The therapeutic potential of low-intensity US is currently being studied in various types of human cancer. A recent study in tumor biology showed that angiogenesis is essential for tumor growth in cancer, and ultrasound irradiation was shown to be a possible mechanical method to deliver small molecules into tumor cells by ‘sonoporation’. Microvascular endothelial cells, which are recruited by tumors, have become an important target in cancer therapy. Our study firstly examined the antitumor effect of an angiogenesis inhibitor combined with low-intensity US irradiation for human cancer in vitro and in vivo, and evaluated its vascularity (angiogenesis) using color Doppler US in real time with a microbubble US contrast agent. The results suggest that the antitumor effect of angiogenesis inhibitors for uterine sarcoma is accelerated by US irradiation, and that this combination might be a potentially effective new cancer therapy. This combination therapy inhibited the mobilization of circulating endothelial progenitor cells by suppressing vascular endothelial growth factor (VEGF) production and stimulated thrombospondin-1 (TSP-1; anti-angiogenic factor) in tumor cells in vivo. We predict the arrival of a new cancer therapy using low-intensity US that will allow simultaneous diagnosis and treatment in real time.

View full abstract

Purpose: Ultrasonic diagnosis is the first important step in the practical management of thyroid nodules. We have our own ultrasound classification system for the diagnosis of thyroid nodules, which consists of five ultrasound classes (USC) based on characteristics of thyroid nodules such as regular or irregular shape, solid or cystic content, presence or absence of microcalcifications, extraglandal invasion, and so on. USC-1 and 2 is defined as benign, USC-3 as border, and USC-4 and 5 as malignant. The purpose of the present study is to verify the accuracy of the ultrasound classification system. Subjects and Methods: Ultrasonographic examination was performed for all primary patients with thyroid nodules during the course of one year (2008) at Kuma Hospital. A total of 13,293 thyroid nodules in 8,469 consecutive patients were included in this study. All the thyroid nodules were divided into five classes according to the ultrasound classification criteria. The cytological and pathological diagnoses of nodules were made by a pathologist independently of ultrasonic diagnosis. The relationship between the ultrasonic diagnosis and the cytological and pathological diagnoses was statistically investigated. Results and Discussion: Ultrasonic diagnosis of thyroid nodules based on our own ultrasound classification system was significantly correlated with the cytological and pathological diagnoses. The sensitivity and specificity of the ultrasound system were 77.1% and 94.7%, respectively, when USC 4 and 5 were regarded as malignant and USC 1, 2, and 3 as benign. The ultrasonic diagnosis based on the system correctly reflects the cytological and pathological diagnoses of thyroid nodules. Conclusion: This ultrasound classification system was considered to be useful for the practical management of thyroid nodules as part of an objective assessment.

View full abstract

Purpose: We focused on the characteristic changes in ultrasonograms of the pancreas in patents diagnosed with alcohol-induced liver cirrhosis (ALC) and examined the frequency of occurrence of these changes. Subjects and Methods: Of 211 patients who were clinically or pathologically diagnosed with ALC during the period from November 2001 through September 2010, we selected 189 patients (175 males, 14 females, average age: 61.1 years, age range: 32-90 years) by excluding patients who had already been diagnosed with chronic pancreatitis (CP) and those who showed poor ultrasonographic images of the pancreas. Ultrasonograms were evaluated by three sonographers with 10 or more years of experience each. Results and Discussion: 1. 71.4% of the cases examined had low levels of echogenicity in pancreatic parenchyma. 2. 95.2% had dotted or linear hyperechoic foci in pancreatic parenchyma. 3. 72.5% had echogenic foci at the marginal zone of the pancreas. Moreover, 70.3% of the cases showed all of the three findings described above. These characteristics in ultrasonograms of the pancreas may reflect the chronic changes observed in the pancreatic parenchyma of CP patients, such as increased inhomogeneous formation of fibrous tissue, cellular infiltration, destruction of the parenchyma, and formation of granulation tissue. Conclusion: Ultrasonography, as a handy and noninvasive imaging technique, may be useful in early diagnostic evaluation of CP.

View full abstract

Purpose: In high-risk pregnancies, uterine artery (UtA) Doppler flow examination has been reported to be valuable for predicting pregnancy-induced hypertension (PIH) and fetal growth restriction (FGR). However, it has scarcely been evaluated in low-risk populations. The aim of this study is to analyze the association between abnormal UtA Doppler flow and adverse pregnancy outcomes in low-risk populations. Subjects and Methods: This prospective observational study was conducted from 2009 to 2010. A total of 880 scans were obtained in the late second trimester. The inclusion criteria were as follows: (1) the neonate did not have congenital malformations; (2) the mother had a low-risk pregnancy, as determined by Japanese pregnancy risk score; and (3) the neonate was born in our institution. The UtA pulsatility index (PI) was measured on both sides, and the mean PI was calculated. An elevated UtA-PI was defined as a UtA-PI above the 95th percentile. Light-for-date (LFD) infants were defined as infants with birth weight below the 10th percentile according to Japanese standards. Statistical analysis was conducted by the χ² or Fisher’s exact tests. In addition, we performed multivariate logistic regression analysis to assess relative factors. Results and Discussion: One hundred and seventy-three women with singleton pregnancies met the inclusion criteria. Three women had an elevated PI; none of these women developed PIH (p=0.978), and two gave birth to LFD infants (p=0.020). Elevated PIs were significantly related to giving birth to LFD infants, but no such relationship was observed in connection with PIH. Multivariate logistic regression analysis showed that elevated PI was the strongest risk factor involved with giving birth to LFD infants. In contrast, no risk factor was found to be associated with PIH. Conclusion: In low-risk pregnancies, performing UtA Doppler flow velocimetry might predict LFD infants. No significant association was observed between elevated PI and PIH; this might be because there are only a few cases of PIH in low-risk populations.

