Interest in molecular imaging and therapy has grown tremendously, and ultrasound has been recognized as a useful tool not only for imaging but also for modern therapy. To understand how therapeutic ultrasound works, it is necessary to understand its biological effects at the molecular level. Here, the biological effects of ultrasound are reviewed, focusing on ultrasound-induced apoptosis, gene transfer, change in gene expression, and gene regulation. Studies have shown that ultrasound can induce apoptosis where certain conditions can lead to optimal apoptosis induction. Ultrasound-mediated gene transfer in different cell lines and tissues has been reported. Moreover, a variety of genes can be up-regulated or down-regulated by sonication. In light of these data, it is expected that ultrasound will play a cardinal role in the development of molecular therapy in the future.

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The basic mechanism of ischemic mitral regurgitation (MR) is augmented leaflet tethering due to the outward displacement of the papillary muscles by left ventricular (LV) remodeling or dilatation. Annular dilatation and LV dysfunction may not be the central mechanism, but they contribute to the development of MR in the presence of augmented tethering. Papillary muscle dysfunction was initially expected to cause leaflet prolapse and MR. However, multiple studies have confirmed that papillary muscle dysfunction per se does not usually cause ischemic MR, and recent studies further suggest that papillary muscle dysfunction may occasionally attenuates tethering and MR. Although surgical annuloplasty is usually effective for treating ischemic MR, occasional patients with persistent or recurrent ischemic MR after surgical ring annuloplasty even with advanced down sizing suggest the need for approaches to address tethering. Finally, leaflet tethering in patients with ischemic MR can be heterogeneous, indicating the need for individualized approaches to correct ischemic MR in affected patients.

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A child with an acute abdomen requires history-taking and a physical examination followed by laboratory and imaging evalutions. It is difficult to obtain an exact history and physical findings from infants and children. Primary imaging of an abdominal emergency in children is a radiograph of the abdomen. In the case of imaging evalution, ultrasound plays an important role in the diagnosis of pediatric acute abdomen. The common causes of acute abdominal pain in children are intussusception, acute appendicitis, and gastroenteritis. The other causes of abdominal pain are choledochal cyst, midgut malrotation, hemorrhagic colitis, and Henoch-Schönlein purpura. High sensitivity and specificity of ultrasound in the diagnosis of intussusception are established, and sonographic reduction methods of hydrostatic enema are increasing. Sonographic reduction can detect not only intussusception but also the presence of a lead point. Acute appendicitis in children can often carry serious complications, i.e., perforation, abscess formation, and peritonitis, especially if the diagnosis is missed. The appendiceal perforation rate is higher in younger children. The diagnostic accuracy of sonography in the diagnosis of intussusception and acute appendicitis in children has become increasingly high. Ultrasound can easily detect the long segmental wall thickening of the intestinal loop, and the wall thickening may suggest hemorrhagic colitis or Henoch-Schönlein purpura. This article details the sonographic findings of these diseases, especially intussusception, acute appendicitis, hemorrhagic colitis, Henoch-Schönlein purpura, midgut malrotation, and choledochal cyst.

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Ultrasonography is a noninvasive diagnostic method that has gained an established role in many branches of medicine. The inability of ultrasound to penetrate bone, however, delayed its application in the orthopedic field. In the 1970’s, the successful work of Dr. Graf in developmental dysplasia of the hip joint with ultrasound helped promote greater use of ultrasonography to evaluate abnormalities of the musculoskeletal system. Over the past two decades it has been increasingly recognized that ultrasound is an useful tool in orthopedics. In this installment, how to read an orthopedic ultrasound, the potential applications, its diagnostic capabilities, and technical aspects of the ultrasound examination are described. It is certain that ultrasonography will be a new method of investigation in orthopedic diagnosis.

