Gray-scale and color duplex Doppler ultrasound of hand joints in the evaluation of disease activity and treatment in rheumatoid arthritis

Aim To evaluate the role of gray-scale and color duplex- Doppler ultrasound (CDUS) in diagnosis of changes of hand joints and assessment of treatment efficacy in patients with rheumatoid arthritis (RA) by comparing qualitative and quantitative US parameters with clinical and laboratory indicators of disease activity. Methods Ulnocarpal (UC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints in 30 patients with RA were examined by gray-scale and CDUS before and after six months of treatment. Morphologic and quantitative Doppler findings (synovial thickness, effusion quantity, vascularization degree, resistance index, velocities) were compared with clinical indicators of disease progression: disease activity score (DAS 28), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). Results Clinical indicators changed significantly after treatment: ESR from 38.1 ± 22.4 mm/h to 27.8 ± 20.9 mm/h (P = 0.013), DAS 28 from 5.47 ± 1.56 to 3.87 ± 1.65 (P < 0.001), and HAQ from 1.26 ± 0.66 to 0.92 ± 0.74 (P = 0.030), indicating therapeutic effectiveness. In all MCP and UC joints we observed a significant change in at least one US parameter, in 6 out of 12 joints we observed a significant change in ≥2 parameters, and in 2 UC joints we observed significant changes in ≥3 parameters. The new finding was that the cut-off values of resistance index of 0.40 at baseline and of 0.55 after the treatment indicated the presence of active disease and the efficacy of treatment, respectively; also it was noticed that PIP joints can be omitted from examination protocol. Conclusion Gray scale and CDUS are useful in diagnosis of changes in UC and MCP joints of patients with RA and in monitoring the treatment efficacy

Korelacija koštane mineralne gustoće mjerene kvalitativnim ultrazvukom i dvoenergetskom rendgenskom apsorpciometrijom

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with consequential increase in bone fragility and susceptibility to fracture. Bone mineral density (BMD) is an important determinant factor of fracture risk. Fifty-eight healthy postmenopausal women aged 53-91 years were included in the study. The subjects were divided into three age groups. Heel bone (calcaneus) BMD detected by qualitative ultrasound (QUS) was correlated with lumbar spine and proximal femur BMD detected by dual energy x-ray absorptiometry (DEXA). Also, subject age and anthropometric parameters (body weight and height) were correlated with BMD values in the calcaneus, spine and proximal femur. A chart was made of T-score conversion for lumbar spine according to T-score of heel bone detected by QUS. Calcaneal BMD showed best correlation in group 2 (58-67 yrs) with total femoral BMD (R=0.72) and intertrochanteric area (R=0.719), both statistically significant (p1=0.0007, p1<0.001; p2=0.0008, p2<0.001). There was no significant correlation between any of the calculated BMD values (calcaneus, lumbar spine and proximal femur) and age, body weight or body height. According to our conversion chart, when T-score calculated on ultrasound densitometry is equal or below -1 it yields a final T-score of lumbar spine between -1 and -2.5, which according to WHO criteria is diagnosed as osteopenia. This makes ultrasound densitometry an excellent screening method to identify patients at a risk of fracture.Osteoporoza je sistemska skeletna bolest obilježena malom koštanom masom i mikroarhitektonskim pogoršanjem koštanoga tkiva, s posljedičnim porastom krhkosti kostiju i sklonosti za prijelome. Koštana mineralna gustoća (BMD) je važan čimbenik koji određuje rizik od prijeloma. Ispitivanje je provedeno u 58 zdravih žena u postmenopauzi, u dobi od 53 do 91 godine. Ispitanice su bile podijeljene u tri dobne skupine. BMD petne kosti (kalkaneus) izmjerena kvalitativnim ultrazvukom (QUS) korelirana je s BMD lumbalne kralješnice i proksimalnog femura izmjerenom dvoenergijskom rendgenskom apsorpciometrijom (DEXA). Također su dob i antropometrijski parametri (tjelesna težina i visina) korelirani s vrijednostima BMD za kalkaneus, kralješnicu i proksimalni femur. Izrađena je vlastita tablica za konverziju T-vrijednosti za lumbalnu kralješnicu prema T-vrijednosti za petnu kost izmjerenima pomoću QUS. Najbolja korelacija za BMD kalkaneusa nađena je u 2. skupini (58-67 godina) s ukupnim BMD femura (R=0,72) i intertrohanterskog područja (R=0,719), obje statistički značajne (p1=0,0007, p1<0,001; p2=0,0008, p2<0,001). Nije bilo značajne korelacije između bilo koje izračunate vrijednosti BMD (kalkaneus, lumbalna kralješnica i proksimalni femur) i dobi, tjelesne težine i tjelesne visine. Prema vlastitoj tablici konverzije, kada je T-vrijednost izračunat ultrazvučnom denzitometrijom jednak ili ispod -1, to daje konačnu T-vrijednost za lumbalnu kralješnicu između -1 i -2,5, što se prema kriterijima SZO dijagnosticira kao osteopenija. To čini ultrazvučnu denzitometriju izvrsnom metodom probira za prepoznavanje bolesnika s rizikom od prijeloma

