46 research outputs found
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 Ā± 22.4 mm/h to 27.8 Ā± 20.9 mm/h
(P = 0.013), DAS 28 from 5.47 Ā± 1.56 to 3.87 Ā± 1.65 (P < 0.001),
and HAQ from 1.26 Ā± 0.66 to 0.92 Ā± 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
ā„2 parameters, and in 2 UC joints we observed significant
changes in ā„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 koÅ”tane mineralne gustoÄe 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 koÅ”tanom masom i mikroarhitektonskim pogorÅ”anjem koÅ”tanoga tkiva, s posljediÄnim porastom krhkosti kostiju i sklonosti za prijelome. KoÅ”tana mineralna gustoÄa (BMD) je važan Äimbenik koji odreÄuje 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 kraljeÅ”nice i proksimalnog femura izmjerenom dvoenergijskom rendgenskom apsorpciometrijom (DEXA). TakoÄer su dob i antropometrijski parametri (tjelesna težina i visina) korelirani s vrijednostima BMD za kalkaneus, kraljeÅ”nicu i proksimalni femur. IzraÄena je vlastita tablica za konverziju T-vrijednosti za lumbalnu kraljeÅ”nicu prema T-vrijednosti za petnu kost izmjerenima pomoÄu QUS. Najbolja korelacija za BMD kalkaneusa naÄena je u 2. skupini (58-67 godina) s ukupnim BMD femura (R=0,72) i intertrohanterskog podruÄja (R=0,719), obje statistiÄki znaÄajne (p1=0,0007, p1<0,001; p2=0,0008, p2<0,001). Nije bilo znaÄajne korelacije izmeÄu bilo koje izraÄunate vrijednosti BMD (kalkaneus, lumbalna kraljeÅ”nica i proksimalni femur) i dobi, tjelesne težine i tjelesne visine. Prema vlastitoj tablici konverzije, kada je T-vrijednost izraÄunat ultrazvuÄnom denzitometrijom jednak ili ispod -1, to daje konaÄnu T-vrijednost za lumbalnu kraljeÅ”nicu izmeÄu -1 i -2,5, Å”to se prema kriterijima SZO dijagnosticira kao osteopenija. To Äini ultrazvuÄnu denzitometriju izvrsnom metodom probira za prepoznavanje bolesnika s rizikom od prijeloma
PSORIATIC ARTHRITIS IMAGING ā AN OVERVIEW AND UPDATE
PsorijatiÄni artritis kroniÄna je upalna bolest zglobova koja se javlja u pacijenata sa psorijazom. TipiÄno zahvaÄa
periferne zglobove (s asimetriÄnim uzorkom) te aksijalni skelet. Ne postoje laboratorijski testovi specifi Äni za psorijatiÄni
artritis pa dijagnostiÄki postupak poÄiva na kliniÄkom nalazu i slikovnim pretragama. NajÄeÅ”Äe se rabe klasiÄne
radioloŔke pretrage i magnetska rezonancija, a sve viŔe raste i upotreba ultrazvuka zbog njegove jednostavnosti i visoke
osjetljivosti za periferne pokazatelje bolesti. Autori donose sažeti pregled psorijatiÄnog artritisa, tipiÄnih 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
Å to zapravo možemo vidjeti primjenom raÄunalno 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
āmistookā 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 raÄunalno potpomognute analize (computer aided detection, CAD) u
probirnoj mamografiji s rezultatima analize dva neovisna radiologa te utvrditi osjetljivost i specifiÄnost CAD-a za lezije u
dojkama. Analizirali smo 436 mamograma pomoÄu CAD-a i usporedili rezultate s interpretacijom dva neovisna radiologa.
IzraÄunali smo osjetljivost i specifiÄnost CAD-a za lezije u dojkama putem tablica kontingencije. Osjetljivost CAD-a za
otkrivanje
svih lezija u dojkama iznosila je 54%, a specifiÄnost 16%. Osjetljivost CAD-a za sumnjive lezije bila je 86%, a za
mikrokalcifikacije 100% uz specifiÄnost od 45%. CAD je uglavnom pogreÅ”no interpretirao žljezdani parenhim, vezivno tkivo
i krvne žile kao tvorbe u dojkama, dok je kalcifikacije u krvim žilama i aksilarni nabor mijeŔao s mikrokalcifikacijama. Ovom
studijom smo potvrdili da je CAD izvrstan alat za otkrivanje mikrokalcifikacija s osjetljivoÅ”Äu od 100%. No, ipak se ne bi
trebao rabiti kao jedina metoda u probirnoj mamografiji dojki uzimajuÄi u obzir koliÄinu lažno pozitivnih rezultata koja je
priliÄno 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 16ā91 (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 2.5ā14 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 viŔeslojne 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 Ā»beltsĀ« 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 20ā38). All of them were healthy and with normal thyroid hormonal status. The mean thyroid volume was 10.68+/-2.83 mL (range 5.71ā17.09 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 (ā¤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