Ultrasonic imaging technology is useful in the noninvasive real-time visualization of both blood-flow dynamics and the shapes of tumors and internal organs. Because this sensing technology is of the reflecting type, it can process such information as transmitted wave form, amplitude, and frequency, as well as the acoustic features of reflecting objects and received signals. Ultrasonic imaging therefore shares the medical field with x-ray CT, and MRI, RI, or both. We describe the three foremost ultrasonic technologies: Harmonic Echo technology, for obtaining echo images of high quality; Virtual Echo technology, for displaying real 3D echo images; and Ubiquitous Echo technology, to facilitate ease of diagnosis in accordance with the goals of the national e-Japan Priority Program.

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Recent introduction of a new generation of real-time three-dimensional (RT-3D) echocardiographic systems enables us to use 3D echocardiography in the clinical situation. Systems available today can be used in the full volume mode to asses left ventricular volume and ejection fraction, as well as left ventricular mass. 3D echocardiography can also be used in stress echocardiography. With this method, images of all the left ventricular segments can be acquired with ease in every stage. 3D images of the mitral valve from the upper part of the left atrium aid in recognizing involved lesions and provide important information before valve surgery. New generation RT-3D echocardiography can be applied to quantitation of left ventricular systolic function, stress echocardiography, and anatomical recognition of valve pathology, and is expected to be widely used in the clinic.

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We describe the basics, devices and utility of three-dimensional transabdominal ultrasonography (3DUS). 3DUS volume measurements are accurate regardless of gallbladder configuration. 3DUS may be the most reliable method to estimate gallbladder motility. Virtual endoscopy imaging using 3DUS made it easier to understand three-dimensional shapes and surface conditions of the lesions, and it was more objective and stringent than conventional ultrasonography. We expect that 3DUS will contribute to the advance of ultrasonographic diagnoses of bilio-pancreatic diseases.

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Effective fetal diagnosis of heart disease requires accurate screening at the first level hospital, and optimal perinatal management at the referral hospital. The method used to screen cases of the fetal heart disease must be easy and not require specific knowledge of congenital heart disease. This screening entails three steps: determining which side of the chest the heart is located in, checking the four-chamber view, and checking the three-vessel view. Screening performed by the comedical staff, comprising midwives, nurses, and technicians, can prove valuable. Optimal planning for perinatal management is crucial when heart disease is detected. Although the pediatric cardiologist is important in this planning, additional knowledge specific to the fetal cardiac disease is essential. Similarly, detailed diagnosis based on the results of both M-mode and Doppler ultrasound examination is important when fetal arrhythmia is detected. Optimal prenatal treatment and perinatal management can be based on this diagnosis.

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The presence of Takayasu arteritis (TA) was detected incidentally by ultrasonography (US) performed for a detailed examination of a mass in the neck. The 32-year-old female patient was a rare case of the disease accompanied by arteriosclerosis in spite of her relatively young age. She had been aware of the mass in her right neck since her mid-20s but did not consult a doctor. In June 2001, the neck lesion was pointed out by a dermatologist during treatment of a skin disease, at which time she underwent a US examination. B-mode US demonstrated a thickened intima-media complex or the so-called macaroni sign in the wall of both common carotid arteries. The patient was thus diagnosed with TA. In addition to the macaroni sign, US findings of partial irregularity and calcification of the vascular walls as well as dilations and stenoses of the lumen suggested that she was at the chronic phase of TA with arteriosclerotic changes. With advances in vascular biology, the relationship between TA and arteriosclerosis has come to be noted. The US findings in this case indicated that the inflammation of TA caused arteriosclerosis, resulting in deterioration of the disease to the late phase.

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A CA19-9 producing tumor in the left ventricle is described. A mass was detected in the left ventricular (LV) posterior wall in a 44-year-old man by echocardiography. The serum CA19-9 was high. The echo image of the mass was characterized by irregular surface and unclear border. Its internal echo was mixture of high and low echo areas. Histological examination showed that the contents of the mass were included many inflammatory cells (neutrophils) within a lump of fibrin. Serum CA19-9 level decreased after surgical removal of the tumor. Immunohistochemistil staining for epithelial marker (keratin) revealed, that the epithelium locally existed, in the specimen. Also the immunohistochemisty for CA19-9 showed locally and strongly positive. The reaction to stain with Gram was negative. From these examinations, it was considered that the tumor produced CA19-9. This is a rare case that the tumor in the left ventricle detected by echocardiography produces CA19-9.

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