Abstracts S57

0428

Evaluation of the Renal Ultrasound Findings Associated withMelamine-Tainted Milk ProductsKevin CH Lau, Kwong Wah Hospital, Hong KongElaine YL Kan, Kwong Wah Hospital, Hong KongCY Lui, Kwong Wah Hospital, Hong KongAnida SF Chong, Kwong Wah Hospital, Hong KongGodfrey KF Tam, Kwong Wah Hospital, Hong KongKP Fung, Hong Kong

Purpose: To evaluate renal ultrasound findings related to melamine-tainted milk products.Methods: Between 26th, September 2008 to 28th, November 2008,1872 children aged 12 years or younger who had consumed melaminetainted milk products for more than one month were referred to ourspecial assessment center for renal ultrasound and urinalysis.Results: A shadowing echogenic focus (6mm) without associatedcalyceal suggestive of renal calculus was found in one child, andsubsequently confirmed with plain CT. Four suspected cases withmelamine related sediments - three children showed 4mm echogeniclesion inside the calyx with no dilatation of the collecting system, andanother child had a few small echogenic lesions (�4mm) associatedwith dilatation of adjacent calyx. No adverse complications such asobstructive uropathy or acute renal failure were noted. Interval ultra-sound showed the child with confirmed renal calculus to be persistent.Of the four suspected cases, two showed persistence of the previouslynoted echogenic lesions, one child showed persistence of the echgenoiclesions but with resolution of calyceal dilatation and another child withresolution of the previously noted echogenic lesions.Conclusion: Melamine coalesces with other milk related products toform crystals that block tubules of the kidney. Little is known about theeffects of melamine in humans. This study evaluates the spectrum andshort term changes of ultrasound findings related to melamine-taintedmilk products. Further evaluation and follow-up of these childrenshown to be affected by melamine may be useful in assessing the longterm sequele.

0430

Live Scanning Workshop: The PlacentaMartin Necas, Antegrade Ultrasound Solutions

Ever considered the placenta just a “routine” part of an ultrasoundscan? Maybe it’s time to give the placenta another chance! Thisinteractive session will present an exciting detailed account of the roleof ultrasound in the assessment of the placenta with particular focus onplacental pathologies and atypical appearances. We will begin ourreview in the first trimester by considering placental development,bleeding issues, determination of chorionicity in multiple pregnancy,retained products versus AVM, and molar pregnancies. In the secondand third trimester, we will examine topics such as placental shapes andpositions, accessory lobes, cord insertion variants, placenta previa,circumvallate placenta versus uterine synechiae, venous lakes versusfibrin deposition, subchorionic and retroplacental bleeds, chorioangio-mas, placenta creta and vasa previa. We will also discuss the role ofumbilical artery Doppler in the assessment of placental resistance.Finally, we will consider the benefits of 3D ultrasound in placentalassessment.

0431

Live Scanning Workshop: Vascular Sonography of the ScrotumRob McGregor, Australian School of Medical Imaging, Australia

Sonographic Examination of the scrotum is a well established tech-

nique in both adult and paediatric patients.

In all scrotal studies assessment by 2D grayscale imaging of thetesticular morphology remains crucial, however there is also an impor-tant role for Spectral and Color Doppler sonography in assessment ofthe vascularity of the testes and any pathology identified.This workshop will discuss;� Technique for spectral and colour Doppler assessment� Normal findings� Strengths and weaknesses of spectral and colour Doppler� Doppler diagnostic criteria in common testicular pathologies includ-ing torsion and orchitis� The extension of the study to include intra abdominal structures

0432

Ultrasound of Salivary Glands - Anatomy and Benign ConditionsNorbert Gritzmann, President of EFSUMB, Austria

