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ULTRASOUND IN MEDICINE AND BIOLOGY Official Proceedings of the 14th Congress of the World Federation for Ultrasound in Medicine and Biology 16th Congress of the Latin American Federation of Ultrasound 43rd Sao Paulo Radiological Meeting

Hosted by the Radiological and Diagnostic Imaging Society of Sao Paulo (SPR), in conjunction with the World Federation for Ultrasound in Medicine and Biology (WFUMB) and the Latin-American Federation for the Ultrasound Societies (FLAUS)

May 2e5, 2013 Transamerica Expo Center, S~ao Paulo, SP, Brazil

ULTRASOUND IN MEDICINE AND BIOLOGY THE OFFICIAL JOURNAL OF THE WORLD FEDERATION FOR ULTRASOUND IN MEDICINE AND BIOLOGY Executive Bureau President: MASATOSHI KUDO, MD, PhD, Japan President-Elect: HASSEN GHARBI, MD, Tunisia Vice-President I: RONALD BENZIE, MD, Australia Vice-President II: CHENG-WEN CHANG, MD, Taiwan Secretary: DAVID EVANS, PhD, UK Treasurer: HARVEY NISENBAUM, MD, USA Immediate Past President: MICHEL CLAUDON, MD, France Administrative Councilors: JACQUES ABRAMOWICZ, MD, USA AZZA HAMMOU, MD, Tunisia SEUNG HYUP KIM, MD, South Korea HERNAN MUNOZ, MD, Chile CHRISTIAN NOLSØE, MD, Denmark FERGUS SCOTT, MD, Australia Co-opted Councilors: BYUNG CHOI, MD, South Korea LEANDRO FERNANDEZ, MD, Venezuela BARRY GOLDBERG, MD, USA Journal Editor: CHRISTY K. HOLLAND, USA

ASSOCIATE EDITORS NOMINATED BY AFFILIATED SOCIETIES American Institute of Ultrasound in Medicine, Douglas L. Miller, Department of Radiology, 3315 Kresge III, University of Michigan Medical Center, 200 Zina Pitcher Place, Ann Arbor, MI 48109-0553, USA Asian Federation of Societies for Ultrasound in Medicine and Biology, Yi-Hong Chou, Division of Ultrasound, Department of Radiology, Veterans General Hospital, 201 Shih-Pai Road, Sec 2, Taipei, Taiwan 11217 Australasian Society for Ultrasound in Medicine, Robert N. Gibson, Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Victoria 3050, Australia European Federation of Societies for Ultrasound in Medicine and Biology, David H. Evans, Department of Medical Physics, Leicester Royal Infirmary, Leicester LE1 5WW, UK Federation of Latin-American Ultrasound Societies, Robert Moncayo, La Pradera y San Salvador, Quito, Ecuador Mediterranean and African Society for Ultrasound, Elisabetta Buscarini, Gastroenterology Department, Ospedale Maggiore, 26013 Crema, Italy For Advertising Orders & Inquiries: North & South America: John Marmero, Jr., Elsevier, 360 Park Avenue South, New York, NY 10010-1710. Tel: (212) 633-3657; Fax: (212) 633-3820; E-mail: [email protected]com. International: Advertising Department Elsevier Inc., The Boulevard, Langford Lane, Kidlington, Oxford, OX5 1GB, United Kingdom, Tel: (44) (0) 1865 843565; Fax (44) (0) 1865 843976; E-mail: [email protected] Japan: Advertising Department Elsevier Inc. Japan Tel: (81) (3) 5561 5033; Fax: (81) (3) 5561 5047. Published 12 per Annum. Annual Institutional Subscription Rate (2013): Domestic Institutional price: USD $2,069; Domestic Individual price: USD $435. International Institutional price: USD $2,176; International Individual price: $461. Prices include postage and are subject to change without notice. Members of the World Federation for Ultrasound in Medicine and Biology may order personal subscriptions at a concessional rate; details of these rates are available upon request. Orders, claims, and journal enquiries: please contact the Elsevier Periodicals Customer Service, (orders, claims, online, change of address): Elsevier Health Sciences Division Subscription Customer Service, 3251 Riverport Lane, Maryland Heights, MO 63043. Tel: 1-800-654-2452 (U.S. and Canada); 314-447-8871 (outside U.S. and Canada). Fax: 314-447-8029. E-mail: [email protected] (for print support); [email protected] (for online support). Amsterdam: Elsevier, Customer Service Department, PO Box 211, 1000 AE Amsterdam, The Netherlands; phone: (31) (20) 4853757; fax: (31) (20) 4853432; e-mail: [email protected] Tokyo: Elsevier, Customer Service Department, 4F Higashi-Azabu, 1-Chome Bldg, 1-9-15 Higashi-Azabu, Minato-ku, Tokyo 106-0044, Japan; phone: (81) (3) 5561 5037; fax: (81) (3) 5561 5047; e-mail: [email protected] Singapore: Elsevier, Customer Service Department, 3 Killiney Road, #0801 Winsland House I, Singapore 239519; phone: (65) 63490222; fax: (65) 67331510; e-mail: [email protected] Reprints. For copies of 100 or more, of articles in this publication, please contact the Commercial Reprints Department, Elsevier Inc., 360 Park Avenue South, New York, New York 10010-1710. Tel: (212) 633-3813; Fax: (212) 633-3820; email: [email protected]

Volume 39

Number 5S

2013

OFFICIAL PROCEEDINGS OF THE 14TH CONGRESS OF THE WORLD FEDERATION FOR ULTRASOUND IN MEDICINE AND BIOLOGY, THE 16TH CONGRESS OF THE LATIN AMERICAN FEDERATION OF ULTRASOUND AND THE 43RD SAO PAULO RADIOLOGICAL MEETING ~ PAULO, SP, BRAZIL MAY 2–5, 2013, SAO Scientific Papers Abdomen Ultrasound CEUS (Contrast Agents) Echocardiography Education in Ultrasound Ultrasound in Emergencies Ultrasound in Gynecology Ultrasound Guided Intervention Ultrasound in Breast Ultrasound in Fetal Medicine/Obstetrics Ultrasound in Musculoskeletal Ultrasound in Nephrourology New Technologies in Ultrasound Ultrasound in Pediatrics Ultrasound in Small Parts Ultrasound in Peripheral Vascular Ultrasound in Veterinary

S1 S3 S5 S6 S7 S8 S9 S10 S11 S11 S12 S13 S16 S17 S18 S19

Scientific Papers – Digital Presentation Abdomen Ultrasound CEUS (Contrast Agents) Echocardiography Education in Ultrasound Ultrasound in Emergencies Ultrasound in Gynecology Ultrasound Guided Intervention Ultrasound in Breast Ultrasound in Fetal Medicine/Obstetrics

S21 S26 S28 S31 S32 S33 S37 S40 S43

(Contents continued on next page) INDEXED IN Index Medicus, MEDLINE, Excerpta Medica, Current Awareness in Biological Sciences, Current ContentsÒ, Biol. Abstr., Electron. & Commun. Abstr., Safety Sci. Abstr., CABS, Appl. Mech. Rev., PASCAL-CNRS Database, Science Citation IndexÒ, ISI Biomed, SciSearchÒ, Sociedad Iberoamericana de Information Cientifica.

ISSN 0301-5629 USMBA3 39(5S) S1–S108 (2013)

(Contents continued)

Ultrasound in Musculoskeletal Ultrasound in Nephrourology New Technologies in Ultrasound Ultrasound in Pediatrics Ultrasound in Small Parts Ultrasound in Peripheral Vascular Ultrasound in Veterinary

S50 S57 S60 S66 S70 S73 S74

Scientific Papers – Oral Presentation Abdomen Ultrasound CEUS (Contrast Agents) Echocardiography Education in Ultrasound Ultrasound in Emergencies Ultrasound in Gynecology Ultrasound Guided Intervention Ultrasound in Breast Ultrasound in Fetal Medicine/Obstetrics Ultrasound in Musculoskeletal Ultrasound in Nephrourology New Technologies in Ultrasound Ultrasound in Pediatrics Ultrasound in Small Parts Ultrasound in Peripheral Vascular Ultrasound in Veterinary

S80 S81 S82 S84 S84 S85 S85 S87 S88 S90 S90 S92 S93 S93 S94 S95

Author Index

S97

AIMS AND SCOPE Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. The journal publishes original contributions on significant advances in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and the interactions between ultrasound and biological materials, including bioeffects. Extended reviews of subjects of contemporary interest in the field are also published, in addition to occasional editorial articles, clinical and technical notes, letters to the editor and a calendar of forthcoming meetings. It is the aim of the journal fully to meet the information and publication requirements of the clinicians, scientists, engineers and other professionals who constitute the biomedical ultrasonic community. Copyright Ó 2013 World Federation for Ultrasound in Medicine & Biology Copyright notice. It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. By submitting a manuscript, the authors agree that the copyright for their article is transferred to the publisher if and when the article is accepted for publication. The copyright covers the exclusive rights to reproduce and distribute the article, including reprints, photographic reproductions, microform or any other reproductions of similar nature and translations. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, electrostatic, magnetic tape, mechanical, photocopying, recording or otherwise, without permission in writing from the copyright holder. Single photocopies of single articles may be made for personal use as allowed by national copyright laws. Permission of the publisher and payment of a fee is required for all other photocopying, including multiple or systematic copying, copying for advertising or promotional purposes, resale, and all forms of document delivery. Special rates are available for educational institutions that wish to make photocopies for non-profit educational classroom use. Permission may be sought directly from Elsevier’s Global Rights Department in Oxford, UK: phone 215-239-3804 or þ44 (0)1865 843830, fax þ44 (0)1865 853333, e-mail [email protected] Requests may also be completed online via the Elsevier homepage (http://www.elsevier.com/permissions). In the USA, users may clear permissions and make payments through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA; phone: (978) 750-8400, fax: (978) 750-4744, and in the UK through the Copyright Licensing Agency Rapid Clearance Service (CLARCS), 90 Tottenham Court Road, London W1P 0LP, UK: phone: (þ44) 171 436 5931; fax: (þ44) 171 436 3986. Other countries may have a local reprographic rights agency for payments. While every effort is made by the publishers and editorial board to see that no inaccurate or misleading data, opinion or statement appears in this journal, they wish to make it clear that the data and opinions appearing in the articles and advertisements herein are the sole responsibility of the contributor or advertiser concerned. Accordingly, the publishers, the editorial board and editors and their respective employees, officers and agents accept no responsibility or liability whatsoever for the consequences of any such inaccurate or misleading data, opinion or statement. Drug and dosage selection. The authors have made every effort to ensure the accuracy of the information herein, particularly with regard to drug selection and dose. However, appropriate information sources should be consulted, especially for new or unfamiliar drugs or procedures. It is the responsibility of every practitioner to evaluate the appropriateness of a particular opinion in the context of actual clinical situations and with due consideration to new developments. (For Post Office use only: Volume 39 issue 5S of 12) Ultrasound in Medicine and Biology (ISSN: 0301-5629) Ó 2013 by the World Federation for Ultrasound in Medicine & Biology is published monthly by Elsevier, 360 Park Avenue South, New York, NY 10010-1710. Periodicals postage paid at New York, NY and additional mailing offices. POSTMASTER: Send address changes to Ultrasound in Medicine and Biology, Elsevier Health Sciences Division, Subscription Customer Service, 3251 Riverport Lane, Maryland Heights, MO 63043. Printed in the USA

Editor-in-Chief CHRISTY K. HOLLAND, University of Cincinnati, OH, USA

Editorial Office ROSE M. RANDOLPH, Managing Editor, University of Cincinnati Cardiovascular Center, Room 3988, 231 Albert Sabin Way, Cincinnati, Ohio 45267-0586, USA, PH: 1-513-558-2508

Deputy Editor and Associate Editor for Therapeutic Applications of Ultrasound GAIL TER HAAR, The Institute of Cancer Research, Royal Marsden Hospital, Surrey, UK

Emeritus Editor PETER N. T. WELLS, Cardiff University, Wales, United Kingdom

Founding Editor DENIS N. WHITE

Associate Editor for Clinical Applications of Ultrasound JONATHAN M. RUBIN, University of Michigan, Ann Arbor, MI, USA

Associate Editor for Image Processing and Instrumentation F. STUART FOSTER, University of Toronto, Canada

Associate Editor for Imaging Physics and Blood Flow Measurements PAI CHI LI, National Taiwan University, Taipai, Taiwan

Associate Editor for Ultrasound Contrast Agents NICO DE JONG, Erasmus University Medical Center, Rotterdam, The Netherlands

Associate Editor for Clinical Applications of Ultrasound MARK L. PALMERI, Duke University, Durham, NC, USA

Associate Editor for Online Subject Index ELEANOR STRIDE, University of Oxford, UK

Associate Editor for Book Reviews ROBERT J. ECKERSLEY, King’s College London, UK

Advisory Editorial Board A. A. ALEXANDER, University of Houston, TX, USA A. S. ANAYIOTOS, University of Alabama, Birmingham, AL, USA M. R. BAILEY, University of Washington, Seattle, WA, USA K. BING, Georgia Technical Research Institute, Smyrna, GA, USA P. BONNIN, APHP Lariboisiere Hospital, Paris, France G. BOUCHOUX, University of Cincinnati, OH, USA M. P. BREWIN, Royal London Hospital, London, UK N. BRUINING, Erasmus MC, Rotterdam, The Netherlands E. L. CARSTENSEN, University of Rochester, NY, USA J. CHEN, Columbia University, New York, NY, USA M. J. CHOI, Jeju National University, Jeju, South Korea C. C. CHURCH, University of Mississippi, Oxford, MS, USA G. T. CLEMENT, Harvard Medical School, Boston, MA, USA G. CLOUTIER, University of Montreal, Canada D. L. COCHLIN, University Hospital of Wales, Cardiff, UK D. O. COSGROVE, Hammersmith Hospital, London, UK L. CURIEL, Thunder Bay Regional Research Institute, Ontario, Canada S. DATTA, Siemens Medical Solutions USA, Mountain View, CA, USA C. L. DE KORTE, UMC St Radboud, Nijmegen, The Netherlands J. D’HOOGE, Catholic University of Leuven, Belgium J. A. EVANS, University of Leeds General Infirmary, UK K. D. EVANS, Ohio State University, Columbus, OH, USA J. B. FOWLKES, University of Michigan, Ann Arbor, MI, USA F. FORSBERG, Thomas Jefferson University Hospital, Philadelphia, PA, USA P. FRINKING, Bracco Switzerland SA, Geneva, Switzerland C. M. GALLIPPI, University of North Carolina, Chapel Hill, NC, USA F. GIOVAGNORIO, Sapienza University of Rome, Italy D. E. GOERTZ, Sunnybrook Health Services Centre, Toronto, Canada A. GOLDSTEIN, Wayne State University, Detroit, MI, USA G. HA€IAT, National Centre for Scientific Research, Paris, France C. J. HARTLEY, Baylor College of Medicine, Houston, TX, USA K. J. HAWORTH, University of Cincinnati, OH, USA P. R. HOSKINS, The Royal Infirmary, Edinburgh, UK J. J. KAUFMAN, Mt. Sinai Medical Center, New York, NY, USA P. KEE, University of Texas Medical Center, Houston, TX, USA S. KLEK, Jagiellonian University, Krakow, Poland T. KODAMA, Tohoku University, Sendai, Japan M. KOLIOS, Ryerson University, Toronto, ON, Canada O. D. KRIPFGANS, University of Michigan, Ann Arbor, MI, USA M. KRIX, Bracco Imaging Germany, Konstanz, Germany P. LAUGIER, UMR CNRS 7623, Paris, France T. G. LEIGHTON, University of Southampton, UK

H. D. LIANG, Bristol General Hospital, UK V. LIONETTI, Sant’Anna School of Advanced Studies, Pisa, Italy T. M. LU, Shenzhen University, Guangdong, China A. LYSHCHIK, Vanderbilt University Medical Center, Nashville, TN, USA E. L. MADSEN, University of Wisconsin, Madison, WI, USA I. R. MAKIN, A.T. Still University, Mesa, AZ, USA W. P. MARTINS, University of Sao Paulo, Sao Paulo, Brazil T. D. MAST, University of Cincinnati, OH, USA F. MOLINARI, Polytechnic University of Torino, Italy M. NANNA, Albert Einstein College of Medicine, Bronx, NY, USA L. N. NAZARIAN, Thomas Jefferson University Hospital, Philadelphia, PA, USA C. T. NGUYEN, Lincoln University, Oakland, CA, USA U. NIXDORFF, European Prevention Center, Duisburg, Germany M. OELZE, University of Illinois, Urbana, IL, USA C. PISLARU, Mayo Clinic College of Medicine, Rochester, MN, USA N. RAPOPORT, University of Utah, Salt Lake City, UT, USA K. L. REED, University of Arizona, Tuscon, AZ, USA R. S. RENEMAN, Maastricht University, The Netherlands G.-M. VON REUTERN, Asklepios Neurological Hospital, Nidda, Germany D. J. SAHN, Oregon Health & Science University, Portland, OR, USA G. SCHMITZ, Ruhr University Bochum, Germany J. SHAO, Tsinghua University, Beijing, China G. J. SHAW, University of Cincinnati, OH, USA Y. SINELNIKOV, Sound Interventions, Stony Brook, NY, USA D. SKOLOUDIK, University Hospital, Ostrava, Czech Republic W. SVENSSON, Charing Cross Hospital, London, UK D. TA, Fudan University, Shanghai, China Y. TAKEUCHI, Kagoshima University, Japan M. X. TANG, Imperial College, London, UK P. TORTOLI, University of Florence, Italy F. TRANQUART, Bracco Research SA, Plan-Les-Ouates, Switzerland G. M. TREECE, University of Cambridge, UK V. ZDERIC, George Washington University, Washington, DC, USA M. ZHANG, Providence Hospital & Medical Center, Birmingham, MI, USA H. ZHENG, Shenzhen Institute of Advanced Technology, People’s Republic of China Y. ZHENG, Hong Kong Polytechnic University, Kowloon, Hong Kong Y. ZHOU, University of Washington, Seattle, WA, USA M. C. ZISKIN, Temple University, Philadelphia, PA, USA

Ultrasound in Med. & Biol., Vol. 39, No. 5S, pp. S1–S96, 2013 Copyright Ó 2013 World Federation for Ultrasound in Medicine & Biology Printed in the USA. All rights reserved 0301-5629/$ - see front matter

Scientific Papers

radiofrequency ablation of intrahepatic cholangiocarcinoma occurs one case. Importance of the Conclusions: Laparoscopic ultrasonography is helpful in choosing an appropriate treatment protocols.

1 - Abdomen Ultrasound PA.01.001

PA.01.003

Acute Cholecystitis Caused by Clonorchis Sinensis: Sonographic Findings C. Tana, P. D’Alessandro, F. Santilli, M. Tana, A. Mezzetti, C. Schiavone Departmental Unit of Internistic Ultrasound, ‘‘G. D’Annunzio’’ University, Chieti, Italy

Polyp Leasions Less Than 6 mm in Gallbladder - Is Follow Up Necessary M. R. Pedersen, C. Dam, C. E. Stovgaard, S. R. Rafaelsen Vejle Hospital SLB. Denmark Brief Description of the Purpose of the Study: His aim of this study was to assess the size distribution and the outcome of US follow-up of GB polyps. Methods: US reports from patients examined with abdominal US in our department from January 2008 to the end of December 2009 were reviewed with a view to including all patients with GB polyps. Patients with GB polyps are routinely recommended a 2-year follow-up with US every six months. Main Results: A total of 203 patients with GB polyps were included; 89 (44%) men and 114 (56%) women. The mean polyp size was 5 mm (range 2-40 mm). In 143 patients (70%) the GB polyp diameter was less than 6 mm. The first US follow-up was performed in 120 patients (59%), and only 31 (15%) completed the full 2-year US follow-up programme. Polyp size was stable in 100 patients, decreased in five patients, increased in eight and resolved in 15 patients. A total of 13 patients (6%) underwent cholecystectomy. Of the 203 patients, none showed neoplastic or malignant GB polyps. Importance of the Conclusions: We recommend that follow-up US of patients with GB polyps , 6 mm is avoided. Alternatively, the intervals between US follow-up of GB polyps , 6 mm may be extended.

Brief Description of the Purpose of the Report: The aim of our report is to describe the typical ultrasonographic features of gallbladder infestation by Clonorchis sinensis. Medical History: A 34 year-old-man, recently returned from China, was hospitalized for fever, jaundice and epigastralgia. He reported an ingestion of "Yusheng", a Chinese raw fish salad. Objectively, he had fever and positive Murphy’s sign. Laboratory workout documented an increase of inflammatory and cholestasis markers. Ultrasound showed a distended gallbladder with thickened walls and lumen occupied by stratified material compatible with biliary sludge. In the dependent portion of the gallbladder, a flocculent, nonshadowing and floating group of echos was appreciated. It changed in position in reaction to a light blow with the transducer. Diagnosis: The sonographic aspects were consistent with previous reports of gallbladder infections by Clonorchis sinensis [1]. The report was confirmed by a stool examination, positive for Clonorchis sinensis. After treatment with mebendazole, the patient became asymptomatic. Discussion and Summary of the Case: The gallbladder involvement by parasites is unusual, but should be considered in the differential diagnosis in the presence of a suggestive history and typical sonographic features. Early medical treatment is associated with a rapid clinical improvement, thus avoiding any surgical approach. References 1. Lim JH et al. Am J Roentgenol. 2007;188(6):1596-603. Reference: 1. Lim JH et al. Am J Roentgenol. 2007;188(6):1596-603.

PA.01.004 Dual Measurement of Liver and Spleen Stiffness for Non-Invasive Diagnosis of Liver Fibrosis Using ARFI H. Tanaka, J. Nishimura, M. Yoshida, S. Nishiguchi, H. Iijima Hyogo College of Medicine, Nishinomiya, Japan

PA.01.002 Use of Laparoscopic Ultrasonography in Surgical Procedures of Hepatobiliary and Pancreatic Diseases C. H. Xiao Kunming First People’s Hospital

Brief Description of the Purpose of the Study: While spleen stiffness measurement (SSM) is not easily assessed by Fibroscan, SSM could be easily quantified by Acoustic Radiation Force Impulse Imaging (ARFI) because it can conduct the assessment by referring to the B-mode without restriction in the measurement distance. However, some cases of SSM for the prediction of the liver fibrosis stage are different with that of liver stiffness measurement (LSM). The aim of this study was to evaluate the significance of the dual measurement methods of LSM and SSM by ARFI for diagnosis of liver fibrosis. Methods: Of the 803 patients with chronic liver disease confirmed by liver biopsy and evaluated by ARFI for obtaining LSM in our center, 261 patients who were obtained both LSM and SSM were included in this study. Main Results: AUROC of SSM for distinguishing cirrhosis was 0.927 and the highest in all parameters (LSM 0.905; hyaluronic acid 0.866; platelet, 0.808). There were 10 F0-3 chronic hepatitis patients above the LC cutoff level both in LSM and SSM. When 3 sever obesity

Brief Description of the Purpose of the Study: To explore the applied value of laparoscopic ultrasonography in surgical procedures of hepatobiliary and pancreatic disease. Methods: The examination results of laparoscopic ultrasonography in surgery of 43 cases with hepatobiliary and pancreatic diseases were retrospectively analyzed. Main Results: It is found that among 34 cases of patients with cholecystetomy, patients with oledocholithiasis occur 4 cases and 2 lesions which are not displayed through preoperative imaging examination are detected in liver. Leading windowing decompression of liver cyst is four cases, and guiding resection of cholecyst preservation of gallbladder adenomas is one case, resection of insulinoma occurs one case and S1

S2

Ultrasound in Medicine and Biology

patients were excluded due to the poor examination, 6 patients were clinically LC. Importance of the Conclusions: Dual measurement methods of LSM and SSM were useful for the differential diagnosis of LC. PA.01.006 The New Non-Invasive Quantification of Hepatic Steatosis With Morbid Obesity by Acoustic Structure Quantification (ASQ) From Ultrasound Echo Amplitude Mio Onodera Morioka, Iwate, Japan Brief Description of the Purpose of the Study: Non-alcoholic fatty liver disease (NAFLD) has increased during recent years. A quantitative and non-invasive method for the ultrasound diagnosis of NAFLD is needed. We quantitated the liver parenchyma of hepatic steatosis using Acoustic structure quantification (ASQ), and studied its efficacy. Especially, we studied the efficacy analysis of hepatic steatosis and its follow-up. Methods: Subjects comprised 42 patients with Non-alcoholic fatty liver disease (NAFLD) and 20 healthy controls. They underwent liver biopsy, abdominal CT exam, abdominal ultrasonic exam and enrolled in this study between August 2010 and August 2012. An AplioXG ultrasound scanner (Toshiba Medical Systems, Otawara, Japan) was combined with a 3.75 MHz transducer for ultrasonographic investigations in this study. ASQ mode and its analysis parameter called ‘‘focal disturbance ratio (FD-Ratio)’’. In those cases, we could compare ultrasound findings, histopathological findings and CT findings (CT number; CTN). The hepatic fat droplet area and size were measured using the Image-J software package (NIH, USA). Main Results: Mean FD-Ratio was 0.03 6 0.02 and 0.26 6 0.08 in the NAFLD and control groups, respectively. FD-Ratio was significantly lower in the NAFLD than in the control groups (p , 0.0001). FD-Ratio was positively correlated significantly with CTN (r50.53. p , 0.01). FD-Ratio was negatively correlated significantly with fatty area of the liver (r5-0.75. p , 0.01). During 6 months follow-up after treatment of obesity, we obtained a statistically significant decrease in body weight (28.3 6 11.6kg) and excess weight loss was 47%. FD-Ratio was measurable in all case, and significantly increased from 0.018 6 0.008 to 0.102 6 0.056 (p , 0.01) in 6 month after surgery. L/S-Ratio increased from 0.86 6 0.3 to 1.06 6 0.9 (p , 0.01). Importance of the Conclusions: The results suggest that ASQ is useful for evaluating the tissue characteristics of hepatic steatosis and its follow-up. PA.01.008 The Usefulness of Abdominal Ultrasound for the Evaluation of Patients With Acute Pancreatitis A. Popescu, I. Sporea, S. Bota, O. Gradinaru-Tascau, M. Popescu, R. Sirli, M. Danila Department of Gastroenterology and Hepatology, ‘‘Victor Babes’’ University of Medicine and Pharmacy Timisoara, Romania Brief Description of the Purpose of the Study: To assess the usefulness of abdominal ultrasound for the evaluation of patients with acute pancreatitis (AP). Methods: Our retrospective study included 819 hospitalized patients with AP. The etiology of AP was: biliary - 46.6%, alcoholic - 31.9% and non-alcoholic/non-biliary - 21.5% of cases. According to the Atlanta criteria, 60.5% of patients had mild and 38.5% severe AP. Ultrasound examination was performed in emergency at admission and in follow-up at 2-3 days. Main Results: The pancreas was visible by ultrasound in 71.4% of all patients at admission, in a significantly higher number of cases in mild AP as compared with severe AP: 79.6% vs. 58.5%, p , 0.0001. In patients with the final diagnosis of biliary pancreatitis, the ultrasound

Volume 39, Number 5S, 2013 examination performed in emergency established the etiology in 86.8% of cases. From de ultrasound signs, an enlarged, hyperechoic, bursa omentalis (described at any moment during hospitalization), as a predictor of severity, was observed in a significantly higher number of patients with severe AP vs. mild AP: 14.2% vs. 5.6%, p , 0.0001. Importance of the Conclusions: Abdominal ultrasound examination was a useful method for the emergency evaluation of patients with AP, the pancreas being visible in 71.4% of patients and biliary etiology being established in emergency, in 86.8% of cases. The large hyperechoic bursa omentalis is a useful ultrasound sign for prediction of severe outcome of AP. PA.01.009 Focal Disorders of the Gallbladder: Diagnosis by Ultrasonography. Where Can We Get? L. N. Elias, M. B. G. Funari, M. J. Francisco Neto, R. G. Garcia, A. Maurano, A. Rahal Junior Hospital Israelita Albertb Einstein Introduction: A wide spectrum of injuries originates from gallbladder; benign changes such as inflammatory, benign tumors, tumorlike lesions and malignant neoplasms. Ultrasonography is typically the initial imaging modality to assess these diseases, showing high sensitivity and specificity for this purpose. We will show a wide range of focal alterations of the gallbladder, characterized and diagnosed by US, at the Department of Diagnostic Imaging of our hospital. Methods Involved: US Studies conducted at the emergency department and outpatient clinic of a private hospital. Discussion: The different presentations of focal lesions of the gallbladder should be well known by the sonographer, than he can diagnoses benign conditions, indicate further studies in equivocal cases, or even aiming at the preoperative staging. This method, if operated by a radiologist familiar with these lesions, defines diagnosis and in most cases. Conclusion of the Presentation: This pictorial essay illustrates the findings by ultrasound of the various types of focal lesions that originates in the gallbladder. Knowledge of these findings allows early diagnosis, with direct impact on patients prognosis. PA.01.012 Sındrome Do Quebra-Nozes: A Aplicac¸~ao Da Ultra-Sonografia Com Doppler E Relato De Caso M. A. P. Figueiredo, L. D. Do Olival, N. L. Leal, C. Fernandez, N. G^enova, A. B. Alla, C. A. S. Junior S~ao Luiz Jabaquara, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Report: Nutcracker syndrome is caused by compression of the left renal vein through the superior mesenteric arteries and aorta. Usually manifested by chronic pelvic pain, lower back pain and left varicocele, hematuria and proteinuria. Occurs more often in women between 30 and 40 years. Medical History: We report the case of a male patient of 16 years, who sought our doppler ultrasound clinic complaining of left testicular pain, which diagnosed the left renal vein narrowing between the superior mesenteric artery and the aorta, with consequent hypertension of the left gonadal plexus, suggestive of Nutcracker syndrome. Diagnosis: Nutcracker syndrome is caused by the narrowing in the anatomical passage formed by the aorta and to the superior mesenteric artery, causing increased pressure in the territory of the left renal vein. Various imaging tests can aid in the diagnosis, such as Doppler ultrasound, computed tomography, magnetic resonance and phlebography. Discussion and Summary of the Case: The type of treatment that must be adopted is still controversial, and there are several surgical options, such as the use of intravascular stent and conservative behaviour. Usually late diagnosis, this syndrome should be included in the investigation of patients with hematuria of unknown origin.

