3 [7.3]), while asymptomatic patients had above-average physical SF-12 scores (54.9 [4.0]). Painful right ankle and/or foot were significantly associated with SF-12 physical health (R² = 0.2, P < .03) and VISA-A (R² = 0.6, P < .001) scores. Painful left ankle/foot was associated with only VISA-A (R² = 0.5, P < .003). The modified D’Agostino scores for positive sonographic evidence of pathology were statistically linked to painful right (P < .02) and left ankle/foot (P < .04). The combination of SF-12 physical health score, palpable myofascial trigger points (MTrPs), and MTrPs sonographically visualized were statistically associated with the VAS for pain (P < .02). In conclusion, sonography of the foot/ankle combined with self-reported data could aid in the holistic evaluation of ankle/foot pain.

Because of the typical sonographic appearances of many salivary gland masses, as well as the normal appearance and anatomy of the glands, differentiation of salivary glands tumors based only on clinical and imaging criteria is difficult. We compared the utility, safety, specificity, and accuracy of ultrasound-guided fine needle aspiration cytology (UG-FNAC) in the detection of nonpalpable tumors in the major salivary glands. A retrospective review was done of a 5-year experience of 102 consecutive patients undergoing UG-FNAC. Clinical opinion, FNA results, and final pathologic findings were examined. Histological evaluation showed 29 malignant tumors and 54 benign lesions (neoplasms and nonneoplastic lesions). The cytologic findings were nondiagnostic in 19 cases (18.6%), true negative in 50 (49%), true positive in 20 (19.6%), false negative in 9 (8.8%), and false-positive in 4 (3.9%) cases for detecting malignant tumors. Six of 20 (30%) malignant tumors (true positive) and 41 of 50 (82%) benign lesions (true negative) were classified accurately. The accuracy, sensitivity, and specificity were 84.3%, 68.9%, and 92.6%, respectively. Ultrasound guided FNAC was found to be highly specific for malignancy and its sensitivity for malignancy was good. It is a reliable and accurate diagnostic technique with minimal complications and easy to perform with high specificity 92.5% (95% CI: 82.09%-97.90%). It should be the preferred primary approach for initial investigation in diagnosing salivary gland tumors.

While the common organs assessed in chest pain are the heart, lungs, and inferior vena cava, one must also consider other diagnoses. Splenic rupture can be either traumatic or atraumatic, and splenomegaly can make this vulnerable organ even more susceptible to injury. A case is reported of a patient who presented to the emergency department with a complaint of left-sided chest pain; a focused assessment with sonography for trauma (FAST) examination showed significant intraperitoneal free fluid consistent with splenic injury. The role of bedside sonography in acquiring a rapid and accurate diagnosis is discussed.

Unilateral or bilateral paralysis of the diaphragm is an acquired dysfunction caused by injury or trauma to the phrenic nerve. Patients will often experience symptoms of respiratory distress, and severe cases can be life-threatening. Though not widely used, sonography, specifically M-mode imaging, has proven to be convenient and effective in the detection of this condition. A case is presented describing the sonographic techniques used to evaluate this entity.

Patients are frequently referred for pelvic sonograms to evaluate for adnexal masses. Determining the etiology of the adnexal mass can be challenging, but is necessary to establish a follow-up strategy and correct diagnosis. It is particularly important in those cases when adnexal lesions appear to be complex and the ovaries are not visualized sonographically. Perineural cysts were found incidentally by Tarlov in 1938 during autopsy. This report documents a lesion now bearing his name, Tarlov cysts (TCs). They are defined as cerebrospinal fluid–filled saccular lesions located in the extradural space of the sacral spinal canal and are formed within the nerve root sheath at the dorsal root ganglion. The perineurium and neural tissue make up the cysts’ walls. Usually asymptomatic, a TC is mostly found on magnetic resonance imaging (MRI) of the lumbar spine and sacrum. Occasionally, a TC mimics an adnexal cyst.

Obstetric sonography has a long-standing reputation assisting in the detection of chromosomal abnormalities in utero. Additional diagnostic testing can be performed to confirm a genetic anomaly, including noninvasive prenatal testing, nuchal translucency, and amniocentesis. Comprehensively studied chromosomal abnormalities include trisomies 21, 13, and 18 and monosomy X. Although chromosomal abnormalities cannot be treated, they can be managed and monitored by serial sonograms and genetic counseling prior to delivery, allowing for preparation for a special needs child. This case study presents a fetus with multiple anomalies, including a rare presentation of cystic hygroma. In this specific case, the patient refused a genetic amniocentesis, leaving the cause(s) of the multiple anomalies unknown.

Cervical cancer is not considered to be a highly prevalent carcinoma, as there are more cases of pre-cancer detected than invasive cases. It is also on the decline due to the use of routine Papanicolaou (Pap) tests, and immunizations against Human Papilloma Virus (HPV) have also helped diminish the number of cases. A case is presented of a cervical mass with metastases into the bladder and hydronephrosis of the kidneys detected using computed tomography (CT) and further evaluated using sonography. These imaging modalities together were able to provide global visualization of the pathology, resulting in accurate diagnosis and plan for treatment.