Ultrasonography of the Peripheral Nerves of the Forearm, Wrist and Hand: Definition of Landmarks, Anatomical Correlation and Clinical Implications.

Background:  Peripheral nerve pathologies of the upper extremity are increasingly assessed by high-resolution ultrasonography (HRUS), yet rapid identification of nerve segments can be difficult due to small nerve diameters and complex regional anatomy. We propose a landmark-based approach to speed up and facilitate evaluation and intervention in this region.

Method:  Relevant landmarks and section planes for eleven nerve segments of the forearm, wrist and hand were defined by ultrasonography in cadaver arms before cryosection and topographical neurovascular preparation.

High resolution ultrasound in posterior interosseous nerve syndrome.

Introduction: Posterior interosseous nerve (PIN) syndrome is a rare compression neuropathy of the PIN in the region of the supinator muscle, most common by the arcade of Frohse. We aimed to specify ultrasonographic findings in patients with PIN syndrome in comparison to healthy volunteers.

Methods: Ultrasound images and clinical data of 13 patients with PIN syndrome confirmed by neurological examination and electrophysiological testing were evaluated retrospectively.

Ultrasound-guided injections in the middle and lower cervical spine.

Injection therapies play a major role in the treatment of cervical pain and are becoming integral parts of a multidisciplinary approach in treatment and rehabilitation of such patients. Pararadicular- and facet-joint injections in the cervical spine are preferentially performed under computed tomography (CT) or fluoroscopy-guidance. In this article we present an alternative, simple and easy to learn step by step US-guided technique for injection therapy in the cervical spine.

Perfusion pattern of musculoskeletal masses using contrast-enhanced ultrasound: a helpful tool for characterisation?

Objective: We report 54 patients with histologically evaluated musculoskeletal masses who underwent grey-scale and contrast-enhanced ultrasound (CEUS), followed by ultrasound-guided biopsy. We hypothesise that the definition of a CEUS-based enhancement pattern improves the characterisation of tumour malignancy.

Methods: Fifty-four patients with soft-tissue masses were examined according to our standardised ultrasound procedure.

Ultrasound of the median arcuate ligament syndrome: a new approach to diagnosis.

Introduction: The currently accepted pathophysiological concept behind median arcuate ligament syndrome (MALS) is vascular compromise by atypically positioned median arcuate ligament. Despite many articles on MALS, only sparse data on the outcome in general and the rather poor outcome after intervention have been reported and this makes at least questionable the current concepts of the underlying disease.

Material And Methods: A total of 364 patients with suspected celiac trunk pathology underwent a standardized ultrasound assessment procedure: suspected diagnostic features for MALS such as typically elevated peak flow velocities (PV) in the celiac trunk or atypical celiac trunk deflection-angles (DA) were defined in patients and in 20 matched volunteers.

Contrast Enhanced Ultrasound of the lower limb deep venous system: a technical feasibility study. Technical innovation.

Background: A clear diagnosis of deep venous thrombosis (DVT) is still challenging: many patients with unclear compression/duplex-sonography undergo a trial of anticoagulative treatment with the immanent risk of systemic hemorrhagic complications. As contrast enhanced ultrasound (CEUS) has the potential to visualize the blood pool, we conducted this pilot study to determine its potential in the characterization of the deep venous system of the lower limb.

Material And Methods: CEUS was performed with a 9-3 MHz broadband linear transducer (iU22®, Philips, USA) after the standard-application of a second-generation contrast agent (SonoVue®, Bracco, Italy) in three healthy volunteers.

Ultrasound guided core needle biopsy of soft tissue tumors; a fool proof technique?

Aim: To assess technical and lesion related factors affecting the quality of ultrasound guided core needle biopsy (CNB) of musculoskeletal soft tissue tumors.

Materials And Methods: Data of 223 CNBs were evaluated in a retrospective study. Diagnostic yield was calculated for all lesions on the basis of lesion location (extremity/torso), examiner, biopsy needle gauge/length and number of acquired samples.