Abstracts PA.01.013 Padr~ oes Incomuns De Apresentac¸~ao Da Esteatose Hepatica: Ensaio Pict orico E Revis~ao Da Literatura I. X. C. R. Rebouc¸as, R. M. Mendonc¸a, E. A. Q. Lisboa, J. C. D. Oliveira, M. A. Borba, Z. J. Queiroz, M. Moreira Neto Hospital Universit ario Onofre Lopes, Natal, Rio Grande Do Norte, Brasil Introduction: Fatty liver disease is commonly detected in patients undergoing imaging tests, with a prevalence of 15-95%, depending on the population. Biopsy with histopathology is the gold standard for diagnosis, but non-invasive methods such as ultrasound (US), computed tomography (CT) and Magnetic Resonance Imaging (MRI) can accurately diagnose the condition when applying established criteria. Methods Involved: Survey of cases of fatty infiltration of the liver in its unusual presentations, studied by different imaging methods in our service, especially the standards ultrasound appearance and established diagnostic confirmation. Discussion: The most common presentation of steatosis is relatively homogeneous and diffuse deposition of fat in the liver, but the greasy buildup can manifest with unusual patterns of distribution, such as perivascular, periportal, multinodular, and focal subcapsular that mimic neoplastic, inflammatory, or vascular lesions. In these cases, diagnostic errors and unnecessary invasive procedures can occur. To avoid this, radiologists must be prepared to recognize the various forms of presentation of this pathology. Conclusion of the Presentation: Identify the fat content of the lesion, location, morphology, pattern contrast and mass effect usually enable the correct diagnosis, and Chemical shift GRE sequences on MRI are more reliable/accurate than US or CT to detect intralesional fat, and may be required when the diagnosis is doubtful. PA.01.014 Ultrasonographic Evaluation of Body Mass R. Santos, J. Ferreira Instituto Politecnico De Coimbra-Escola Superior De Tecnologia Da Saude De Coimbra, Coimbra, Portugal Brief Description of the Purpose of the Study: Obesity is a problem that increasingly affects and concerns worldwide. The prevalence of obesity has increased dramatically in recent decades and is now one of the biggest health problems in Western societies. Increasingly popular are more direct and indirect methods of obtaining measurements of body mass as the scales of bioimpedance and ultrasound. However, there is some contorversia regarding the distribution of body mass and the relationship between these two methods. The aim is to compare the different measures of these two methods to evaluate the relationship with sociodemographic factors and verify the importance of ultrasound in this area. Methods: 20 healthy individuals underwent an ultrasonographic examination and bioimpedance were recorded and the age, gender, level of physical activity. Main Results: There was no difference between the measurements by both methods. Changes in measures of body mass are related to the practice of physical exercise. Importance of the Conclusions: It is concluded that the ultrasound is an important method for reliably measuring the body weight. The physical activity is also an important factor for a healthy life and for the prevention of obesity. PA.01.015 Hepatic Involvement by Hemochromatosis. Ultrasound, Doppler and ARFI Elastography R. L. S. Muniz, E. B. C. Esberard, T. Guarana, P. Pollo Clinica RM, Niter oi, RJ, Brasil

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Brief Description of the Purpose of the Report: Hemochromatosis is a hereditary iron metabolism disorder where there is an excessive deposition of this metal in the parenchymal cells, mainly in the liver, heart and pancreas. Medical History: With the accumulation of iron deposition, tissue damage occurs with skin hyperpigmentation, hepatomegaly, cirrhosis and its complications, and even liver failure. Diagnosis: The authors present two cases of hemochromatosis evaluated by ultrasound, color Doppler and liver elastography Virtual Touch (ARFI - Acoustic Radiation Force Impulse), which uses acoustic pulses of short duration to produce dislocations in the examined tissue and measure the stiffness of the structure. Discussion and Summary of the Case: The study of these cases shows that elastography can collaborate in monitoring of patients with hemochromatosis.

3 - CEUS (Contrast Agents) PA.03.003 Contrast-Enhanced Ultrasonography for Evaluating Treatment of Sorafenib in Hepatocellular Carcinoma K. Arai, T. Yamashita, E. Mizukoshi, S. Kaneko Kanazawa University Hospital, Kanazawa, Ishikawa, Japan Brief Description of the Purpose of the Study: The purpose of this study was to assess the efficacy of contrast-enhanced ultrasonography (CEUS) with perflubutane microbubbles (Sonazoid) to evaluate the therapeutic response and adverse effect of antiangiogenic agent sorafenib for hepatocellular carcinoma (HCC). Methods: Eleven HCC patients who received sorafenib were included. CEUS were performed in all patients before treatment and 3 and 7 days after treatment. Image analysis was performed to plot the time intensity curve (TIC) at the tumor and background liver which set the diameter of the region of interest of intensity measurement. Main Results: Peak intensity (PI) of tumor after treatment was decreased (3days : 9.8+/-18.6, 7days : 14.1+/-18.6), compared with data before treatment. PI of background liver after treatment was also decreased (3days : 10.0+/-11.1, 7days : 5.0+/-14.8). Time to peak intensity (TPI) of tumor after treatment was prolonged (3days : 0.68+/3.69sec.). The change of PI was not correlate to tumor response (SD 7cases, PD 4cased) nor severe non-hematological adverse effect. In case of severe liver injury, PI of tumor (3days after treatment) was significantly decreased. Importance of the Conclusions: CEUS could detect alteration of tumor and parenchymal vascularity by sorafenib. We showed the possibility that CEUS provide the parameter of an early prediction for adverse effect. PA.03.004 Assessment of the Therapeutic Response of Hepatocellular Carcinoma Treated With Radiofrequency Ablation: Comparison of Contrast-Enhanced Ultrasonography and Computed Tomography K. Arai, T. Yamashita, E. Mizukoshi, S. Kaneko Kanazawa University Hospital, Kanazawa, Ishikawa, Japan Brief Description of the Purpose of the Study: The purpose of this study was to assess the efficacy of contrast-enhanced ultrasonography (CEUS) with perflubutane microbubbles (Sonazoid) to evaluate the therapeutic response to radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in comparison with contrast-enhanced computed tomography (CECT).

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Methods: 25 patients with 30 HCCs within 3cm were included. CECT and CEUS were performed in all patients after RFA treatment in the following 2-7 days later. Total 39 assessments of therapeutic response were performed. Absence of contrast enhancement and presence of ablative margin in the treated HCCs were statistically analyzed. CECT was used as gold standard in analyzing the accuracy of CEUS. Main Results: Follow-up CECT detected residual lesions in 2 of 39 assessments and incomplete ablative margins in 18 of 39 assessments. CEUS detected residual lesions in 2 of 39 assessments and incomplete ablative margins in 18 of 39 assessments. CEUS predicted the CECT results 90% (sensitivity 90%, specificity 89%, positive predictive value 90%, negative predictive value 89%). Importance of the Conclusions: Contrast-enhanced ultrasonography with perflubutane microbubbles has high diagnostic accuracy compared with CECT in assessment of RFA treatment response. PA.03.005 How Often Does Liver Fibrosis Stage Predicted by Transient Elastography (TE) Differ From the One Diagnosed by Liver Biopsy in Chronic Hepatitis C Patients? I. Sporea, R. Sirli, S. Bota, A. Popescu, I. Dan, A. Deleanu, M. Ardelean, N. Cornu Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timis¸ara, Romania Brief Description of the Purpose of the Study: Aim: to evaluate how often does liver fibrosis stage predicted by Transient Elastography (TE), using cut-off values proposed by meta-analysis, differ from the one diagnosed by liver biopsy (LB) in chronic hepatitis C patients. Methods: 473 patients with chronic hepatitis C were evaluated by means of TE and LB (interpreted according to METAVIR score). Reliable measurements were defined as: median value of 10 liver stiffness (LS) measurements with a success rate $ 60% and an interquartile range interval ,30%, values expressed in kPa. We used the LS cut-offs (kPa) proposed in the most recently published meta-analysis (Tsochatzis, J Hepatol 2011): F1-6, F2-7.2, F3-9.6 and F4-14.5. Main Results: Reliable LS measurements were obtained in 453 patients (95.7%). The classification of liver fibrosis in LB was: F0-1.1%, F110.4%, F2-49.6%, F3-30.7% and F4-8.2%. We obtained the following differences between fibrosis obtained in LB and that predicted by using the cut-off values proposed by meta-analysis: perfect concordance-131 patients (28.9%), 1 grade of fibrosis-175 patients (38.6%), 2 grades-130 patients (28.7%) and 3 grades-17 patients (3.8%). Importance of the Conclusions: In two thirds of patients a perfect concordance or at most one grade of fibrosis was observed between the fibrosis predicted by means of TE cut-off values proposed by meta-analysis and that obtained in LB. PA.03.007 The Role of Contrast Enhanced Ultrasound (CEUS) for the Assessment of Percutaneous Treatment for Hepatocellular Carcinoma M. Danila, I. Sporea, R. Sirli, A. Popescu, M. Sendroiu, A. Martie, S. Bota University of Medicine and Pharmacy, Timisoara, Romania Brief Description of the Purpose of the Study: The AIM of this study was to establish the role of CEUS for the assessment of percutaneous treatment for HCC. Methods: We evaluated 48 patients with hepatocellular carcinoma treated by PEIT or RFA. A total of 73 HCC’s nodules were treated. For each nodule we evaluated by CEUS the treatment efficacy 24 hours (in some) and 1 month (in all) after therapy. We defined as incomplete therapy the presence of arterial enhancement in the nodule and as complete therapy if no arterial enhancement was present in the treated

Volume 39, Number 5S, 2013 HCC. If complete therapy was considered, we performed another imaging method (CT or MRI) to validate our findings. For inconclusive cases we also performed another imaging method. Main Results: We performed 220 CEUS for the assessment of percutaneous treatment for HCC. The CEUS examination was conclusive in 200 cases (90.9%). In cases of incomplete treatment, we performed another session of percutaneous treatment during the CEUS examination. The result of CEUS for the assessment of percutaneous treatment correlated with the second imaging method (CT or MRI) in 87.5% of the cases. Importance of the Conclusions: CEUS is a good method for the assessment of percutaneous treatment for HCC and also for targeted therapy of the residual tumor TL.03.003 Ecografıa Con Contraste Intravenoso Para El Diagnostico De Las Lesiones Focales En El Contexto Del Hıgado No Cirrotico: Analisis Costo-Beneficio F. C. Moreira, T. Ripolles, M. J. Martinez Hospital Universitario Dr. Peset, Valencia, Comunidad Valenciana, Espa~na Brief Description of the Purpose of the Study: To assess the costeffectiveness of intravenous contrast enhanced ultrasonography (CEUS) in the diagnosis of focal lesions in the context of non-cirrhotic liver, taking into account the subsequent need to supplement with other methods, computed tomography (CT) or magnetic resonance (MRI). Methods: CEUS examinations were retrospectively studied between May and November 2012. This included 55 patients with focal liver lesions (28 women, range 30-86 years). Main Results: We studied 33 hemangiomas, 5 (15%) showed questionable behavior and required another method (2CT, 3MRI). There were 5 focal nodular hyperplasia, only 1 (20%) required further study (MRI). We detected 12 seudolesiones (focal steatosis), only 1 (8%) was supplemented with CT. There were 8 patients with metastatic lesions, 2 (25%) underwent CT to diagnosis. Two indeterminate lesions were observed, both were recommeded for further analysis with a MRI. 89% of CEUS was performed the same day as the baseline ultrasound, only 6 were undertaken on another day (range: 4-138, average: 58 days). In 81% of cases, CEUS showed typical behavior avoiding another diagnostic method for confirmation. This meant a saving of 49 additional tests. Importance of the Conclusions: CEUS is a fast, cheap, without radiation, that helps avoid other more expensive diagnostic tests and shortening the time to diagnosis. TL.03.010 La Ecografıa Con Contraste Para Clasificacion De Lesiones Quısticas Renales Con Los Criterios Bosniak Adaptados a CEUS F. C. Moreira, T. Ripolles, M. J. Martinez, D. U. Navarro, L. N. Vilar Hospital Dr. Peset, Valencia, Camunidad Valenciana, Espa~na Brief Description of the Purpose of the Study: To evaluate the role of ultrasound with contrast (CEUS) in the classification of renal cystic masses with the Bosniak criteria adapted to CEUS. Methods: We retrospectively analyzed the ultrasonography findings of 35 patients with CEUS, media: 57 years (age range: 24-85) from 2009 to 2012 who had complex cystic renal masses. The results were compared with pathology or with other techniques such as computed tomography (CT), magnetic resonance (MRI), or ultrasound monitoring. Main Results: In CEUS masses were classified as Bosniak category II in 17, III in 6 and type IV in 12. 18 were underwent CT / MRI, coinciding the Bosniak in 12 cases (66%). 2 patients classified Bosniak III were operated with benign findings (hemorrhagic cyst, chronic pyelonephritis). Of 12 patients classified as Bosniak IV, 10 were operated, with findings of malignancy in 8 (4 clear cell carcinomas / 4 papillary

Abstracts

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carcinomas). One Bosniak IV was benign renal myxoma. All malignant lesions that were operated, had classification CEUS Bosniak IV (sensitivity 100%). CT or MRI classified 2 malignant lesions as benign. Importance of the Conclusions: CEUS is a fast method, without radiation, which has good sensitivity for screening for malignant cystic lesions, when we apply the Bosniak classification criteria adapted to CEUS.

Main Results: Compared with control group, Untw-R decreased significantly (p , 0.001) and T-PUV,UHT increased significantly (p , 0.001). For Ptw, PTV, PUV there is no significant difference in between CHD group and Control group. Compared with Single Culprit Vessel Group, Untw-R, PUV decreased significantly (p , 0.05) and T-PUV, UHT increased significantly (p , 0.05) in Multi Culprit Vessel Group. Importance of the Conclusions: The untwisting motion in CHD patients were significantly reduced and delayed, even more significant in Multi Culprit Vessel patients.

4 - Echocardiography

PA.04.003

PA.04.001

Evaluation of Flow Structure Within Left Ventricle in Patients With Chronic Heart Failure by Vector Flow Mapping L. D. Hao, Y. Liu, R. Q. Guo Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China

Assessment of the Left Ventricular Untwisting in Patients With Acute Myocardial Infarction in Different Location by 2D Speckle Tracking Imaging H. N. Song, R. Q. Guo Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China Brief Description of the Purpose of the Study: Left ventricular untwisting movement is considered as an important part of LV diastolic function. The location of myocardial infarction (MI) and number of MI segments may have different impact on left ventricular untwisting movement. Methods: Forty-one patient with AMI (AMI Group) were divided into two groups according to the MI location and 31 age matched subjects (Control group). Locate the position and number of segments of MI according to the bull’s eyes map of systolic strain (LPSS) values acquired by AFI. Access peak twist velocity (PTV) ,untwisting rate in IVRT (Untw-R), peak untwisting velocity (PUV),time to peak untwisting velocity (TPUV)and half time of untwisting (UHT) with STI. Main Results: Compared with control group, LVEF, global LPSS, PUV and Untw-R of AMI group decreased significantly (p , 0.001), T-PUV (p , 0.001) and UHT (p 5 0.028) increased significantly. The number of MI segments correlated with Untw-R (r5-0.420, p 5 0.006) significantly. Untw-R in Anterior wall-Anteroseptum group were lower than Inferior wall-Posterior wall group (p 5 0.022). Importance of the Conclusions: LV untwisting motion of AMI patients can be observed by 2D-STI. Untw-R is a sensitive parameter to evaluate the untwisting motion of AMI patients. The untwisting motion of AMI patients decreased significantly, even worse in Anterior wall-Anteroseptum AMI patients. PA.04.002 Assessment of Impact of Involved Coronary Artery Quantity on Left Ventricular Untwisting in Patients With CHD by 2DSTI L. D. Hao, H. N. Song, R. Q. Guo Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China Brief Description of the Purpose of the Study: Diastolic function in patients with Coronary Heart Disease (CHD) may decrease. To assess LV Diastolic function in CHD patients with different involved coronary artery quantity by measuring the untwisting motion can provide basis for diagnosis for CHD. Methods: 75 patients suspected for CHD were divided in two groups according to the result of selective coronary angiography (SCA): CHD group (45 patients) and Control group (30 patients). According to the number of narrowed coronary, the CHD group was divided into Single Culprit Vessel Group (27 patients) and Multi Culprit Vessel Group (18 patients). 2DSTI indicies included, twist at aortic valve closure (AVCtw), twist at mitral valve open (MVOtw), untwisting rate in IVRT (Untw-R), peak untwisting velocity (PUV), time to peak untwisting velocity (TPUV) and half time of untwisting (UHT).

Brief Description of the Purpose of the Study: Vector flow mapping (VFM) is an application in which blood information in the heart chamber boundary can be quantitatively-analyzed based on information by color Doppler. To evaluate blood flow structure and quantify the variation of the flow within left ventricle, assess the impact of chronic heart failure(CHF) by VFM. Methods: 97 patients with chronic heart failure and 104 controls were involved. The flow vector images on the section plane of the flow within the left ventricle were acquired by VFM. Time-flow (T-F) curve and all other peak systolic and diastolic flow curve include normal velocity profile, parallel velocity profile,vector profile were analyzed by DSARS1 program. Main Results: Ventricular ejection peak S, rapid ventricular filling peak E and atrial systole peak A were relatively lower at basal and middle segments in CHF group than normal control group (p , 0.05). Normal velocity profile, parallel velocity profile, vector profile at peak S and E were lower at basal and middle segments in CHF group than normal control group (p , 0.05). Importance of the Conclusions: VFM technology could provide quantitative and intuitive information to demonstrate the flow structure of the ventricle and evaluate the cardiac function in patients with CHF. PA.04.005 Three-Dimensional Speckle Tracking Echocardiography for the Preliminary Research on the Coronary Heart Disease R. Q. Guo, J. Guo Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China Brief Description of the Purpose of the Study: 3-DSTE overcome the inherent limitations of 2-D STE and tissuel Doppler, in this studies, we performed a comparision study between strain data obtained by 2-D STE and 3D STE to detect CHD from 57 patients underwent coronary angiography. Methods: A total of 57 consecutive patients underwent three-dimensional echocardiography, According to the results of coronary angiography, divided into CHD group (30s) and control group (27s) , Normal reference values of area strain were determined in 27 healthy subjects. Main Results: 3D strain in CHD lower than the control group significantly (p , 0. 01). The ROC shows that: 3D global strain AUC is 0.89 (p , 0.01), the curve Area 95% confidence interval is 0.82-0.95, greater than 0.50. The gloabl 3D strain , 23.88 as detection of coronary heart disease cut-off Point, the sensitivity is 90%, specificity is 70%, the accuracy for 86 %, Youden index is 0. 60. The 2D global strain in ROC, the AUC is 0.75 (p , 0. 01), the 95% confidence interval is 0. 67  0.83, greater than 0.50. The global 2D strain , 28.4 as cut-off point,The sensitivity is 73%, specificity is 63%, the accuracy is 71%, Youden index 0.37.

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Importance of the Conclusions: In the detection of CHD, the global 3D strain sensitivity, accuracy is greater than the2D strain (p , 0.01), but has no significant differences between two methods (p . 0.05), Area strain is a novel automatic index derived from 3-D STE to detect CHD, showing greater feasibility than other conventional strain index.

wall motion abnormalities, and LSDI is the most effective parameter to detecting severe CAD.

PA.04.006

PA.05.001

Two-Dimension Speckle Tracking Assessment of Right Ventricle in Patients With Acute Inferior Myocardial Infarction and After PCI R. Q. Guo, C. F. Song Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China

Principais Achados De Imagem Na Linfangioleiomiomatose J. D. Zavariz, A. P. Carvalho Hospital Das Clinicas Da FMUSP, Sao Paulo, SP, Brasil

Brief Description of the Purpose of the Study: This study was to evaluate the usefulness of speckle tracking imaging (STI) for assessment of systemic right ventricle RV function in patients with acute inferior myocardial infarction (MI) and 7 days after percutaneous coronary interventions (PCI). Methods: Two-dimensional imaging at the four chamber view was obtained with tracing of the entire RV endorcardial border in forty-four patients with acute inferior MI and 50 healthy volunteers Peak longitudinal systolic strain and strain rate (S/Sr) in six RV segment included the basal, mid, and apical segments of the RV free wall and septum. And thirty-four of the patients who accepted PCI were reexamined seven days ago. Main Results: The base and mid segmental systolic strain of the RV free wall and all segments of septum were all significantly lower in patients with acute inferior MI (P , 0.05). But the strain rate only decreased in mid segment of right septum. 7 days after PCI, except the apical part of the RV free wall and septum ,all segmental strain were significantly improved (P , 0.05) and the Sr values were no changes (P , 0.05). Importance of the Conclusions: STI is a new and useful technology for assessment of RV function in acute inferior MI. And early PCI can improved the RV function.

5 - Education in Ultrasound

Introduction: Lymphangioleiomyomatosis is a rare idiopathic multisystem disorder that affects almost exclusively women of reproductive age and is characterized by the abnormal proliferation of smooth muscle cells in the lungs and lymph vessels of the chest and retroperitoneum. The most common clinical manifestations are dyspnea on exertion and pneumothorax, with progressive loss of lung function. The rarity and nonspecificity of the symptoms often generate delay in the diagnosis. In most cases, the radiologist is the first to suggest it. Imaging methods are essential to arrive at the correct diagnosis. Methods Involved: Retrospective evaluation of cases of the Hospital das Clinicas selection of illustrative images. Discussion: There are classic manifestations and unusual manifestations in lymphangioleiomyomatosis. The thoracic CT (computed tomography) findings show multiple thin-walled lung cysts, uniformly sized and distributed diffusely in both lungs. It can also show pleural effusion or pneumothorax associated and mediastinal lymphadenopathy. The main abdominal imaging findings includes: renal angiomyolipomas, chylous ascites, uterine leiomyomas, lymphadenopathy, abdominal and pelvic lymphangioleiomyomas. Conclusion of the Presentation: This pictorial essay aims to demonstrate the main findings of thoracic and abdominal image through ultrasound and CT in reference to aid in the diagnosis of lymphangioleiomyomatosis.

