Practical bedside ultrasound examinations performed in our urological clinic and sharing of examinations between the central examination laboratory and outpatient doctors’ office are described herein. The number of patients with urinary disturbance is increasing as Japanese society continues to age. The triple set of diagnostic tools consisting of ultrasound examination of urinary bladder and prostate, uro-flowmetry, and ultrasound measurement of residual urine volume is very useful as the fundamental examination to diagnose those diseases. General physicians should consider the possibility of latent urological diseases when requesting sonographers to perform abdominal ultrasound screening examinations. Sonographers should also watch for latent urological disorders when performing abdominal ultrasound examinations at the request of general physicians.
In the past, kidneys after long-term dialysis represented a terminal state of renal failure, for which the care provided remained primarily atrophy assessment. Later, however, it was suggested that the development of acquired cystic disease of the kidney (ACDK) after prolonged dialysis was associated with renal carcinoma, drawing attention to the importance of the diagnosis of ACDK. Furthermore, in recent years, a rise in the age of incident patients has been observed concurrently with longer periods of dialysis, highlighting that the diagnosis of renal carcinoma is increasingly important. For this reason, ultrasonic examination of the kidneys in patients on maintenance dialysis is conducted as a quasi-requisite test in many dialysis centers today. Meanwhile, changes in the breakdown of underlying diseases among incident patients due to decreases in those originally suffering from chronic glomerulonephritis and increases in those with diabetic nephropathy-derived renal failure in combination with other factors, including modifications occurring after treatments provided prior to dialysis, have caused changes in the kidneys leading them to appear in varied forms after dialysis initiation. Based on the above observations, it is important to fully understand changes over time in kidneys on long-term dialysis, their relations with the underlying pathology, differences between congenital and acquired cystic kidneys, differences between cystic hemorrhage and renal tumors, as well as the contrast-enhanced echo techniques for diagnosis of renal carcinoma, before performing ultrasonic diagnosis in patients on prolonged dialysis treatment.
The number of JSUM Registered Medical Sonographers, who are categorized by specialty (gastroenterology, cardiology, superficial organs, urology, obstetrics, medical checkup, and blood vessels), is growing. On the other hand, while the total number of doctors has increased by 80% in comparison with 30 years ago, the number of obstetricians has decreased by 20%. Although the number of births has decreased by 30% in the past 30 years, the work of obstetricians has expanded, such as an increase in high-risk pregnant women, and obstetricians have become overworked. Echography is being performed by ultrasonographers in a proactive manner, and it has now become an indispensable physiological examination in every area. Fetal echography performed by ultrasonographers in the obstetrics area may be more necessary than ever in obstetrics medical care, where obstetricians will likely be more and more overworked going foward. I have presented checkpoints for the methods recommended by the Japan Society of Obstetrics and Gynecology and for the fetal echography that we perform.
In the head and neck area, many organs are gathered into a very compact space, making the anatomy in this area is very complicated. A wide variety of diseases and lesions may occur in this area. During a head and neck ultrasound examination, we must detect lesions concerning the anatomy. Ultrasonography has many advantages over other diagnostic imaging modalities. It is a noninvasive and radiation-free investigation, and it does not require troublesome pretreatment or preparations. Moreover, it allows for the possibility of real-time dynamic assessment without interference from dental metal, and it can also provide accurate guidance for interventional procedures. Previously, in the head and neck area, only the thyroid gland or salivary gland was independently investigated by ultrasonography with limited movement of the probe, but recent advances in ultrasonography, especially improvements in close-range spatial resolution and the development of small linear probes, have made it possible to scan the whole neck as one area. To scan the whole neck completely and to assess the findings, practice and learning are necessary to some degree, such as knowledge about the anatomy and diseases, and techniques to overcome the irregular surface made by submandibular bone, clavicle bones, and thyroid cartilage. Trying to record the most suitable image for diagnosis is important for the reproducibility and reliability of ultrasonography.
