Purpose: Left atrial (LA) volume index (LAVI) has been reported to reflect left ventricular (LV) diastolic dysfunction and predict cardiac events in patients with coronary artery disease (CAD). Late diastolic mitral annular velocity (A’) has been shown to correlate well with LA function and LV filling pressure. We hypothesized that A’ could be a useful predictor of mortality and rehospitalization due to heart failure (HF) in CAD patients with dilated LA volume. Subjects and Methods: This study included 212 patients (mean age: 64 years, 166 men) who were admitted to the coronary care unit at our hospital due to acute coronary syndrome (ACS). They underwent echocardiography including tissue Doppler imaging (TDI). None of them had atrial fibrillation and atrial flutter or more than moderate mitral valvular disease. The primary study endpoints were mortality and rehospitalization due to HF. Results and Discussion: During a mean follow-up of 508 days, eight patients died and nine patients were rehospitalized due to HF. According to a previous report, the patients were divided into two groups. Group A: LAVI≥32 ml/m² (n=62) and Group B: LAVI⟨32 ml/m² (n=150). Receiver operator curve analysis revealed that A’≥10.7 cm/s was the optimal cut-off value to predict mortality and rehospitalization due to HF in Group A. In Group A, patients with A’≥10.7 cm/sec showed a significantly lower incidence of cardiac events than those with A’⟨10.7 cm/sec (log-rank, p=0.0019). However, A’ could not be a predictor of events in Group B. Conclusion: A’ could be a useful predictor of mortality and rehospitalization due to HF in ACS patients with large LAVI.

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Purpose: We reported in 1982 the significance of hepatorenal contrast in ultrasound diagnosis of fatty liver. Since then, advances in the device have enabled us to improve the penetration of the ultrasound beam and forced us to re-evaluate diagnostic criteria for the detection of fatty liver. In this paper, we will re-evaluate diagnostic findings, i.e., hepatorenal contrast, vascular blurring, and deep attenuation, using an advanced ultrasound system equipped with differential tissue harmonic imaging (THI). As a gold standard to estimate the degree of fatty change, CT number (CTN) was adopted. Subjects and Methods: Chosen as subjects were 312 persons who underwent, in the process of health screening, both abdominal ultrasound and chest X-ray and proceeded to chest CT (including upper abdomen) because of chest abnormality. In those cases, we could compare ultrasound findings and CT findings of the liver coincidentally. A commercially available ultrasonoscope (Tosiba XARIO-XG) and a CT scanner (Siemens Somatom definition AS+) were used. Results: CTN in the hepatorenal contrast negative group, hepatorenal contrast positive group, hepatorenal contrast + vascular blurring positive group, and hepatorenal contrast + deep attenuation positive group was 59.6±4.5 HU (n=227), 52.6±7.0 HU (n=36), 36.4±11.6 HU (n=39), and 26.2±11.0 HU (n=10), respectively. Conclusion: Improvement in beam penetration enabled us to diagnose fatty change around 30% of the hepatic lobules by only detecting a moderate degree of hepatorenal contrast. A combination of hepatorenal contrast and vascular blurring presented fatty change over 50% of hepatic lobules.

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Purpose: To assess the tissue characteristics of chronic liver disease, we statistically analyzed the speckle signal from liver parenchyma. Subjects and methods: Analysis was performed for 65 patients with biopsy-proven chronic hepatitis C; individuals with fatty liver, heavy drinkers, and those with a thick abdominal wall were excluded. The probability density function of radio-frequency signal amplitude was statistically analyzed using a new analytical method. We focused on strong signals which deviated remarkably from the Rayleigh distribution. By applying the analytical results, lesions that caused the strong signals were displayed as red scatter overlaid on B-mode images (we called the red scatter “US-Red” in this study). US-Red% occupancy on the color image was statistically compared with pathological findings. Results: US-Red suggests the existence of an acoustic reflectional plane mainly formed of fibrous bridge and septa. US-Red% increased significantly with progression of liver fibrosis stage. US-Red% varied widely in cirrhosis, and US-Red% in the large nodule group was significantly higher than that in the small nodule group. Conclusion: The results suggest that US-Red% is useful for evaluating liver fibrosis stage (F1-3) and the size of nodules in cirrhosis. In addition, visually detecting the acoustic reflectional plane, which increases with progression of disease, as color images will be clinically beneficial.

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Two cases of breast cancer in which wide but weak echogenic areas were seen around hypoechoic masses on ultrasound are herein reported. The findings were different from the usual “halo” on breast ultrasound. A “halo” is almost always specific to breast cancer and is usually caused by cancer infiltration to the surrounding fat. In one case, the tumor was well-circumscribed both on mammography and histologically. In the other case, infiltration of the mass to the surrounding fatty tissue, which corresponds to the ultrasound feature, was not identified on the mammograms. The echogenic areas of these two cases may be functional and were referred to as “pseudohalo.” Both cases were immunologically ER(-), PgR(-), and Her2 score 0, i.e., so-called triple-negative breast cancers.

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The case: The patient is a 69-year old man. Ultrasonography (US) revealed a 47 x 35 mm space-occupying lesion (SOL) in the upper right quadrant of his abdomen. The internal echo pattern was homogeneous and more hyperechoic than the kidney cortex. The posterior echo was accentuated, and a well-defined border and a hypoechoic margin were observed. Color Doppler imaging detected no internal blood flow.After surgery, pathological examination of the mass lead to a diagnosis of fat necrosis covered with a fibrous capsule. Discussion: Concerning pseudotumoral fat necrosis, a qualitative diagnosis is made by differences in stage of disease at time of discovery. If, however, a mass with a fibrous cap and no internal blood flow is detected in the mesentery, the possibility of this kind of fat necrosis should be born in mind. Further, because surgical methods may vary depending on degree or range of adhesion, we suggest that it is more important to investigate existence, degree, or range of adhesion by utilizing the greatest advantage of ultrasound, namely the possibility of real-time observation of mass movement.

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