PA.04.007 Evaluation of Left Ventricular Dyssynchrony in Coronary Heart Disease Without Visual Segmental Wall Motion Abnormalities by Strain Delay Index Q. Zhou, J. Huang, R. Q. Guo Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China Brief Description of the Purpose of the Study: Conventional twodimensional echocardiography is difficult to detect significant wall motion dyssynchrony in patients without visual segmental wall motion abnormalities. Methods: 135 patients under suspicion of CAD were recruited in this study. The time to minimal systolic longitudinal, radial, circumferential strain were measured from the start point of QRS wave in electrocardiogram. The left ventricular segmental standard deviation, maximal difference and longitudinal, radial, circumferential strain delay index were calculated. Main Results: According to coronary angiography results, patients were divided into three groups: severe stenosis,mild stenosis and control group. Compared with the other 2 groups, SDI and Tssl-SD, Tssl-Dif were decreased in severe stenosis group. There were not significant differences between the mild stenosis group and the control group except Tssr-SD. The receiver operating characteristic curves analysis demonstrated that LSDI had the highest accuracy and Tssl-SD had the lowest accuracy for detecting severe CAD. Importance of the Conclusions: SDI can be helpful for assessing the left ventricular dyssynchrony in patients without visual segmental

PA.05.003 Ultrasonography of Lung Consolidation: Alveolar Pattern (Ultrassonografia Das Consolidac¸~oes Pulmonares: Padr~ao Alveolar) J. R. T. Vicentini, E. B. Bevilacqua, D. G. O. A. Medrado, F. R. Ferreira, F. L. Mazzucato, M. H. Pardo, M. J. F. Neto, M. C. Chammas, G. G. Cerri Instituto De Radiologia - HC/FMUSP, S~ao Paulo/SP, Brasil Introduction: Ultrasonography is useful to study diseases of lung peripheral parenchyma, pleural cavity and chest wall, as well as to evaluate opacities detected in radiological studies. Methods Involved: The subject was discussed based on daily practice at University of Sao Paulo Medical School Department of Radiology (FMUSP - InRad) and literature review in order to illustrate ultrasound usage to evaluate alveolar consolidation. Discussion: Alveolar pattern represents the sonographic appearance of parenchymal disorders that cause alveolar filling, such as pneumonia. This pattern shows hypoechoic consolidation mimicking liver/spleen parenchyma, with multiple foci of air and liquid within, representing air and fluid bronchogram respectively. Color Doppler can be used to distinguish simple pneumonia from other kinds of consolidation. For not using ionizing radiation, ultrasound is a good option as a followup method for these pathologies, mainly in children and pregnant women, besides being useful to predict prognosis and to perform guided biopsies whenever it’s important to determine etiology. Conclusion of the Presentation: Therefore, ultrasound is an excellent method to diagnose peripheral alveolar pattern, mainly when it is not

Abstracts detected in conventional radiological exams, contributing to improve medical treatment. PA.05.004 Hipertens~ ao Portal - Sistematizac¸~ao Do Exame Ultrassonogr afico Com Doppler F. C. F. Fleming, D. B. N. Bortolazzi, L. R. A. Camara, A. P. F. Almeida, M. J. F. Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: The portal hypertension is a clinical condition characterized by pathological increase in portal pressure that can occur portal overflow and / or increased hepatic resistance, defined by increased portal pressure above the normal range or by increased the pressure gradient between the portal vein and hepatic vein / inferior vena cava. Doppler ultrasonography of the portal system is a method that can detect changes due to portal hypertension, it is an inexpensive, innocuous and accessible. Methods Involved: Presentation of systematization studies of Doppler Ultrasound portal system, performed in our department. Discussion: Many patients with portal hypertension develop insidiously and asymptomatic, complicating the clinical analysis. For this reason patients with liver disease are benefited with systematic ultrasound, because it can detect changes that occur even before clinical manifestations of the disease. The most reliable sonographic finding of portal hypertension is the collateral circulation, and can be well characterized by Doppler. Conclusion of the Presentation: The importance of the diagnosis of portal hypertension makes systematic ultrasound portal system a great choice for the diagnosis and monitoring of portal hypertension in patients with liver disease.

6 - Ultrasound in Emergencies PA.06.001 Gravidez Heterot opica: Relato De Caso E Revis~ao Da Literatura De Uma Emergente Patologia M. L. Duarte, F. T. Delcaro, F. L. A. De Oliveira, E. R. Duarte, J. B. A. Ferreira Irmandade Da Santa Casa Da Misericordia De Santos, Santos, S~ ao Paulo, Brasil Brief Description of the Purpose of the Review of Literature: Report a pathology whose incidence is of 1:30,000 gestations and have a favorable end for one gestation thanks to early diagnostic stage provided by ultrasound. Description(s) Condition(s), Method(s) or Technique(s): The heterotopic gestation is rare and potentially fatal. Previous ectopic pregnancy, pelvic surgeries, pelvic inflammatory disease among others, are risk factors for extra-uterine implantation of the conceptus, because they alter the mobility, the anatomy and the peristaltism of the uterine tubes, interfering in the fimbrial ovular capitation. It’s incidence has increase with the assisted reproduction reaching valves of 1:100 up to 1:500, being the uterine tubes the most common ectopic place. Done review of all the case reports in the literature with emphasis ion the ultrasonographic diagnosis in the last 13 years utilizing Pubmed, Scielo and Cochrane data with the keywords ovarian pregnancy, ectopic topical and heterotopic pregnancies and ultrasonography. Conclusion: The ultrasonographer must always be alert to the possibility of the heterotopic gestation, increasing the sensibility of the method and reducing the risks of complications through adequate therapeutics in an early way. According to medical literature ultrasound is

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the best benefit cost exam for such diagnosis due to its good sensibility, low cost and easy access, providing the treatment in some opportunities. Brief Discussion of the Case: null PA.06.002 Apresentac¸o~es Pouco Usuais De Oclus~oes Vasculares Na Emerg^encia: Diagnostico Por Doppler D. B. N. Bortolazzi, M. J. Francisco Neto, A. Rahal Junior, F. Vieira, G. Mariotti, C. A. P. Ventura, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: The vascular occlusions less typical, unlike the more common presentations (deep vein thrombosis, atheromatosis), are a real challenge for initial low suspicion and technical difficulties, being important to search etiologic in the initial evaluation. In this context, history and persistence of the sonographer in the individualization and interpretation of imaging findings are essential for early and correct diagnosis. Methods Involved: Radiologists Emergency physicians should be familiar with ultrasound images of atypical vascular occlusions and indirect signs, knowing possible sites, sparing the patient additional tests such as arteriography, which presents risks and specific contraindications and may be waived in case of conclusive study dopplervelocimetric . Discussion: In the distal limb vascular occlusions, highlight, like less frequent presentations, the Tromboangeıite obliterans and Raynaud’s phenomenon, in the renal vein occlusion, ‘‘status’’ after renal transplantation, sepsis, hypovolemia, nephrotic syndrome and direct tumor invasion. In iliac artery occlusion highlight ‘‘status’’ after renal transplantation and vasculitis. Conclusion of the Presentation: Doppler ultrasonography is the method of choice in the initial evaluation of suspected vascular occlusions in emergency, both in presentations more frequent, as in unusual, being an examination of high accuracy, able to define conduct and saving the patient from exams, improving the dynamics in the Emergency. PA.06.004 Sindrome Do Ligamento Arqueado: Diagnostico Por Doppler Na Emerg^encia D. B. N. Bortolazzi, Y. C. Bohrer, M. J. F. Neto, C. A. P. Ventura, A. R. Junior, A. Maurano Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: The arcuate ligament is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus, passing above the celiac trunk. May have a lower insertion and compress the celiac trunk, resulting in a reduced blood flow distal. The symptoms are nonspecific as abdominal pain, vomiting and diarrhea. About 24% of asymptomatic people have this change. Methods Involved: Performed Doppler ultrasound in patients with epigastric pain and nausea, which was observed in the color mapping the point of proximal stenosis in the celiac trunk. The systolic peak velocity during inspiration and expiration and angle of the trunk to the aorta were measured. Discussion: Arcuate ligament syndrome is a condition consisting of the set of typical symptoms and sonographic findings. The treatment is surgical and resolving in 53-76% of patients. Cases refractory to surgical treatment are due to other causes of obstruction. Conclusion of the Presentation: In most cases the diagnosis of this syndrome is not hypothesized by the requesting physician, given the rarity. The radiologist should perform an active search, with completion Dopplervelocimetric in patients with gastrointestinal symptoms that

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raise suspicion, once already removed the other causes that most often lead to symptoms in question.

PA.06.006 The Role of Ultrasound in Thoracic Trauma (Aplicac¸~oes Da Ultrassonografia Do Torax: Cenario Do Trauma) J. R. T. Vicentini, L. R. P. Marin, F. O. Lima, P. H. D. M. Moraes, M. J. Francisco Neto, M. C. Chammas, G. G. Cerri Instituto De Radiologia - Hc/FMUSP, S~ao Paulo/SP; Brasil Introduction: Thoracic trauma is a condition that affects mostly young people, with high rates of morbidity and mortality, demanding fast and effective treatment. Thoracic ultrasound is a useful tool in these cases, usually contributing to complement FAST (Focused Assessment with Sonography for Trauma) exam and enabling the diagnosis of several disorders that may require medical intervention. Methods Involved: This pictorial essay illustrates some disorders related to thoracic trauma and their imaging findings on ultrasound evaluation. Discussion: Ultrasonography has the advantage of being easily accessible in different places where polytraumatized might be taken to, such as emergency rooms and intensive care unities, situations that frequently demand immediate diagnostic and therapeutic measures. Some disorders that can be diagnosed by the method are soft tissue hematomas, rib fractures, pneumothorax, hemothorax and lung consolidation. Besides its high sensitivity, the method can also assist therapeutic procedures, such as guided thoracic drainage. Conclusion of the Presentation: Therefore, in evidence-based medical practice, ultrasonography plays a crucial role in thoracic trauma scene, as it’s a fast and versatile method, representing a technique that should be mastered by every radiologist.

PA.06.009 ~es Agudas Em Pacientes Oncologicos Detectadas a Complicac¸o Ultrassonografia B. L. Moreira, A. G. V. Bitencourt, G. L. Barros F, M. J. S. Maciel, T. C. Almeida, R. Chojniak Hospital A.C. Camargo (Fundac¸~ao Ant^onio Prudente), S~ao Paulo (SP), Brasil Introduction: The oncologic patient with acute complaints can present several complications related to the disease or treatment. Due to its greater availability and lower cost, ultrasound is often the first imaging method performed in these cases. Methods Involved: This pictorial essay aims to show examples of acute complications detected by ultrasound in patients with cancer in an oncologic institution. Discussion: Oncologic patients may develop acute complications related to various direct or indirect effects of the tumor, treatment side effects or mmunosuppression. Ultrasound can be useful in several situations such as venous thrombosis, effusions, abscesses or biliary and urinary obstructions. Venous thrombosis are up to seven times more common in patients with cancer than general population, and Doppler ultrasonography has a major role in its diagnosis. Empyema, abscess, typhlitis and other infectious complications are also relatively common in oncologic patients and can be evaluated by ultrasound. In patients with suspected biliary or urinary obstruction, ultrasonography can confirm the diagnosis and determine the etiology. This method can also be useful in guiding invasive procedures. Conclusion of the Presentation: Ultrasonography is an efficient, cheap, fast and safe for prompt evaluation of various acute complications in oncologic patients.

Volume 39, Number 5S, 2013 7 - Ultrasound in Gynecology PA.07.002 Colour Maps and Reproducibility of Sonographic Endometrial Thickness Measurements Q. Lam, R. Phillips Derriford Hospital (PHNT), Plymouth, Devon, UK and University of West of England, Bristol, Avon, UK Brief Description of the Purpose of the Study: The colour map function is widely available on modern ultrasound equipment and may enhance ultrasound visualisation. However, there is little evidence of its use. This research investigates if colour maps affect reproducibility of sonographic endometrial thickness measurements. Methods: A longitudinal greyscale image of the uterus and endometrium are acquired from 25 women by transvaginal ultrasound scans. The colour map function is applied to this image in red, purple, pink, green and blue. 4 reviewers independently and blindly obtain 2 endometrial thickness measurements from each image. Main Results: Bland and Altman’s 95% limits of agreement are applied to the data. The average intra-reviewer and inter-reviewer agreement is 0.929 and 0.935 respectively. The agreement of the measurements within each colour map is 0.949 jointly for grey, green, pink and purple, 0.939 for red and 0.918 for blue. The agreement of measurements from images with colour map vs. greyscale is 0.980 jointly for green and purple, 0.975 for red, 0.970 for blue and 0.965 for pink. The average kappa statistic based on categorising measurements into normal, borderline and abnormal, is 0.80. Importance of the Conclusions: Colour maps do not affect the reproducibility of endometrial thickness significantly and may be used interchangeably with greyscale images during the ultrasound examination. PA.07.007 Cistoadenoma Mucinoso De Ovario Em Coexist^encia Com Adenocarcinoma De Colon: Relato De Caso S. T. Regina, R. G. Barbosa, O. A. C. Silva, M. A. V. Seda, L. U. M. A. Silva, R. P. V. Magalhaes Todos os autores s~ao Medicos Residentes de Radiologia e Diagnostico por Imagem do Hospital Escola de Itajuba, Itajuba, MG, Brasil, Hospital Escolade Itajuba, Itajuba, Minas Gerais, Brasil Brief Description of the Purpose of the Report: To report a case of a patient who presented simultaneously ovarian mucinous cystadenoma and colon adenocarcinoma. Just two similar reports were found in the literature. Medical History: Female patient, 72 years old, history of oophorectomy (total left and partial right) at age 20, was admitted in hospital with abdominal pain, constipation and vomiting starting three days ago. The patient reported one ovarian cyst diagnosed by ultrasonography four years ago and noted the increased of her abdominal volume one year ago. Radiological workup suggested semi-obstructive acute abdomen. Ultrasonography and Computed Tomography (CT) scanning showed a huge multi-loculated cyst in her lower abdomen. Carcinoembryonic antigen (CEA) and cancer antigen 125 (CA 125) levels were high. Performed right oophorectomy and resection of stenotic lesion in the descending colon, evidenced during surgery. The excised surgical specimens were sent for histo-pathological study. Diagnosis: Ovarian mucinous cystadenoma and colon adenocarcinoma. Discussion and Summary of the Case: Mucinous cystadenomas represents 15% to 20% of ovarian tumors. Colorectal tumor is the fourth highest incidence neoplasia in the world, being the most common type adenocarcinoma. History of ovarian cancer increases the chance of developing colorectal tumor. Image exams are important in the management and diagnosis of these synchronous diseases, since both occur with elevated tumor markers.

Abstracts

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PA.07.010

PA.08.002

Proposta Para a Classificac¸~ao Das Massas Anexiais: Gi-Rads An alise Crıtica A. J. Reis Neto, B. L. Peixoto, K. B. Alcantara, R. M. Ferlin, J. F. Jordao, A. C. Ferreira Instituto De Diagnostico Por Imagem, Hospital Santa Casa Ribeirao Preto, SP, Brasil

Tıtulo: Elastografia Em Nodulos Tireoideanos: Experi^encia De 46 Casos, Com Boa Correlac¸~ao Com Paaf R. G. Garcia, A. Maurano, G. F. Mendes, A. Rahal Jr., C. Barcellos, D. G. L. Araujo Hospital Israelita Albert Einstein, S~ao Paulo/SP, Brasil

Brief Description of the Purpose of the Report: Analyze the system GI-RADS based on prospective multicenter study of sonographic findings of 432 adnexal masses in 372 women aged between 13 and 78 years old, in a period of 36 months. Medical History: Patients were assessed with transvaginal ultrasound by 3 expert examiners. Classification of adnexal masses followed IOTA criteria for malignity as well benignity. It was suggested that the patients classified as GI-RADS 2 would have further clinical follow-ups, GI-RADS 3 would be referred to gynecological surgery and GI-RADS 4 and 5 would be referred to gynecologic oncology. Diagnosis: Of the 432 tumors examined, 112 were classified as maligt and 320 benign as, with following GI-RADS percentage being obtained: 92 cases of GI-RADS 2 (21%), 184 cases of GI-RADS 3 (43%), 40 cases of GI-RADS 4 (9%) and 116 IG-RADS case of 5 (27%). The study showed sensitivity for malignancy of 99.1%, specificity of 85.9%, positive predictive value of 71.1% and negative predictive value of 99.6%. Discussion and Summary of the Case: Through the study, GI-RADS was found to be a great communication system with unification of language in adnexal masses with high risk of malignancy, proving to be very useful for clinical decision.

8 - Ultrasound Guided Intervention PA.08.001 On-Site Cytology Evaluation Effective for Endoscopic Ultrasound-Guided Fine Needle Aspiration Diagnosis of Pancreatic Tumors T. Y. Cheng, H. P. Wang, J. T. Lin National Taiwan University Hospital, Taipei, Taiwan Brief Description of the Purpose of the Study: Endoscopic ultrasound (EUS) with EUS-guided fine needle aspiration (FNA) has become the standard diagnostic procedure for pancreatic cancer. On-site cytology evaluation is useful for improving diagnostic yield of EUS-FNA. Our aim was to assess the cytology modification effect on the EUS-FNA diagnosis of pancreatic tumors.

Introduction: To describe a series of 46 thyroid nodules submitted to fine neddle aspiration biopsy(FNAB) and evaluated before the procedure with quantitative elastography. Methods Involved: Nodules with different ecographic patterns that were FNAB indicated were evaluated using TIRADS classification and quantitative elastography. The ultrasound manufacturer used was Siemens. Discussion: A total of 46 thyroid nodules were evaluated. 3 nodules were characterized as papilliferous carcinoma, all of them with elastography values higher than 4. 3 nodules were found with values between 2 and 4, two with citology suggestive of goiter and one wit folicular carcinoma. 1 nodule was described with elastography value higher than 4, but it had a macrocalcification that was included in the measurement and therefore must be disregarded. The literature shows that a threshold value of 4 is highly both sensitive and specific of papiliferous carcinoma. Values lower than 2 are associated with benign nodules and values between 2 and 4 are indeterminated. Consequently, nodules more consistent than 2 shall be submitted to FNAB, and nodules with values lower than 2 can be followed with ultrasound. Conclusion of the Presentation: Quantitative elastography is a reliable and stablished in literature method and helps in indication and contraindication of FNAB.

TL.08.004 A Three-Dimensional Visualization Preoperative Treatment Planning System in Microwave Ablation for Liver Cancer: A Preliminary Clinical Application X. L. Yu, F. Y. Liu, P. Liang, Z. G. Cheng, T. Lu Chinese PLA General Hospital, Beijing, China Brief Description of the Purpose of the Study: To evaluate the clinical application value of three-dimensional visualization preoperative treatment planning system in microwave ablation for liver cancer.

Methods: From December 2001 to November 2012, 468 patients with pancreatic tumors received EUS-FNA with on-site cytology evaluation at our institution. Hemacolor stain was utilized for all on-site cytology specimens, and ultrafast Papanicolaou stain was added in the recent three years.

Methods: We used the self-developed three-dimensional visualization preoperative treatment planning system assisting microwave ablation to cure 36 cases of liver cancer with 44 lesions(mean maximum diameter, 3.11 6 1.30 cm; range,1.08-5.27cm). A complete preoperative treatment planning was finalized by the preoperative planning system before microwave ablation. Microwave ablation was performed according to the preoperative treatment planning under ultrasound guidance. After ablation, therapeutic efficacy was assessed by contrast-enhanced imagings during follow-up.

Main Results: On improving skills and methods, we divided the 11 years into three periods: first four-year learning period, second fouryear experienced period, and last three-year modification period. There were 62,169, and 237 patients in each period. The operating characteristics of EUS-FNA in each period were as follows: sensitivity 93.5%, 95.8%, 96.7%; specificity 100%, 100%, 100%; positive predictive value 100%, 100%, 100%; negative predictive value 82.4%, 90.7%, 90.2%, and accuracy 95.0%, 97.0%, 97.5%.

Main Results: The preoperative planning of all tumors was achieved successfully. The preoperative planning ablation rate was 100%. The number of antenna insertions planned was 2.67 6 1.69. All tumors were completely ablated according to the contrast-enhanced images 1 month after microwave ablation. The technique effective rate was 100%. The evidence rate of serious complication was 2.78% (1/36). No patients occurred local tumor progression during 3-12 months follow up (median, 6 months).

Importance of the Conclusions: On-site cytology evaluation offered good diagnostic accuracy. Though modification of cytology methods could guide treatment planning more efficiently by identifying certain pancreatic tumors suitable for non-surgical treatment, it had limited effects on improving sensitivity and accuracy of EUS-FNA.

Importance of the Conclusions: The three-dimensional visualization preoperative treatment planning system is able to improve the accuracy of ablation therapy, strengthen doctors’ confidence in ablation therapy, and lower the complication rate; therefore, it has a relatively high clinical application value.

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9 - Ultrasound in Breast PA.09.001 Ultrasound Diagnosis of Breast Intraductal Tumors H. Luo Shenzhen People’s Hospital Brief Description of the Purpose of the Study: The purpose of this study was to describe the features of breast intraductal tumors shown on high-resolution sonography and to correlate them with histopathology to evaluate the prognostic ability of sonographic findings. Methods: We retrospectively reviewed sonographic images of 56 breast intraductal tumors from January 2009 to June 2011. Sonography was performed using a high-resolution unit with a 5- to 12-MHZ linear array probe on a Philips IU22. We documented the following features of masses: size, echo, shape, margin, border, architectural distortion, ductal extension and dilatation, microcalcifications, posterior acoustic phenomena and color-flow signal. Main Results: Of the 56 cases, 39 cases were breast intraductal papilloma, 17 cases were intraductal carcinoma. Sonography revealed a regional widening of tubular in 33 cases (%) of intraductal papilloma,branching hypoechoic structure in 10 cases (%), and a mass in 5 cases (%), architectural distortion with microcalcifications in 7 cases (%) of intraductal carcinoma,a irregular mass in 5 cases (%), dilated retroareolarducts in 5cases (%). Importance of the Conclusions: Sonography has high sensitivity for ductal extension and dilatation. Ductal extension and architectural distortion with microcalcifications are further important sonographic features that aid in differentiating malignant from benign processes. Therefore,sonography should plays an important role in diagnosis mammary intraductal tumors.

PA.09.002 Ultrasound-Guided Diffuse Optical Tomography (DOT) of Invasive Breast Carcinoma: Does Tumour Total Haemoglobin Concentration Contribute to the Prediction of Axillary Lymph Node Status? Q. L. Zhu, M. S. Xiao, S. S. You, Y. X. Jiang, Q. Dai Peking Union Medical College Hospital, Beijing, China Brief Description of the Purpose of the Study: To prospectively study the ultrasound-guided near-infrared diffuse optical tomography (DOT) findings of the total haemoglobin concentration (THC) detected in invasive breast carcinomas and its contribution to the prediction of axillary lymph node (LN) status. Methods: A total of 195 invasive breast carcinomas were prospectively studied with DOT before surgery. Lumpectomy or mastectomy with full axillary nodal dissection was performed. Tumour size and THC level were correlated with LN status by a logistic regression analysis. Main Results: One hundred twenty-four patients (63.59%) was LN(2) and 71 (36.41%) was LN(+). The average THC was significantly higher in the LN(+) group than in the LN(2) group (252.94 6 69.19 mol/L versus 203.86 6 83.13 mol/L, p 5 0.01). A multivariate analysis showed an independent relationship between the probability of axillary metastasis, elevated THC level (p 5 0.01), and tumour size (p 5 0.001). The odds ratio with THC $ 140 mol/L was 13.651 (1.781-104.560), whereas that of tumour size with a 1 cm increment was only 1.777 (1.283-2.246). Importance of the Conclusions: The THC level and the tumour size are independent and preoperative predictors of axillary nodal status;

Volume 39, Number 5S, 2013 these variables may improve the diagnosis of patients with lymph node metastasis. PA.09.003 Breast Carcinomas Simulating Cyst in Ultrasonography D. A. B. Buttros, M. Branco, V. Romera, L. C. Simionato Gold Imagem, Rio Claro, S~ao Paulo, Brasil Introduction: Cysts are commonly seen on ultrasound images and present as anechoic / hypoechoic, circumscribed, with posterior acoustic enhancement. These characteristics are also associated with special ductal carcinomas, with histological subtypes: medullary, papillary, mucinous. Methods Involved: Knowledge of the epidemiology and pathophysiology are essential to differentiate them. Discussion: The cysts occur in young women, mostly between 40 and 50 years, with rare after menopause. They are fibroelastic at physical examination (PE), and can be painful. Appear in short time. Papillary and mucinous carcinomas are rare, accounting for 2% of all breast neoplasms. They are circumscribed and are composed, respectively, by blood and mucin, giving soft consistency in PE and posterior acoustic enhancement on ultrasound. Papillary carcinoma usually has retroareolar and vegetation inside, being identified with the aid of the doppler. Medullary carcinoma is also rare (7%), occurring in young patients (,35 years) with positive family history of breast cancer. They are circumscribed and have the interior composed of necrosis, giving benign features in PE and ultrasonography. Conclusion of the Presentation: A careful review of ultrasound circumscribed and anechoic images can determine the diagnosis of rare carcinomas. Early identification is associated with better prognosis and survival of patients.

PA.09.005 O Uso De Phantoms De Baixo Custo No Ensino De Procedimentos Guiados Por Ultrassom Na Mama B. A. Rocha, S. Castro, L. Assirati, E. Endo, L. Chala, N. Barros, M. Rudner, V. C. S. Ferreira, S. J. Hsieh, C. Shimizu, B. T. Jacinto, F. S. Castro, G. G. Cerri Inrad-Hc FMUSP, S~ao Paulo, SP, Brasil Introduction: Breast procedures guided by ultrasound are widely present in radiology routine. These procedures require technical skills such as eye-hand coordination, needle localization and depth notion, that take some time to acquire. In our country, these skills end up being developed through supervised practice directly on the patient, which brings some risks and anxiety. The use of Phantoms has been a global trend in teaching procedures, so that when the begginer professional perform the real procedure for the first time, he has already learned certain basic skills to do it. Methods Involved: We used materials that are widely available and inexpensive to assemble homemade ‘‘phantoms’’. Our model is made of a gelatin mixture thickened with Metamucil and targets made of materials such as olives, capers among others. Discussion: The advantages of this model are the low cost and availability of the materials. On the downside, there is poor durability of the models. Besides basic coordination skills, specific situations such as deep nodules and biopsies with breast implants can be simulated. Conclusion of the Presentation: It is possible to teach basic skills to perform breast procedures guided by ultrassound using homemade ‘‘phantoms’’ with low cost materials.

Abstracts 10 - Ultrasound in Fetal Medicine/Obstetrics

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like a ring. Treatment is usually surgical. The early diagnosis and treatment have a direct impact on the development of intrauterine pregnancy.

