Ultrasound

Ultrasound is a sensitive tool for assessing focal salivary gland lesions and is the initial imaging modality of choice for investigating such conditions. Whilst certain lesions have very characteristic ultrasound appearances, many hyperechoic lesions have non-specific imaging features resulting in diagnostic uncertainty based on imaging alone. Here we review the appearances of these lesions on ultrasound and highlight the importance of proceeding to ultrasound-guided fine-needle aspiration for cytology or core biopsy to reach a definitive diagnosis.

Non-invasive vascular ultrasound has been introduced in patient specific cardio/cerebro-vascular risk evaluation, treatment efficiency estimation, and drug-development strategies. The ultrasound measurement system is based on analysis of radio frequency echo data and is usually combined with evaluations of textural, contextual, morphological and clinical features in a multi-parameter approach. Processing of radio frequency data enables individual vascular risk evaluation depending on the clinical purpose. The non-invasive nature of radio frequency based techniques makes them suitable for screening large populations, and evaluation of drug efficiency in vascular risk reduction.

This review describes the advantages and disadvantages of ultrasonography in the two most frequent thyroid pathologies of the dog: thyroid neoplasia and acquired primary hypothyroidism. Although ultrasonography and nuclear medicine are routine imaging modalities for the investigation of thyroid disease in dogs and cats, computed tomography and magnetic resonance imaging are gaining increasing popularity. Both of these latter modalities are especially useful in staging thyroid neoplasia.

The purpose of this study is to compare arterial vasodilation in response to two occlusive cuff positions and various protocols under reactive hyperaemic stimulus. For determining the optimal reactive hyperaemia protocol we studied 10 healthy young adults and calculated the relative strain and haemodynamic changes of the left brachial artery with motion estimation from sequential ultrasonic images and Doppler sonograms. The results from two occlusion cuff positions (left proximal upper arm and distal forearm) showed that brachial artery vasodilation was significantly greater under upper arm occlusion than under forearm occlusion. Results from optimizing reactive hyperaemia protocols showed that the optimum occlusion pressure was 150 mmHg, with an occlusion time of 5 min. The optimum time interval for recording ultrasonic images and estimating relative strain after releasing the cuff was 45-60 s. Use of these conditions resulted in higher vasodilation and larger blood flow changes. We conclude that the magnitudes of relative strain and blood velocity are related not only to the choice of the location of cuff inflation and the magnitude of occlusion pressure and time, but also to the time interval after the release of the occlusive cuff.

Cysticercosis is a parasitic disease, which is common in developing countries and in the immigrant populations of developed countries. It most commonly presents as neurocysticercosis, but rarely involves the muscles, where it may mimic a tumour. On ultrasound, the intramuscular form is seen as a well-defined, elliptical cystic lesion with an eccentric hyperechoic area within it. Surrounding inflammation may be seen within the muscle. Lesions with similar ultrasound characteristics observed within the muscle should raise a suspicion of cysticercosis in patients that may have been exposed to this parasite.

Complete androgen insensitivity syndrome (CAIS) is a rare and complicated endocrine condition in which individuals inherit a female phenotype but a male karotype of 46XY. It occurs as a result of a defect on the X chromosome inhibiting the effect of androgens during embryological development. Although magnetic resonance imaging is considered the gold standard imaging technique in cases of CAIS, these patients will often present in the ultrasound department with primary amenorrhoea. This case highlights both the value and limitations of ultrasound in such circumstances. Also considered are the many complex and sensitive issues involved, and the multi-disciplinary approach required, in the treatment of individuals diagnosed with CAIS.

We describe a case of the development of a testicular tumour in a patient with unilateral limited testicular microlithiasis after five years on a follow-up surveillance program. We discuss the risk factors for the development of a testicular tumour, review the literature, and suggest a management strategy for follow-up of patients with testicular microlithiasis.

Prenatal screening for Down syndrome should be offered to all pregnant women. The screening option chosen will be influenced by maternal preference, local availability of tests, and the gestation at which the pregnant woman presents. Screening tests take into account the effect of maternal age on Down syndrome risk. The combined first trimester screen using nuchal translucency and first trimester maternal serum screening can achieve a detection rate for Down syndrome of 90% with a 5% false positive rate, when performed by appropriately trained individuals. Midtrimester maternal serum screening is a good screening option for women unable to undergo the combined first trimester screen.

This study presents a UK-wide snapshot of the experiences of families of children with idiopathic congenital talipes equinovarus (CTEV). 111 families with 112 affected children completed a questionnaire containing open and closed questions about demographic data, diagnosis, treatment, and support, from 50 of 72 UK counties. All children were born between July 2002 and June 2007. CTEV was diagnosed prenatally in 81 (72%) infants. Most families (73, 66%) felt that the prenatal care they received could have been improved. The most common complaint (38 families) was lack of information at the time of diagnosis. The most common reaction (50 families) was shock or distress. A comparison between modes of information delivery revealed that prenatal consultations and leaflets were commonly provided but that families preferred prenatal consultations, the internet, and a DVD. Almost all families (102 out of 111, 92%) who responded said they sought information independently. Most families (84%) used the internet and some were distressed by what they found. We conclude that the experience of families when a child is diagnosed with CTEV during the 20-week prenatal ultrasound scan is less stressful when good quality information is provided or when families are signposted to reputable sources.

This is an account of a two week introductory programme in abdominal ultrasound run at and by the University of Salford (UoS) in the UK, jointly planned and delivered by four European institutions, and funded as an ‘intensive programme’ by the EU Lifelong Learning Programme, in order to promote development of education and practice in diagnostic ultrasound throughout the EU member countries. The course syllabus was embedded within existing modules at UoS. Each partner institution was asked to supply a cohort of students and a teacher to assist with delivery of the programme: 30 students from the four institutions attended the course. The course did not in any way confer or imply any measure of clinical competency and this was clear to all participants. The success of the course proves the value of international healthcare education and brings us a step closer to harmonisation of ultrasound education and practice across Europe.