PSORIATIC ARTHRITIS IMAGING – AN OVERVIEW AND UPDATE

Psorijatični artritis kronična je upalna bolest zglobova koja se javlja u pacijenata sa psorijazom. Tipično zahvaća periferne zglobove (s asimetričnim uzorkom) te aksijalni skelet. Ne postoje laboratorijski testovi specifi čni za psorijatični artritis pa dijagnostički postupak počiva na kliničkom nalazu i slikovnim pretragama. Najčešće se rabe klasične radiološke pretrage i magnetska rezonancija, a sve više raste i upotreba ultrazvuka zbog njegove jednostavnosti i visoke osjetljivosti za periferne pokazatelje bolesti. Autori donose sažeti pregled psorijatičnog artritisa, tipičnih nalaza slikovnih metoda i novosti iz literature.Psoriatic arthritis (PsA) is a chronic infl ammatory joint disease that occurs in patients with psoriasis. Typically, involvement of the peripheral joints (with an asymmetric pattern) and the axial skeleton can be recognized. Th ere are no specifi c laboratory tests for PsA and the diagnosis relies on clinical and imaging fi ndings. Conventional radiology and magnetic resonance are the most valuable imaging modalities, with ultrasound becoming more and more used due to its feasibility and high sensitivity for peripheral disease manifestations. Th e authors off er a concise overview of PsA, common imaging fi ndings, and literature update

Što zapravo možemo vidjeti primjenom računalno potpomognute analize kod mamografije?

The main goal of this study was to compare the results of computer aided detection (CAD) analysis in screening mammography with the results independently obtained by two radiologists for the same samples and to determine the sensitivity and specificity of CAD for breast lesions. A total of 436 mammograms were analyzed with CAD. For each screening mammogram, the changes in breast tissue recognized by CAD were compared to the interpretations of two radiologists. The sensitivity and specificity of CAD for breast lesions were calculated using contingency table. The sensitivity of CAD for all lesions was 54% and specificity 16%. CAD sensitivity for suspicious lesions only was 86%. CAD sensitivity for microcalcifications was 100% and specificity 45%. CAD mainly ‘mistook’ glandular parenchyma, connective tissue and blood vessels for breast lesions, and blood vessel calcifications and axillary folds for microcalcifications. In this study, we confirmed CAD as an excellent tool for recognizing microcalcifications with 100% sensitivity. However, it should not be used as a stand-alone tool in breast screening mammography due to the high rate of false-positive results.Svrha ovoga istraživanja bila je usporediti rezultate računalno potpomognute analize (computer aided detection, CAD) u probirnoj mamografiji s rezultatima analize dva neovisna radiologa te utvrditi osjetljivost i specifičnost CAD-a za lezije u dojkama. Analizirali smo 436 mamograma pomoću CAD-a i usporedili rezultate s interpretacijom dva neovisna radiologa. Izračunali smo osjetljivost i specifičnost CAD-a za lezije u dojkama putem tablica kontingencije. Osjetljivost CAD-a za otkrivanje svih lezija u dojkama iznosila je 54%, a specifičnost 16%. Osjetljivost CAD-a za sumnjive lezije bila je 86%, a za mikrokalcifikacije 100% uz specifičnost od 45%. CAD je uglavnom pogrešno interpretirao žljezdani parenhim, vezivno tkivo i krvne žile kao tvorbe u dojkama, dok je kalcifikacije u krvim žilama i aksilarni nabor miješao s mikrokalcifikacijama. Ovom studijom smo potvrdili da je CAD izvrstan alat za otkrivanje mikrokalcifikacija s osjetljivošću od 100%. No, ipak se ne bi trebao rabiti kao jedina metoda u probirnoj mamografiji dojki uzimajući u obzir količinu lažno pozitivnih rezultata koja je prilično visoka