PA.10.010 Ultrassonografia Virtual Em Obstetrıcia No Primeiro Trimestre A. C. Ferreira, R. M. Ferlin, F. S. Costa, K. B. Alcantara, A. J. Reis Neto, J. F. Jordao Instituto De Diagnostico Por Imagem, Hospital Santa Casa Ribeirao Preto, SP, Brasil Brief Description of the Purpose of the Report: Analyze the intraobserver reproducibility of real three-dimensional ultrasonography (3D) in relation to virtual ultrasonography in multiplanar and volumetric modalities. Medical History: Prospectively, 132 blocks from 44 evaluations of 26 fetuses were examined. Eighteen fetuses were about eight weeks and eight weeks and six days, and twenty-six were about ten weeks and ten weeks and six days of gestational age diagnosed by ultrasound. 3D ultrasound was performed, analyzing: crown-rump length, gestational sac, amniotic sac, fetal nuchal translucency, conduit omphalomesenteric, yolk sac, upper limbs, lower limbs, head/thorax distinction, side view of face, the coronal face, ear implantation, side view of spine, coronal spine, closed abdominal wall. After this systematization, obtainment of three blocks per fetus was performed for posterior virtual ultrasound. Diagnosis: In group I, the real 3D multiplanar ultrasonographic evaluation versus 3D virtual multiplanar, showed no significant difference. In group II, real 3D volumetric ultrasound evaluation versus virtual 3D volumetric, results of analyzes of categorical variables, showed accordance for most variables in both groups. Discussion and Summary of the Case: The practice of virtual ultrasound is possible. There is intraobserver reproducibility of 3D ultrasound with virtual mode.

PA.10.012 Ultrassonografia Tridimensional Nas Malformac¸~oes Uterinas A. C. Ferreira, R. M. Ferlin, F. S. Costa, K. B. Alcantara, A. J. Reis Neto, J. F. Jordao Instituto De Diagnostico Por Imagem, Hospital Santa Casa Ribeirao Preto, SP, Brasil Brief Description of the Purpose of the Report: Exposure of the benefits of three-dimensional ultrasonography of uterine malformations (UM). Medical History: MFs are due to flaws in development, reabsorption ou combination of M€ullerian ducts. Around the sixth week of embryonic development, an invagination of the coelomic lining epithelium forms a depression that creates a groove, which edges combine to form the M€ullerian duct (or paramesonephric). As a result of that, the UM are also called M€ullerian malformations or anomalies. Several methods have been introduced in gynecological propaedeutic for evaluation. As an example, radiological examinations through hysterosalpingography; surgical procedures: laparotomy, laparoscopy, vıdeolaporoscopy and hysteroscopy. Uterine malformations are uncommon findings in gynecologic practice, the carriers of these alterations being often oligosymptomatic or even asymptomatic preserving menstrual function, and even sexual reproduction. Diagnosis: The 3D ultrasound provided information that helped the therapeutic and prognosis. Discussion and Summary of the Case: The 3D ultrasound diagnostic method is essential to the evaluation of uterine malformations, allowing accurate diagnoses, more specific than the simple description of double endometrial cavity and provides information that helps therapeutic conduction and prognosis and has already been established as having an important role and been increasingly consolidated.

PA.10.011 ~o Heterot Gestac¸a opica Com Poliovulac¸~ao Documentada Ao Doppler De Amplitude E Correlac¸~ao Com Intra-Operatorio. Relato De Caso E Revis~ao Da Literatura K. B. Alcantara, A. J. Reis Neto, R. M. Ferlin, F. S. Costa, J. F. Jordao, A. C. Ferreira Instituto De Diagnostico Por Imagem, Hospital Santa Casa Ribeirao Preto, SP, Brasil

11 - Ultrasound in Musculoskeletal

Brief Description of the Purpose of the Report: We report a case of heterotopic pregnancy diagnosed by ultrasound at six weeks of gestation. Medical History: Female patient, 37 years old, with complaints of diffuse abdominal pain two days ago. Ultrasound examination showed intrauterine gestational sac, left ovary containing three corpus luteum. Ovarian ectopic pregnancy picture containing gestational sac and vesicle without embryo. The patient underwent a minilaparotomy, uneventful and favorable. Diagnosis: Heterotopic pregnancy. Discussion and Summary of the Case: The most common symptom is abdominal pain, found in 83% of cases of tubal heterotopic pregnancy. Endovaginal ultrasound detects approximately 70% of cases, with the necessity of gestacional sac being viewed. The location in the fallopian tube is the most common and the presence of an adnexal mass separate from the ovary and the fallopian tube is the most recurrent finding. Another finding is the sign of double deciduous, which is seen as two concentric rings and low resistance to the use of Doppler. The image of the fire-ring is the Doppler effect surrounding the corpus luteum

Brief Description of the Purpose of the Study: Clarity ultrasound image characteristics of the cross-shaped arterial circulation in the rear of the Buttocks. Methods: Application of PHILIPSIU22 high-frequency ultrasonic diagnostic apparatus for High-frequency ultrasound examination of the cross-shaped arterial circulation in the rear of the Buttocks. Main Results: The deep branch of the medial femoral circumflex arteries , the transverse branch of the lateral femoral circumflex artery, the inferior gluteal artery and the ascending branch of the first perforating arteriesthe four of which form a cross-shaped arterial circulation intersection structure in the lower edge of the quadratus femoris muscle. The medial femoral circumflex arteries and the femoral head side branch of the lateral femoral circumflex artery are the most important blood vesselwhich supply blood for the femoral head. When they had ischemiathe inferior gluteal artery and the ascending branch of the first perforating arteries will become the main source of the bloodstream in supplementary. Importance of the Conclusions: High-frequency ultrasound examination of the cross-shaped arterial circulation in the rear of the Buttocks,

PA.11.001 High-Frequency Ultrasound Examination of the Cross-Shaped Arterial Circulation in the Rear of the Buttocks E. Zhansen Shenzhen Longgang Central Hospital

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Volume 39, Number 5S, 2013

PA.11.002

(p . 0.01). There is no significant difference in longitudinal images and transverse images between the different third groups (p . 0.01). Importance of the Conclusions: Acoustic Radiation Force Impulse Imaging of the normal ligamenta patella is a feasible method. Further studies are required to assess the clinical value of this method.

Ultrasonographic and Anatomic Study of the Canine Elbow A. Villamonte-Chevalier, R. Latorre, M. Soler, F. Gil, R. Sarria, A. Agut University of Murcia, Murcia, Spain

PA.11.005

which will become an important method of assessment of the femoral head blood supply.

Brief Description of the Purpose of the Study: The purpose of this study was to assess the canine elbow joint using a high frequency transducer (18 MHz), and to correlate the ultrasonographic (US) images with plastinated anatomical sections obtained on the same planes. Methods: Us study: Five adult German Shepherd-crossed breed dogs were used for the US assessment of elbow joints on the medial, caudal and lateral approaches. Anatomic study: Elbow joints from five dogs euthanized for reasons unrelated to this study were used to obtain 2 mm thick transparent sections that were plastinated through the E12 technique. Correlations between ultrasonographic and anatomic images were performed. Main Results: On the medial approach: the attachments of insertion tendons of brachialis and biceps brachii muscles, the medial collateral ligament, the medial coronoid process, the median nerve and the brachialis artery were assessed. On the caudal aspect: the anconeal process and the tendon of insertion of the triceps brachii muscle were evaluated. On the lateral aspect: the lateral collateral ligament and the lateral coronoid process were assessed. There was a good correlation between of US images and anatomical sections. Importance of the Conclusions: The good correlation between US images and anatomical sections contributed to a comprehensive US assessment of the canine elbow joint.

PA.11.003 On the Feasibility of Visualization Ligamentum Patella Using Acoustic Radiation Force Impulse Imaging L. I. Liu Peking University Shenzhen Hospital, Shenzhen, Guang Dong Province, China Brief Description of the Purpose of the Study: To assess the feasibility of Acoustic Radiation Force Impulse Imaging in depicting the ligamenta patella of healthy volunteers.

Bursa Adventıcia Associada a Osteocondroma Detectada a Ultrassonografia No Contexto De Sındrome Do Impacto Isquiofemoral B. L. Moreira, W. S. Cerqueira, A. G. V. Bitencourt, T. T. Min, D. B. Soto, R. Chojniak Hospital A.C. Camargo (Fundac¸~ao Ant^onio Prudente), S~ao Paulo (SP), Brasil Brief Description of the Purpose of the Report: We report a case in which ultrasound detected adventitious bursa in a patient with a previous diagnosis of osteochondroma. Medical History: Male patient, 25 years-old, attended the emergency department with previous trauma history presenting with pain and swelling of the right thigh. Radiography and ultrasonography were requested. Radiography showed sessile osteochondroma on the lesser trochanter of the right femur. No signs of fracture were demonstrated. At ultrasound, echogenic collection was detected in the medial thigh’s intermuscular plane. Further evaluation with MRI confirmed the sonographic findings and showed partial rupture of the bursa. Patient had no signs of infection and was discharged after orientations and medication. Surgery was planned for the following month. Diagnosis: Ischiofemoral impingement syndrome secondary to osteochondroma, with formation of adventitious bursa in the intermuscular plane. Pathology of the surgical specimen revealed no signs of malignancy associated with osteochondroma. Discussion and Summary of the Case: This case showed how the ultrasound may be useful in detecting adventitious bursa related to osteochondroma, complication usually reported at sites of friction (in this example, the ischiofemoral space). In cases of swelling and pain in patients with osteochondroma, it is important to exclude malignant transformation, and ultrasonography combined with others methods aids in this differentiation.

12 - Ultrasound in Nephrourology PA.12.002

Methods: Eight-four asymptomatic ligamenta patella of 42 healthy volunteers were examined by Acoustic Radiation Force Impulse and grey scale ultrasound respectively, using a Acuson s2000 ultrasound equipment and a 413 MHz multifrequency linear array transducer. The ligamenta patella were divided into the following 3 sections for image evaluation: proximal, middle, and distal. Longitudinal and axial images of each section were obtained using Acoustic Radiation Force Impulse Imaging.

Complicac¸~oes Pos-Transplante Renal: Um Ensaio Pictorico E Destaque Dos Aspectos Ultrassonograficos I. X. C. R. Rebouc¸as, R. M. Mendonc¸a, E. A. Q. Lisboa, J. C. D. Oliveira, M. A. Borba, Z. J. Queiroz Hospital Universitario Onofre Lopes, Natal, Rio Grande Do Norte, Brasil

Main Results: The normal ligamenta patella’s contour was regular and sharply definedappearing as tightly packed echoic structures with fine paralle1 internal linear echoes. The mean thickness of the ligamenta patella of the healthy volunteers is 2.99 6 0.33 mm (range, 2.893.10 mm). In longitudinal images, the shear-wave speed of Proximal third is 3.24 6 0.64m/s, middle third is 3.45 6 0.72m/s. Distal third is 3.27 6 0.56m/s. In transverse images, the shear-wave speed of Proximal third is 2.85 6 0.78 m/s, middle third is2.88 6 0.60m/s. Distal third is 2.64 6 0.42m/s. There is no significant difference in different thirds between the longitudinal images and transverse images groups

Introduction: Kidney transplantation is the treatment of choice for kidney patients terminals. Despite advances in peritoneal dialysis and hemodialysis, post-transplant survival is greater. The conventional and Doppler sonography is the method of choice in the postoperative follow-up and long-term because it is widely available, low cost, and without ionizing radiation, while still allowing guided diagnostic and therapeutic procedures. Methods Involved: Survey of cases of vascular and non-vascular grafts complications in kidney transplant patients in our service, standing out the ultrasound findings and correlate them to other diagnostic modalities

Abstracts (tomography, angiography), and the surgical/pathological when available. Discussion: Complications after renal transplantation are common and have a significant impact on morbidity and mortality. Vascular complications include renal artery stenosis, infarctions, arteriovenous fistula, pseudoaneurysm, renal vein thrombosis. The most frequent nonvascular are obstruction ureteral, perirenal collections and immune rejection. Early diagnosis and image-guided intervention procedures avoided surgical reoperations due and improved survival. Conclusion of the Presentation: Taking into account the increasing number of kidney transplants, it is necessary knowledge and training ultrasonographers able to do the monitoring of patients renal receptors and diagnose early and properly post-transplant complications.

PA.12.004 Pielonefrite Enfisematosa Em Enxerto Renal: Aspectos Ultrassonogr aficos E Revis~ao Da Literatura J. C. D. Oliveira, I. X. C. R. Rebouc¸as, R. M. Mendonc¸a, E. A. Q. Lisboa, M. A. Borba, Z. J. Queiroz Hospital Universit ario Onofre Lopes, Natal, Rio Grande Do Norte, Brasil Brief Description of the Purpose of the Report: Report and discuss a case of emphysematous pyelonephritis in a renal allograft, emphasizing the ultrasound findings and correlated the computed tomography and surgical/pathological aspects. Medical History: Male, 22 years, with terminal chronic kidney disease for polycystic kidney disease in early postoperative renal transplant, the patient developed pain in the right iliac fossa. Ultrasonography detected hypoechoic area suggestive of ischemia in the upper pole of the graft, which evolved into hypoechoic collection/heterogeneous, with gas in between. The association with tomographic findings, surgical (nephrectomy) and histopathology allowed close diagnosis. Diagnosis: Emphysematous pyelonephritis in renal allograft. Discussion and Summary of the Case: Severe condition inflammatory/ infectious affecting renal grafts in situations of hypoxia, emphysematous pyelonephritis is a rare entity, with 14 cases described in the literature. Some authors classify it into two types: 1 - absence of fluid collections; 2 - fluid collection renal/perirenal, this being the patient in question. Escherichia coli is etiologic agent in over 50% of urocultures. Imaging tests are essential to diagnosis and associated conditions such as obstructive uropathy and nefrolitıases also are well evaluated by ultrasound. This method also enables guided percutaneous drainage, which associated with antibiotic therapy, has shown the best therapeutic option for these patients, previously widely treated with graft nephrectomy.

PA.12.005 Torc¸~ ao Testicular Associada a Linfoma N~ao Hodgkin Da G^ onada B. L. Moreira, L. Graziano, A. G. V. Bitencourt, M. M. Medeiros, M. R. B. Poli Hospital A.C. Camargo (Fundac¸~ao Ant^onio Prudente), S~ao Paulo (SP), Brasil Brief Description of the Purpose of the Report: We report a case of testicular torsion with pathological specimen of orchiectomy revealing testicular infiltration by non-Hodgkin lymphoma. Medical History: Male patient, 59 years-old, with a history of nonHodgkin lymphoma in the gluteal region treated with chemotherapy and radiation therapy for over 15 years, attended the emergency depart-

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ment with increased volume of scrotum and local pain for about 15 days, with worsening in the last 24 hours. Physical examination showed inflammatory signs in right scrotum. Ultrasound was requested, which showed right testicle with increased dimensions and diffusely heterogeneous, with no flow on Doppler, associated with hydrocele. Left testicle had normal appearance. Patient underwent right orchiectomy, and histopathology revealed testicular infiltration by non-Hodgkin lymphoma. After surgery, PET / CT was performed and showed no active disease. Subsequently received chemotherapy and radiotherapy. Diagnosis: Testicular torsion associated with non-Hodgkin lymphoma of the gonad. Discussion and Summary of the Case: Lymphoma accounts for 5% of all testicular tumors, being most commonly found in older men. Its most common presentation is painless testicular enlargement. However, in our case, the patient was admitted to the emergency department with pain related to testicular torsion in a gonad infiltrated by lymphoma, which is a rare condition.

13 - New Technologies in Ultrasound PA.13.001 Ultrasound Exposure Improves the Targeted Therapy Effects of Galactosylated Docetaxel Nanoparticles on Hepatocellular Carcinoma Xenografts Li-Wu Lin, Zhi-Kui Chen, En-Sheng Xue Department of Ultrasonography, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China Brief Description of the Purpose of the Study: In this study, the impact of the biological effects of ultrasound on nanoparticle targeting to liver carcinoma was explored. Methods: The copolymer MePEG-PLGA was used to prepare the galactosylated docetaxel nanoparticles (GDN). The impact of ultrasound exposure (UE) on tumor hemoperfusion was observed by contrastenhanced ultrasonography (CEUS), and the distribution of docetaxel in tumors and liver were detected by HPLC. In the GDN combined with UE treatment group, the mice were injected intravenously with GDN, followed by ultrasound exposure on the human hepatocellular carcinoma xenografts, and the tumor growth inhibition rate was calculated, the expression of Survivin and Ki67 in tumor tissues were determined by immunohistochemistry assay. Main Results: After ultrasound exposure, the tumor peak-base intensity difference value, examined by CEUS, increased significantly. The drug content in the tumor was 1.8 times higher than in the GDN treated control. In vivo, GDN intravenous injection combined with ultrasound exposure therapy achieved the best anti-tumor effect with a tumor growth inhibition rate of 74.2%, and the expression of Survivin and Ki67 were significantly decreased as well. Importance of the Conclusions: Ultrasound exposure can improve targeting nanoparticles accumulation in the tumor, and achieve a synergism antitumor effect on the hepatocellular carcinoma xenografts.

PA.13.002 Microbubble-Enhanced Ultrasound Exposure Improves the Antiangiogenic Effects of Endostar-Loaded Thermosensitive Hydrogel on Triple Negative Breast Cancer Xenograft Li-Wu Lin, Zhi-Kui Chen, En-Sheng Xue Department of Ultrasonography, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China

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Ultrasound in Medicine and Biology

Brief Description of the Purpose of the Study: To investigate the influence of microbubble-enhanced ultrasound exposure on endostar-loaded thermosensitive hydrogel (ELTH) inhibiting angiogenesis of triple negative breast cancer xenograft. Methods: SonoVue was injected by bolus via the tail vein and followed by ultrasound exposure (0.75 W/cm2) on triple negative breast cancer xenograft of nude mice immediately, and then contrast-enhanced ultrasonography was performed to evaluate the tumor blood perfusion. ELTH was intratumorally injected, followed by SonoVue injection and ultrasound exposure, then the blood drug level was detected and tumor growth inhibition rate was calculated. Immunohistochemistry was used to detect the microvessel density and maturity, and the expression of VEGF was detected by fluorescent quantitation PCR. Main Results: Ultrasound exposure enhanced ELTH drug release rate in a sound intensity-dependently manner. Microbubble-enhanced ultrasound exposure interrupted the tumor blood perfusion. ELTH intratumoral injection followed by ultrasound exposure enhanced the blood drug level, while microbubble-enhanced ultrasound exposure decreased the endostar blood level obviously. Microbubble-enhanced ultrasound exposure significantly improved the anti-tumor effect of ELTH with a tumor growth inhibition rate of 56.7%. The microvessel density decreased and microvessel maturity increased, and the expression of VEGF was downregulated significantly. Importance of the Conclusions: Microbubble-enhanced ultrasound exposure can interrupt the tumor blood perfusion, which improve the anti-angiogenesis effect of endostar-loaded thermosensitive hydrogel.

PA.13.003 Which Factors Are Associated With the Impossibility to Obtain Reliable Liver Stiffness Measurements by Means of Acoustic Radiation Force Impulse (ARFI) Elastography? S. Bota, I. Sporea, R. Sirli, A. Popescu, A. Jurchis, M. Danila, D. Suseanu, O. Gradinaru-Tascau, S. Racean Department of Gastroenterology and Hepatology, Victor BabesUniversity of Medicine and Pharmacy, Timisoara, Romania Brief Description of the Purpose of the Study: To identify factors associated with impossibility to obtain reliable liver stiffness (LS) measurements by means of ARFI. Methods: Our study included 994 subjects, with or without hepatopathy, in which LS was evaluated by means of ARFI. Ten valid ARFI measurements were performed in each subject and median values were calculated, expressed in meters/second (m/s). Failure of ARFI measurements was defined as no valid measurement obtained after at least 10 shots, and measurements were considered as unreliable if: fewer than 10 valid shots obtained; with success rate (SR),60% and/or interquartile range interval (IQR)$30%. Main Results: Failure of LS measurements by means of ARFI was observed in 4 subjects (0.4%), unreliable measurements in 59 subjects (5.9%). Median age and BMI were significantly higher in subjects with failed and unreliable measurements vs. those with reliable measurements: 59 years (24-77) vs. 55years (18-87), p 5 0.03 and respectively 30.5 kg/m2 (21.4-45.2) vs. 25.2 kg/m2 (17.5-46.2), p , 0.0001. Gender, presence of cirrhosis or ascites, serum level of aminotransferases, alkaline phosphatase, gamma glutamyl-transpeptidase, bilirubin, albumin, cholinesterase and prothrombin time were not associated with unreliable measurements. Importance of the Conclusions: Valid ARFI measurements were obtained in 93.7% of subjects. Older age and higher BMI were associated with impossibility to obtain reliable ARFI measurements.

Volume 39, Number 5S, 2013 PA.13.004 Does the Etiology of Liver Cirrhosis Influence Liver and Spleen Stiffness Values Obtained by Means of Acoustic Radiation Force Impulse (ARFI) Elastography? S. Bota, I. Sporea, R. Sirli, A. Popescu, A. Jurchis, M. Danila, D. Suseanu, O. Gradinaru-Tascau, A. Martie, M. Sendroiu Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Brief Description of the Purpose of the Study: Aim: to identify if liver stiffness (LS) and spleen stiffness (SS) values are influenced by the etiology of liver cirrhosis. Methods: Our study included 181 cirrhotic patients newly diagnosed by means of clinical, biochemical, ultrasound, endoscopic and/or histological criteria. No patient was treated with beta-blockers before ARFI measurements and none had portal thrombosis on ultrasound examination. Ten valid ARFI measurements were performed in each patient in the liver and ten in the spleen, median values were calculated, expressed in meters/second (m/s). Main Results: Ten valid ARFI measurements were obtained in the liver in all patients and in the spleen in 178 patients (98.3%). The mean LS values (m/s) according to cirrhosis etiology were: HCV-2.80 6 0.69; HBV-2.80 6 0.93; alcohol-3.08 6 0.62; non-alcohol non-viral-2.85 6 0.78. The mean SS values (m/s) were: HCV-3.18 6 0.54; HBV3.38 6 0.53; alcohol-3.10 6 0.51; non-alcohol non-viral-3.16 6 0.50. Mean LS values were significantly higher in alcoholic etiology as compared with HCV etiology (p 5 0.02) and with viral etiology (all patients with HBV and HCV) (p 5 0.02). The mean SS values were similar in all etiologies. Importance of the Conclusions: The etiology of liver cirrhosis influences the LS values assessed by ARFI elastography (higher values in alcoholic etiology as compared with viral etiology), but not the SS values.

PA.13.005 How Useful is the Evaluation of Liver Stiffness by Means of Transient Elastography in Type 2 Diabetes Patients? I. Sporea,1 R. Timar,2 I. Dan,1 A. Sima,2 S. Bota,1 A. Vlad,2 A. Deleanu,1 R. Sirli1 1 Department of Gastroenterology and Hepatology, ‘‘Victor Babes’’ University of Medicine and Pharmacy Timisoara, Romania, 2 Department of Diabetes and Nutritional Diseases, ‘‘Victor Babes’’ University of Medicine and Pharmacy Timisoara, Romania Brief Description of the Purpose of the Study: To assess the feasibility of liver stiffness (LS) evaluation by means of Transient Elastography (TE) in type 2 diabetes patients. Methods: We enrolled 262 patients with type 2 diabetes mellitus. TE measurements were considered reliable if 10 valid measurements could be acquired with at least 60% success rate and less than 30% IQR. We used the Wong criteria (Hepatology 2011) in TE for NAFLD to categorize patients according to fibrosis severity: TE,7.9kPa (F$3 excluded); TE 7.9-9.6 kPa (‘‘gray zone’’); TE.9.6kPa (F$3). Main Results: Reliable LS measurements by TE were obtained in 72.1% of cases. In obese patients, the rate of reliable measurements was significantly lower as compared with normal weight and overweight patients: 61.8% vs. 82.2% (p 5 0.007) and 61.8% vs. 86.3% (p 5 0.006), respectively. In the cohort of 189 NAFLD and NASH patients with reliable LS measurements, using the Wong criteria1, 72.4% had no severe fibrosis, 13.8% were in the "gray zone" in which biopsy is recommended and 18.5% had severe fibrosis.

Abstracts Importance of the Conclusions: TE was feasible in 72.1% of diabetes patients, the rate of reliable LS measurements decreasing with the increase of BMI. Quite severe liver fibrosis was observed in 18.5% of NAFLD patients.

PA.13.006 How Useful is Transient Elastography for the Evaluation of Liver Fibrosis in Non Alcoholic Steatohepatitis (NASH) Patients? I. Sporea, A. Jurchis, R. Sirli, S. Bota, A. Popescu, M. Sendroiu Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timioara, Romania Brief Description of the Purpose of the Study: To evaluate the severity of liver damage in NASH patients, by means of Transient Elastography (TE), using prespecified cut-off values of liver stiffness (LS) measurements. Methods: Our retrospective study included 478 NASH patients. Ten LS measurements were performed in each patient by means of TE (Mprobe). A median value expressed in kPa was calculated. Reliable measurements were defined as: median value of 10 LS measurements with a success rate$60% and an interquartile range interval,30%. Patients were divided using prespecified TE cut-offs for LS (Wong criteria, Hepatology 2010):,7.9kPa (F$3 excluded); values ranging between 7.9-9.6 kPa ("gray zone"); and .9.6kPa (F$3). Main Results: Reliable measurements were obtained in 81.6% of NASH patients. The percentage of women, mean age and median BMI were significantly higher in patients with failed and unreliable vs. those with reliable measurements: 44.3% vs. 30.2%, p 5 0.01, 51.2 6 10.7 years vs. 45.4 6 11.9 years, p , 0.0001 and 31.1 kg/m2 (17.6-41) vs. 28.7 kg/m2 (17.5-53.6),p 5 0.0004 respectively. 390 patients with reliable LS measurements were included in the final analysis. Of those, 70.8% had no severe fibrosis, 10.8% were in the "gray zone" and 18.5% had severe fibrosis. Importance of the Conclusions: Reliable LS measurements were obtained in 81.6% of NASH patients, using a standard M-probe. Approximately 30% of NASH patients had LS measurements compatible with severe fibrosis.

PA.13.010 How Often Do We, Miss-Chronic Hepatitis C Patients That Must Be Treated by Using Transient Elastography (TE) Cut-Off Values Proposed by Meta-Analysis? R. Sirli, I. Sporea, S. Bota, A. Popescu, A. Deleanu, I. Dan, M. Ardelean, N. Cornu, M. Danila Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timioara, Romania Brief Description of the Purpose of the Study: TE is a increasingly used for the non-invasive evaluation of liver fibrosis. The aim of our study to evaluate how often we -miss- chronic hepatitis C patients that must be treated (F$2) by using TE cut-off values proposed by metaanalysis. Methods: Our study included 473 patients with chronic hepatitis C patients evaluated by means of TE and liver biopsy-LB (interpreted according to METAVIR score). Reliable measurements were defined as: median value of 10 liver stiffness (LS) measurements with a success rate$60% and an interquartile range interval,30%, values expressed in kPa. For predicting F$2 we used the LS cut-off proposed in the most recently published meta-analysis (Tsochatzis, J Hepatol 2011): 7.2 kPa.