The "dark tendon sign" (DTS): a sonographic indicator for idiopathic trigger finger.

Although the diagnosis of "idiopathic trigger finger" (stenosing tenovaginitis) is normally based on clinical examination alone, to date there is no reliable evaluation defining this idiopathic disease beyond an exclusion of secondary causes or an unnecessary sonographic certification of high-grade impairment. By standardized assessment of 32 patients who retrospectively fulfilled the study inclusion criteria and their comparison to a matched group of volunteers, we defined the diagnostic efficiency of the here newly proposed sonographic dark tendon sign (DTS) alone, of impaired tendon gliding alone and the combination of these two features. Pulley thickness in patients and volunteers was significantly different.

Ultrasound-guided injections in the lumbar spine.

Injection therapies play a major role in the treatment of low back pain and radiculopathy and are becoming integral parts of a multidisciplinary approach in treatment and rehabilitation of patients with pain. Pararadicular- and facet-joint injections in the lumbar spine are preferentially performed with computed tomography (CT) or fluoroscopy-guidance. In this paper we present an alternative, simple and easy to learn US-guided technique for injection therapy in the lumbar spine.

The validity of ultrasonographic assessment in cubital tunnel syndrome: the value of a cubital-to-humeral nerve area ratio (CHR) combined with morphologic features.

Diagnosis of a typical idiopathic cubital tunnel syndrome (CuTS) is straight forward but the work-up of mild forms is clinically challenging. The diagnostic value of high-resolution ultrasound (HRUS) relying solely on nerve measurements is doubtful. Additional textural analysis of the nerve may possibly overcome this drawback.

State-of-the-art HR-US imaging findings of the most frequent musculoskeletal soft-tissue tumors.

High resolution ultrasound (HR-US) including color Doppler ultrasound (CD-US), power Doppler ultrasound (PD-US), and spectral wave analysis (SWA), is a broadly available, non-invasive and relatively low-cost modality without ionizing radiation. It is increasingly used for initial assessment of an ambiguous musculoskeletal soft-tissue lesion and for sonographically guided core biopsy. The aim of this review is to provide sonographic findings of the most frequent benign and malign soft-tissue lesions.

Practical experience with sonographically guided phenol instillation of stump neuroma: predictors of effects, success, and outcome.

Objective: Phantom limb pain and stump pain frequently occur after limb amputation, and stump neuromas play an important role in generation of the pain. The purpose of this study was to evaluate the effects of a previously described optimized procedure for sclerosis of painful stump neuromas under real-time high-resolution sonographic guidance.

Subjects And Methods: In this prospective study, neurosclerosis was performed on 82 patients by means of high-resolution sonographically guided injection of up to 0.

High-resolution ultrasound of peripheral neurogenic tumors.

Peripheral nerve tumors are not frequent, but due to their association with a nerve they are somewhat special. They may be encountered incidentally during evaluation of a soft-tissue mass or when a nerve lesion is clinically suspected and the recognition of such a lesion and its differential diagnosis is key for successful therapy and patient prognosis. As sonography is often the first line modality in the work-up of a soft-tissue mass, the sonographer should be aware of the typical features of such lesions in order to arrive at the correct diagnosis, and this article tries to give an overview of the histological subtypes of peripheral nerve tumors and their sonographic characteristics.

Leg edema formation and venous blood flow velocity during a simulated long-haul flight.

Introduction: Long-distance traveling in a sitting position may be associated with an increased incidence for venous thromboembolism. As major contributing factors immobility and compression of leg veins are discussed. At present no studies have been performed measuring the time course of lower limb blood flow, leg volume and leg tissue thickness during a long-haul flight.

High-resolution ultrasound of the supraclavicular brachial plexus--can it improve therapeutic decisions in patients with plexus trauma?

Patients with major traumatic brachial plexus lesions benefit from early surgery, but they are seldom isolated by today's diagnostic workup. Subjects with ambiguous findings after such workups usually undergo a trial of conservative treatment and those without improvement delayed surgery. Our study focuses on this problem.