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Purpose: Generally, atherosclerosis forms in a specific region, e.g., bifurcation of a large artery. Therefore, we often encounter plaque formation in one side of the carotid sinus (CS). Thus, we investigated whether or not the diameter and angle of the carotid artery impact plaque formation in CS using carotid ultrasound. Subjects and Methods: The candidates for this study were 655 subjects who underwent carotid ultrasound at Teramotokinen Nisitenma Clinic between April 2009 and March 2010. Exclusion criteria were plaque formation on both sides of the CS, unclear connection between the common carotid artery (CCA) and the CS, plaque formation or wall thickening of the CCA, and severe stenosis or total occlusion of the internal carotid artery (ICA). Eligible data from 100 subjects were ultimately used for this study. We analyzed relationships between plaque formation and CCA diameter (CCAd), CS diameter (CSd), ratio of CSd to CCAd (CS/CCA), angle between CCA and CS (angle), mean intima-media thickening, and velocity. We defined side with plaque formation as the positive side (P side) and the intact side as the negative side (N side), and compared factors between the two sides. Results and Discussion: We found that angle, CSd, and CS/CCA on the P side were significantly higher as compared with the N side. The present study demonstrated that vessel diameter and angle might influence shear stress, resulting in involvement in plaque formation in the CS. Conclusion: Our findings confirmed that the diameter of the CS and the angle between the CCA and the CS play a role in plaque formation in the CS.

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We report our experience with 3 cases of gallbladder disease accompanied by hyperechoic nodules of the gallbladder wall in ultrasonographic images. All 3 patients complained of abdominal pain or back pain. Hyperechoic nodules were observed throughout the gallbladder wall in 2 patients, and a hyperechoic nodule was found in the body of the gallbladder of the third patient. Abdominal CT was performed in all 3 cases, and plain CT revealed high density nodules in 2 cases. MRI was performed in all cases, and in all of them, all of the hyperechoic nodules were high intensity in T1WI. The pathology in all cases was diagnosed as adenomyomatosis accompanied by chronic cholecystitis. Abscess was detected in fundus in one case, but it was unclear and poorly demarcated in the ultrasonic images. Demarcated hyperechoic nodules in the ultrasonographic images were thought to be Rokitansky-Aschoff sinus (RAS) with concentrated bile or sludge, or minute stones. An unclear hyperechoic nodule with an irregular margin was thought to be an abscess. We concluded that a hyperechoic nodule in gallbladder wall was RAS with inflammation. Xanthogranulomatous cholecystitis (XGC) is thought to result from rupture of the RAS, and almost all cases of XGC are accompanied by gallstones. But the cause of XGC when no gallstones are present is not known. The 3 cases reported here would appear to be a precursor stage of XGC.

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Skeletal dysplasia is a rare disease and has numerous classifications, so accurate prenatal diagnosis is difficult. Hypophosphatasia and hypochondrogenesis, in particular, have a poor prognosis. Therefore, assessment of the prognosis is the key to successful management. We report two cases of hypophosphatasia and hypochondrogenesis detected by ultrasonography. Case 1: A 24-year-old primigravida was referred to our hospital at 29 weeks due to shortening of the fetal femur. Ultrasonography demonstrated shortening of all long bones. The skull yielded easily to pressure with the probe. The skull, vertebral bodies, and bilateral hands and feet were not detected by 3D-CT. Based on these findings, hypophosphatasia was strongly suspected. The female baby weighed 2436 g and was delivered with an Apgar score of 1(1’)/1(5’). She died 20 minutes after delivery due to respiratory failure. Her phosphatase value was 5 IU/L. Case 2: A 31-year-old multigravida was referred to our hospital at 20 weeks due to shortening of the fetal femur. Ultrasonography demonstrated shortening of all long bones. The femur looked like metaphyseal splaying. The skull did not yield easily to pressure with the probe. The thorax was very small. Based on these findings, lethal osteochondrodysplasia was strongly suspected. The patient had an abortion. Accurate assessment of the prognosis is the key to successful management. Therefore, it may be clinically significant to measure all bones and examine them carefully using 3D-CT.

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A 51-year-old woman visited our hospital because of a palpable mass in the right breast. Mammography showed an ill-defined dense mass, and power Doppler ultrasonography (US) demonstrated a well-defined heterogeneous tumor with vascularity. T2-weighted MRI showed a mass with high signal intensity in the right breast. Post-contrast T1-weighted MRI revealed a rim enhancement. These MRI findings are suggestive of breast carcinoma with massive central necrosis or matrix-producing carcinoma. The tumor was diagnosed as matrix-producing carcinoma by core needle biopsy. On the basis of the pathologic-ultrasonographic correlation, heterogeneous echo patterns in the tumor corresponded to the myxomatous matrix with various amounts of cancer cells. US is thought to be useful for understanding the histological internal structures of this rare tumor.

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