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Main Results: Reliable LS measurements by means of TE were obtained in 453 patients (95.7%). The classification of liver fibrosis in LB was: F0-1.1%, F1-10.4%, F2-49.6%, F3-30.7% and F4-8.2%. In our study, 240 patients (53.1%) had LS values ,7.2 kPa; from these 80.4% had F$2 in LB. From the 213 patients with LS values$7.2 kPa, only 2.3% had F0 or F1 in LB. Importance of the Conclusions: In chronic hepatitis C, patients with LS assessed by TE , 7.2 kPa should be evaluated by LB, since most of them will have indication for antiviral treatment after LB.

PA.13.014 Interoperator Reproducibility of Acoustic Radiation Force Impulse (ARFI) for the Evaluation of Kidney Stiffness Preliminary Results F. Bob,1 S. Bota,2 I. Sporea,2 L. Petrica,1 R. Sirli,2 A. Popescu,2 M. Danila,2 A. Schiller1 1 Department of Nephrology, ‘‘Victor Babes’’ University of Medicine and Pharmacy, Timisoara, Romania, 2Department of Gastroenterology and Hepatology, ‘‘Victor Babes’’ University of Medicine and Pharmacy, Timisoara, Romania Brief Description of the Purpose of the Study: ARFI elastography is very useful for liver stiffness assessment, but few information are available regarding kidney stiffness (KS). Our aim was to assess the interoperator reproducibility of KS measurements by ARFI. Methods: Our study included 62 subjects (mean age 39.9 6 18.5years): 47 healthy subjects and 15 patients with various etiologies of kidney disease. Five valid ARFI measurements were performed in the right kidney in the same day, by two operators blinded to the results of previous measurements and to other clinical and biological data, median values were calculated, expressed in m/s. For statistical analysis the intraclass correlation coefficient (ICC) was used. Main Results: Valid ARFI measurements were obtained in all subjects by the two operators. We obtained a strong agreement between KS measurements obtained by the two operators: ICC50.70 (95%CI: 0.50-0.82). Higher ICCs were obtained in patients with kidney disease as compared with -healthy subjects-: 0.73 (95%CI: 0.73-0.91) vs. 0.63 (95%CI: 0.34-0.79); in men as compared with women: 0.67 (95%CI: 0.29-0.84) vs. 0.58 (95%CI: 0.17-0.79) and in subjects older than 50 years as compared with those aged up to 50 years: 0.75 (95%CI: 0.380.90) vs.0.51 (95%CI: 0.10-0.74). Importance of the Conclusions: A strong agreement was obtained between the two operators for KS evaluation.

PA.13.015 Contrast-Enhanced Images of Endoluminal Ultrasound Biomicroscopy From Mouse Colorectal Tumors Using VEGFR2-Targeted Contrast Agents T. L. Nascimento, P. T. C. R. Rosa, R. C. Soletti, H. L. Borges, J. C. Machado Federal University of Rio De Janeiro, Rio De Janeiro, RJ, Brazil Brief Description of the Purpose of the Study: Colorectal cancer (CRC) has a 90% cure chance if the tumors are diagnosed in the early stages, therefore motivating the development and design of diagnostic methods for CRC detection. This work tested contrast enhancement of ultrasound images from mouse colon tumors using VEGFR2 (vascular endothelial growth factor receptor 2)-targeted ultrasound contrast agent (UCA) and 40 MHz endoluminal ultrasound biomicroscopy (eUBM). Methods: Colon tumors were induced in mice (n55) using azoxymethane/dextran sulfate sodium and their images were obtained, in vivo,

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Ultrasound in Medicine and Biology

before and 10-15 minutes after VEGFR2-targeted UCA injection into the animal tail vein. Five regions of interest (ROI), 0.3 square millimeters each, over distinct tumor sites along each animal colon were selected from images obtained pre and post UCA injection and the average pixel intensity (API) calculated, using ImageJ software, for the entire set of five ROI. Two API groups (pre and post UCA injection) were formed and Student’s t-test used to verify the null hypothesis of equal means among them. Main Results: Mean(std) pixel intensity units of 39.2(6.4) and 26.2(7.9) were found for pre and post API groups, respectively, and considered statistically different (p , 0.05). Importance of the Conclusions: The results point to contrast-enhancement of eUBM images from mouse colon tumors and this may improve tumor early detection.

Volume 39, Number 5S, 2013 Methods: Between September and December 2012, 24 hvs (11 males, 13 female), mean age 35 (range 25-63), BMI 22.3 6 2.4 were enrolled and submitted to PQ elastography (iU22 Philips, Bothell, WA, USA) by three operators: two US and elastography providers (one expert and one intermediate), one transient elastography (TE) (Fibroscan) operator with no expertise in US. 10 examinations have been performed by each operator on the right lobe of the liver (V, VI and VIIs). Intraobserver and interobserver agreement were assessed by intraclass correlation coefficient (ICC). Main Results: Intraobserver agreement between measurements performed in the same subject showed an ICC of 0.60 (95% c.i.0.450.76) for LE in the expert operator. Interobserver agreement among the three different operators was 0.70 (0.50-0.85), between the expert and the intermediate providers was 0.82 (0.62-0.92). Importance of the Conclusions: PQE is a reliable and reproducible non invasive method for the assessment of LE.

PA.13.016 Shearwave Elastography Imaging of Carotid Plaques: Clinical Feasibility Study J. W. Garrard, S. Nduwayo, T. C. Hartshorne, R. B. Panerai, A. R. Naylor, T. G. Robinson, K. R. Ramnarine Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom Brief Description of the Purpose of the Study: Improved methods of identifying the unstable carotid plaque are required, rather than reliance on percentage stenosis and blood-flow changes. ShearWave Elastography (SWE) imaging is a novel method of quantifying tissue stiffness, and this study assesses the feasibility of SWE in assessing carotid plaques. Methods: 125 patients were recruited; mean age 72, 66% male. Patients underwent SWE using a SuperSonicImagine AixplorerÒ ultrasound system. The Young’s Modulus (YM) was recorded as an estimation of tissue stiffness. The YM was compared in symptomatic and asymptomatic patients, and also linked to subjective assessments of plaque appearance. Histological features were assessed in 9 patients following carotid endarterectomy excision. Main Results: 94 plaques of .30% stenosis were assessed. 55 plaques were symptomatic, YM (81 6 5kPa) was significantly lower (p 5 0.001) than in 39 asymptomatic plaques (104 6 8kPa). Echolucent plaques (73 6 8.5kPa) had lower YM than echogenic plaques (108 6 8.3kPa). Mean inter-frame coefficient of variation (CoV) was 0.22. YM increased with age (R250.23) and smokers more likely to have carotid disease. Plaques describes as unstable had a lower YM than stable plaques. Importance of the Conclusions: The use of SWE in carotid plaques is feasible, with YM linked to symptoms, plaque appearance and histological findings. The reproducibility in the carotid region is comparable to its use in other tissue.

PA.13.017

PA.13.018 Estimating Embolus Composition During Catheter Ablation Using Transcranial Doppler Ultrasound C. Banahan, J. D. Spiers, N. Patel, J. Janus, D. H. Evans, P. Brown, G. A. Ng, E. M. L. Chung Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK Brief Description of the Purpose of the Study: The aim of this pilot study was to detect the incidence and timing of particles and bubbles (emboli) entering the cerebral circulation during a cardiac procedure called catheter ablation, and to estimate their composition based on their backscattered signal intensity measured as an embolus-to-blood ratio, EBR. In a previous study, 95 % of  850 thrombus emboli detected post-carotid endarterectomy had EBR values below 17.3 dB. Applying this as a threshold, emboli above this value were assumed to be gaseous. Methods: Transcranial Doppler ultrasound monitoring of the middle cerebral artery was performed in 17 patients undergoing catheter ablation. The timing of embolic signals was linked to possible origins of emboli transcribed during the procedure. EBR values were measured for 12 sets of data to estimate embolus composition. Main Results: Patients experienced hundreds to thousands of emboli peri-procedure (1749 6 1438, mean 6 SD). Of the total number, 76 6 19% occurred during energy application, the remainder occurred during contrast injection (12 6 12%), catheter manipulation (7 6 8%), and transseptal puncture/mapping (6 6 3%). During energy application 96 6 4% of emboli had EBR values above 17.3 dB. Importance of the Conclusions: Patients undergoing catheter ablation are at risk of brain injury due to embolisation. Although the majority of emboli are gaseous, a small percentage may be particulate in nature.

14 - Ultrasound in Pediatrics

Interobserver Agreement of PQ Elastography in the Evaluation of Liver Elasticity in Three Operators With Different Expertise C. De Molo, E. Fiorini, S. Righi, E. Mazzotta, L. Brodosi, F. Conti, A. Paccapelo, P. Andreone, C. Serra Department of Gastrointestinal Disease and Internal Medicine S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy

PA.14.001

Brief Description of the Purpose of the Study: To evaluate the reproducibility of point quantification elastography (PQE) in assessing liver elasticity (LE) in healthy volunteers (hvs) comparing three operators with different expertise.

Introduction: Chest radiography is the traditional method to initially approach thoracic diseases in children. There are several factors that provide a better ultrasonographic pleuropulmonary access in this age group. The classic indication of chest ultrasonography is a quantitative

Ultrassonografia Do Torax Na Inf^ancia: Rompendo as Barreiras De Uma Simples Avaliac¸~ao De Derrame M. A. Rocha, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, F. F. Gasparini, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, SP, Brasil

Abstracts and qualitative evaluation of pleural effusions, also enabling guided thoracocentesis when necessary. With the evolution of the method, it is possible to go further, and use it to diagnose other pleuropulmonary disorders. This study aims to illustrate different aspects of several pleuropulmonary disorders in children by sonography studies, emphasizing benefits of this method. Methods Involved: Chest ultrasonography examinations performed in children admitted to a private hospital pediatric ICU with chest radiographic correlation. Discussion: This study illustrates and discusses several ultrasonographic evaluated thoracic pathologies in children, such as simple and complex pleural effusions, simple and complex pneumonias, pulmonary thromboembolism, tumoral lesions and pneumothorax, among others, with chest radiographs correlation. Conclusion of the Presentation: In order to reduce children’s exposure to radiation, pediatric chest ultrasonography should be more performed since it can detect a wide range of diagnostic possibilities, allows a dynamic real time evaluation and a serial bedside follow-up.

PA.14.002 Usual and Unusual Diagnoses Face to a Palpable Abdominal Mass in Newborns V. N. Marcos, L. E. Nable, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, F. F. Gasparini, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: Palpable abdominal mass in neonates (PAMAN) is a great anxiety cause for parents and physicians, reason why radiologists should be aware of the correct diagnosis to avoid unnecessary procedures and determine the correct conduct as quickly as possible. We show in this study usual and unusual sonographic diagnoses of PAMAN. Methods Involved: PAMAN sonographic studies at the neonatal ICU of a private hospital, with the following diagnoses: hydronephrosis by ureteropyelic junction stenosis, congenital giant hydrocolpos, congenital neuroblastoma, meconium ileus associated with volvulus and large ovarian cyst. Discussion: The sonography should be the method of choice in the initial PAMAN evaluation for being a highly sensitive and specific method for the differential diagnoses. In our reported cases, the ultrasonography was decisive in the diagnosis, not requiring any further investigation, accelerating the medical management. Conclusion of the Presentation: The ultrasonography has a fundamental role as the initial method, and sometimes the unique, in the PAMAN evaluation and diagnosis. The usual and unusual diagnostic possibilities knowledge is fundamental to determine an accurate conduct as quickly as possible, thus affecting directly in these patient’s prognosis.

PA.14.007 Hipotermia Induzida Em Neonatos Com Encefalopatia Hip oxico-Isqu^emica Grave: Estudo Preliminar Dos Achados a Ultrassonografia Transfontanelar Modo B E Doppler Com Avaliac¸~ ao Da Hemodin^amica Cerebral M. J. Iani, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. Magalh~ aes, F. F. Gasparini, M. H. Kim, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, Sao Paulo, SP, Brasil Brief Description of the Purpose of the Study: Neonatal hypoxicischemic encephalopathy (NHIE), characterized by early onset of neuro-

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logical dysfunction, is a major cause of morbidity and mortality. Systematic studies have shown good results in the use of induced hypothermia as neuroprotective treatment in NHIE severe cases, reducing the risk of death or sequelae. Transfontanellar Doppler sonographic study is already well established for monitoring changes in cerebral hemodynamics. Methods: To demonstrate transfontanellar sonographic findings with cerebral hemodynamic evaluation in patients with severe NHIE that have undergone therapeutic hypothermia. Retrospective data analyses collected in a neonatal ICU of a private hospital from 2010 to 2012. Nine newborns have undergone hypothermia and US Doppler were performed in four of them. Resistive indices (RI) of cerebral arteries and B mode findings were used as parameters. Main Results: Literature data have shown that RI values ,0.55 indicate poor prognosis and increased risk of sequelae in patients with severe NHIE, with no further conclusive studies in neonates undergoing hypothermia. In our study, two infants who had unfavorable prognosis presented low values of RI. Importance of the Conclusions: In this preliminary study, we suggest that low RI levels may be related to poor prognosis in these neonates requiring further studies to obtain conclusive statistical data.

PA.14.011 Avaliac¸~ao Ultrassonografica Dos Efeitos Estrog^enicos No Recem Nascido (Rn) D. B. N. Bortolazzi, Y. T. Sameshima, E. T. Koshimura, F. F. Gasparini, E. E. Dutenhefner, M. J. F. Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: In the 3rd trimester maternal serum levels of estrogen are increased as well as the fetal levels because passing through the maternal-placental barrier. After birth reduces the levels of circulating maternal estrogen. It can cause changes in the fetus and therefore the RN persisting for several months. Development of mammary glandular tissue, ovarian cyst, thickening and endometrial polyps are examples. Methods Involved: Present, by ultrasonography, effects of estrogen in RN. Discussion: Development of mammary glandular tissue occurs in the presence of a rate increase estrogen / testosterone persisting for up to 2 months. Remember that there are other causes of breast development, and if necessary should be removed. Ovarian cyst is very common in newborns. Approximately 98% of newborn girls have ovarian cyst. Becomes worrisome if the dimensions are increased, because increases the risk of complications. The thickening and endometrial polyps are estrogen dependent changes, cause vaginal discharge and are treated expectantly. Conclusion of the Presentation: The compression of the effects of estrogen in the newborn by the radiologists, not only aspects of ultrasound, as well as clinicians is essential. The role of the radiologist is to make the diagnosis, exclude differential diagnoses that perhaps the neonatologist suspects and follow up.

15 - Ultrasound in Small Parts PA.15.002 Mucoepidermoid Carcinoma of the Salivary Glands: Ultrasonographic Features D. W. Park, Y. J. Lee, S. R. Lee, C. K. Park College of Medicine, Hanyang University, Seoul, Korea

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Brief Description of the Purpose of the Study: The purpose of this study is to evaluate ultrasonographic features of mucoepidermoid carcinomas (MECs) in the salivary glands.

Brief Description of the Purpose of the Report: We report a case of Madelung’s disease (MDL) with extensive involvement of the scrotum sack.

Methods: Sonographic features of 26 MECs in the salivary glands were retrospectively evaluated, focusing on gross and internal appearances, lesional and post-lesional echoes, vascularization and regional lymph nodes. They are categorized and compared as 3 MEC groups of low (15), intermediate (7), and high grade (4), according to histology.

Medical History: Male patient, 54 years old, chronic alcoholic, smoker, reporting pain and increase in size of scrotum and cervical area dating four months back. He did not report trauma or other changes. During examination, a large symmetric mass was found in the cervical, dorsal and scrotal areas, not adhered to deep planes. The diagnostic hypothesis was thyroid goiter and inguinal hernia, with further evaluation with imaging being the chosen method.

Main Results: Sonographic features of salivary gland MECs mostly include irregular shape, indistinct margins, and variable heterogeneous echotexture with or without necrotic or cystic changes. They occasionally show vascularized Doppler colors and regional lymph node enlargement. No significant sonographic differences between low-, intermediate-, and high-grade MEC are presented, except the tumor size, which of low-grade MEC is smaller than those of the others. Importance of the Conclusions: Salivary gland MECs demonstrates non-specific sonographic appearances of malignant lesion. Sonographic features of MECs have no association with histologic grades except tumor size. PA.15.004 Real-Time, 2D and 3D Ultrasound Evaluation of Needle-Free Vaccination Devices S. K. Kodaira, G. S. Brito, G. T. Guerrini, R. R. Guerrini, M. C. Chammas, J. Kalil Filho, G. G. Cerri INRAD-HCFMUSP, S~ ao Paulo, Sao Paulo, Brazil Brief Description of the Purpose of the Study: Intradermal injections induces better immunological response than subcutaneous or intramuscular injections with smaller vaccine volumes. Real-time, 2D and 3D Ultrasound imaging was performed to better understand tissue distribution of needle-free-jet-injection (NFJI) systems to evaluate depth of penetration and tissue dispersion of vaccines. Methods: Two different brands of NFJE were evaluated comparing intradermal injection performances. Twenty healthy human volunteers were selected to participate in the study. They were equally distributed among two device groups according to racial, age, sex and BMI. Two needle free injections of 0,2 and 0,5 ml saline solution were monitored using real time ultrasound imaging scanning tissue distribution, cavitation and leak back phenomena. Imediately, 2D and 3D scans were performed to evaluate dermal thickness pre and post injection, maximum dispersion and maximum depth of injection. These data were analised with ANOVA and Mann-Whitney /Wilcoxon tests. Main Results: The skin thickness not varies significantly with populational parameters but there were significant differences between pre and post injection thickness. Ultrasound could confidently discriminate intradermal and/or subcutaneous saline distribution in patients with different populational parameters and different injector brands, pressure profiles and performances. Importance of the Conclusions: Ultrasound is a good, harmless, confident, reproductible and cheap method to evaluate performance NFJI devices optimization with huge impact in populational immunization. PA.15.005 Doenc¸a De Madelung Com Grande Envolvimento Da Bolsa Escrotal: Correlac¸~ ao Da Ultrassonografia Bidimensional Com a Tomografia Computadorizada Tridimensional De Corpo Inteiro K. B. Alcantara, A. J. Reis Neto, A. C. Ferreira, B. K. D. Filho, F. L. F. Marsico, R. C. S. Faria Instituto De Diagnostico Por Imagem, Hospital Santa Casa Ribeirao Preto, SP, Brasil

Diagnosis: Benign symmetric lipomatosis or Madelung’s disease. Discussion and Summary of the Case: The CDM is characterized by fat deposits, unencapsulated, symmetrical, painless, diffusely distributed. Affecting the cervical region in 100% of cases, retroauricular in 95%, deltoidea in 84%, thoracic in 60%, abdominal in 58% in inguinal and 42% in lower limbs, being very rare in the scrotum as in our case. It is more frequent in males and in middle aged adults. The pathogenesis is unknown. Fat deposits can be lodged in the cervical or mediastinal regions leading to disorders severe aesthetic and compressive symptoms. Computed tomography and magnetic resonance delimit the fat. The therapeutic approach is lipectomy and liposuction with good prognosis.

PA.15.006 Metastasis of Gastric Carcinoma to the Thyroid Gland: A Case Report D. G. Medrado, J. R. T. Vicentini, M. A. Ferreira, V. S. Yamachira, F. L. Pereira, M. C. Chammas, G. G. Cerri INRAD - HC-FMUSP, Sao Paulo, SP, Brasil Brief Description of the Purpose of the Report: The occurrence of metastases to the thyroid gland is a rare clinical event, despite its rich vasculature. The primary sites most frequently reported are kidney, breast, lung, uterus and esophagus. Thyroid metastasis from the stomach is even less common, with only few cases described in literature. Medical History: This report presents the case of a female patient, aged 73, admitted to the emergency with progressive dyspnea and inappetence. During investigation, computed tomography scan of the chest revealed a thyroid nodule suspicious for malignancy in the right lobe. Diagnosis: Ultrasound-guided fine needle aspiration (FNA) was performed, and the immunocytological diagnosis was metastatic adenocarcinoma, consistent with gastric primary, which was confirmed by endoscopic biopsy. Discussion and Summary of the Case: It’s difficult to determine sonographically if a malignant thyroid neoplasm is primary or secondary due to their nonspecific morphological features. Therefore, FNA becomes an important differential diagnosis method. Therapeutic procedures in these cases are controversial, because it’s not clear whether surgical intervention would result in real benefit to the patient.

16 - Ultrasound in Peripheral Vascular PA.16.001 Duplex Study of Carotid Artery in Patients With Ischemic Stroke N. Sultana, R. Islam, T. K. Majumder, A. K. M. F. Bari, M. D. Bashir Institute of Nuclear Meidicne and Ultrasound Brief Description of the Purpose of the Study: To determine the frequency and characteristics of carotid artery stenosis in acute ischemic

Abstracts stroke patients and to assess the significance of common risk factors for carotid stenosis in these patients Methods: It was cross-section observational study in one hundred hospital admitted patients with acute ischemic stroke . Doppler ultrasound was performed during the hospitalization to find out the degree of carotid artery stenosis. Main Results: Out of one hundred (100) patients, eighty (80%) were males and twenty were (20%) were females. The patients were dividing into two groups with and without carotid stenosis. Less than 50% carotid artery stenosis (insignificant stenosis) was seen in 40% (n540) cases and significant stenosis was seen in 60% (n560) patients. Overall 86% (n5 46) out of 60 patients were found have carotid artery stenosis on the ipsilateral side corresponding to the ischemic lesion. And 19% (n511) had stenosis on the contra lateral side as well. Degree of stenosis was mild (50% stenosis) in 12% (n57) patients, moderate (51-69%) stenosis in 50% (n5 30) patients and severe (.70%) stenosis in twenty (n533%) patients . Near total occlusion was seen in three (5%) patients. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factors Importance of the Conclusions: Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke

17 - Ultrasound in Veterinary PA.17.001 Sonograhic Assessment of Deep Vascular Thrombosis in Dogs L. C. De Pina, C. F. Carvalho Provet, Sao Paulo, S~ ao Paulo, Brasil Brief Description of the Purpose of the Study: Deep venous thrombosis (DVT) is relatively common in humans, but rare in animals. Vascular Doppler ultrasonography (DUS) allows a noninvasive assessment of the vessels. The objective of this work was to evaluate DUS parameters for diagnosis of DVT in dogs. Methods: A high-resolution transducer was used to perform B-mode, color and pulsed Doppler study between January 2010 and December 2011 in 5 dogs with clinical signs of peripheral DVT disease. B-mode criteria evaluated were: 1) lumen deformity; 2) echogenicity of the lumen; 3) unchanged of vessel diameter characterized by dynamic maneuvers. The criteria evaluated through color and pulsed Doppler were: 1) presence of aliasing; 2) presence of collateral vessels; 3) difference of blood flow velocity. It was evaluated sensitivity and specificity for each criterion. Main Results: Changes of vessel caliber and/or deformity of the lumen were the best criteria in B-mode. All parameters together improved sensitivity and specificity values obtained. We also found others useful parameters: the presence of collateral vessels adjacent to the point of venous occlusion and loss of valve’s wall movement distal to the point. Importance of the Conclusions: The combination of parameters could be used to provide the best sensitivity and specificity values to produce conclusive diagnosis of DVT. PA.17.002 Ultrasound-Guided Approach and Blockage of the Sciatic and Femoral Nerves in Felines P. Haro, F. G. Laredo, F. Gil, M. Soler, E. Belda, M. D. Ayala, A. Agut University of Murcia, Murcia, Spain Brief Description of the Purpose of the Study: To develop ultrasound (US)-guided approaches to block the sciatic (SCN) and femoral (FN) nerves in the cat.

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Methods: In vitro study: 24 feline cadavers were employed. On eight cadavers, anatomical dissections and transversal cryosections were performed to determine the anatomical landmarks. Sixteen cadavers were employed to determine the ultrasonographic approaches and appearance of the ScN and FN using a 4-13MHz linear transducer (MyLab70, Esaote). In vivo study: Nine adult experimental cats, sedated with medetomidine 30 mg kg1 and butorphanol 0.2 mg kg1 IM, were employed to perform an US-guided block of the ScN and FN. A peripheral nerve block needle was inserted close to the target nerves and lidocaine 2% (2 mg kg1) diluted in saline (total volume 1mL) was infiltrated around them. Sedation was reversed with atipamezol (75 mg kg1) IM, and the efficacy of the block and occurrence of complications assessed. Main Results: The midfemoral approach for the ScN and the dorsal approach for the FN, allowed US-guided location and blockade of these nerves in all cases. No complications were observed. Importance of the Conclusions: The midfemoral and dorsal approaches allowed an accurate US-guided location and blockade of the ScN and FN in felines.

PA.17.004 Transcranial Ultrasonography in Forty-Six Healthy Dogs C. O. Ghirelli, C. A. B. Lorigados, L. Kamikawa, A. C. B. C. Fonseca Pinto FMVZ-USP, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Study: Determinar, por meio da ultrassonografia, as estruturas intracranianas observadas em c~aes sadios e identificar a arteria basilar e aferir seu ındice de resistividade (IR) nesses animais. Methods: Trata-se de um estudo prospectivo no qual foi realizada ultrassonografia modo B e Doppler transcraniana em 46 c~aes que n~ao apresentavam manifestac¸~oes neurologicas, de rac¸as variadas, pesando entre 1.7 kg e 50.5 kg. Os c~aes foram divididos em quatro grupos pelo porte. Main Results: Em todos os c~aes de porte micro foi possıvel observar as estruturas intracranianas e aferir o IR da arteria basilar. Em nove animais (19.5%) n~ao foi possıvel realizar nenhuma das mensurac¸~oes propostas (ventrıculos laterais, terceiro ventrıculo e IR), sendo que oito pertenciam ao grupo de grande porte. O valor medio dos ventrıculos laterais foi 0.24 cm, do terceiro ventrıculo foi 0.25 cm e do IR foi 0.68. Importance of the Conclusions: O exame ultrassonografico transcraniano e uma ferramenta diagnostica possıvel de ser empregada em c~aes de micro e pequeno porte, porem com contribuic¸~ao variada para c~aes de medio porte. Nos c~aes de grande porte, esse metodo mostrouse pouco util para avaliac¸~ao das estruturas intracranianas, sendo possıvel apenas a avaliac¸~ao hemodin^amica da arteria basilar em 53% dos animais desse grupo.

