RESUMO
Endoluminal sonography is a technique well suited to imaging structures beyond the lumen of the hollow viscus. The development of small-diameter (6.2F), catheter-enclosed ultrasound probes has made this technique available for use within the urinary tract. It is capable of defining adjacent vessels, calculi, and masses. Ureteropelvic junction (UPJ) obstruction has been increasingly treated by incisional techniques, either nephroscopic, ureteroscopic, or radiographically controlled, with each incision at risk for causing damage to any adjacent vessel. Endoluminal sonography of the obstructed UPJ was attempted in 46 patients and completed in 45 patients, 41 with primary and 4 with secondary obstruction. Adjacent vessels could be seen in 24 patients. Twelve were located anterior or medial to the UPJ or both. Nine patients had vessels at the UPJ located laterally or anterolaterally, posterolaterally, or medially and laterally. Sonographic localization guided the choice of incision site in all patients and changed therapy in five patients. This technique also allows recognition of high insertion of the ureter into the renal pelvis. Endoluminal sonography of the obstructed UPJ is a valuable technique to determine the location and nature of associated vessels and, therefore, to guide decisions in treatment.
Assuntos
Ultrassonografia/métodos , Obstrução Ureteral/diagnóstico por imagem , Adulto , Angiografia , Artérias/diagnóstico por imagem , Desenho de Equipamento , Fluoroscopia , Humanos , Masculino , Ultrassonografia/instrumentação , Ureter/irrigação sanguínea , UrografiaRESUMO
During the past 25 years, many attempts have been made to establish effective ultrasound contrast agents for both cardiac and noncardiac applications. The ideal ultrasound contrast agent would be: (a) nontoxic; (b) injectable intravenously; (c) capable of passing through the pulmonary, cardiac and capillary circulations; and (d) stable for recirculation. A variety of potential ultrasound contrast agents have been or are now under development. Present and future ultrasound contrast agents should provide for increased diagnostic capabilities in a variety of normal and abnormal vessels and organs throughout the body. These agents will enhance tumor vascularity, delineate areas of ischemia, as well as improve visualization of vascular stenosis. Future developments with modification of ultrasound equipment should increase the capabilities of these agents to improve imaging as well as Doppler sensitivity.
Assuntos
Meios de Contraste , Ultrassonografia , Fenômenos Biofísicos , Biofísica , Meios de Contraste/administração & dosagem , Meios de Contraste/química , Meios de Contraste/farmacocinética , Ecocardiografia , HumanosRESUMO
PURPOSE: To determine guidelines for biopsy in men with normal prostate-specific antigen (PSA) levels and suspected prostate cancer. MATERIALS AND METHODS: The clinical-sonographic features of 91 lesions of reduced echogenicity in 83 men with normal PSA levels who underwent transrectal ultrasound-guided biopsy were analyzed. RESULTS: Sixteen men (19%) had cancer, two with bilateral foci, and four had prostatic intraepithelial neoplasia (PIN). Fourteen of 47 discrete hypoechoic lesions yielded cancer or PIN versus only five of 44 ill-defined vaguely hypoechoic lesions (P = .03). Fifteen of 18 malignant lesions exceeded 1 cm in longest dimension. In 47 men, sonographic and digital rectal examination (DRE) findings corresponded; 17 (36%) had cancer or PIN. By contrast, of 36 patients with differing sonographic and DRE findings, only three (8%) had malignancy at biopsy (P < .01). CONCLUSION: Predictors of malignancy at sonography of the peripheral prostate gland in men with normal PSA levels include (a) lesion size, (b) degree and focality of hypoechogenicity, and (c) correspondence with the site of DRE abnormality.
Assuntos
Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Exame Físico , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/patologia , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/patologia , Prostatite/diagnóstico por imagem , Prostatite/patologia , Estudos Retrospectivos , Ultrassonografia de IntervençãoRESUMO
A model for the scattering of ultrasound from breast tissue is proposed. The model is based on the use of non-Rayleigh statistics, specifically the K distribution to describe the backscattered echo from the tissue. A multiparameter test based on this model has been designed to characterize the tissue. The data from the B-scan images of the breasts of 6 different patients were analyzed using this model. The results indicate that the non-Rayleigh statistics seem to be useful in characterizing and identifying malignant, benign, and normal tissue regions.
