The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study.

Purpose To evaluate whether an incidentally noted splenic mass at abdominal computed tomography (CT) requires further imaging work-up. Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, a search of a CT database was performed for patients with splenic masses at CT examinations of the abdomen and chest from 2002 to 2008. Patients were divided into three groups: group 1, patients with a history of malignancy; group 2, patients with symptoms such as weight loss, fever, or pain related to the left upper quadrant and epigastrium; and group 3, patients with incidental findings.

Utility of transabdominal ultrasound for surveillance of known pancreatic cystic lesions: prospective evaluation with MRI as reference standard.

Objectives: To prospectively assess the utility of transabdominal ultrasound in surveillance of known pancreatic cystic lesions (PCL) using same day MRI as reference standard.

Methods: In an IRB-approved study with written informed consent, patients with known PCL underwent pancreas US on same day as surveillance MRI. US was performed blinded to same date MRI results.

Pancreatic surgery: a multidisciplinary assessment of the value of intraoperative US.

Purpose: To assess the value of intraoperative ultrasonography (US) for different types of pancreatic surgery.

Materials And Methods: An institutional review board-approved, HIPAA-compliant retrospective review with waiver of informed consent was performed to evaluate all cases of pancreatic surgery with intraoperative US or laparoscopic US that occurred at a single institution during a 10-year period. Surgical notes, radiologic images, and clinical data for each surgical procedure and subsequent clinical course were reviewed by pancreatic surgeons and radiologists.

Complication rate of ultrasound-guided percutaneous cholecystostomy in patients with coagulopathy.

Objective: The purpose of this article is to compare the complication rate for ultrasound-guided percutaneous cholecystostomy in patients with coagulopathy to the rate in patients with normal coagulation.

Materials And Methods: We performed a database search for patients who underwent ultrasound-guided percutaneous cholecystostomy from January 2000 through December 2010. Patients were divided into those with normal coagulation and those with coagulopathy, as documented by abnormal laboratory values (international normalized ratio ≥ 1.

Lessons learned from quality assurance: errors in the diagnosis of acute cholecystitis on ultrasound and CT.

Objective: The purpose of this article is to study errors in the diagnosis of acute cholecystitis reported in the online departmental quality assurance (QA) database.

Materials And Methods: The departmental QA database was searched from October 2005 to April 2010 for cases of acute cholecystitis. Errors were classified into overcalls and undercalls.

Can Doppler sonography discern between hemodynamically significant and insignificant portal vein stenosis after adult liver transplantation?

Objective: The purpose of our study was to determine whether Doppler sonography, using a strict reference standard, can specifically identify hemodynamically significant portal vein anastomotic stenosis after liver transplantation in adults.

Materials And Methods: The duplex and color Doppler examinations of 13 consecutive adult patients who underwent portal venography for suspected portal vein stenosis after liver transplantation were retrospectively examined. Peak systolic velocity (PSV) and change in PSV (ΔPSV) along the portal vein were correlated with portal venography.

Intraoperative ultrasonography of the pancreas.

Intraoperative ultrasonography (US) of the pancreas is a versatile technique that provides excellent spatial and contrast resolution and real-time imaging capabilities, making it useful for diagnostic imaging as well as for guidance of laparoscopic and open operative procedures. Intraoperative US may be used for applications such as staging and localizing tumors; performing regional metastatic surveys; documenting arterial and venous patency; identifying endocrine tumors; distinguishing pancreatitis from a neoplasm; and guiding biopsy, duct cannulation, and drainage of abscesses or cysts. The scanning approach and technique vary according to the application, with many different equipment and transducer options and sterilization methods available.

Incidentally detected gallbladder polyps: is follow-up necessary?--Long-term clinical and US analysis of 346 patients.

Purpose: To determine the natural history of gallbladder (GB) polyps incidentally detected at ultrasonography (US) and to propose management guidelines for these lesions based on polyp size.

Materials And Methods: The HIPAA-compliant study was approved by the institutional review board, and informed consent was waived. A database search for "polyp" in all US examinations of the GB between January 1, 1999, and December 31, 2001, at a single institution was performed.

Benign hepatic tumors and iatrogenic pseudotumors.

Myriad benign tumors may be found in the liver; they can be classified according to their cell of origin into tumors of hepatocellular, cholangiocellular, or mesenchymal origin. Common benign hepatic tumors may pose a diagnostic dilemma when they manifest with atypical imaging features. Less frequently encountered benign hepatic tumors such as inflammatory pseudotumor or biliary cystadenoma demonstrate less specific imaging features; however, awareness of their findings is useful in narrowing differential diagnostic considerations.

Current techniques in imaging of fistula in ano: three-dimensional endoanal ultrasound and magnetic resonance imaging.