PA.17.007 Como a Resson^ancia Magnetica Pode Contribuir Para a Caracterizac¸~ao Medular De Pacientes Com Suspeita De Les~ao Hansen Tipo III? C. T. Pereira, R. A. S. M. Toyota, C. R. Oliveira, R. F. Giglio Hospital Caes E Gatos, Osasco, Sao Paulo Brief Description of the Purpose of the Report: To assess the magnetic resonance imaging (MRI) contribution to patients with presumptive diagnostic of Type III Hansen, acute high velocity non compressive intervertebral disc extrusions.

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Medical History: Eight dogs, medium age and medium size were attempted to the MRI service with clinical history of acute neurological sign characterized by hind limbs paralysis and thoracic and lumbar pain. Diagnosis: MRI demonstrated intramedullary hyperintensity on T2weighted images, variable dimensions and no disc compression were characterized. Discussion and Summary of the Case: Although MRI does not provide Type III Hansen definitive diagnostic, the association of clinical history with MRI findings can help predict outcome in dogs with acute non compressive nucleus pulposus extrusions, a non surgical lesion.

Main Results: The Tei index increased in all tested protocols and the routine ecocardiographic also showed a decrease in fractional shortening, ejection fraction and heart rate in dogs medicated with alpha 2 agonists compared with narcotics in combination with acepromazine, which maintained a stable cardiovascular and hemodynamic without statistically significant side effects. Importance of the Conclusions: In narcoleptoanalgesia protocols the Tei index values showed no significant changes and preliminary reference values of myocardial performance in dogs under preanesthetic tranquilization were established.

PA.17.008

PA.17.011

Renal Ultrasonographic Evaluation in Dogs After Radiocontrast D. M. Rodriguez, C. G. Sarto, P. M. Souza, R. M. I. Zulim, M. J. Mamprim Universidade Estadual Paulista Julio De Mesquita Filho Unesp, Brasil. Botucatu, Sao Paulo, Brasil

Alterac¸~oes Ultrassonograficas Da Mucosa Duodenal Observadas Em C~aes Com Doenc¸a Intestinal Inflamatoria E Linfangiectasia - Relato De 2 Casos I. Oliveira, M. A. Araujo, M. C. S. Santos, A. M. Ferreira Universidade Federal Fluminense, Niteroi, Rio De Janeiro, Brasil

Brief Description of the Purpose of the Study: El presente estudio evalu o los ri~ nones de caninos, por medio de ultrasonografıa (US) modo B y Doppler espectral y colorido, antes y despues del examen angiotomografico. El objetivo fue evaluar el parenquima y parametros hemodinamicas renales, a traves de la US y correlacionarla con los valores de urea y creatinina. Methods: Fueron evaluados 8 caninos de raza pointer de 9 meses de edad, siendo 5 machos y 3 hembras de 18-24 kg. Todos sometidos previamente a evaluaci on angiotomografia con medio de contraste (MC) iopromide (Ultravist 300Ò) 3 mL/kg intravenoso. Fue realizada US renal antes, inmediatamente despues, e 24, 48 e 72 horas tras la administraci on del MC, con el animal en decubito dorsal e lateral. Fueron realizados cortes sagital, frontal e transversal de ambos ri~nones. Se evaluaron los valores de urea y creatinina antes, 24, 48 y 72 horas despues de la aplicaci on del MC. Main Results: No fueron observadas alteraciones del parenquima renal en ninguno de los animales. Con relacion al IR, IP, velocidad sistolica y diast olica hubo aumento de los valores pos-contraste, pero permanecieron dentro de la normalidad sin diferencias estadısticas. Importance of the Conclusions: Por lo tanto, estudios ultrasonograficos deben ser realizados con mayor numero de caninos para determinar seguridad y precision del MC.

PA.17.009 Evaluaci on Del Indice Tei En Diversos Protocolos De Tranquilizaci on Preanestesica En Caninos Sanos I. D. Alvarez,1 E. F. Buritica,2 D. F. Echeverry2 1 Departamento De Ciencias Fisiologicas Y Clınica De Peque~nos Animales De La Universidad De La Salle. Bogota - Colombia. Grupo De Investigaci on Cisahe, 2Grupo De Investigacion En Medicina Y Cirugıa De Peque~ nos Animales, Facultad De Medicina Veterinaria Y Zootecnia, Universidad Del Tolima Brief Description of the Purpose of the Study: Tei index (myocardial performance index) has been shown to be clinically useful for estimating the ventricular function. This study determined the changes of Tei index occurring under several pharmacological protocols in healthy dogs. Methods: Thirty healthy dogs were allocated into three groups: group 1 was sedated with xylazine (2 mg / kg), group 2 was sedated with a combination of buprenorphine (5m/kg) and acepromazine (0.05 mg/kg) and group 3 was sedated with a combination of Fentanyl (5 m/kg) and acepromazine (0.05 mg/kg).

Brief Description of the Purpose of the Report: The aim of this study was to report the sonographic and histopathologic of 2 dogs with suspected Inflammatory Bowel Disease. Medical History: Animals with chronic vomiting clinic were submitted to ultrasound examination. Diagnosis: Ultrasound examination that found the presence of hyperechoic spots in the intestinal mucosa without changes in thickness or intestinal architecture. Histopathologic findings confirmed the suspected of inflammatory bowel disease associated with lymphangiectasia, though the latter had not been suspected by ultrasonography. Discussion and Summary of the Case: It was concluded that ultrasound is not always able to identify the dilation of ducts lacteals and that more studies are needed to evaluate the sensitivity of the technique to realize such intestinal disorders.

PA.17.012 Hemangiossarcoma Renal Bilateral Primario Em C~ao - Relato De Caso J. L. Carvalho, V. I. Rodrigues, D. C. C. Carvalho, T. M. Passos, M. A. F. Vincler Rio De Janeiro, Rio De Janeiro, Brasil Brief Description of the Purpose of the Report: Reporting of renal neoplasm with aid sonographic image. Medical History: Canine female, SRD, 12 years, 19 Kg, vomiting and pale anorexia. Mucosas, abdominal swelling, pain on palpation of the hypogastrium right and left side, tachypnea, dehydration and temperature of 38.1 C. Diagnosis: Normocytic normochromic anemia, leukocytosis neutrophilic. Elevated serum creatinine and urea. Left kidney with partial loss of architecture, increased echogenicity of the cortical region. Ureter hydronephrosis. Cranial mass with mixed echogenicity in the sagittal plane. Right kidney-increased echogenicity in the cortical region. Perirenal mass with mixed echogenicity with hipoecog^enea anecog^eneas areas. The histopathologic diagnosis was bilateral renal hemangiosarcoma, without evidence of neoplastic cells in other organs such as spleen, liver and right atrium. Discussion and Summary of the Case: Renal neoplasms are rare and may produce local or systemic manifestations signs of renal failure with azotemia, as evidenced in the dog study. The more common in dogs, hemangiosarcoma is in the right atrium and the kidney as metastasis, which was not observed in this study, confirming a case of bilateral renal primary hemangiosarcoma.

Abstracts Scientific Papers – Digital Presentation 1 - Abdomen Ultrasound PA.01.011 Hiperplasia Nodular Focal Durante Abdome Agudo Diagnostico Ultrassonogr afico E Correlac¸~ao Com a Tomografia Computadorizada E Resson^ancia Magnetica Durante Um Abdome Agudo A. C. Ferreira, F. S. Costa, A. J. Reis Neto, K. B. Alcantara, J. F. Jord~ao, R. C. S. Faria Instituto De Diagnostico Por Imagem, Hospital Santa Casa Ribeirao Preto, SP, Brasil Brief Description of the Purpose of the Report: We describe a case of acute abdomen diagnosed as focal nodular hyperplasia (FNH) during our shift, correlating the imaging methods. Medical History: Female patient, caucasian, 34 years old, was admitted with a history of colic in the right subcostal area 2 days ago, on physical examination the patient was found to be in a good state, with no fever, nausea, vomiting, jaundice and trauma. Diagnosis: Focal nodular hyperplasia. Discussion and Summary of the Case: The ultrasound showed isoechogenic injury of partially defined interface, color Doppler identified vascularity inside, compatible with possible focal nodular hyperplasia with probable perinodular and intranodular bleeding. Computed tomography (CT) and magnetic resonance imaging (MRI) were also performed to confirm diagnosis but with no presence of intralesional bleeding. Although the etiology of FNH is still controversial, probably comes from a vascular malformation which leads to a local increase in blood flow. Complications such as abdominal discomfort, intratumoral hemorrhage and intraperitoneal rupture are rare and may require surgery. Despite our patient presenting abdominal pain, intranodular bleeding was discarded by CT and MRI, conservative treatment being chosen with regular image control.

PD.01.001 Comparison of Abdominal Ultrasonographic Findings With Endoscopic Ultrasonographic Findings of Solid Pseudopapillary Tumor of Pancreas J. J. Chung, W. S. Jung, J. S. Yu, J. H. Kim, E. S. Cho Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Brief Description of the Purpose of the Study: To compare abdominal ultrasonographic (AU) findings with endoscopic ultrasonographic (EUS) findings of solid pseudopapillary tumor (SPT) of pancreas. Methods: Thirteen patients (M:F53:10; mean age, 36 years) with surgically proven SPT were included, who underwent both preoperative AU and EUS. Ultrasonographic findings of 2 modalities were compared according to internal echogenicity, solid or cystic portion, internal septum, calcification, fluid-fluid level, demarcation and main pancreatic duct dilatation. Main Results: Among 13 cases, 8 cases showed hypoechogenicity on both AU and EUS. Remaining 5 cases showed different echogenicity on both modalities; hypoechogenicity (n53) and isoechogenicity (n52) on AU, hyperechogenicity (n52), unremarkable echogenicity due to dense rim calcifications (n52), isoechogenicity (n51) on EUS. In two cases with rim calcifications, evaluation of the internal content was more difficult on EUS, compared to AU. Two cases with central punctate calcifications and 1 case with peripheral calcifications were seen. Internal fluid-fluid level was noted in 2 cases on both modalities.

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All cases showed good demarcation without pancreatic ductal dilatation or internal septum. Importance of the Conclusions: EUS was somewhat superior to AU in the evaluation of internal echo texture (solid or cystic) of pancreatic SPT. However, AU was superior to evaluate the larger size tumor and tumors with dense rim calcifications. PD.01.002 Evaluation of SWV Measured by ARFI Technology in Hepatic Fibrosis Y. E. Zhen, B. A. O. Zhongtao, G. U. Lijuan Department of Ultrasound,the First Affiliated Hospital of Fujian Medical University, China Brief Description of the Purpose of the Study: To explore the application value of the liver shear wave velocity (SWV) measured by acoustic radiation force impulse (ARFI) technology in hepatic fibrosis caused by chronic hepatitis B. Methods: The use of ACUSON S2000 color ultrasound system. The measurement of liver SWV in left lateral decubitus were performed on patients with chronic hepatitis B (n5210) and normal volunteers (n520) and the position were as liver biopsy as possible. All patients with chronic hepatitis B were accepted liver biopsy under ultrasoundguided. Main Results: SWV values in the cases with chronic hepatitis B increased gradually with the growing degree of hepatic fibrosis. SWV values among each fibrosis groups were remarkably different(P50.000). Using the cutoff values of 1.43m/s, 1.78m/s, 2.15m/s and 2.45m/s for diagnosis of $S1,$S2,$S3 and 5 S4, the corresponding areas under receiver operating characteristic curves (AUROC) were 0.826, 0.829, 0.845 and 0.880 respectively. The sensitivity was 85.3%, 90.6%, 87.1% and 89.1%; the specificity was 87.5%, 90.1%, 82.8% and 87.4%; the accuracy was 89.4%, 84.6%, 88.1% and 83.2% respectively. Undertaking Spearman double variables correlated analysis between the SWV values and the parameters of fibrosis grade, inflammation grade and steatosis grade, the analyses shown were statistically significant between SWV value and fibrosis grade,SWV value and inflammation grade. The correlation coefficient were 0.713 (p 5 0.000)and 0.496 (p 5 0.001),but there was no obvious correlation between SWV value and steatosis grade in our study, the correlation coefficient was 0.145 (p 5 0.368). Multiple linear regression showed that it had correlation relationship between SWV values and fibrosis grade (p 5 0.000), the standard regression coefficient was 0.664,but there was no obvious correlation relationship between SWV values and inflammation grade, SWV values and steatosis grade (P.0.05). Importance of the Conclusions: SWV measurement can directly reflect the elasticity modulus of liver, and the value can reflect the difference of hardness among every S stage. It can also identify hepatic fibrosis degree in a effective, convenient and non-invasive way. SWV measurement can be recommended as a new and to judge hepatic fibrosis degree. PD.01.003 Can Ultrasound Give Valuable Clues in the Diagnosis of Bile Leakage? C. Tana, P. D’Alessandro, M. Tana, A. Mezzetti, C. Schiavone Departmental Unit of Internistic Ultrasound, Department of Medicine and Science of Excellence on Aging, -G. D’Annunzio- University, Chieti, Italy Brief Description of the Purpose of the Report: The purpose of our case report was to demostrate that ultrasound can reveal the presence of valuable clues to diagnose a biloma.

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Ultrasound in Medicine and Biology

Medical History: A 72-year-old woman, with a history of previous cholecystectomy and ischemic heart disease, was hospitalized for the persistence of epigastric pain, not associated with vomiting, diarrhea or fever, evoked by deep palpation and associated with torpid peristalsis. Laboratory exams documented the presence of hyperamylasemia, hyperlipasemia and sign of inflammation (increased ESR, CRP and leukocytosis). Abdomen ultrasound revealed, in the IV hepatic segment and in proximity of the site of previous cholecystectomy, the presence of a heterogeneous hypo-anechoic lesion, with hyperechoic, calcified walls, a maximum size of 3.89x3.42 cm, in absence of echo color doppler signal. Within the lesion there were numerous hyperechoic formations with an evident cone of shadow. The pancreas showed a normal size with heterogeneous echotexture and blurred margins. Diagnosis: The clinical and laboratory findings were consistent with a diagnosis of acute pancreatitis. Discussion and Summary of the Case: The cyst-like lesion could be confused with a pseudocyst, but the history of previous cholecystectomy, its atypical site and the close proximity to the biliary tract, as confirmed by MR cholangiopancreatography, posed diagnosis of biloma.

PD.01.004 Papel Da Ultrassonografia No Abdome Agudo Obstrutivo V. S. Yamachira, A. H. Ban, S. F. Ferraciolli, A. Talans, M. J. Francisco Neto, M. C. Chammas, G. G. C Cerri Hospital Das Clınicas Da Faculdade De Medicina Da Universidade De Sao Paulo, Sao Paulo, SP, Brasil Introduction: Acute intestinal obstruction represents an intestinal obstruction syndrome caused by the presence of an obstacle or mechanical alteration of intestinal motility that prevents the normal progression of the bolus. Approximately 20% of hospital admissions for abdominal pain are due to intestinal obstruction, and of these, 80% occur in the small bowel and 20% in the large bowel. Methods Involved: Cases will be presented using different imaging techniques (radiography / tomography) and its correlation with sonographic findings. Discussion: Ultrasound has been increasingly used because it allows quick access to the most sensitive location and severity of the disease, without using ionizing radiation. However it does not define the cause neither allows diagnosing ischemic complications. It is the method of choice in children, pregnant women and when thin fluid distension allows appropriate window. Conclusion of the Presentation: Ultrasound is the only method in advanced diagnostic imaging can be performed at bedside quickly and effectively. It makes a perfect bridge for interventional procedures, which can solve the problem immediately.

PD.01.005 Sındrome Do Quebra-Nozes: Relato De Tr^es Casos A. E. P. G. Miranda, E. S. Kobayashi, E. J. Carvalho, J. M. A. Miranda Sonimed Diagn osticos Avanc¸ados, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Report: Discuss and describe the clinical and ultrasound Doppler of three cases of the nutcracker syndrome. Medical History: The three patients came for abdominal ultrasound, one of them complaining of microscopic hematuria, another with pain left lumbar and last asymptomatic. Diagnosis: The nutcracker syndrome can be classified as before, when the clamping of the left renal vein occurs between the aorta and superior

Volume 39, Number 5S, 2013 mesenteric artery, or later, when the left renal vein has retroaortic course and undergoes compressive effects between the aorta and spine. Discussion and Summary of the Case: Three cases of the nutcracker syndrome diagnosed by abdominal ultrasonography with color Doppler. The nutcracker syndrome is rare, and that knowledge of this condition is fundamental to clinical suspicion and early diagnosis. PD.01.006 Avaliac¸a~o Ultrassonografica Das Suprarrenais No Paciente Oncologico M. Valente, A. C. Dourado, A. P. Bolinelli, B. D. Santana, A. O. Neto Hospital Estadual Vila Alpina, Seconci-SP, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Report: This case report aims at demonstrating the importance of abdominal ultrasonography evaluation in oncology patient, emphasizing the suprarenal glands study, commonly forgotten in day-by-day practice Medical History: Female patient, 62 years old, came to us complaining about abdominal pain and loss of weight for 6 months. The directed anamnesis showed a smoker patient (29 years / packet), with loss of approximately 25 kilos in 6 months and diffuse abdominal pain for 2 months. The physical exam showed diffuse abdominal painful with pain on superficial and deep palpation, but with no signs of peritonitis. After clinical evaluation, an abdominal ultrasonography was requerided as a complementary exam. It demonstrated periaortic lymphadenopathy, besides lobulated and heterogeneous mass in the suprarenal glands topography and focal liver injury. Because of the findings, we required an evaluation through contrasted computer tomography of the lungs and abdomen in order to compare the clinical and ultrasonography data related to the patient. Diagnosis: Bilateral adrenal metastasis. Discussion and Summary of the Case: This case illustrates the importance of abdominal ultrasonography when looking for patient with oncology suspicion, many times overcoming the simple radiography, and this study systematization so that all the abdominal organs are correctly examined. PD.01.007  Possivel Alinhar O Diagnostico Les~oes Hepaticas Focais: E Apenas Ao Usg? M. C. Lopes, M. Q. P. Silva, T. R. G. Wu, K. B. Calil, C. Akiho, P. V. Matos Webimagem, Sao Paulo, SP, Brasil Brief Description of the Purpose of the Review of Literature: Ultrasound is able to demonstrate such lesions and guide the procedures accurately in a large proportion of cases. However the radiologist often faced with complex cases and "challenging." Description (S) Condition (S), Method (S) Or Technique (S): Injuries poorly defined or poorly visualized are significant technical limitations. Although the characterization of focal liver lesions can be a challenge for radiologists, most lesions presents with imaging features that allow your possible diagnosis. Conclusion: Objective of this paper is to review the main aspects of imaging benign and malignant liver lesions most commonly found in adult liver, using the Ultrassom.com imaging features that allow your possible diagnosis. Brief Discussion of the Case: Null PD.01.008 Sonography of Gastrointestinal Tract Abnormalities D. M. Yang, D. H. Lee, H. C. Kim, S. W. Kim Department of Radiology, School of Medicine, Kyung Hee University, Seoul, Korea

Abstracts Brief Description of the Purpose of the Review of Literature: To illustrate the sonographic findings of the various kinds of gastrointestinal tract abnormalities. Description (S) Condition (S), Method (S) Or Technique (S): We retrospectively reviewed the sonographic findings of various kinds of gastrointestinal tract abnormalities. All sonographic examinations were performed with high frequency linear arrary transducers. All cases were confirmed by surgical resection, biopsy or radiological follow-up study. A variety of sonographic features were identified in various kinds gastrointestinal tract abnormalities. The disease entities include infectious and inflammatory diseases (appendicitis, Crohn disease, ulcerative colitis, tuberculous enterocolitis, diverticulitis, terminal ileitis, typhlitis, epiploic appendagitis, pseudomenbranous colitis, syphilis), ischemic disease, intussusception, benign tumors, malignant tumors (malignant GIST, lymphoma, carcinoma, metastases) and intramural hematoma. Conclusion: Although there was substantial overlap of sonographic findings in the various kinds gastrointestinal tract abnormalities, familiarity with the sonographic findings can assist in making the correct diagnosis.

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Brief Description of the Purpose of the Study: Preventive abdominal ultrasound is not formally described in the general medical guidelines for healthy individuals, but it is regular practice in Brazil to use it as an additional tool on the check-up exams. Methods: Abdominal ultrasound exams were performed by a staff of radiologists using Phillips HDI5000 and Toshiba Aplio XG equipments in a population of executives referred by their companies to a check-up in our service. Lifestyle aspects, comorbidities, and other exams were compared to the findings of the ultrasound. Main Results: In 2011, there were 6927 patients with an average age of 43 years. 53% of them had between 30-45 years and 24% were women. 60% were overweight or obese. 14% had metabolic syndrome and 44% had high cholesterol levels. Ultrasound identified steatosis in 34%. Importance of the Conclusions: NASH (Non-alcoholic steatohepatitis), one of the most commom liver diseases in the western countries, can progress to cirrhosis. Recent studies are associating steatosis as an risk factor for diabetes. The diagnosis of steatosis play a role on preventive issues for these cited pathologies and is also an important tool for persuade patients for lifestyle changes.

Brief Discussion of the Case: Null PD.01.011 PD.01.009 Pitfalls in the Ultrasonic Diagnosis of Hepatobiliary and Pancreatic Disorders J. I. Hwang, S. K. Lee Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan Brief Description of the Purpose of the Report: To describe the pitfalls of the upper abdominal ultrasonography most often encountered in the daily practice. Medical History: With the improvement of resolution & introduction of color Doppler, transabdominal ultrasonography has played more important role in the diagnosis of hepatobiliary and pancreatic disorders. Many disease entities may be mis-interpreted by sonographers or ultrasonists, such as peripheral nodule near dome or lingual process of liver, caudate lobe lesions, Infiltrating HCC, fatty liver with nodule or focal fatty sparing, regenerating nodule versus small HCC in severe liver cirrhosis, IHD stones with lobar atrophy & hypertrophy, pneumobilia versus pneumoportogram, Mirizzi’s syndrome or cholangiocarcinoma of CBD, pseudotumor caused by collapsed intestinal loops, pancreatic tumor at uncinate process and pseudoaneurysm versus pseudocyst of pancreas. Diagnosis: The most common problems are owing to technical limitations, perceptive errors or patient’s condition such as much gas retention in the gastrointestinal tract. How to resolve these conditions? Experienced hand is the key point. Discussion and Summary of the Case: This pictorial essay will display many interesting cases as mentioned above and share our experience. The young sonographer or radiologist should be familiar with normal anatomy and its different pathological conditions to avoid serious missing diagnosis.

PD.01.010 Abdominal Ultrasonography in the Check-Up E. Suenaga, S. N. Guariglia, R. D. O. Conceic¸~ao, V. A. Tabone, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, SP, Brasil

Ultrasound Features of Tumorlike Lesions and Tumors of the Gallbladder : Correlation with CT and MR S. Y. Baek, J. K. Lee Department of Radiology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea Introduction: Ultrasound (US) is the first imaging modality recommended for diagnosis of the gallbladder pathology. The differential diagnosis should be done between tumorlike lesions and tumors of the gallbladder, because the preoperative diagnosis may significantly alter therapy and patient prognosis. Therefore, we reviewed the US features of tumorlike lesions and tumors of the gallbladder and correlated US features with CT and MR findings. Methods Involved: We performed US exams of the gallbladder using either a 2-5 MHz convex transducer or a 5-12 MHz linear transducer on an HDI 5000 unit or IU-22 (Philips Medical Systems, Bothell, WA) ultrasound system. After an overnight fast of 8 to 12 hours, the gallbladder was scanned on longitudinal, oblique and transverse orientation. Discussion: Tumorlike lesions are commonly found in the gallbladder and include several kinds of polyps, adenomyomatosis, xanthogranulomatous cholecystitis. Benign tumors consist of adenomas, glandular cell tumors, gastric heterotopias and pseudotumors. Malignant tumors are carcinomas, metastases, lymphomas and sarcomas. We illustrated US features of each lesion and correlated them with CT and MR findings. Conclusion of the Presentation: US is very effective and informative to diagnose the gallbladder pathology and well correlated with CT and MR imaging.

PD.01.012 Comparac¸a~o Entre Alterac¸~oes Ultrassonograficas Renais, Histograma E Exames Laboratoriais Em C~aes M. J. Mamprim, R. Sartor, V. R. Barbcsak, T. Freitas UNESP, Botucatu, S~ao Paulo, Brasil Brief Description of the Purpose of the Study: This work studied the altered kidney ultrasound images of dogs and measured quantitatively increased echogenicity of the renal cortex by histogram and compared

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Ultrasound in Medicine and Biology

these with laboratory tests of renal function, in order to search for information that may guide more specifically renal ultrasonography . Methods: Sonographic examinations were selected for adult dogs with abnormal renal ultrasound, dated urinalysis and renal function tests at most 3 days of ultrasound examination. The standardized and digitized images, had three areas of interest renal cortex selected to perform the histogram. Subsequently, the results were compared with the histogram results of laboratory tests. Main Results: Of all animals, about 65% had significant changes to ultrasound. Of all animals, 10 (38%) showed significant changes at ultrasound and laboratory tests were normal or slightly altered. According to the histogram performed, there is a greater echogenicity and echotexture greater heterogeneity in the kidneys compared to patients not changed. Importance of the Conclusions: A significant portion had altered image and normal laboratory tests, which reinforces the ultrasound changes are detected and preceding laboratory abnormalities, enabling early diagnosis of kidney diseases acting positively on prognosis.

Volume 39, Number 5S, 2013 were categorized into three prognosis groups (A, proximal bile duct (BD) dilatation but no symptom or treatment requirement [n56]; B, temporary biliary stent placement after LT [n54]; C, biliary stent placement persistently after LT [n517]). SWE was performed five times on average in the liver right lobe and liver stiffness (LS) was compared with each other and receiver operating characteristic (ROC) analysis was performed. Main Results: LS values in group A-C were 5.95 6 1.4, 5.91 6 2.9, 11.8 6 7.3 (kPa), respectively (p 5 0.01). Group C in which persistent biliary stent placement was needed, showed significantly higher LS value than groups A and B in which stent insertion was not performed or done temporarily. Cut-off value was .8.7 kPa (AUC, 0.850; sensitivity, 64.7%; specificity, 100%) for predicting group C in which persistent biliary stent placement was required. Importance of the Conclusions: SWE may help for predicting clinical outcome of the biliary stricture in LT patients.