Peroneal nerve palsy associated with knee luxation: evaluation by sonography--initial experiences.

Objective: Traumatic knee dislocation needs immediate surgical repair to restore joint function. A concomitant traction injury of the peroneal nerve is reported to exist in up to 25% of cases and is often overlooked initially. In patients with major nerve lesions, immediate surgical nerve repair might be necessary to avoid irreversible loss of neural function.

Detection and characterization of perianal inflammatory disease: accuracy of transperineal combined gray scale and color Doppler sonography.

Objective: To evaluate the accuracy of transperineal gray scale and color Doppler sonography for the detection and characterization of perianal inflammatory disease with surgical correlation.

Methods: Eighty-seven patients with suspected perianal inflammatory disorders underwent transperineal gray scale and color Doppler sonography with a linear 4- to 7-MHz transducer that was used to scan the entire perianal region for the detection of suspected inflammatory disorders. Each detected inflammatory disorder was evaluated to determine its morphologic characteristics and extent.

Sonographic evaluation of primary peripheral nerve repair.

Objective: This feasibility study was undertaken to define the potential of sonography for the follow-up evaluation of patients with surgical repair after nerve transection and persistent impairment of nerve function.

Methods: Nineteen patients with primary repair of a transected peripheral nerve because of direct trauma or complex fractures were evaluated with sonography. All patients had persistent clinical symptoms and neurologic signs of impaired nerve function.

Resolution requirements for monitor viewing of digital flat-panel detector radiographs: a contrast detail analysis.

With the introduction of digital flat-panel detector systems into clinical practice, the still unresolved question of resolution requirements for picture archiving communication system (PACS) workstation monitors has gained new momentum. This contrast detail analysis was thus performed to define the differences in observer performance in the detection of small low-contrast objects on clinical 1K and 2K monitor workstations. Images of the CDRAD 2.

The ultrasonographic appearance of the femoral nerve and cases of iatrogenic impairment.

Objective: To assess the feasibility of ultrasonography of femoral nerves in a cadaveric specimen, healthy volunteers, and patients.

Methods: In 1 unembalmed cadaveric specimen (female, 90 years) and 20 healthy volunteers (9 male and 11 female, 18-50 years; n = 40 scans), the topographic features, cross-sectional shapes (oval or triangular), and cross-sectional areas of the femoral nerves were evaluated by ultrasonography (5- to 12-MHz broadband linear array). In a subsequent study, 7 consecutive patients with postoperative findings assigned to the femoral nerve were evaluated and assessed by a neurologist.

Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy.

Objective: To determine feasibility of ultrasonography in detecting the normal accessory nerve as well as pathologic changes in cases of accessory nerve palsy.

Methods: Four patients with accessory nerve palsy were investigated by ultrasonography. Three cases of accessory nerve palsy after lymph node biopsy and neck dissection were primarily diagnosed on the basis of ultrasonography using a 5- to 12-MHz linear transducer.

Storage phosphor radiography of wrist fractures: a subjective comparison of image quality at varying exposure levels.

Image quality of storage phosphor radiographs acquired at different exposure levels was compared to define the minimal radiation dose needed to achieve images which allow for reliable detection of wrist fractures. In a study on 33 fractured anatomical wrist specimens image quality of storage phosphor radiographs was assessed on a diagnostic PACS workstation by three observers. Images were acquired at exposure levels corresponding to a speed classes 100, 200, 400 and 800.

Direct digital radiography versus storage phosphor radiography in the detection of wrist fractures.

Aim: To define the value of digital radiography with a clinical flat panel detector system for evaluation of wrist fractures in comparison with state of the art storage phosphor radiography.

Material And Methods: Hard copy images of 26 fractured wrist specimens were acquired with the same exposure dose on a state of the art storage phosphor radiography system and a clinical flat panel detector. Image features like cortical bone surface, trabecular bone, soft tissues and fracture delineation were independently analysed by 4 observers using a standardised protocol.