Medical Imaging Special: Selection of peer-reviewed literature on ultrasonography

The number of peer-reviewed papers covering the field of ultrasonography is huge, to such an extent that it is frequently difficult for healthcare professionals to keep up with the literature. As a special service to our readers, IHE presents a few key literature abstracts from the clinical and scientific literature chosen by our editorial board as being particularly worthy of attention.

Heart failure secondary to dilated cardiomyopathy: a role for emergency physician bedside ultrasonography.

Sivitz A, Nagdev A. Pediatr Emerg Care. 2012 Feb;28(2):163-6.

Heart failure as a result of cardiomyopathy is an uncommon presentation in the pediatric emergency department (PED). The initial presenting symptoms in these cases are often nonspecific and may be confused with more common paediatric illnesses. This article reports the case of a 3-year-old girl initially discharged from a PED after routine evaluation of vomiting and diarrhoea with a diagnosis of acute gastroenteritis, only to return one week later in heart failure from a dilated cardiomyopathy. A bedside ultrasound performed by the emergency physician in the PED allowed for the initiation of appropriate, rapid, goal-directed therapy and expedited timely transport to a facility with paediatric cardiothoracic surgery. Dilated cardiomyopathy and the role of emergency physician echocardiography is reviewed.

The validity of ultrasonography in the diagnosis of zygomaticomaxillary complex fractures.

Ogunmuyiwa SA et al. Int J Oral Maxillofac Surg. 2012 Feb 3.

This study determined the sensitivity, specificity, positive and negative predictive values of ultrasonography in detecting zygomaticomaxillary complex fractures, and highlighted factors that may affect the validity of ultrasonography in these diagnoses. Twenty-one patients with suspected fractures of the zygomaticomaxillary complex were included in this prospective study. All the patients had plain radiographic and computed tomography (CT) investigations. All underwent ultrasonographic examination of the affected region using an ultrasound machine with a 7.5MHz probe. The different radiologists were not aware of the results of the other two investigations. Statistical significance was inferred at P<0.05. The validity of ultrasonography varied with fracture sites with a sensitivity of 100% for zygomatic arch fractures, 90% for infraorbital margin fractures and 25% for frontozygomatic suture separation. Specificity was 100% for the three types of fracture. There was no statistically significant difference in the ability of CT and ultrasonography to diagnose fractures from various zygomaticomaxillary complex fracture sites (P=0.47). Ultrasonography appears to be a valid tool for the diagnosis of zygomatic arch and displaced infraorbital margin fractures. Imaging inflammatorybreast cancer.

Alunni JP. Diagn Interv Imaging. 2012 Feb;93(2):95-103.

Carcinomatous mastitis is a severe form of breast cancer and its diagnosis is essentially clinical and histological. The first examination to perform is still mammography, not only to provide evidence supporting this diagnosis but also to search for a primary intramammary lesion and assess local/regional spread. It is essential to study the contralateral breast for bilaterality. Ultrasound also provides evidence supporting inflammation, but appears to be better for detecting masses and analysing lymph node areas. The role of MRI is debatable, both from a diagnostic point of view and for monitoring during treatment, and should be reserved for selected cases. An optimal, initial radiological assessment will enable the patient to be monitored during neoadjuvant chemotherapy.

Current role of ultrasound in chronic liver disease: surveillance, diagnosis and management of hepatic neoplasms.

Irshad A, Anis M, Ackerman SJ. Curr Probl Diagn Radiol. 2012 Mar;41(2):43-51.

Despite certain inherent limitations in evaluating chronic liver disease on routine gray-scale US, it is still widely used for the initial evaluation in patients suspected of liver disease as well as for hepatocellular carcinoma (HCC) screening in patients with known cirrhosis. Due to recent advances in digital technology and US imaging software, various new computer protocols have been incorporated in the new US equipment. This in turn has resulted in a great improvement in image quality and image resolution. Consequently, the increased ability of US to better characterise the liver texture in general has enabled sonographers to identify subtle changes in the liver texture and delineate smaller masses in the liver with greater success.