PD.01.015

PD.01.013 Various Abdominal and Endoscopic Ultrasonographic Appearances of Pancreatic Serous Cystadenoma and Pancreatic Neoplasms Mimicking Serous Cystadenoma Hyoung Jung Kim Asan Medical Center, Seoul, Republic of Korea Introduction: Asymptomatic pancreatic serous cystadenomas can be managed without surgery, but surgical resection may be required for unreliable preoperative diagnosis. Unreliable preoperative diagnosis is due to the various morphologic appearances of pancreatic serous cystadenomas. The purpose of this exhibition is to illustrate to various abdominal and endoscopic ultrasonographic imaging appearances of pancreatic serous cystadenomas and pancreatic neoplasms mimicking serous cystadenoma. Discussion: The common morphologic patterns of serous cystadenoma are polycystic, honeycomb, and oligocystic pattern. Rarely, they may involve the entire pancreas or they may manifest as a purely solid mass, either as diffuse or solid pattern. A gamut of pancreatic cystic or solid lesions will be illustrated and arranged according to the five morphologic patterns of pancreatic serous cystadenomas. Limitations of US and additional role of CT and MR in the diagnosis of serous cystadenomas will also be presented. Conclusion of the Presentation: Knowledge of the various abdominal and endoscopic ultrasonographic imaging appearances and awareness of the diagnostic limitations of ultrasonography are important for accurate diagnosis of serous cystadenomas of the pancreas.

^ Vısceras Ocas - Enfase Em Ultrassonografia - Anatomia E Tecnica De Exame L. D. R. Francisco, D. C. Grassi, V. F. L. Ferreira, M. A. Hirose, F. M. P. Abdo, F. M. Lote, R. Pinho, V. B. Porcionato, M. T. Passos, M. J. Francisco Neto, P. Boarini, L. R. Boarini Tranduson; Carapicuiba, Sao Paulo, Brasil Introduction: The hollow viscera, from the mouth to the anus, has been increasingly studied by ultrasound and knowledge of their anatomy and examination technique has its importance increasingly pronounced in the current scenario, particularly in emergency medicine. Methods Involved: Analysis of ultrasound studies of the hollow viscera, performed in our department with emphasis on exam technique and anatomy. Discussion: The examination technique in this context must be known, to delimitation, protocols and basic cuts and plans to be analyzed including the mouth, esophagus transition gastric, stomach, duodenum, thin straps, colons (ascending, transverse, descending, sigmode and rectum. The layers and different ecogenicidades are detailed, with proper histological correlation. Conclusion of the Presentation: Ultrasound has been shown to be an excellent method for diagnosing many conditions that affect the hollow viscera. In daily practice, the use of transducers with high frequency and millimeter resolution, greatly assist the final diagnosis. Thus, knowledge of technique and examination protocol, as well as mastery of the anatomy of the various segments of the digestive tract, are fundamental to the doctor imagenologist.

PD.01.017 PD.01.014 Prediction of Biliary Stricture Prognosis After Liver Transplantation Using Shear Wave Elastography: Preliminary Study J. H. Yoon, J. K. Han, J. Y. Lee, J. M. Lee, B. I. Choi Seoul National Univ. Hospital, Seoul, South Korea Brief Description of the Purpose of the Study: To determine shear wave elastography (SWE) can predict prognosis of biliary stricture after liver transplantation. Methods: Twenty-seven (M:F520:7, mean age 57.7 years) post liver transplantation (LT) patients who had biliary stricture and underwent SWE were included. According to medical record review, patients

Assessment of Hepatic Fibrosis With Real-Time Tissue Elastography in Chronic Viral Hepatitis N. Yada, M. Kudo, S. Hagiwara, T. Arizumi, M. Takita, S. Kitai, T. Inoue, Y. Minami, K. Ueshima, N. Nishida Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan Brief Description of the Purpose of the Study: The aim of this study was to assess prospectively the accuracy of measurement of hepatic fibrosis with real-time tissue elastography (RTE) in patients with chronic viral hepatitis. Methods: Two hundred and forty one patients were prospectively enrolled. Pathological diagnosis was performed with specimens obtained by ultrasound-guided biopsy. RTE was evaluated using Liver

Abstracts fibrosis index (LF index). LF Index and serological markers were compared with pathological diagnosis. Main Results: Activity was significantly correlated with fibrosis (r50.528, p , 0.001). LF Index in stage F0-F1, F2, F3, and F4 was 1.64, 2.11, 2.52, and 2.72, respectively, demonstrating a stepwise increase with increasing severity of liver fibrosis (p , 0.001). LF Index in activity A0, A1, A2, and A3 was 1.48, 1.85, 2.30, and 2.10, respectively, demonstrating a stepwise increase with no-significantly increasing severity of liver activity (r50.295). The area under the receiver operating characteristic curve of the LF Index, platelet count, aspartate/alanine aminotransferase ratio, aspartate aminotransferaseto-platelet ratio, and FibroIndex for predicting cirrhosis (F4 vs. F0-F3) was 0.842, 0.833, 0.688, 0.797 and 0.841; for predicting F3 stage or higher (F3-F4 vs. F0-F2) was 0.875, 0.831, 0.723, 0.784 and 0.826, respectively. Importance of the Conclusions: Assessment of Hepatic Fibrosis with RTE in Chronic Viral Hepatitis is useful, not affected by the activity.

PD.01.018 Ultrassonografia Com Doppler: Metodo De Triagem No P os-Transplante Hepatico G. L. Barros F, M. M. Bezerra, B. L. Moreira, G. M. Cervantes, L. F. Lira, R. Chojniak Hospital A.C. Camargo, S~ao Paulo, Brasil Introduction: The liver transplantation has become the treatment of choice for patients with end-stage hepatic disease. Early detection of postoperative complications is essential for graft and patient survival. Methods Involved: We conducted tests of ultrasound (U.S.) Doppler abdomen of recipient patients after surgery. Discussion: The use of U.S. in the postoperative follow-up of the liver transplantation can detect parenchymal , abdominal cavity, biliary and vascular disoders. Parenchymal evaluation aims to diagnose common complications such as hematomas and collections, and severe findings that suggest ischemia and rejection. The information of the abdominal cavity are related surgery, such as seroma and abscess. Biliary complications occur in an estimated 25% of liver transplant recipients, usually within the first 3 months after transplantation. Among these, the most common is stenosis of the choledochocholedochostomy. Vascular complications usual are the stenosis and thrombosis, especially hepatic artery. Prompt diagnosis requires early intervention and can save the graft. Conclusion of the Presentation: Clinical signs of complications often are nonspecific, and diagnoses frequently are based on imaging findings. In this context, the US is the preferred postoperative screening method because it is cost-effective, accessible, noninvasive, and easily performed at bedside.

PD.01.019 Estudo Comparativo Dos Exames Ultrassonografico E Urinalise Em Animais Com Suspeita De Doenc¸a Do Trato Urinario Baixo Comparative Study of Ultrasound Exams and Urinalisys in Animals With Suspected Lower Urinary Tract Disease M. G. S. N. Ramos, M. C. S. Santos, D. A. B. Lessa, M. C. N. Caststro, A. M. Souza, T. A. L. Trancoso Universidade Federal Fluminense, Niteroi, Riode Janeiro, Brasil Brief Description of the Purpose of the Study: The objective of this work is to compare the ultrasonographic aspect of the urinary bladder

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with the exam of the abnormal elements and sedimentoscopy on animals with or without lower urinary tract disease. Methods: A survey was realized from January to November 2012, and were selected animals that had been submitted to ultrasound and urinalysis by cystocentesis guided or not by the ultrasound, with or without lower urinary tract disease. Were included 82 animals, among dogs and cats, with no distinction of gender, age or breed. Main Results: Among the 82 animals evaluated, 35 showed changes in both exams, 32 animals did not showed changes in both exams and 5 animals showed changes only in urinalysis. No animal showed changes only in the urinary bladder ultrasound. Importance of the Conclusions: We concluded that there was a correlation between the findings of the two studied methods in most of the cases, also complementing the evaluation of the animals suspected of lower urinary tract disease.

PD.01.020 Doppler Sonographic Evaluaiton in the Assement of Disease Activity of Ulcerative Colitis S. S. Park, S. S. Hwang St. Vincent’s Hospiital, Suwon, Gyeionggi-Don, South Korea Brief Description of the Purpose of the Study: To evaluate clinical usefulness of Doppler ultrasonography in the assesment of diseaes activity in ulcerative colitis (UC). Methods: The duplex Doppler sonography of superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) of 10 patients with clinically inactive UC and 20 patients with active UC were evaluated by one radiologist who was blinded to clinical information. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) of the SMA and IMA were evaluated. All patients underwent biochemical and endoscopic evaluations thereafter. Correlation between disease activity by the Truelove-Witts classification and the Mayo scoring system was measured, and we compared hemodynamic parameters between active and inactive UC. Main Results: Correlation rate of disease activity between these two scoring systems was 93.3%. Flow velocities (PSV, p , 0.001 and EDV, p 5 0.03) and PI (p 5 0.03) were significantly higher in patients with active UC than inactive UC. PSVs of the SMA and IMA were also significantly correlated with disease severity. The active UC could be accurately diagnosed using Doppler sonography (AUC50.83; 95% confidence interval 0.68-0.99). Importance of the Conclusions: In patients with UC, Doppler sonography was a readily available method, and PSV of SMA would be clinically useful in predicting of disease activity and severity.

PD.01.021 Ultrasonography in Patients With Autoimmune Pancreatitis: Pancreatic and Extrapancreatic Features K. W. Kim, G. S. Hong, J. H. Kim, H. J. Kim, J. S. Lee Asan Medical Center, Seoul, Korea Introduction: Autoimmune pancreatitis (AIP) has been considered an extraordinary type of chronic pancreatitis, with characteristic abundant IgG4-positive plasma cell infiltration and accompanying sclerosis, and was recently recognized as the pancreatic manifestation of IgG4-related sclerosing disease. Diagnosis of AIP has been recently increased with increase in awareness, dramatic improvement of radiological examination such as CT and MRI, and immunologic diagnostic assay tool including IgG and IgG4. Many investigators have focused on the image

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Ultrasound in Medicine and Biology

findings of AIP on CT and MR and its differential diagnosis from the common bile duct (CBD) or pancreatic cancer. The patients with AIP present with obstructive jaundice the most commonly, followed by abdominal pain or weight loss.1,2 Ultrasonography is a good screening modality for the patients with those symptoms. Therefore ultrasonography can be the initial screening modality to evaluate the patients with AIP. Because the ultrasonographic features of AIP have not been well-known, differential diagnosis of AIP on initial screening ultrasonography is practically difficult. In this article, we illustrate ultrasonographic findings of AIP. Methods Involved: N/A Discussion: N/A Conclusion of the Presentation: N/A

3 - CEUS (Contrast Agents) PA.03.001 WITHDRAWN

Volume 39, Number 5S, 2013 Brief Description of the Purpose of the Study: Retrospective evaluation of the effectiveness of CEUS in the differential diagnosis between benign and malignant thrombus of the portal vein. Methods: 85 patients underwent CEUS in the period from 06/2005 to 12/2011, so as to research portal vein thrombosis, all with chronic liver disease and hepatocellular carcinoma suggesting nodules. In order to confirm the nature of the thrombus, other imaging exams such as CT and MRI were analyzed over a period of 6 months from the date of CEUS. Considered benign (hematic): thrombus which remained stable, decreased or recanalized over time, showed no enhancement or arterial spectrum after the contrast. Considered malignant in case of disruption of the vessel wall, increased in size after the first examination, and showed enhancement in the arterial phase or arterial spectrum after contrast. Main Results: 15/85 patients had no portal vein thrombosis, 06 were not found in the system and 25 lost follow up, remaining 39 patients. 22/39 were malignant and 17/39, benign. The CEUS was conclusive in 37/39 patients [kappa 5 0.897 (p , 0.0000001)]; sensitivity of 90.9% and specificity of 100%. Importance of the Conclusions: CEUS proved to be an excellent diagnostic method for assessing the nature of the thrombus in patients with chronic liver disease complicated with portal vein thrombosis.

PA.03.006 When and How to Use Contrast Enhanced Ultrasound in Nonhepatic Lesions, in Clinical Practice? I. Sporea, M. Ardelean, A. Martie, R. Sirli, M. Danila, A. Popescu Department of Gastroenterology and Hepatology, ‘‘Victor Babes’’ University of Medicine and Pharmacy, Timisoara, Romania Brief Description of the Purpose of the Study: To present our experience in the evaluation of extrahepatic pathologies, using CEUS, over 32 months. Methods: We performed a retrospective, single centre study, that included 574 nonhepatic CEUS examinations,over 3 years. We evaluated abdominal organs for the following pathologies: tumors, pancreatic necrosis in severe acute pancreatitis, vascular thrombosis (especially portal vein thrombosis in patients with chronic liver diseases). The enhancement pattern was assesed according to the EFSUMB CEUS Guidelines from 2011. Main Results: There were made 574 CEUS examinations to evaluate abdominal organs and vassels such us: pancreas, portal vein patency, kidneys, gallbladder, spleen, others. Based on the typical enhancement pattern, CEUS established a positive diagnosis in 462 cases (80.4%). Most of the CEUS examinations were performed for pancreatic lesions (27%). 68.4% for pancreatic masses and 26.4% for pancreatic necrosis, but also for the portal vein thrombosis (23%). Other fields of interest were: kidneys masses (10.2%), gallbladder unspecific masses (10.4%), splenic lesions (7.5%) and the rest included perithoneal cavity, adenopathies, colon, main billiary tract (22%). Overall, CEUS established the benign or malign character of an extrahepatic lesion in 455 cases (79.2%). Importance of the Conclusions: Using CEUS, we could established a correct diagnosis in 80% of cases.

PD.03.001 CEUS Na Caracterizac¸~ao Da Trombose De Veia Porta  M. C. Chammas, M. J. A. D’Avila, A. C. Oliveira, A. C. Gomes, O. C. Saito, G. G. Cerri INRAD HC FMUSP, S~ao Paulo, Brasil

PD.03.002 Targeted Delivery of GDNF Through the Blood-Brain Barrier by Mri-Guided Focused Ultrasound W. Feng, S. Yu, L. Lin, L. Li, C. Youli, Z. Hairong, L. Xin, Y. Fei, Z. Chao, S. Chengyu, S. Jie, L. Shukun, C. Yun Department of Ultrasound, Peking University Shenzhen Hospital, Biomedical Research Institute, Shenzhen Pku-Hkust Medical Center, Shenzhen, Guangdong China Brief Description of the Purpose of the Study: Neurotrophic factors, such as glial cell line-derived neurotrophic factor (GDNF), are promising therapeutic agents for neurodegenerative diseases. However, the application of GDNF to treat these diseases effectively is limited because the blood-brain barrier (BBB) prevents the local delivery of macromolecular therapeutic agents from entering the central nervous system (CNS). Focused ultrasound combined with microbubbles (MBs) using appropriate parameters has been previously demonstrated to be able to open the BBB locally and noninvasively. Methods: This study investigated the targeted delivery of GDNF MBs through the BBB by magnetic resonance imaging (MRI)guided focused ultrasound. Evans Blue extravasation and histological examination were used to determine the optimum focused ultrasound parameters. Enzyme-linked immunosorbent assay was performed to verify the effects of GDNF bound on MBs using a biotin-avidin bridging chemistry method to promote GDNF delivery into the brain. Main Results: The results showed that GDNF can be delivered locally and noninvasively into the CNS through the BBB using MRIguided focused ultrasound combined with MBs under optimum parameters. Importance of the Conclusions: MBs that bind GDNF combined with MRI-guided focused ultrasound may be an effective way of delivering neurotrophic factors directly into the CNS. The method described herein provides a potential means of treating patients with CNS diseases.

Abstracts TL.03.001 Noninvasive Assessment of Portal Hypertension by Ultrasonography Qu Enze, Liu Yang, Wang Jin Rui Peking University Third Hospital, Beijing, China Brief Description of the Purpose of the Study: To explore the feasibility of noninvasive assessment of portal hypertension (PHT) by ultrasonography. Methods: A total of 18 PHT patients who were planning to undergo splenectomy combiend with pericardial devascularization received ultrasonography one week before surgery (PHT group). In addition, 20 healthy volunteers were enrolled as the controls (control group). The conventional two-dimentional (2D) ultrasound, Doppler ultrasound and contrast-enhanced ultrasound (CEUS) parameters were compared between these two groups. For patients in the PHT group, the portal vein pressure was measured using portal vein puncture, and its relationship with the above parameters were further analyzed. Main Results: The 2D ultrasound, Doppler ultrasound and CEUS parameters showed significant differences between the PHT group and control group (p , 0.01). Three ultrasonographic features including area under the time-intensity curve (TIC) of portal venous phase/hepatic arterial phase (Qp/Qa), intensity of portal venous phase/hepatic arterial phase (Ip/Ia), and base-to-peak ascending slope (bp/ba) were negatively correlated with the portal vein pressure (correlation coefficient: -0.701, -0.625, and -0.494, respectively). Importance of the Conclusions: In this study, Qp/Qa and Ip/Ia have reduced significantly in PHT group compared with that in the control group (p ,0.01), suggesting that in PHT patients, intensity and proportion of portal vein perfusion declined; while intensity and proportion of hepatic artery perfusion gradually rise due to buffering effect, thus gradually reversed the proportion of blood supplying through portal vein and hepatic arteries. Meanwhile, the decline of bp/ba, TTP, and RT confirmed that the increased flow velocity of the hepatic artery and decreased flow velocity of portal vein led to increased slope of TIC curve of the ascending branch of hepatic artery segment and decreased slope in portal vein segment, moreover; meanwhile, the increased overall slope of curve caused an advanced time to peak. In PHT group, Qp/Qa, Ip / Ia, and bp/ba were negatively correlated with the portal vein pressure, with correlation coefficients of -0.701, -0.625 and -0.494, respectively, indicating that these three ultrasound contrast parameters not only objectively reflected the pathophysiological process and the hemodynamic characteristics of chronic liver diseases but also showed a good correlation with portal pressure, therefore it was expected for clinical use as a new method for noninvasive assessment of portal vein pressure in PTH patients.

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probe (GE Healthcare, Milwaukee, WI). Baseline scanning was performed in both B-mode and power Doppler. Patients then received a 0.25 ml bolus of Definity (Lantheus Medical Imaging) for HI followed by a bolus injection of 20 ml/kg for SHI. Main Results: To date 60 patients have completed the protocol. Of the completed cases, SHI resulted in improved tissue suppression relative to HI in 58 of the cases. The degree of contrast enhancement in both cases has relied heavily on lesion vascularity (as judged from the power Doppler baseline images). However in vascular cases (approximately 28), SHI resulted in improved depiction of the lesion vasculature due to superior tissue suppression. Importance of the Conclusions: While imaging breast lesions, 4D SHI provides improved tissue suppression relative to 4D HI. While contrast enhancement depended heavily on lesion vasculature, in enhanced cases this suppression results in an improved ability to image lesion vasculature.

TL.03.004 Method to Improve Visualization of Vascularity Using 4D Subharmonic Breast Imaging P. Machado, A. Sridharan, J. R. Eisenbrey, D. A. Merton, K. Wallace, C. L. Chalek, K. E. Thomenius, F. Forsberg Thomas Jefferson University, Philadelphia, PA, USA Brief Description of the Purpose of the Study: To develop a method for improving visualization of vascularity in breast lesions using 4D contrast-enhanced subharmonic imaging (SHI). Methods: A modified Logiq 9 (GE Healthcare) scanner with a 4D10L probe was used for harmonic imaging (HI) and SHI of breast lesions in 55 patients. Imaging was performed after administration of bolus injection of ultrasound contrast agent (UCA) Definity (Lantheus Medical Imaging), 0.25mL for HI and 20mL/kg for SHI. Two ultrasound engineers selected cases that showed presence of UCA for processing. For each case, averaged slice time-intensity, total slice time-intensity and percentage change in intensity curves were used to identify an estimated time-point of peak UCA wash-in (Test). A threshold was constructed around Test to isolate slices showing peak UCA intensity within the threshold. A background template generated from baseline was used to filter out tissue signal through the isolated slices. Main Results: Vessel-to-tissue contrast ratio were increased over 90% in 4D SHI post processing while no improvements were seen in 4D HI. Overall, 4D SHI had better depiction of vascularity compared to 4D HI via improved tissue suppression (60% more in 4D SHI). Importance of the Conclusions: Future work will involve using the vascular volumes to generate perfusion maps in breast lesions.

TL.03.002 Initial Experiences With 4D Subharmonic Breast Imaging P. Machado, J. R. Eisenbrey, A. Sridharan, D. A. Merton, R. F. Mattrey, H. Ojeda-Fournier, K. Wallace, C. L. Chalek, K. E. Thomenius, F. Forsberg Thomas Jefferson University, Philadelphia, PA, USA Brief Description of the Purpose of the Study: To compare 4D contrast enhanced harmonic imaging (HI) and subharmonic imaging (SHI) for the characterization of mammographically-identified breast lesions. Methods: Four-dimensional SHI (ftransmitting 5 5.8 MHz, freceive 5 2.9 MHz) 4D HI (f0 5 5 MHz, freceive 5 10 MHz) was implemented on a Logiq 9 ultrasound scanner with a mechanically controlled 4D10L

TL.03.012 The Epoch Method of Defect Re-Purfusion Imaging to Diagnose Small Hepatocellular Carcinoma With New Second Contrast Agent Sonazoid C. Ogawa, M. Kudo, M. Shibatouge, K. Takaguchi Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan Brief Description of the Purpose of the Study: In this study we evaluated the usefulness of the epoch-making technique, Defect Reperfusion Ultrasound Imaging (double-contrast US) using new second agent Sonazoid, to diagnose and evaluate the histological grade of small hepatocellular carcinoma.

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Methods: A total of 18 patients with 20 HCC nodules within 2cm who underwent surgical resection were evaluated in this study. All patients underwent CE-US, CTHA, CTAP and Gd-EOB-DTPA MRI within one and a half months before operation. To confirm the location of HCC with US, we used the newly developed real-time fusion navigation system (V-NAVI). Sonazoid is able to get the real-time vascular imaging and stable Kupffer imaging. The reinjection of Sonazoid during Kupffer imaging (10-60 minutes after injection) enables us to get more information than one injection procedure. Main Results: We were able to detect all HCC nodules using CE-US from surface or intra-operative CE-US using defect re-perfusion imaging. And using this method, we were able to evaluate histological grade of HCC easily and there are no significant differences of the three modalities (CE-US, CTHA, CTAP, Gd-EOB-DPA MRI). Importance of the Conclusions: Defect Re-Perfusion Imaging using new second agent Sonaziod is very easy and useful to diagnose small HCC within 2cm.

Volume 39, Number 5S, 2013 Brief Description of the Purpose of the Study: This study was undertaken to investigate left ventricular (LV) strain of hypertensive (HT) patients with myocardial hypertrophy using three-dimensional speckle tracking echocardiography. Methods: Myocardial movement was analyzed in 37 primary HT patients with myocardial hypertrophy and 27 healthy volunteers. Longitudinal, circumferential, radial and area strains were measured in each of the 17 segment of LV, as well as global longitudinal (GSL), circumferential (GSC), radial (GSR) and area (GSA) strains. LV mean longitudinal (MSL), circumferential (MSC), radial (MSR) and area (MSA) strains were calculated as the average strain values of 17 segment. The correlation between each strain parameter and LV ejection fraction (LVEF) was analyzed. Main Results: LV GSL, GSR, GSA and MSL, MSR, MSA of HT patients with myocardial hypertrophy were significantly lower than the contrast group, whereas GSC and MSC showed no significant difference between the two groups. There were significant correlation between LVEF and GSL, GSC, GSR, GSA, MSL, MSC, MSR, MSA. Importance of the Conclusions: Impairment of LV global and regional myocardial contractility can be detected by three-dimensional speckle tracking echocardiography.

4 - Echocardiography PA.04.004 Evaluation of the Function and Synchronization of Left Atrial in Patients With Paroxysmal Atrial Fibrillation by Two Dimensional-Speckle Tracking Imaging S. Cao, R. Q. Guo Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China Brief Description of the Purpose of the Study: To evaluate the function and synchronization in patients with paroxysmal atrial fibrillation (PAF) by 2D-STI. Methods: 30 controls and 35 PAFs were studied. The PAFs were divided into group PAF1 at the interval of PAF and group PAF2 during the stage of attack. The peak velocity, strain and SR (SRs, SRe and SRa) were acquired in the systole, the early and late diastole, respectively. The synchronization of left atrial (Ts-SD, Te-SD and Ta-SD) could be gotten from the time to peak strain. The correlation were analysed between the synchronization and SR. Main Results: Compared with the controls, the LAD increased and DT decreased in PAF1 and PAF2 (p , 0.05). The peak velocity, strain and SR were lessened in PAFs (p , 0.05), except SRa (p . 0.05). The Ts-SD and Te-SD had significant differences during the three groups (p , 0.05), the PAF2 showed fewest synchronization; the Ta-SD was higher in PAF1 than the controls (p , 0.05). The Ta-SD had a positive correlation with SRa (r50.61, p , 0.01). Importance of the Conclusions: The reservoir and conduit function of left atrial are impaired in PAFs, the booster pump could recover partially at the interval of PAF, disappear during the stage of attack. There are dyssynchronization, especially at the stage of attack.

PD.04.002 Quantification of Shear Modulus in In Vitro Porcine Myocardium Using Real-Time Shear Wave Elastography Y. B. Deng, Q. Y. Tang, J. Sun, W. Zhou Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China Brief Description of the Purpose of the Study: This study was undertaken to investigate in vitro porcine myocardial shear modulus using real-time shear wave elastography (SWE). Methods: Shear wave elastography was used on four in vitro porcine hearts. The probe was placed parallel to the long or short-axis of the heart on the anterior wall of the left ventricle, and myocardial shear modulus were measured in subepicardial, middle, subendocardial layers, respectively. Main Results: Shear modulus of subepicardial, middle, subendocardial myocardium were (46.04 6 17.07) kPa, (87.70 6 29.67) kPa, (115.73 6 30.04) kPa, respectively, when the probe was placed parallel to the long-axis of the heart; whereas those were (78.71 6 26.48) kPa, (77.08 6 34.00) kPa, (70.69 6 41.38) kPa, respectively, when the probe was placed parallel to the short-axis of the heart. Importance of the Conclusions: By using real-time shear wave elastography, the shear modulus values measured in subepicardial, middle, subendocardial myocardium of the left ventricle are different, even the shear modulus values of myocardium in the same location are different when the probe orientation are different.

