Internal carotid artery (ICA) stenosis is a cause of stroke. ICA stenosis is generally measured using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiography method, though ultrasonography (US) is often used in practice. This study aimed to identify the correlation between ultrasonographic and angiographic findings in the calculation of ICA stenosis degree using the NASCET method. US and angiography were performed in 42 patients. The ICA stenosis grades calculated using the angiographic NASCET method were compared to those from ultrasonographic findings of longitudinal views (Longitudinal axis NASCET method), transverse views (Transverse axis NASCET method), and the peak systolic velocity (PSV method). The values obtained on the Transverse axis NASCET method (r = 0.80, p < 0.01), the Longitudinal axis NASCET method (r = 0.74, p < 0.01), and the PSV method (r = 0.75, p < 0.01) significantly correlated with the percent stenosis measured by the angiographic NASCET method. The error of the Transverse axis NASCET method was significantly lower than that of the Longitudinal axis NASCET method (p = 0.022). The Transverse axis NASCET method is more closely correlated with the angiographic NASCET than the Longitudinal axis NASCET or PSV methods.
Second generation long-acting injectable antipsychotics (SG-LAIs) injected muscle region show high-echogenicity with acoustic shadowing on B-mode scan. This study aimed to distinguish two specific types of SG-LAIs at the gluteal muscle. Forty-seven patients [risperidone (RLAI): 28 patients, aripiprazole (ALAI): 19 patients] were examined using grayscale histogram analysis of echo-intensities. Pre- and immediately after (post)-injected SG-LAI region of interest (ROI) was placed on the same sites of gluteal muscle, and the grayscale histograms were recorded. Pre- and post-injected echogenicity values were analyzed using paired t-test, and Pearson’s moment correlation coefficient. Mixed effects model regression analysis was performed on variations in average echogenicity from age and medication type. Statistical significance was at 5%. There was no significant correlation between age and average echogenicity of ROI pre-intramuscular (IM) injection (r = 0.26, p = 0.078). In both RLAI and ALAI, the mean echogenicity post-IM injection was significantly higher than pre-IM injection (p < 0.001). With increasing age, the values of echogenicity of post-injection was decreased significantly (p = 0.002). The increasing values of the echo-intensities post-injections of RLAI showed significantly higher than ALAI (p = 0.002). It was considered that administered type of LAI could be identified because each LAI exhibits specific echographically findings, it also will be able to applied clinically.
Transoral carotid ultrasonography (TOCU) is a powerful tool for evaluating ICA lesions located from carotid bifurcation to the second cervical vertebra. In recent case reports, contrast-enhanced transoral carotid ultrasonography (CETOCU), which is essentially TOCU performed with perfluorobutane microbubbles as the ultrasonography contrast agent, produces clear intraluminal image of extracranial ICA, which is not possible with conventional carotid artery ultrasonography (CUS). Superb microvascular imaging (SMI) is a new Doppler imaging technique that employs a unique algorithm to minimize motion artifacts by eliminating clutter signals based on analysis of tissue movement. SMI significantly reduces motion artifacts and allows visualization of low-velocity blood flow in vessels. CUS with SMI and contrast enhanced carotid ultrasound are similar in images, and evaluate plaque neovascularization. We performed TOCU with SMI to two healthy persons, in order to examine similarity between CETOCU and TOCU with SMI. Although there were some inadequacies for small lesions, we found that TOCU with SMI can obtain images similar to CETOCU. TOCU with SMI is expected to be applied to clinical use.
Introduction: Although relatively rare, the occurrence of idiopathic spinal cord hernia (ISCH) cases continue to rise due to advances in diagnostics techniques. Here, we report on the feasibility of ultrasonography during ISCH surgery. Case report: A 47-year-old man with no history of spinal pathology developed Brown-Séquard syndrome. Magnetic resonance imaging (MRI) revealed an attachment between his spinal cord and the vertebral body at the T4/5 level. Tumors and cystic lesions were excluded on computed tomography (CT) and myelographic examination. The patient was subsequently diagnosed with ISCH and underwent surgery. After laminectomy at T3/5, we performed an ultrasonogram of the epidural space. Results showed that the spinal cord was attached to the vertebral body at the T4/5 level which showed no signs of pulsation. On opening the dura mater, ultrasonography revealed attachment of an ostensibly unremarkable spinal cord. We therefore released the spinal cord and patched with the fascia. On closing the dura mater, ultrasonography confirmed a return of pulsation and improvement in the shape of the spinal cord. Conclusion: Although the thoracic cord appeared macroscopically normal after dural incision, further intervention was actually required. Intraoperative ultrasonography was found to be useful in ISCH surgery, both for positional identification and as a checkpoint for further surgical manipulation.