Sonographic appearance of the normal appendix in adults

取得学位 : 博士（保健学）, 学位授与番号 : 医博甲第1953号 , 学位授与年月日 : 平成20年3月22日, 学位授与大学 : 金沢大学, 審査結果の報告日 : 平成20年2月13日, 主査 :真田 茂 , 副査 :高山 輝彦, 鈴木 正

Accuracy assessment methods of tissue marker clip placement after 11-gauge vacuum-assisted stereotactic breast biopsy: comparison of measurements using direct and conventional methods

BACKGROUND:　 The objective of the study was to compare direct measurement with a conventional method for evaluation of clip placement in stereotactic vacuum-assisted breast biopsy (ST-VAB) and to evaluate the accuracy of clip placement using the direct method.　 METHODS:　 Accuracy of clip placement was assessed by measuring the distance from a residual calcification of a targeted calcification clustered to a clip on a mammogram after ST-VAB. Distances in the craniocaudal (CC) and mediolateral oblique (MLO) views were measured in 28 subjects with mammograms recorded twice or more after ST-VAB. The difference in the distance between the first and second measurements was defined as the reproducibility and was compared with that from a conventional method using a mask system with overlap of transparent film on the mammogram. The 3D clip-to-calcification distance was measured using the direct method in 71 subjects.　 RESULTS:　 The reproducibility of the direct method was higher than that of the conventional method in CC and MLO views (P = 0.002, P < 0.001). The median 3D clip-to-calcification distance was 2.8 mm, with an interquartile range of 2.0-4.8 mm and a range of 1.1-36.3 mm.　 CONCLUSION:　 The direct method used in this study was more accurate than the conventional method, and gave a median 3D distance of 2.8 mm between the calcification and clip

Videofluoroscopy-guided balloon dilatation for treatment of severe pharyngeal dysphagia

Balloon dilatation is a widely accepted technique in the management of esophageal and other types of gastrointestinal strictures, but it is rarely used for the treatment of pharyngeal dysphagia. Therefore, the aim of our prospective study was to evaluate the use of videofluoroscopy-guided balloon dilatation (VGBD) for the treatment of severe pharyngeal dysphagia. The study included 32 stroke patients who had been diagnosed with oral and/or pharyngeal dysphagia. All patients underwent dilatation of the esophageal inlet using a balloon catheter under videofluoroscopic guidance during one or more sessions. Following esophageal dilatation, manual feeding was provided twice weekly. VGBD was effective in 10 out of 32 patients; however, the remaining 22 patients were unable to attempt oral food consumption because aspiration was not completely resolved on videofluoroscopy. According to this case series, VGBD may provide treatment for patients with severe pharyngeal dysphagia, who have not consumed food orally for a long period of tim

Sonographic analysis of hyoid bone movement during swallowing

金沢大学医薬保健研究域保健学系Purpose: Videofluoroscopy is generally considered a "gold standard" technique; however t technique exposes subjects to radiation. Ultrasonography is applied widely in clinical practice because of low cost, safety of the technique, and absence of radiation exposure. The aim of this study was to evaluate hyoid bone movement trajectories during swallowing in healthy subjects using ultrasonography.Subject and Methods: Data were obtained from 15 healthy volunteers (mean age: 34.9± 9.3).The subjects were divided into 3 groups: 5 subjects in their 20s, 5 subjects in their 30s and 5 subjects in their 40s. The subjects were examined while sitting in an upright position, with the back against a wall to control movement. The transducer was placed in a longitudinal scan above the larynx. The hyoid bone was identified on the scan as a high echoic area with posterior acoustic shadow. Then, the subjects swallowed 5 mL of mineral water, with a measurement frequency of 5 times. The digital-ultrasonographic recordings were viewed at 30 frames/s for 3 seconds. Results: The movement was divided into 4 phases: A, slowly ascending phase; B, rapidly ascending phase; C, temporary pause phase (position of maximum rise); D, rapid and slow descending shifts toward the resting position phase. We easily visualized the hyoid bone trajectory using ultrasonography. In all cases, ultrasonographic analysis of the hyoid bone was confirmed to have a similar trajectory as determined with videofluoroscopy. Ultrasonography can accurately determine swallowing duration and trajectory of hyoid bone movement. There was a significant difference in swallowing duration between the 20s groups and 30s groups and between the 20s groups and 40s groups (P < 0.05). However, the difference between the 30s group and 40s group was not significant (P=0.87).Conclusion: The results show that the dynamic phase image of the hyoid bone movement can be revealed by ultrasonographic visualization. © 2009 Springer Berlin Heidelberg