Duplex-Doppler Ultrasonography in the Detection of Lower Extremities Deep Venous Thrombosis and in the Detection of Alternative Findings

The diagnoses observed in patients referred for the Doppler ultrasonographic examination of peripheral and iliac veins for suspected deep venous thrombosis (DVT) are presented in this study. During 48 months 2,610 patients were examined by duplex Doppler ultrasonography (US). Among these, 1,879 were women (72%) and 731 men (28%), with the age-range 16–91 (mean 56, 2) years. Ultrasonic scanners Acuson 128 XP 10, ATL HDI 5000, GE Logiq 7, and GE Logiq 9 were used, with transducers in the frequency range from 2.5–14 MHz. Findings were categorized into four main categories: (1) deep venous thrombosis (DVT); (2) pathology predominantly related to superficial veins without DVT; (3) pathology of adjacent structures; (4) normal findings. 562 patients had DVT (21.5%). 1,108 patients (42.5%) had predominant pathology of superficial veins: postthrombotic syndrome, superficial thrombophlebitis and varicose veins. 390 patients (14.9%) had pathology of surrounding structures, unrelated to veins, the most common pathology being popliteal cysts and muscular hematomas. These lesions must be properly diagnosed by US to avoid erroneous anticoagulant treatment

Comparison of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage [Usporedba višeslojne kompjuterizirane tomografije i duplex Doppler ultrazvuka u otkrivanju aterosklerotskih karotidnih plakova kompliciranih krvarenjem u plak ]

This study compared sensitivity and specificity of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. Carotid plaques from 50 patients operated for carotid artery stenosis were analyzed. Carotid endarterectomy was performed within one week of diagnostic evaluation. Results of multidetector-row computed tomography and duplex Doppler ultrasonography diagnostic evaluation were compared with results of histological analysis of the same plaque areas. American Heart Association classification of atherosclerotic plaques was applied for histological classification. Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 14.7 Hounsfield units. Median tissue density of noncalcified segments of uncomplicated plaques was 54.3 Hounsfield units (p = 0.00003). The highest tissue density observed for complicated plaques was 31.8 Hounsfield units. Multidetector-row computed tomography detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 70.4%, with tissue density of 33.8 Hounsfield units as a threshold value. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed sensitivity of 21.7% and specificity of 89.6% in detecting plaques complicated with intraplaque hemorrhage. Multidetector-row computed tomography showed a very high level of sensitivity and a moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed a low level of sensitivity and a moderate-high level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage

US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications

PURPOSE: The aim of this study was to assess diagnostic accuracies of ultrasonography (US) and magnetic resonance imaging (MRI) in lesions that manifest as mammographic BI-RADS 4 and 5 microcalcifications, in the setting of conjoined use of mammography, US, and MRI. ----- METHODS: Patients with mammographic BI-RADS 4 or 5 microcalcifications, without additional findings, were included in this prospective study. All patients subsequently underwent breast US and MRI. Histopathologic diagnosis, obtained by US-guided core-needle biopsy or surgical excision, served as a reference standard. Diagnostic accuracies of US and MRI were calculated, and positive predictive value for different MRI BI-RADS imaging features were determined. ----- RESULTS: The study group consisted of 113 women with 125 areas of suspicious microcalcifications. MRI reached sensitivity, specificity, positive predictive value 3 (PPV3), and negative predictive value (NPV) of 100%, 70.1%, 67.6%, and 100%, respectively. Statistically significant differences in MRI morphologic features and kinetic enhancement curves were observed between malignant and benign microcalcifications. Sensitivity, specificity, PPV3, and NPV for US were: 85.4%, 66.2%, 61.2%, and 87.9%. There was statistically significant difference in presentation of malignant and benign microcalcifications at US. ----- CONCLUSION: In the setting of conjoined use of mammography, US, and MRI, MRI can reliably exclude malignancy in suspicious microcalcifications. Thus, negative MRI findings may influence the decision to biopsy the microcalcifications