RESUMO
Endoluminal sonography of the urinary tract was performed by using endoluminal ultrasound transducers contained within 2-mm-diameter catheters. The catheters were inserted into the urinary bladder via the urethra and advanced into the ureters and renal pelvis under cystoscopic control; then, cross-sectional images of the bladder, ureters, and renal pelvis were obtained. Two dogs and seven human patients were studied. In one dog, a 4.5-mm pseudopolyp, which was surgically created in the bladder wall, was successfully imaged; in the other, stones 2 mm or larger inserted into the bladder were identified. Of the seven patients, sonography showed stones embedded in the renal parenchyma (one patient) and the mucosa of the distal ureter (one patient). These were ultimately confirmed by their eventual removal. In a third, sonography showed a tumor of the distal ureter and identified the depth of the tumor. This was confirmed by biopsy. In a fourth, sonography clearly showed a crossing vessel as the cause for narrowing of the proximal ureter. In a fifth, sonography showed that the cause of a ureteral stricture was idiopathic. In the last two cases, sonography did not reveal a cause for hematuria. In these last three cases, negative sonographic results were confirmed by direct ureteroscopic examinations and follow-up studies. Our observations based on this limited study suggest that endoluminal sonography is a useful procedure for diagnosing diseases of the urinary tract. Further study is warranted.
Assuntos
Doenças Urológicas/diagnóstico por imagem , Adulto , Idoso , Animais , Cães , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Cálculos Urinários/diagnóstico por imagem , Sistema Urinário/diagnóstico por imagem , Neoplasias Urológicas/diagnóstico por imagemRESUMO
Preoperative ultrasonography was used as an alternative to x-ray mammography to localize 92 breast lesions encountered in 82 patients. Recommendation for biopsy was made on the basis of the ultrasonographic finding of a nonpalpable mass or an area of architectural distortion, or in the presence of equivocal physical findings if sonomammography demonstrated a solid or an anechoic mass. Sonomammography was performed in the operating room, just before anticipated biopsy, with a hand-held high-resolution scanner. When the suspicious area was imaged and its precise location noted, the breast was then prepared and draped in the usual manner, and a biopsy was performed. If the suspicious area could not be easily localized after the incision was made and the breast explored, the transducer was "gowned" and used directly in the wound to help find the lesion. This technique has proven effective and accurate. In selected patients ultrasonography may be used as well as, or instead of, x-ray needle localization for the precise excision of nonpalpable breast lesions, excluding calcifications.
Assuntos
Biópsia por Agulha , Doenças Mamárias/diagnóstico , Mamografia , Palpação , Ultrassonografia , Adulto , Idoso , Biópsia por Agulha/métodos , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Ultrassonografia/instrumentação , Ultrassonografia/métodosRESUMO
Serial ultrasound imaging of the brain was used to determine the ventricular index (VI), and the ratio (VR) of the VI to the cranial hemidiameter during the nursery course and first year post-term in preterm infants of less than 33 weeks gestation. Twenty-nine of the infant survivors with no intracranial hemorrhage or major medical complication during their nursery course composed group 1. Twenty-two survivors with intracranial hemorrhage unassociated with early ventricular dilation composed group 2. Group 3 was comprised of 10 other survivors who had neonatal intraventricular hemorrhage with early ventriculomegaly; all 10 infants had at least one major medical complication during their neonatal course. In groups 1 and 2 the VR decreased and the VI increased significantly with age post-conception. Infants in group 3, compared with those in groups 1 or 2, had decreased occipitofrontal growth during the early postnatal period and increased VR and VI during the neonatal period and first year post-term. These results suggest that the ventriculomegaly associated with neonatal intracranial hemorrhage cannot be explained by posthemorrhagic hydrocephalus alone and may also be related to cerebral atrophy or decreased brain growth or both. Neurodevelopmental assessments at 20 to 30 months of age disclosed significantly lower Bayley Motor Development scores in group 3 compared with groups 1 or 2. Four infants in group 3, but none in groups 1 or 2, had cerebral palsy. The neurodevelopmental deficits in group 3 infants may reflect the complex pathogenesis of the ventriculomegaly as well as the effects of the intraventricular hemorrhage and posthemorrhagic hydrocephalus.