Perianal fistula is an abnormal communication between the anal canal and perianal skin. The majority of perianal fistulous disease results from either cryptoglandular inflammation or Crohn's disease. These groups differ in pathophysiology, prognosis, and strategies for imaging and treatment.

Ultrasound staging of rectal cancer.

Endorectal ultrasound (ERUS) is a primary imaging technique in the preoperative evaluation of patients with rectal adenocarcinoma. The purpose of this report is to review ultrasound staging with emphasis on technique and potential pitfalls. The role of ultrasound in multimodality staging and surveillance is also explored.

Focal hepatic lesions: US-guided biopsy--lessons from review of cytologic and pathologic examination results.

Purpose: To retrospectively assess factors affecting the success of ultrasonographically (US)-guided core liver biopsy of focal lesions on the basis of experience when both cytologic and pathologic examination results were available.

Materials And Methods: This HIPAA-compliant retrospective study was granted an exemption from the institutional review board. All percutaneous US-guided biopsies of focal liver lesions performed at one institution from January 2000 through February 2006 for which both cytologic and pathologic examination results were available were included.

Intraoperative ultrasonography of the brain and spine.

Intraoperative ultrasonography can play a particularly useful role in facilitating surgery or guiding biopsies in the brain and spinal canal. Given the limited access that is frequently afforded to the operating surgeon, coupled with lesions that may be located in deep or seemingly inaccessible locations, sonography performed through tiny burr holes is useful for confirming location of lesions, guiding biopsy, and confirming extent of resection. In the spine, sonography is most helpful for confirming the precise location of intradural or extradural masses and guiding biopsies.

Intraoperative laparoscopic ultrasound.

In parallel with the increasing move from open surgical procedures to laparoscopic approaches, laparoscopic ultrasound (LUS) is being used with increasing frequency to image normal structures and intra-abdominal pathology. Special transducers and scanning techniques are required to perform LUS with a different set of considerations. Within the spectrum of LUS applications, LUS is used to complement laparoscopy for oncology staging, to facilitate an array of surgical procedures, and to guide laparoscopic biopsies.

Budget variance analysis of a departmentwide implementation of a PACS at a major academic medical center.

In this study, the costs and cost savings associated with departmentwide implementation of a picture archiving and communication system (PACS) as compared to the projected budget at the time of inception were evaluated. An average of $214,460 was saved each year with a total savings of $1,072,300 from 1999 to 2003, which is significantly less than the $2,943,750 projected savings. This discrepancy can be attributed to four different factors: (1) overexpenditures, (2) insufficient cost savings, (3) unanticipated costs, and (4) project management issues.

Intraoperative US of the liver: techniques and clinical applications.

Intraoperative ultrasonography (US) of the liver provides the operating surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach. Current applications for intraoperative US of the liver include tumor staging, metastatic survey, guidance for metastasectomy and various tumor ablation procedures, documentation of vessel patency, evaluation of intrahepatic biliary disease, and guidance for whole-organ or split-liver transplantation. To obtain the most useful information with intraoperative US, the sonographer should use a dedicated transducer and a scanning method appropriate for the purpose of the examination.

Intraoperative sonography for neurosurgery.

Objective: The purpose of this study was to review the technical aspects and the clinical applications of intraoperative sonography of the central nervous system (CNS) as well as the characteristic appearances of brain and spine diseases.

Methods: A pictorial review of cases is presented on the basis of the performance and interpretation of intraoperative sonography of the CNS from January 1998 to December 2004 at a single academic institution.

Results: This technique is most commonly used for the localization and characterization of intracranial and spinal masses.

Image-guided tumor ablation: standardization of terminology and reporting criteria.

The field of interventional oncology with use of image-guided tumor ablation requires standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments that use different technologies, such as chemical (ethanol or acetic acid) ablation, and thermal therapies, such as radiofrequency, laser, microwave, ultrasound, and cryoablation. This document provides a framework that will hopefully facilitate the clearest communication between investigators and will provide the greatest flexibility in comparison between the many new, exciting, and emerging technologies. An appropriate vehicle for reporting the various aspects of image-guided ablation therapy, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings, are outlined.

Utility and safety of ultrasound-guided fine-needle aspiration of salivary gland masses including a cytologist's review.

Objective: To evaluate the utility and safety of ultrasound-guided fine-needle aspiration of the salivary glands for diagnosis of focal masses in the salivary glands, including the prevalence of nondiagnostic sampling, the impact of the presence of a cytologist during the procedure, and the usefulness of flow cytometry.

Methods: A retrospective analysis of 43 ultrasound-guided fine-needle aspirations of the salivary glands from 36 lesions in 33 patients was performed. Fine-needle aspirations were obtained under sonographic guidance, and 1 to 6 punctures were made with 20- to 25-gauge needles.