Comparative US-MRI evaluation of the Insall–Salvati index

Purpose: To investigate whether the universally accepted range of normal patellar height ratio derived from MRI for the Insall–Salvati (IS) method could be similarly applied to ultrasound (US). Materials and methods: This study included 52 patients (age range 11–75 years) who underwent a bi-modality (US and MRI) examination, with a total of 60 knees evaluated. IS index (ratio of the patella tendon length to length of the patella) was acquired with both methods. Two operators, with different experiences of musculoskeletal imaging and blinded to the results of other investigators, separately performed the MRI and US measurements. Results: For the two operators, MRI reported a mean value of patellar height ratio of 1.10 ± 0.16 (mean ± standard deviation SD), while US a mean value of 1.17 ± 0.16 (mean ± SD). For comparable results, the small addition of 0.16 is needed for the measurements on US compared with MRI. Inter-observer agreements using intra-class correlation coefficient (ICC) was, respectively, 0.97 for MRI and 0.98 for US. The difference of mean values in patellar height ratios between MRI and US was not statistically significant (p = 0.15). The ICC between the two modalities was 0.94. Conclusion: According to our experience, IS index can be appropriately evaluated on US images, reducing the need of other imaging techniques

Doppler ultrasonography of the upper mesenteric artery in chronic intestinal inflammation

Purpose. We evaluated the importance of dynamic studies of the superior mesenteric artery in defining the abnormal parameters that could help diagnose an inflammatory bowel disease. Material and methods. Our patient population consisted of 10 normal subjects, 10 patients with active and 10 with inactive Crohn disease; 10 patients with celiac disease were also examined, before treatment and then after 6 months' dieting. We used a 5 MHz transducer, with 2.8 MHz Doppler frequency and PRF of 5 KHz; longitudinal scans were performed at 2-3 cm from the origin, with 50-60 degrees Doppler angle. The examination was performed after overnight fasting and at least 5 minutes' supine recumbency and then repeated 15 minutes after ingestion of a liquid meal. We measured the resistive index (RI) both on fasting and after the meal; the parameter defined as resistive difference (RD) was used to measure postprandial changes in resistance. Results. In the healthy volunteers, RI on fasting was 0.81±0 .02, versus 0.67±0.03 after the meal (RD 0.14±0.2). In the patients with inactive Crohn disease, RI on fasting was 0.82±0.03, versus 0.69±0.04 15 minutes after the meal (RD 0.13±0.3). In the patients with active Crohn disease, RI on fasting was 0.78±0.03, versus 0.70±0.02 after the meal (RD 0.08±0.03). In the patients with untreated celiac disease, RI on fasting was 0.78±0.05, versus 0.74±0.01 15 minutes after the meal (RD 0.04±0.01). In the patients with treated celiac disease, RI on fasting was 0.79±0.03, versus 0.70±0.02 after the meal (RD 0.09±0.02). Conclusions. The evaluation of postprandial flow changes in the mesenteric district is of more than physiologic interest because it can be the only way to detect an inflammatory disease which becomes apparent only during functional stress. Doppler US can therefore be proposed as a follow-up method to assess acute phase regression

Sonography of the cervical vagus nerve: normal appearance and abnormal findings.

OBJECTIVE: The purpose of this study was to assess the appearance of the cervical vagus nerve in healthy individuals and to investigate the potential role of sonography in revealing neck masses that cause vagal dysfunction. SUBJECTS AND METHODS: We examined 150 consecutive patients. In 144 patients the presence of thyroid, salivary gland, or lymph node disease was suspected. In three patients a cervical mass was palpable, and three patients had symptoms of dysfunction of the inferior laryngeal or vagal nerves. The pathologic diagnoses of the masses were obtained at biopsy. RESULTS: In 144 individuals the normal vagus nerve was recognized on each side of the neck as a thin band that occupied the posterior angle formed by the common carotid artery and the internal jugular vein. Three patients had tumors arising from the vagus nerve: one neurofibroma, one neurinoma, and one chemodectoma. These tumors were located in the neurovascular bundle and posterior to the vessels; their origin from the vagus nerve was clearly visible in all patients because of the contiguity of the mass with the nerve bundle. In the other three patients, sonography revealed an extrinsic mass that compressed and displaced the vagus nerve out of its longitudinal axis; two cases were hyperplastic nodules of the thyroid, and in one case the nodule was a branchial cyst. CONCLUSION: Sonography can reveal the vagus nerve in healthy conditions and correctly reveal the vagal origin of some tumors in the parapharyngeal spaces

Power Doppler sonography in knee arthritis--a pilot study.

We compared power Doppler sonography to laboratory indices of disease activity in patients with knee arthritis to determine the clinical relevance of hypervascularity. Eight healthy volunteers and 22 patients with symptoms and signs of knee arthritis were studied. Presence or absence of hypervascularity, synovial thickening, effusion, and Baker's cysts were recorded. Disease activity was measured by erythrocyte sedimentation rate, c-reactive protein, alpha2-globulins, sideremia, hemoglobinemia, and serum white cell count. Various grades of synovial hyperemia were found in 12/22 cases. Patients with and without synovial hypervascularity showed statistically significant differences in age (P=0.017), erythrocyte sedimentation rate (ESR) (P = 0.039), hemoglobinemia (P = 0.009), and sideremia (P = 0.012). Power Doppler sonography is able to demonstrate synovial hyperemia, which is correlated with some laboratory indices of inflammation