View full abstract

Nager syndrome is a rare form of acrofacial dysostosis first described by Nager in 1948. It is characterized by mandibulofacial dysostosis and upper limb anomalies. A typical craniofacial finding is micrognathia-like Treacher-Collins syndrome. Limb malformation associated with Nager syndrome most often involves the radial aspect of the upper limbs and may result in thumb hypoplasia and/or hypoplasia of the radius. There are few reports about prenatal diagnosis of this syndrome. We made a prenatal diagnosis of Nager syndrome with 3D/4D ultrasound at 30 weeks of gestational age. The fetus was complicated with life-threatening disseminated intravascular coagulation (DIC) and laryngotracheoesophageal cleft (LTEC) type 3.

View full abstract

To our knowledge, this is the first report of a case of fetal anemia due to rupture of a vein on the surface of placental chorioangioma. A 29-year-old primigravida was referred to us for clinical follow-up and serial ultrasonographic (US) surveillance. The patient had a normal course until a placental mass was noted by obstetric US examination at 28 weeks. Routine obstetric US images demonstrated a 65×80-mm hypoechoic, circumscribed, and ovoid intraplacental mass that protruded into the amniotic cavity. Amniotic fluid pocket was measured as 87 mm, and power Doppler images demonstrated remarkable flow within the anechoic spaces in the placental mass. The diagnosis of chorioangioma and polyhydramnios were made, and the patient was admitted to our hospital. At admission, we did not find any apparent complications such as fetal anomaly, anemia, growth restriction, or placental abruption. Following examinations, the size of the mass gradually increased, and the middle cerebral artery-peak systolic velocity (MCA-PSV) MoMs were also increased. Furthermore, the sinusoidal pattern appeared on the fetal heart rate tracing. Then, emergency cesarean section was performed under the diagnosis of non-reassuring fetal status due to fetal anemia. At the operation, we found that amniotic fluid was bloody due to rupture of the placental mass. Neonatal hemoglobin and albumin were 8.3 g/dl and 1.5 mg/dl, respectively, and the platelet count was within the normal range (19.1×10⁴/μl). The cause of fetal anemia was thought to be hemorrhage due to rupture of the placental mass. It has been suggested that we should pay attention to rupture of tumor vessels when we manage cases with chorioangioma complicated by polyhydramnios.

View full abstract

Purpose: We performed contrast-enhanced ultrasound for breast disease using the second-generation contrast agent Sonazoid^® to investigate characteristic findings and its meaning. Subjects: Subjects were 97 breast cancer lesions and 30 benign lesions confirmed by tissue diagnosis after contrast-enhanced ultrasound was conducted. Sonazoid^® was observed by low-mechanical-index pulse subtraction imaging and micro flow imaging. Results and Discussion: Because contrast-enhanced ultrasound could image the resonance signal of the micro air bubbles in high time and spatial resolution, the depiction of a minute perfusion image and a small vascular image was possible. The perfusion image reflected the uniformity in the lesion, and the neighboring perfusion image showed the presence of the tumor vessel with infiltrative growth, a finding peculiar to an invasive cancer. The vascular image reflected the growth form of the lesion. The malignant lesion showed a little vascular image in the branch, whereas the benign lesion had a large number of branches on contrast-enhanced ultrasound. Conclusion: We were able to examine the minute structure of the lesion by contrast-enhanced ultrasound of the breast using Sonazoid^®.

View full abstract

Objective: The aims of this study were to examine the ultrasound images of normal ribs and rib fractures, present an examination checkpoint, and propose a new representation and scanning method for rib lesion sites. Subjects and methods: Forty-four patients (24 men, 20 women) with an average age of 64 years (range, 24- 84 years) were selected from a group of 83 patients who underwent diagnostic ultrasound for suspected rib fractures over a period of 54 months from August 2006 to February 2011. The following points were investigated: (1) Body position of subject and scanning methods, (2) Ultrasound images of healthy ribs, (3) Images resembling fractures, (4) Checkpoints based on rib fracture ultrasound findings, and (5) Proposal of a new representation of lesion sites. Results: The subjects underwent ultrasound diagnosis in the oblique or lateral recumbent position. Depending on the scanning method used, healthy ribs and costal cartilages had different appearances on ultrasound images and were confused with fractures. Ultrasound findings indicating rib fractures were mostly cortical step-offs (step sign) and hematomas on the surface of the bone, consistent with the location of tenderness. Fracture sites were displayed using the clock method, which allowed retroactive and objective display. Conclusions: Ultrasound examination of ribs was performed by scanning locations of tenderness using a linear transducer to produce enlarged images. Both step signs and echo-free spaces on the bone surface were scanned. Ultrasound examination of rib fractures was easy to perform and effective as a diagnostic tool. It is preferred in suspected rib fracture cases.

View full abstract