Insights into a Mummy: A Paleoradiological Analysis

The aim of the study was to analyze possible human skeletal remains within the wrappings of a mummy from the Archaeological Museum, Zagreb, Croatia through the use of the multidetector CT (MDCT) technology. Plain X-ray films and MDCT images of the mummy were taken in both frontal and lateral views. In a single volumetric acquisition of the whole body by MDCT, 0.75 mm axial slices were obtained and combined with sagittal and coronal reformatting and three-dimensional (3D) reconstruction. Sex and age was assessed visually using standard anthropological methods. The results suggest that the mummy was of an adult female, most likely over 40 years of age at death. Pathologies observed included degenerative changes on the vertebral column and healed fractures of the lower right arm. Damage of the ethmoid bone at the roof of the nasal cavity was most likely caused by mortuary brain removal practice. Remnants of a resin and an unusual object were found inside the cranial cavity. An elongated metal object and additional three metal »belts« can be seen on the lower portion of the body. All internal organs were removed and thoracic and abdominal cavities were filled with various substances, most likely mud and pieces of linen cloth. Our results show that the MDCT is a very useful technique for assessing the human remains in archeological samples, especially in comparison to the use of plain film (X-ray), where important details are obscured and 3D imaging impossible

Ultrasonographic Measurement of the Thyroid Volume

According to the published data, endemic goiter was until recently, still present in some regions in Croatia. In this study the thyroid volume in grown-up, student population was measured. It was also analyzed which of the several traditional physiological attributes (body weight, body height, and body surface area (BSA)) were best correlated with the thyroid volume. Fifty one randomly selected female students from University of Zagreb Medical School were studied. Mean age of our subjects was 22 (range 20–38). All of them were healthy and with normal thyroid hormonal status. The mean thyroid volume was 10.68+/-2.83 mL (range 5.71–17.09 mL). The results show that thyroid volume was best correlated with body height (r=0.37; p=0.001), followed with body surface area (r=0.28; p=0.017). The thyroid volume was found normal in all our subjects

Shear-wave sonoelastographic features of invasive lobular breast cancers

Aim To evaluate shear-wave elastographic (SWE) and related gray-scale features of pure invasive lobular breast carcinoma (ILC) and compare them with invasive ductal breast cancers (IDC). Methods Quantitative SWE features of mean (El-mean), maximum (El-max), minimum (El-min) elasticity values of the stiffest portion of the mass, and lesion-to-fat elasticity ratio (E-ratio) were measured in 40 patients with pure ILC and compared with 75 patients with IDC. Qualitative grayscale features of lesion size, echogenicity, orientation, and presence of distal shadowing were determined and compared between the groups. Results ILC were significantly larger than IDC (P = 0.008) and exhibited significantly higher El-max (P = 0.015) and higher El-mean (P = 0.008) than IDC. ILC were significantly more often horizontally oriented, while IDC were significantly more often vertically oriented (P < 0.001); ILC were significantly more often hyperechoic than IDC (P < 0.001). Differences in stiffness between ILC and IDC determined by quantitative SWE parameters were present only in small tumors (≤1.5 cm in size), ie, small ILC had significantly higher El-max (P = 0.030), El-mean (P = 0.014), and El-min (P = 0.045) than small IDC, while tumors larger than 1.5 cm had almost equal stiffness, without significant differences between the groups. Conclusion Specific histopathologic features of ILC are translated into their qualitative sonographic and quantitative sonoelastographic appearance, with higher stiffness of small ILC compared to small IDC. Gray-scale and sonoelastographic features may help in diagnosing ILC