This presentation represents an attempt to provide an overview of an approach to the ultrasonographic diagnosis of gastrointestinal diseases in three essential steps: identification, imaging, and interpretation. Positive identification of a lesion requires systemic scanning of the entire gastrointestinal tract and must be based on thorough knowledge of anatomy. Adequate use of the ultrasound equipment must include proper magnification of ultrasound images, application of harmonic imaging, and active utilization of high-frequency probes if it is to be effective in obtaining clear images with well-defined stratification of the gastrointestinal wall. A reliable sonographic diagnosis must be based on careful analysis of the image, not a cursory glance. I propose that this analysis include the following ten factors: (1) wall thickness, (2) site and distribution of the lesion, (3) wall stratification, (4) echogenicity of the lesion, (5) extramural changes, (6) peristalsis, (7) compliance and compressibility, (8) luminal stenosis or dilatation, (9) deformity, and (10) blood flow. Identification, Imaging, and Interpretation are three keys that open the way to detecting and accurately diagnosing an array of gastrointestinal disorders.

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I present findings from transabdominal ultrasound (US) examination of urologic neoplasms, report the frequency of the various findings, and discuss clinical procedures most likely to lead to accurate diagnosis of urologic neoplasms after the sonographic examination. We also assess the clinical efficacy of x-ray examination in patients with urolithasis and other benign urologic disorders and point out the importance of measuring serum prostate-specific antigen and carrying out transrectal ultrasound examination. Current urologic examinations for evaluating benign prostatic hyperplasia are also covered.

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The resolution of the latest ultrasound equipment using Gaussian transmission enables higher quality imaging. This paper classifies and compresses resolutions of conventional technology and new technology. The new equipment using Goussian transmission restricts side lobe by coherence phase information. In conjunction with this an additional device enables high quality images.

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Purpose: We studied the prevalence of deep venous thrombus (DVT) in preoperative orthopedic patients who had sustained leg injury. Materials and methods: Subjects of this study were 66 of the 129 adult individuals aged an average of 82.5 years who had been admitted to this institution for treatment of orthopedic disease of the legs from April 2002 through January 2005, those with D-dimer concentrations in excess of 1.0 μg/ml above the normal range. We carried out ultrasonographic examination of deep venous thrombi from the bilateral external iliac vein to the calf muscle veins and evaluated the existence of deep venous thrombi, paying particular attention to (1) presence of thrombus echo in B-mode images, (2) vein compressibility, and (3) absence of blood flow in the affected vein on compression of the muscles of the lower legs. Results: Twenty-six (39.4%) of these 66 patients had deep venous thrombi: In 1 patient, the deep venous thrombus was in the popliteal vein; in the remaining 25, thrombi were found in the veins of the lower legs. Twenty patients had deep venous thrombi in the injured leg; 10, in both legs; and 4, in the leg uninjured leg. Fourteen of 26 patients had deep venous thrombi on the side opposite the site of injury. We found no significant difference in average D-dimer concentration in patients with deep venous thrombi (mean, 28.8 μg/ml) and those without these lesions (mean, 24.6 μg/ml). Thirteen of 26 patients with less than 20.0 μg/ml of D-dimer had deep venous thrombi. Discussion: Although about 40 percent of patients with D-dimer values above the normal range had deep venous thrombi, their D-dimer values were not associated with the presence of deep venous thrombus. Almost all the patients studied had deep venous thrombi in the veins of their lower legs, and more than 50 percent of these patients had deep venous thrombi on the side opposite the site of injury, indicating that both legs, especially the lower legs, should be screened for deep venous thrombi. Conclusion: Ultrasonographic study of the legs of orthopedic patients with D-dimer concentration above the normal range was useful in evaluating presence of deep venous thrombus.

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Purpose: To use contrast-enhanced color Doppler ultrasonography and histopathologic examination modalities to investigate changes in hepatic blood vessel architecture that accompany development of chronic liver disease. Methods: Subjects were 54 patients with biopsy-proven chronic liver disease; individuals with cardiopulmonary disease or intrahepatic tumors were excluded. The divergence angles of the intrahepatic peripheral vessels were measured onto the liver surface with color Doppler sonography (Toshiba Power Vision 8000) in the dynamic-flow mode after contrast enhancement with 300 mg/ml of Levovist. Biopsy specimens were classified according to the New Inuyama classification. Results: Peripheral vessel divergence angle and histopathologic findings were not significantly correlated. Linear blood vessels were always observed in F1 to F3 patients; however, U-shaped vessels were observed only in F4 (Liver cirrhosis) patients. Sensitivity, specificity, and overall accuracy of detecting U-shaped blood vessels in the patients with liver cirrhosis were 76%, 98%, and 91%, respectively. Conclusion: Development of U-shaped vessels is characteristic of the peripheral hepatic vasculature in patients with liver cirrhosis.

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Quadricuspid aortic valve, like bicuspid aortic valve, is characterized by congenital malformation and resulting dysfunction of the aortic valve. This condition is rare, occurring less frequently than bicuspid aortic valve. We report two cases of quadricuspid aortic valve diagnosed preoperatively by echocardiography. Case 1: Quadricuspid aortic valve in a 63-year-old man who had previously received a permanent pacemaker. The patient presented dyspnea on exertion and was hospitalized. Echocardiography showed severe aortic regurgitation in a four-cuspid aortic valve with an accessory cusp between the left and non-coronary cusps. Quadricuspid aortic valve was confirmed on surgery, and the valve was replaced with a prosthesis (SJM 23 mm). Mild fibrosis and myxomatous degeneration were observed on histologic examination. Case 2: Quadricuspid aortic valve in a 58-year-old woman under treatment for hypertension and bronchial asthma. The patient presented dyspnea on exertion and was hospitalized. Transthoracic echocardiography showed severe aortic regurgitation and aortic stenosis, but the configuration of the aortic valve was unclear. Transesophageal echocardiography demonstrated a four-cuspid aortic valve with an accessory cusp between the left and right coronary cusps. Quadricuspid aortic valve was confirmed on surgery, and the valve was replaced with a prosthesis (SJM 17 mm). Histologic examination showed calcification and extensive fibrosis. Quadricuspid aortic valve should be considered when using echocardiography to investigate the cause of aortic valve disease.

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Purpose: We studied the surface irregularity of cirrhotic livers by ultrasonography (US) using a high-performance, high-frequency US probe. To determine the efficacy of US evaluation of cirrhotic liver, we examined the liver surface by US and compared the results with laparoscopic liver surface classification. Subjects and Methods: The participants in the study were patients with chronic liver disease who had undergone both abdominal US and laparoscopic inspection during the period from October 2003 to October 2004. For US, HDI-5000-sonoCT (ATL Co. Ltd.) with a high-frequency linear probe, L12-5 (5-12 MHz), was used. The liver surface was examined by US by measuring the depth from the line connecting the tops of two adjacent nodules on the liver surface. Laparoscopic classification of the liver surface was done according to a 7-stage classification system: (0) smooth, (1) slightly irregular, (2) moderately irregular, (3) highly irregular, (4) slightly tuberous, (5) moderately tuberous, and (6) hemispheric tuberous (bunch of grapes). Results: The correlation coefficient between US evaluation of the liver surface nodularity and laparoscopic classification was ρ=0.941 (P<0001) for the left lobe and ρ=0.943 (P<0001) for the right lobe (Spearman rank order correlation coefficient). Conclusions: US classification of the surface of the cirrhotic liver is possible using a high-performance, high-frequency probe. Furthermore, it is a useful way to non-invasively evaluate the stage of cirrhosis.

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