We outlined both the clinicopathological features of cystic lesions of the pancreas and the diagnostic imaging techniques, with a focus on ultrasonography, used to detect those lesions. Understanding the clinicopathological features of neoplastic cysts such as serous cystic neoplasms, mucinous cystic neoplasms, and intraductal papillary-mucinous neoplasms is linked to accurate diagnostic imaging of those cysts. Pancreatic endocrine tumors and solid-pseudopapillary tumors originally begin as solid tumors but frequently present with findings resembling a cystic neoplasm because of necrotic changes in the tumor. As a secondary cyst, retention cysts have important significance as an impetus for the detection of pancreatic cancer. Congenital cysts, which include cysts found in von Hippel-Lindau disease, cysts indicating polycystic disease, lymphoepithelial cysts, and epidermoid cysts, are seldom encountered and thus crucial. There are limited types of cystic lesions of the pancreas that are clinically important; if the pathological features of these types of lesions can be recognized and diagnosed with imaging, this will allow accurate clinical diagnosis. Moreover, if cystic lesions of the pancreas can be accurately diagnosed with imaging, unnecessary surgery can also be avoided.

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There are many parameters for assessing global left ventricular function such as ejection fraction and transmitral flow. We assess global function when we want to know the severity of a disease, judge the timing of surgery and determine the prognosis of the disease. We have to choose the most suitable one from among many parameters to achieve our purpose. There are also many parameters for assessing regional left ventricular function such as wall motion and tissue velocity, although tissue velocity may be affected by whole heart motion. We want a regional parameter that can detect subtle changes in regional function because such regional changes may precede global changes. Myocardial strain can be such a parameter. Myocardial strain can be obtained by tissue Doppler echocardiography but has a limitation of Doppler angle dependency. Recent development of the speckle tracking technique facilitates easy measurements of myocardial strain irrespective of Doppler incident angle and may open new avenues for the assessment of regional function.

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Echocardiography is indispensable in medical examination for congenital heart diseases. Its ease of use by medical staff arises from its noninvasiveness. However, some misdiagnoses have come to be called “echo disease” and can cause misdirection in diagnosis and treatment. These pitfalls can result from human error, improper adjustment of the device, unsuitable view selection, and insufficient understanding of the characteristics, hemodynamics, or both, of the disease. With sufficient understanding and knowledge, however, these pitfalls can be avoided. We summarize possible causes of these pitfalls and provide useful examples.

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Carotid ultrasound examination is useful in evaluating the whole-body development of atherosclerosis, because the carotid arteries are susceptible to atherosclerosis and easy to examine. The first stage of evaluating carotid-artery atherosclerosis is based on the thickness of the intima-media complex. Development of arthrosclerosis creates plaque that forms local protruding lesions. Presence of this plaque produces narrowing of the arteries, adversely effecting blood flow. Although intima-media thickness (IMT) is a useful parameter, a resolution of 7-10 MHz proves only the presence of plaque with a thickness of at least 0.1 mm. Thin plaque, around 1.1 mm thick, does not always correspond pathologically to the identified atheroma. Echogenesity, heterogeneity, surface, and mobility should be evaluated when the plaque is large. It should be noted that the calculated number of carotid artery stesosis varies with method of calculation, and that stenosis is usually evaluated from peak systolic velocity in Europe and the United States.

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Objectives and methods: Fifty normal pregnant women ranging from 26 to 41 weeks of gestation underwent ultrasonographic examination. First, we identified the trachea between both bilateral carotid arteries in the cross-section of the fetal neck. We then traced the trachea up to the bilateral bronchi, observed the spatial correlation to the heart and great vessels, and clarified the optimal section for identifying the respiratory tract image. Last, we measured the inside diameters of the trachea and bronchi. Results: The fetal respiratory tract could be identified below the larynx. In the three-vessel tracheal view, the cross-sectional image of the trachea was most easily seen behind the middle portion of the transverse aorta. When the aortic arch was clearly depicted, the cross-sectional image of the left bronchus was confirmed slightly occipito-posteriorly to the right pulmonary artery and inside the arch. In addition, bifurcation of the tracheae and bilateral bronchi were easily described by tracing the left bronchus medially. The ductal arterial arch view provided a cross-sectional image of the left bronchus between the right pulmonary artery and the ductal artery. Further, several other standard views obtained in cardiac screening also provided distinct images of the respiratory tract. The azygos vein was the landmark of the right bronchus. The fetal trachea and bronchi were measurable after the 26th week of gestation. Average inside diameters of the trachea and the right and left bronchi increased gradually from 2.9 mm, 2.0 mm, and 1.9 mm, respectively, at 26-27 weeks to 6.0 mm, 4.7 mm, and 4.6 mm, respectively, at 40-41 weeks of gestation. After week 36, the inside diameters of the trachea, and the right and left bronchi exceeded 4.5 mm and 3.0 mm, respectively, in all cases. Conclusion: The fetal respiratory tract can be observed concurrently with the cardiac screening examination of the fetus. This makes prenatal screening of pathologic condition of the fetal respiratory tract possible.

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AbstractPurpose: To evaluate the influence of the menstrual cycle on parenchymal strain in ultrasound elastography of the breast. Subjects and methods: Ultrasound elastography was used to examine the 40 breasts of 20 healthy premenopausal women volunteers (mean age, 31.4 years; age range, 24 to 46 years). Each of the women had a regular menstrual period. We determined the values of the subcutaneous fat-parenchymal strain ratio by ultrasound elastography three different times: at the beginning and end of the menstrual period and again during the ovulation period. On each examination, we measured the strain ratio in each breast, obtaining five repeated measurements in the fixed direction. Results: We used the Freidman assay for the statistical analysis of the median and average values of every subcutaneous fat-parenchymal strain ratio. No significant differences were found among the vales of subcutaneous fat-parenchymal strain ratio at the beginning and end of the menstrual period, and the ovulation (average: p=0.36, median: p=0.33. Conclusion: Ultrasound elastography is not influenced by the menstrual cycle.

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A 61-year-old man was referred to our hospital complaining of pancreatic tumor. Ultrasonogram (US) showed a tumor at the site of the pancreas body. The tumor was 40 mm in diameter, having a clear margin and a hypoechoic internal echo mixed with high echo areas, and the main pancreatic duct was not dilated. Additionally, the splenic vein was not depicted near the tumor, and collateral veins were found around the tumor on US. Laparotomy revealed that the tumor could be easily dissected from the pancreas but it was fused with the splenic vein. Excision of the tumor with the undetachable splenic vein was performed. The tumor was histologically diagnosed as leiomyoma of the splenic vein. Review of US showed the “beak sign” at the splenic vein, a finding that might be clue to help differentiate the site of the tumor.

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