Due to their superficial position the parotid, the submandibular and thesublingual glands can be imaged with high-resolution transducers.In acute inflammatory diseases sonography can differentiate betweenobstructive or non-obstructive sialoadenitis. Abscess formations maybe detected and the maturation of the colliquation may be controlled.Abscesses may be punctured under US guidance. In Sjogren�s Syn-drome the sonographic changes correlate with the histological destruc-tion, in acute forms hypervascularisation is found in color Doppler. Infibrotic cases the stimulation-induced hyperemia is impaired.In siaIoadenosis inflammatory and tumorous lesions can be ruled out bysonography.Tumors of the salivary glands can be visualized with high sensitivity.Like other imaging methods the specificity in assessment of the his-tology of a tumor is low. Multilocular lesions as sarcoidosis, lym-phoma, metastases or cystadenolymphoma are discussed.In deep located, malignant tumors or when the tumor cannot bedelineated completely, MR or CT are obligatory to delineate the tumor.Sonography enables the diagnosis of cysts or ranulae.The accuracy of sonography in assessment of sialolithiasis is about 90%. Non-opaque stones can be visualized too. However small stones ofless than 2mm are difficult to detect since the posterior shadow may bemissing. The concrements can be differentiated into intraductal orintraglandular stones. Indirect signs like ductal dilatations or inflam-matory changes may be found.Pseudotumorous lesions as hypertrophy of the masseter muscle, tuber-culosis, sarcoidosis or lymphoepithelial lesions in AIDS are discussed.In children the main differential diagnosis of salivary gland pathologiesare addressed.

0433

Imaging of Salivary Gland CancerAnil Ahuja, The Chinese University of Hong Kong, Hong Kong

Salivary gland diseases may present clinically as a facial / neck lump,diffuse swelling or pain. Common major salivary gland abnormalitiesinclude calculus-related disease, acute or chronic inflammatory condi-tions, salivary gland neoplasms and vascular lesions. High-resolutionultrasound (US) is an ideal initial imaging investigation. In mostcircumstances, salivary gland abnormalities are adequately assessed byultrasound supplemented by fine needle aspiration cytology (FNAC). Inaddition, US helps to select patients who may require further imagingstudies such as contrast sialography, computed tomography (CT) andmagnetic resonance imaging (MRI).Ultrasound features such ill-defined margin, infiltration of adjacentstructures, presence of intratumoral disorganized vascularity and ab-normal regional lymphadenopathy help to identify salivary gland ma-lignancies. Ultrasound also provides image guidance for FNAC or

biopsy of suspected salivary gland malignancy. US is unable to eval-

S58 Ultrasound in Medicine and Biology Volume 35, Number 8S, 2009

uate the deep lobe of the parotid gland and in such cases MRI isparticularly useful in assessing the deep lobes and evaluating the extentof large parotid lesions.The aim of this presentation is to discuss the imaging features ofsalivary gland malignancy and other commonly encountered salivarygland lesions including calculus-related disease, acute / chronic inflam-matory conditions, and benign salivary gland neoplasms.

0435

Study of Ultrasound Microbubble Enhancement Characteristicsof Parathyroid Lesions?Chris I Harvey, Hammersith Hospital, United KingdomNina Tunariu, Hammersith Hospital, United KingdomDavid Cosgrove, Hammersith Hospital, United KingdomFausto Palazzo, Hammersith Hospital, United Kingdom

Aim: The aim of this study was to study the enhancement character-istics of parathyroid lesion with ultrasound microbubbles.Methods: 24 patients (18 females, mean age 57 range 33-80) withhyperparathyroidism were scanned (Sequoia, Siemens) with US beforeand after Sonovue microbubbles (Bracco, Italy). All patients underwentsurgery. The patients were scanned using B mode, colour Doppler andin Cadence Contrast Pulse Sequencing (CPS) mode, using a 15L8linear probe, after bolus injections of Sonovue (4.8ml).Results: The final diagnoses were adenoma (n�17), and hyperplasia(n� 7). B-mode showed homogeneous echopoor lesions in 18/24 withheterogeneous appearance in 6/24. Unenhanced Colour Doppler find-ings characteristic of parathyroid lesions were present in 16/24 of thelesions. Contrast enhanced imaging showed partial or total hypervas-cularity of all the lesions. In addition the use of microbubbbles showedcystic/necrotic areas in 6 lesions corresponding to the heterogeneousappearance seen on B mode.Conclusion: The addition of ultrasound microbubbles facilitated moreaccurate characterisation and increased the diagnostic confidence in thediagnosis of parathyroid lesions compared to unenhanced B- mode andcolour Doppler.