Purpose: The purpose of this study is to clarify the clinical usefulness of splenic elasticity measured with real-time tissue elastography (RTE) in chronic liver disease. Subjects and Methods: Subjects were 78 patients with various chronic liver disease. We measured splenic and liver elasticity with RTE and compared those to the size of the spleen (spleen index: SI), platelet count (PLT), AST to platelet ratio index (APRI), and the degree of portal hypertension measured by US, respectively. We also studied the relationship between splenic elasticity and the presence and degree of esophageal varices (EV) in 73 patients who had undergone upper gastrointestinal endoscopy, and then evaluated the potential of splenic elasticity for predicting EV and EV with red color sign (RC+). Results and Discussion: Splenic elasticity was well correlated with SI, PLT, APRI, liver elasticity, and the degree of portal hypertension. Splenic elasticity values were significantly increased in the EV+ group, especially in the EV/RC+ group. Splenic elasticity was superior to liver elasticity for predicting both EV (AUROC: 0.93, cutoff value of 72.2 with 84.6% sensitivity and 91.2% specificity) and EV/RC+ (AUROC: 0.81, cutoff value of 42.7 with 78.6% sensitivity and 81.0% specificity). Conclusion: Splenic elasticity measured with RTE is a good predictor of the degree of portal hypertension in chronic liver disease and could be a promising tool that allows us to predict the presence and degree of EV.
Purpose: Pancreatic ductal adenocarcinoma (PDAC) is one of the worst cancers, and development of early detection methods and effective therapies for PDAC is needed. The usefulness of ultrasonography for early detection of small-sized PDAC has been suggested, although only limited reports have described in detail the ultrasonographic findings for small-sized tumors using large cohorts. Here we investigated ultrasonographic findings in 46 resected cases of PDAC in which the tumor diameter was 20 mm or less. Subjects and Methods: A total of 46 lesions from 46 patients with PDACs histopathologically determined to be 20 mm or less in diameter were investigated. Specific ultrasonographic findings included tumor size, shape, boundaries, contours, and internal signal intensity, as well as the presence/absence of spinous structures, dilatation of the pancreatic tail-side main pancreatic duct, or cystic components. Contrast-enhanced ultrasonography using Levovist was performed on 17 lesions. Results: Of the 46 lesions, 42 could be visualized as tumors in B mode. The remaining four lesions showed only dilatation and disruption of the main pancreatic duct, although three of them were detected as tumors on contrast-enhanced ultrasonography. The average size of these 45 detectable 45tumors was 15.7 ± 3.8 mm (range 8 - 22 mm). Of the 42 lesions visualized in B mode, 40 (95.2%) were irregularly shaped, 28 (66.7%) were well circumscribed, and all demonstrated irregular contours and low signal intensity. Spinous structures, main pancreatic duct dilatation, and cystic components were observed in 13 (31.0%), 32 (69.6%), and eight lesions (17.4%), respectively. Various levels of contrast effect were observed for the 17 lesions on contrast-enhanced sonography. Conclusions: These results indicate that ultrasonographic findings obtained from small-sized PDACs are almost the same as those usually observed in cases of PDAC in advanced stages. It is suggested that even small-sized PDACs can be diagnosed through detailed ultrasonographic observation.
Purpose: The purpose of this study was to investigate flow changes of the deep femoral vein at different exercise patterns in a lower leg immobilized using an ankle brace. Subjects and Methods: Subjects were 87 healthy individuals (average age 41 years) without any history of diabetes, cardiovascular disease, or varix. Isometric exercise was performed using three patterns: 2 times/min, 6 times/min, and 12 times/min. For each exercise, the femoral vein flow velocity (peak velocity) and vein flow volume, and the peak velocity just after exercise and the time for peak velocity to return to resting velocity (the duration of exercise effect), were measured with ultrasonic diagnostic imaging equipment. Friedman test with post hoc Holm test was used for statistical analysis (p<0.001). Results: Peak velocity mean and volume for all three exercise patterns increased significantly compared with rest (p<0.001); however, no significant difference was found among these exercise patterns. The effect of 12 times/min exercise continued significantly longer than the other exercise patterns (p<0.001). Conclusion: The 12 times/min isometric exercise showed the highest peak velocity and flow volume and the longest duration of exercise effect. In the future, exercise periods and intervals per day should be studied to identify the optimal exercise for prevention of deep venous thrombosis.
It is said that pregnancy in a woman with a mechanical prosthetic heart valve increases the risk of thromboembolic complications. Therefore, more thorough anticoagulation therapies are needed. Usually, warfarin is used to prevent the development of thromboembolism after mechanical prosthetic heart replacement, but it also causes fetal abnormalities if taken in early pregnancy. On the other hand, heparin therapy has less risk of teratogenicity than warfarin, but increases the risk of thromboembolic complications in pregnancy. We herein present a case of a pregnant woman with a stuck mechanical mitral valve. Before she was pregnant, her anticoagulation therapy was switched from warfarin to heparin calcium self-injection at home. Her mechanical heart valve, however, was found to be stuck 5 months after the change in therapies.