Development and evaluation of automated ultrasonographic detection of bladder diameter for estimation of bladder urine volume

Bladder urine volume has been estimated using an ellipsoid method based on triaxial measurements of the bladder extrapolated from two-dimensional ultrasound images. This study aimed to automate this process and to determine the accuracy of the automated estimation method for normal and small amounts of urine. A training set of 81 pairs of transverse and longitudinal ultrasound images were collected from healthy volunteers on a tablet-type ultrasound device, and an automatic detection tool was developed using them. The tool was evaluated using paired transverse/longitudinal ultrasound images from 27 other healthy volunteers. After imaging, the participants voided and their urine volume was measured. For determining accuracy, regression coefficients were calculated between estimated bladder volume and urine volume. Further, sensitivity and specificity for 50 and 100 ml bladder volume thresholds were evaluated. Data from 50 procedures were included. The regression coefficient was very similar between the automatic estimation (β = 0.99, R2 = 0.96) and manual estimation (β = 1.05, R2 = 0.97) methods. The sensitivity and specificity of the automatic estimation method were 88.5% and 100.0%, respectively, for 100 ml and were 94.1% and 100.0%, respectively, for 50 ml. The newly-developed automated tool accurately and reliably estimated bladder volume at two different volume thresholds of approximately 50 ml and 100 ml

Ultrasonographic evaluation of intravenous lobular capillary hemangioma in the cephalic vein

A 60-year-old man presented with focal swelling on the dorsal surface of the left wrist. The sonographic exam revealed the presence of a smoothly rounded hypoechoic mass, with internal blood flow in the lumen of the vein. The histopathological findings led to the diagnosis of intravenous lobular capillary hemangioma (LCH). Here, we reported an intravenous LCH arising from the cephalic vein on the dorsal surface of the left wrist hand and discussed the related ultrasonographic findings

Color doppler ultrasonography to evaluate hypoechoic areas in pressure ulcers: A report of two cases

Ultrasound (US) is frequently used for evaluating inflammation of subcutaneous tissue caused by pressure ulcers (PUs), but color Doppler mode (CDM) helps to better identify inflammatory edema in subcutaneous fat and necrotic tissue in PUs. We report two cases where inflammatory edema in subcutaneous fat and necrotic tissue in PUs are identified using small US equipment with CDM. Case 1 – An 82-year-old male presented with cerebral infarction and a Category III PU in the sacral region. B-mode gray-scale US imaging (B-mode imaging) revealed a thickened layer of subcutaneous fat with fat lobules and homogeneous cobblestone appearance with fluid accumulation within the echo-free space. CDM did not identify any color signal (CS) in hypoechoic areas. Case 2 – A 29-year-old female presented with cytopenia and decreased renal function with a Category IV PU with undermining in the coccyx region. B-mode imaging distinguished the necrotic tissue, indicating a diffuse hypoechoic area with no layers, unclear borders, and uneven gray level (cloud-like image) in the subcutaneous fat. Similar B-mode imaging findings were obtained in inflammatory edema with cobblestone appearance. CDM did not detect a CS in the hypoechoic areas but confirmed peripheral hypervascularity. CDM imaging identified inflammatory edema in the subcutaneous fat and necrotic tissue in PUs. Specifically, CDM may better evaluate early-stage PUs with necrotic tissue by distinguishing necrosis from intense inflammatory edema