0436

Preoperative Staging of Papillary Thyroid Carcinoma:Comparison of Ultrasonography and Computed TomographyEun-Kyung Kim, KoreaJi Soo Choi, Yonsei University, Severance Hospital, Seoul, KoreaJinna Kim, Yonsei University, Severance Hospital, Seoul, KoreaJin Young Kwak, Department of Diagnostic Radiology, ResearchInstitute of Radiological Science, Yonsei University College ofMedicine, KoreaMin Jung Kim, Korea

Objective: To compare the diagnostic accuracies of US and CT in thepreoperative evaluation of primary tumors and cervical lymph nodes inpapillary thyroid carcinoma (PTC) patients, and to identify if CTprovides additional diagnostic role compared to US alone in thesepatients.Materials and Methods: A total of consecutive 299 patients withpathologically proven PTC underwent US and CT for preoperativeevaluation. We assessed diagnostic accuracies of US,CT and combinedUS and CT (US/CT) for the evaluation of primary tumors and lymphnode metastasis. Subgroup analysis was performed comparing papil-lary thyroid microcarcinoma (PTMC, 10mm or less in maximum di-ameter of tumor) with PTC more than 1cm in maximum diameter oftumor.Results: In the evaluation of primary tumors, US predicted extrathy-roidal tumor extension and bilateral malignancy more accurately than

CT (p�0.05) for all lesions as well as for two subgroups. For predicting

central node metastasis, US/CT was superior to US alone (p�0.009) inPTC more than 1cm, but there was no statistical difference betweenUS/CT and US in PTMC. For predicting lateral node metastasis,US/CT did not produce significant differences than US alone for alllesions as well as for two subgroups (p�0.05).Conclusions: High-resolution US can be a useful imaging modality forthe preoperative evaluation of extrathyroidal tumor extension and lat-eral lymph node metastasis compared with CT. Especially in PTMC,CT had no additional diagnostic value compared with US alone in theevaluation of central and lateral lymph node metastasis.

0437

Usefulness of 3D Ultrasonography Before Minimally InvasiveFocused Parathyroidectomy; Importance of Coronal ImageRika Miyabe, Department of Surgery, Teikyo University School ofMedicine, JapanYoshifumi Ikeda, Department of Surgery, Teikyo University School ofMedicine, JapanYuzo Sasaki, Department of Surgery, Teikyo University School ofMedicine, JapanHiroshi E Takami, Department of Surgery, Teikyo University Schoolof Medicine, Japan

Objective: The aim of this study was to evaluate the usefulness of 3Dultrasonography as a noninvasive preoperative localization procedurebefore performing minimally invasive focused parathyroidectomy inpatients with primary hyperparathyroidism.Patients and Methods: Between January 2002 and February 2006, 76patients with a solitary adenoma detected by ultrasonography under-went minimally invasive focused parathyroidectomy. To assess thesurgical usefulness of 3D ultrasonography we compared patientstreated in early period (2002 – 2004), who were examined by 2Dultrasonography alone (2D group), and patients treated in the lateperiod (2004- 2006), who were examined by both of 2D and 3Dultrasonography (3D group). Age, preoperative serum intact-PTH level,duration of surgery, length of skin incision, and weight of the resectedspecimen were compared in the two groups, and a multivariate analysisfor duration of surgery was performed.Results: There were no significant differences between the 2D groupand 3D group in age, preoperative intact-PTH level, length of skinincision, or weight of the resected specimen, but mean duration ofsurgery was significantly shorter in the 3D group (p�0.01). The mul-tivariate analysis showed that 3D US and weight of the resectedspecimen were associated with the duration of surgery (p�0.05).Conclusion: The coronal images obtained by 3D ultrasonographyhelped surgeons to perform rational surgical procedures and shorten theduration of surgery. The coronal images are useful to detect preciselocalization of the parathyroid masses in patients with primary hyper-parathyroidism undergoing minimary invasive focused parathyroidec-tomy for a solitary adenoma.

0438

Fetal CNS - It’s Not Just VentriculomegalyAnts Toi, Mount Sinai Hospital, Canada

This presentation will discuss assessment and disorders of midlinestructures of the fetal brain including:� Corpus callosum� Cavum veli interpositi.� Posterior fossa structures such as Blake’s pouch and cerebellar vermis.Midline structures require special non-standard views and are moredifficult to evaluate than structures such as the ventricles which arevisible on standard axial views. Sagittal trans-fontanelle views and 3D

ultrasound can allow more detailed assessment of midline structures