Ultrasound

This month's cover story ("MR elastography inspires new wave of hepatic imaging," page 20) is devoted to a rare event: the birth of a new imaging modality. MR elastography is a wonder of human ingenuity that employs MRI, a modality that itself still seems like a miracle.

Just in time for a looming onset of new liver disease, MR elastography has arrived to employ principles as old as palpation and as new as cross-sectional imaging to create an accurate, noninvasive way to diagnose and stage hepatic fibrosis and other liver disorders.

Pro-radiology forces are claiming mandated Medicare accreditation as a victory. They will have to wait until January 2012, however, to see the actual implementation of federal law passed in July to mandate accreditation for high-tech medical imaging covered by outpatient Medicare.

The U.S. Department of Veterans Affairs has awarded a three-year contract to the American College of Radiology to serve as the accrediting organization for 33 VA hospital radiation oncology facilities across the country.

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Robotic tools that could one day perform surgery on battlefields, in space, and at remote locations with minimal human guidance use 3D ultrasound as a key component.

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Calvarial dermoids and epidermoids in young pediatric patients can be monitored using ultrasound alone instead of x-ray based imaging, according to German researchers. Besides being safer and cheaper, sonography could rule out unnecessary surgeries.

Molecular imaging researchers have shown that coronary vascular dysfunction uncovered with PET may be diagnostically more powerful than vascular ultrasound or CT calcium tests for identifying early coronary artery disease in type 2 diabetes patients.

Color Doppler ultrasound, not CT, should be the first imaging modality for triage of adult patients with suspected acute appendicitis, according to a study from Israel.

Women with uterine fibroids remain in the dark about the potential benefits of uterine artery embolization more than a decade after the development of the nonsurgical treatment. Specialists contend that both ob/gyn providers and interventional radiologists should intensify efforts to educate women with the condition about their treatment options.

Screening ultrasound paired with mammography improved breast cancer detection in high-risk women, but the combination also caused a spike in the number of false positives, according to an update to the American College of Radiology Imaging Network 6666 trial. These results may render ultrasound less attractive than MRI in this patient population.

Ultrasound experts have challenged their colleagues and regulatory agencies to scientifically validate the benefits and risks of clinical sonography.

Bedside ultrasound can be a valuable diagnostic tool for monitoring pulmonary congestion in patients with acute decompensated heart failure. As the heart weakens, fluid backs up into the lungs, and critical patients could benefit greatly by being monitored for their condition without having to be moved for radiographs or other diagnostic tests.

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An Achilles’ heel may not be such a bad thing after all. Data from a prospective study performed in Switzerland on more than 6000 women showed that an ultrasound scan of the heel, combined with other clinical parameters, may predict the risk of fractures in elderly women afflicted by osteoporosis.

Contrast-enhanced ultrasound with microflow imaging provides noninvasive analysis of the vascular structure and hemodynamics of liver nodules. This analysis, in turn, provides information about how advanced hepatocellular carcinoma is.

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Endoscopic ultrasound, a common test for adults, is rarely used on children. Researchers in Israel who studied the efficacy of the test on these smaller patients have found it to be a safe and effective tool for diagnosing pediatric gastroenterology patients.

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Diastematomyelia case study: A 40-year-old man with upper and lower back pain. He denied any bowel or bladder dysfunction, radiating symptoms, or motor deficits.

Solid renal parenchymal lesions with a diameter of 5 cm or less can be difficult to diagnose, requiring irradiation and biopsy. Catching renal cell carcinoma in early stages before tumors grow larger than 7 cm, however, increases a patient’s chances of survival over five years. Researchers in China have found that contrast-enhanced ultrasound can accurately diagnose these small lesions.

Interventional radiologists, like their diagnostic counterparts, remain under pressure as payers ratchet back reimbursements. But they continue to fight on the reimbursement front and see some silver linings in new government programs designed to improve the quality of care.

Posterior fossa anomalies detected on fetal MR imaging should be confirmed with postnatal imaging, according to a study in the June American Journal of Roentgenology. Investigators from the U.S. and Canada found significant discrepancies between fetal and postnatal posterior fossa findings on MRI.

Contrast-enhanced ultrasound for abdominal applications in radiology was first approved in Canada in 2001. Although reimbursement issues have prevented its general dissemination and adoption, ample publications describe the benefits and applications of this exciting and robust technique.

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Short-interval follow-up is most often suggested for women whose diagnostic mammograms are flagged as probably benign. But this second look at 12 months has a low sensitivity for detecting cancer, according to a study in the American Journal of Roentgenology.

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Ultrasound measurement of optic nerve sheath diameter can gauge intracranial pressure in patients who cannot tolerate invasive assessments. Sonography has proved useful in brain-injured pediatric patients, and a recent study confirmed that optic nerve sheath diameter correlates with intracranial pressure in adults with brain injuries.

Liver imaging is benefiting considerably from the improvement of ultrasound systems and sequences dedicated to contrast-enhanced examinations. The use of ultrasound contrast to detect and characterize focal liver lesions is now routine.