PD.04.003

PD.04.001

A Case of Giant Papillary Fibroelastoma in the Left Atrium T. Tsugu, S. Iwanaga, I. Nakamura, M. Kobayashi, Y. Kitamura, S. Inoue Hino Municipal Hospital, Hino City, Tokyo, Japan

Evaluation of Left Ventricular Myocardial Strain in Hypertensive Patients With Myocardial Hypertrophy Using Three-Dimensional Speckle Tracking Echocadiography Y. B. Deng, Q. Y. Tang, J. Sun, W. Zhou Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China

Introduction: Papillary fibroelastoma (PFE) is mainly found on the valves. We present a case of giant PFE of attached to left atrial surface of the intraatrial septum near the foramen ovale. Methods Involved: A 70-year-old female without any symptom was referred to our hospital because of hypertension. For the evaluation of systolic ejection murmur, echocardiography was performed. A

Abstracts mobile low-echoic restiform lesion was found on the left atrial septum near the foramen ovale. Thrombus trapped at the foramen ovale was suspected and surgical resection was performed to prevent embolism. The tumor had a short pedicle and multiple papillary fonds, 34 3 8 3 3 mm in size. Its pathological diagnosis was papillary fibroelastoma. No recurrence was observed until eleven months after the surgery. Discussion: The prevalence of PFE was 7% of primary cardiac tumor. 85% of PFE was originated from valvular endocardium. PFE is usually under 10 mm in size, and the tumor with more than 20-mm size is rare, ,1%. A echocardiography is the most useful technique for the daignosis, and accuracy is 88.4% when the tumor is larger than 2mm. Conclusion of the Presentation: The treatment strategy of PFE is controversial because of their rarity. Immediate diagnosis and surgical removal are important to avoid embolic complications.

PD.04.004 The Clinical Case of Hypertrophic Cardiomyopathy in a Patient With Systemic Lupus Erythematous N. G. Shamsutdinova, M. M. Mangusheva, E. R. Kirillova Kazan State Medical University, Kazan, Russian Federation Introduction: According to literature data only few clinical cases of association of hypertrophic cardiomyopathy with systemic lupus erythematosus (SLE) were described. A fundamental role in establishing the diagnosis of hypertrophic cardiomyopathy has echocardioscopy. Methods Involved: Patient M, 26 years observed in the rheumatologist for 4 years with diagnoses ‘‘Systemic lupus erythematosus, chronic form, minimal activity, with lesions of the skin (photodermatitis), joints (arthritis, FN 0)’’. She complained of pain in the left side of chest radiating to the left arm and back, stabbing pain character, which appear during exercise (walking distance 500 m), shortness of breath when climbing on the 3rd floor. Pain disappear on their own at rest after 15 minutes. Patient complained on episodes of palpitations during exercise (walking). On the echocardioscopy were found left ventricular hypertrophy, mostly interventricular septum with outflow tract obstruction of the left ventricle. Based on clinical data and results of echocardioscopy we diagnosed hypertrophic cardiomyopathy with outflow tract obstruction of the left ventricle in association with SLE. Discussion: In the literature, only few cases of association between systemic disease and hypertrophic cardiomyopathy. This is consistent with our data. Conclusion of the Presentation: Ehokardioskopic research plays an important role in the diagnosis of cardiovascular disease in patients with SLE.

PD.04.006 Conventional Pulsed Wave Doppler in Assessment of Left and Right Ventricular Systolic and Diastolic Function N. Nelassov, E. Mirzayan, T. Karkoshko, E. Ponomarenko, I. Perepechai, M. Morgunov, O. Eroshenko Rostov State Medical University, Rostov-On-Don, Russian Federation Brief Description of the Purpose of the Study: Only 10% of echocardiographs in Russia are equipped with spectral tissue Doppler (TDI) and 100% with conventional pulsed wave Doppler (PW). Nowadays it is

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strongly recommended to use TDI for assessment of left and right ventricular systolic and diastolic function. We decided to analyze if PW can be used for these purposes instead of TDI. Methods: 16 subjects (mean age 53.8 6 17.8 years) underwent dopplerechocardiographic exam. TDI and PW tracings were obtained from lateral border of mitral and tricuspid annulus. During registration of PW Doppler gain was significantly diminished. Correlations between homological components of TDI and PW spectrograms (left and right side systolic velocity parameters-sl’ and sl, sr’ and sr; early diastolic velocity parameters-el’ and el, er’ and er) were evaluated. Main Results: In all cases registered PW curve was clear cut. High levels of correlation were found between sl’ and sl (r5.79, p 5 .0002), el’ and el (r5.82, p 5 .0001), er’ and er (r5.90, p 5 .000002), moderate-between sr’ and sr (r5.63, p 5 .008). Importance of the Conclusions: Significant correlations between homological components of TDI and PW were obtained. It means that PW can be used for assessment of left and right ventricular systolic and diastolic function in cases when TDI is unavailable.

PD.04.007 The Clinical Impaction of Fetal Echocardiography in the Low Birth Rate Era J. K. Chang, C. C. Lin, D. C. Huang, K. P. Weng, K. S. Hsieh Cheng-Hsin General Hospital, Taipei and Veterans General Hospital Kaohsiung, Taiwan Brief Description of the Purpose of the Study: The purpose of this analysis is to evaluate the practice of fetal echocardiography and its impact on fetal outcome in the low birth rate era. Methods: The fetal cardiac diagnosis, the relevant follow up after respective fetal echocardiographic examinations were collected for analysis. Main Results: Among these 220 fetus, 69 fetus were found to be abnormal, including 50 fetus with congenital heart diseases (CHD) and 19 fetus with arrhythmia. Of the fetus with CHD, there was 14 fetus with complex CHD, 7 fetus with Tetralogy of Fallot, 5 fetus with tricuspid valve anormaly, 4 fetus with hypoplastic heart syndrome, 3 fetus with VSD, 2 fetus with mitral valve anormaly, 2 fetus with pulmonary stenosis, 2 fetus with CoA, 2 fetus with ASD. Among the 50 fetus, 19 of them went to terminate to pregnancy, including 10 fetus with complex congenital heart disease, 2 fetus with Tetralogy of Fallot, 3 fetus with hypoplastic heart syndrome, 1 fetus with CoA and 3 others. Importance of the Conclusions: Our experience in fetal echocardiography showed that an alarming high incidence of decision to terminate the pregnancy once the diagnosis of CHD was made. The relative alarming high termination rate for many treatable CHD deserves medical and social concern.

PD.04.008 To Investigate the Progression of Myocardial Infarction by Echocardiographic Assessment B.-J. Pan, M.-S. Jiang, C.-J. Liang, W.-P. Chen, P.-C. Li, Y.-L. Chen National Taiwan University, Taiwan

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Brief Description of the Purpose of the Study: Myocardial infarction (MI) is a major health problem and the leading cause of death in both industrialized and developing nations. To develop a noninvasive method to detect early the changes of cardiac function is very emergent and important. Methods: In the study, MI was induced in C57BL/6 mice by a ligation of left anterior descending artery. The potential influence of myocardial infarction on cardiac tissues was evaluated by the echocardiographic assessment and the histological staining. Transthoracic echocardiographic study was performed before surgery, and at 1, 3, 7, and 14 days after MI with a dynamically focused 40 MHz linear-array transducer (Prospect, S-Sharp, Taipei, Taiwan) with a depth setting of 1.5 cm. M-mode tracings were recorded from the short axis view at the papillary muscle level of the left ventricle. Main Results: Fractional shortening (FS%), and ejection fraction (EF %) were measured. EF% reduced from 62.18 6 7.30 (normal mice) to 19.61 (14 days after MI), FS% decreased from 33.44 6 5.15 to 8.84. We also observed the significant morphological changes in cardiac sections by hematoxylin and eosin staining. They include the decreased number of cardiomyocytes and the increase of connective tissue. Importance of the Conclusions: These findings suggested that the echocardiographic instrument would be used as the noninvasive and effective detection for MI.

PD.04.009 Using Prospect High Resolution Imaging System to Monitor Cardiac Function in Post Myocardial Infarct Mice Treated With or Without a TGFb Inhibitor W. P. Chen, L.-C. Lin, P.-C. Li National Taiwan University, Taiwan Brief Description of the Purpose of the Study: The present study aimed to use Prospect high resolution imaging system to assess whether the TGFb inhibitor can ameliorate cardiac dysfunction. Permanent myocardial infarction was induced in mice by the surgery of left anterior descending coronary ligation under isoflurane inhalation anesthesia. Methods: M-mode echocardiography was performed under isoflurane inhalation anesthesia to measure cardiac parameters using Prospect high resolution imaging system (S-Sharp Corporation, Taiwan) with the probe providing the central frequency ranging from 20-50 MHz. The change of ejection fraction (EF) of the same mouse was measured before and after MI surgery. Mice with EF,45% were randomly assigned for further treatment with DMSO or TGFb inhibitor. The TGFb inhibitor (10 mg/kg) and BrdU were administrated 3 days post-MI and once per day for continuous 7 days via intraperitoneal injection. Main Results: TGFb inhibitor treatment could increase the renewed cardiomyocytes in association with the decrease of fibrotic area. The ejection fraction of post-MI hearts in TGFb inhibitortreated group was significantly improved at the second week after drug-treatment as compared to those of DMSO (0.1% v/w)-treated group. Importance of the Conclusions: Prospect imaging system could acquire clear image of the detailed morphology of mice myocardium to demonstrate that TGFb inhibitor could ameliorate cardiac dysfunction in post-MI mice.

Volume 39, Number 5S, 2013 TL.04.002 Early and Late Improvement of Left Ventricular Function of Acute Myocardial Infarction After Percutaneous Coronary Intervention B. Hu, R. Q. Guo Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China Brief Description of the Purpose of the Study: The clinical values of the characteristics of heart function improvement of AMI patients treated by percutaneous coronary intervention (PCI) were discussed. Methods: 73 patients who had AMI for the first time and had been treated by primary PCI and examined in the follow-ups in our hospital were enrolled. Patients were divided into left ventricular function improved group (DLVEF6$5%) and not-improved group; According to the comparison of LVEF before PCI and 3 months after PCI, improved group were divided into left ventricular function early-improved group (DLVEF3$5%) and late-improved group. Main Results: LPSS before PCI and at the follow-ups and RPSS at 3 months after PCI in early-improved group were higher than those in late-improved group (LPSS at 3 months after PCI: p , 0.001; Other parameters: p , 0.05). LPSS before PCI was more closely related to DLVEF3 (r5-0.781, p , 0.001); CPSS at 6 months after PCI was more closely related to DLVEF6 (r5-0.834, p , 0.001). Importance of the Conclusions: Early and late function improvement of left ventricle in AMI patients who was treated by PCI were accurately assessed by speckle tracking imaging (STI). The precise analyses of longitudinal and circumferential movements in STI were important for clinical diagnosis. TL.04.006 Mechanism Study of Pulsus Paradoxus Using Mechanical Models T. S. Cao, C. Y. Xing, L. J. Yuan, Z. Wang, K. Wang, H. R. Ren, Y. Yang, Y. Y. Duan Tangdu Hospital, Xi’an, China Brief Description of the Purpose of the Study: Pulsus paradoxus (PP) is an exaggeration of the normal inspiratory decrease in systolic blood pressure. Despite a century of attempts to explain this sign consensus is still lacking. The aim of this study was to solve the controversy and reveal the exact mechanism of PP. Methods: Model 1 was to observe the primary influence of respiratory intrathoracic pressure change (RIPC) on systemic and pulmonary venous return systems (SVR, PVR) respectively. Model 2 was to study the secondary influence of RIPC on the motion of the interventriclar septum (IVS). Main Results: Model 1 demonstrated that the simulated RIPC had opposite influence on the simulated SVR and PVR. Model 2 revealed the three major factors determining the respiratory displacement of IVS in normal and different pathophysiological conditions: the magnitude of RIPC, the pressure difference between the two ventricles and the intrapericardial pressure. Importance of the Conclusions: Different anatomical arrangement of the two venous return systems leads to a different effect of RIPC on right and left ventricles, and thus a pressure gradient across IVS that tends to shift IVS left- and rightwards. When the leftward displacement of IVS reaches a considerable amplitude in some pathologic condition such as cardiac tamponade, PP occurs.

Abstracts

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5 - Education in Ultrasound

PD.05.003

PD.05.001

Papel Da Ultrassonografia No Torax A. H. Ban, S. F. Ferraciolli, V. S. Yamachira, A. Talans, M. J. Francisco Neto, M. C. Chammas, G. G. Cerri Hospital Das Clınicas Da Faculdade De Medicina Da Universidade De S~ao Paulo, S~ao Paulo, S~ao Paulo, Brasil

Influence of Gain Adjustment On Three-Dimensional Power Doppler Indices and On Stic Volumetric Pulsatility Indices Using an In Vitro Flow Phantom Experiment A. H. Miyague, N. J. Rainne-Fenning, Z. P. Theo, L. T. Polanski, M. N. Baumgarten, C. O. Nastri, W. P. Martins Departamento De Ginecologia E Obstetrıcia Do Hospital Das Clınicas Da Faculdade De Medicina De Ribeir~ao Preto, Universidade De S~ao Paulo (FMRP-USP), Ribeir~ao Preto - SP, Brasil Brief Description of the Purpose of the Study: To compare the effect of color gain on the volumetric pulsatility index (vPI) using an in vitro flow phantom model. We hypothesized that the vPI would remain unchanged despite serial increments in gain whilst conventional three dimensional 3D vascular measures would increase in a linear fashion. Methods: We divided gains into 3 bands: -8 to -1 (no noise); -1 to +5 (low noise); and +5 to +8 (obvious noise). The vPI was determined from the 3D vascularization index (VI) or vascularization flow index (VFI) using the formula: vPI 5 (maximum-minimum)/(average). we plotted the values of VI, VFI and vPI obtained with each gain setting. Main Results: Using ‘no noise’ gains, we observed that whilst the VI and VFI increased linearly with gain, the vPI was significantly less dependent on this adjustment. The VI and VFI continued to increase linearly with gain while the vPI decreased slightly using ‘low noise’ gains. When gain was increased above the lower limit of ‘obvious noise’ (+5) the VI and VFI increased pronouncedly and there were marked reductions in the vPI. Importance of the Conclusions: We conclude that the vPI is less affected by changes in color gain than the VI and VFI at ‘no noise’ gains. PD.05.002 Assessing the Repeatability of 3D Doppler Indices Obtained by Static 3D and Stic Power Doppler: A Combined In Vitro/In Vivo Flow Phantom Study A. H. Miyague, N. J. Rainne-Fenning, L. T. Polanski, L. H. Martinez, E. A. Junior, T. Z. Pavan, W. P. Martins Departamento De Ginecologia E Obstetrıcia Do Hospital Das Clınicas Da Faculdade De Medicina De Ribeir~ao Preto, Universidade De S~ao Paulo (Fmrp-Usp). Ribeir~ao Preto, SP, Brasil Brief Description of the Purpose of the Study: To compare the variability of vascularization flow index (VFI) related to serial acquisitions between spatio-temporal image correlation (STIC) and conventional static three-dimensional (3D) power Doppler (PD), using both an in vitro and an in vivo models. And to evaluate whether the curves from VFI values obtained in a STIC dataset are visually stable and resemble the spectral Doppler waveforms. Methods: Two models were analyzed: a flow phantom (in vitro model) and a common carotid artery (in vivo model). VFI values were assessed from 0.38 cm3 spherical samples of main flow region of the static 3D datasets and from every ‘frame’ of STIC datasets. The variance of the minimum, mean, and maximum VFI values were compared between STIC and static 3D datasets. Main Results: We observed significant reduction in the variance of VFI values obtained in STIC compared to static datasets. The curves of VFI values obtained across the frames contained in the STIC are stable across different datasets and resemble the spectral Doppler waveforms. Importance of the Conclusions: 3DPD indices derived from STIC are more stable than those obtained from conventional static 3DPD datasets. Curves of VFI throughout a reconstituted cardiac cycle using STIC are repeatable and resemble those obtained from spectral Doppler analysis of the vessel.

Introduction: Ultrasonography in the evaluation of chest is useful to study pleura, pulmonary parenchyma and chest wall diseases, as well as to interpretate, locate and identify the nature of opacities seen in chest radiography and computed tomography. Methods Involved: Various applications of ultrasound in the thorax will be presented, using, whenever necessary, correlation with different imaging methods (radiography/tomography). Discussion: Ultrasound has been particularly used at bedside in intensive care unit patients, where radiography can either mimic or mask clinical significant abnormalities, and in differentiating pleural or parenchymal abnormalities. It is routinely used in the classification of pleural effusions in order to establish the differential diagnosis and to guide interventions, biopsies and thoracic drainage. The exam also contributes to the analysis of signs of tumor invasion through the study of pleural mobility, providing real-time information. Conclusion of the Presentation: The main advantages of the use of ultrasound in the chest study can be summarized as it follows: non-ionizing method, fast procedure, dynamic study, widely available, portable, allowing use at bedside, in emergency rooms or advanced care units. PD.05.004 Beam Profile of High-Frequency Transducers for Breast Sonography A. Kawamoto, Y. Aoki, K. Ishi Tokyo Medical University Hospital, Shinjyuku, Tokyo, Japan Brief Description of the Purpose of the Study: The purpose of this exhibit is : 1. To knowledge the beam profile of high-frequency transducers for breast sonography. 2. To understand optimal zone of the high-frequency transducers from the beam profile. Methods: A special phantom model 538N is used to measure the depth where the elevation focus is located (ATS, USA). The following evaluation according to Skolnick methods (Radiology 180; 1991) for some ultrasound transducers - Slice thickness (elevation plane) - Elevation focal point - Comparison with beam profile (frequency, harmonic image, and compound image) - Estimate optimal zone for various highfrequency transducers Main Results: Elevation focal point showed a range of from 1 to 3 cm. Beam profiles described various pattern. Importance of the Conclusions: 1. The excellent depth is various though the spatial resolution improbes by the frequency high. 2. It is important to know the beam profile in the direction of acoustic lens of use transducers. PD.05.005 US-Guided Joint Approach for Diagnostic or Therapeutic Purposes S. Lee, S. Y. Song, Y. Kim, T. H. Kim Hanyang University Hospital College of Medicine, Seoul, Korea Introduction: Benefits of US Guided Joint Aspiration 1. To patientdetermine if joint fluid is really present to avoid traumatic, unnecessary aspiration attempt-detect other fluid collections such as bursitis, and soft tissue abscess to avoid septic inoculation-without radiation hazard 2. To radiologist - Expand hands-on skills and radiologists’ role Methods Involved: Step approach with US 1. Position - Relaxed as possible 2. US examination of affected body area - Localize joint under

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ultrasound 3. Identify effusion - Confirm the expected findings - Identify the most adequate path 4. Aspirate using sterile technique Skin prep, draping, anesthesia, visualization, puncture and aspiration Discussion: In daily practice, diagnostic or therapeutic joint approaches are carried out under ultrasonographic guidance because of several advantages. Accurate knowledge of variable joint anatomies and entry sites makes patients comfortable. We will describe the appropriate positioning and various sonographic approaches for variable joints with some technical tips. Conclusion of the Presentation: 1. US guided joint aspiration offers several advantages over the blind aspiration. 2. Knowing appropriate positioning, and entry sites, the beginners and non-experts can easily approach variable joints.

Volume 39, Number 5S, 2013 Main Results: After analysing the results there was a significant discrepancy regarding the number of hours in the theoretical and practical lessons in ultrasound. For this reason, it is understood that the majority of countries noticed that the Radiographers do not perform some types of diagnostic exam. Importance of the Conclusions: The Radiographers’ skills, in ultrasound, differ according to the country and the basic formations. Therefore, it is necessary to invest on a certified training and an internationally recognized career.

6 - Ultrasound in Emergencies PD.06.001

PD.05.006 Intra- and Interobserver Reliability of Phantom Image Evaluation of Ultrasound Using a Standardized Phantom J. I. Choi, J. Y. Byun, M. Y. Park, S. Lee, S. E. Jung Department of Radiology, Seoul St. Mary’s Hospital, Seoul, Republic of Korea Brief Description of the Purpose of the Study: To evaluate intra- and interobserver agreement of phantom image evaluation of ultrasound using a standardized phantom Methods: Three radiologists (a resident, two board-certified radiologists of 2-year and 7-year experience in evaluating ultrasound phantom images, respectively) evaluate the gray scale test for ultrasound machine using a standardized phantom. They scored the number of visible cylindrical structures of varying degree of brightness and decided ‘‘pass or fail’’. First, they scored 49 phantom images from 2010 survey with the brief knowledge for phantom images twice. After then, radiologists underwent an hour of interactive education for the phantom images and scored another 91 phantom images from 2011 survey twice. Intra- and interobserver agreement before and after the interactive education session were analyzed using kappa analyses. Main Results: Before education, kappa values for intraobserver agreement for 7-year experienced, 2-year experienced radiologists and a resident were 0.386, 0.469, 0.465, respectively. After education, kappa values were improved (0.823, 0.611, 0.711). For interobserver agreement, kappa values were also better after the education (0.067, 0.002, 0.547 before education and 0.635, 0.667, 0.616 after education). Importance of the Conclusions: Intra- and interobserver agreement of the results of gray scale could be improved by the interactive education session. PD.05.007 The Role of Radiographer in Sonography at International Level R. Santos, G. Paulo, D. Bento, S. Gomes Instituto Politecnico De Coimbra-Escola Superior De Tecnologia Da Saude De Coimbra, Coimbra, Portugal Brief Description of the Purpose of the Study: Currently, ultrasound is a diagnostic exam performed by various health professionals. The Radiographers, based on their training, also have some knowledge on this area, acquiring skills in order to perform such exams. However, several factors preclude their professional activities, including legislation that exists in that country or the lack of authority to certify the skills of Radiographers. The aim is to know if the basic training in Radiography is suitable for performing ultrasound and if health authorities are able to certify these professionals. Methods: An enquiry was created on an online survey with several questions concerning the qualifications and tasks of Radiographers. It was answered by representatives of associations and trade unions from 10countries of the European Union, and subsequently was taken a strategy of critical evaluation.

Ensaio Iconografico: Diagnostico Diferencial Da Dor Em Fossa ^ Ilıaca Direita, Com Enfase Na Correlac¸~ao US E CT L. D. R. Francisco, D. C. Grassi, V. F. L. Ferreira, M. A. Hirose, F. M. P. Abdo, F. M. Lote, R. Pinho, V. B. Porcionato, M. T. Passos, M. F. Francisco Neto, P. Boarini, L. R. Boarini Transduson, Carapcuiba, Sao Paulo, Rasil Introduction: Acute abdominal pain in the right lower abdomen, in daily clinical practice, represents a diagnostic and therapeutic challenge to the internist. The methods of image plays a central role in this scenario. Methods Involved: Illustrative cases will be presented with acute abdominal pain in the right lower abdomen, with different diagnosis: acute appendicitis, intussusception, mesenteric adenitis, calculus in JUV and JUP, hemorrhagic cyst, ectopic pregnancy and differentials, which were addressed both as ultrasound and computer tomography. Discussion: The pain in the right lower abdomen have clinical findings that are comparable to many conditions and early diagnosis can be difficult. Ultrasound examination has been initially used to deal this condition, and the method used in CT Imaging approach in situations of differential diagnosis difficult. Conclusion of the Presentation: The pain in the right lower abdomen is a very common clinical emergency and with wide range of differential diagnosis. The use of imaging methods synergistically in this condition, permits the implementation of differential diagnosis of safe and reproducible manner and should be dominated by radiologist. PD.06.002 Differentiation of Acute Perforated From Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography G. C. Choi Department of Radiology, Soonchunhyang University Gumi Hospital, Gumi, Gyeong-Buk, Korea Brief Description of the Purpose of the Study: To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis Methods: The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter . 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. Main Results: All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p , 0.001). The sensitivity of circumferential loss of the echogenic

Abstracts submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter .10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. Importance of the Conclusions: High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis. PD.06.003 Sonographic Findings in Patients With Acute Scrotal Pain Y. Y. Jung Eulji Hospital, Eulji University School of Medicine, Seoul, Repulic of Korea Introduction: Ultrasonography (US) is the primary imaging modality for the diagnosis of scrotal diseases. The acute scrotum is a common in emergency departments. Therefore, US evaluation of the acute scrotum is common in clinical practice. Methods Involved: I provides a sonographic findings of conditions causing acute scrotal pain and a brief review of diseases. Discussion: In some conditions, such as testicular torsion or rupture must be surgically corrected immediately. Therefore, understanding the sonographic findings of conditions causing acute scrotal pain is important. Conclusion of the Presentation: Understanding the sonographic features of diseases causing acute scrotal pain helps to accurate diagnosis and proper treatment. PD.06.004 Linfoma De Parede Abdominal Na Emerg^encia: Caracterizac¸~ao Ultrassonogr afica E Diferenciais A. Rahal, Jr. R. Gobbo, C. N. Baldoni, G. Mariotti, P. R. Silverio, M. J. Franscisco Neto Hospital Israelita Albert Einstein Brief Description of the Purpose of the Report: The aim is to describe a case of abdominal wall linfoma in patient with colecistites hipotesis. Medical History: Female, 89 years with abdominal pain. Diagnosis: Linfoma. Discussion and Summary of the Case: It’s most important not limitate only take the protocol of ultrasound exam. PD.06.005 Spontaneous Hematoma of the Rectus Abdominis Muscle - Ultrasound Diagnosis P. M. V. Franca, B. F. C. Cesario, A. C. Barros, G. M. T. Soares, R. A. P. Silva, R. Figueiredo, J. P. K. Matushita Hospital Das Clınicas Da Universidade Federal De Minas Gerais, Belo Horizonte, MG, Brasil Brief Description of the Purpose of the Report: Spontaneous hematoma of the rectus abdominis muscle is the accumulation of blood inside the abdominal rectus sheath as a consequence of rupture of the epigastric vessels. It could be mistaken for other abdominal diseases, because of its clinical presentation. Medical History: Female, 61 years old, presented at the emergency department with acute coronary syndrome, submitted to angioplasty followed by antiplaquetary drugs. She improved clinically, except for persistent cough. After 20 days, she complained of abdominal pain, associated with hypotension and tachycardia. Ultrasound showed a large heterogeneous fluid collection localized inside the belly of the left abdominal rectus muscle. Diagnosis: Spontaneous hematoma of the rectus abdominis muscle.

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Discussion and Summary of the Case: The spontaneous hematoma of the abdominal rectus muscle is considered a rare pathology, more common among women and associated with the use of anticoagulation drugs, vomits, cough and physical activity. The clinical presentation is acute abdominal pain with tachycardia, hypotension, echymosis of the abdominal wall and palpable mass. The use of image is important for the differential diagnosis with other acute abdominal conditions. Ultrasound diagnosis is feasible and desirable due to availability and lack of radiation, with a sensibility around 71%, allowing a quick and accurate evaluation of size and localization of the hematoma. PD.06.006 Ultrassonografia - Principais Armadilhas Que Devem Ser Conhecidas No Exame Abdominal De Urg^encia L. D. R. Francisco, D. C. Grassi, V. F. L. Ferreira, M. A. Hirose, F. M. P. Abdo, F. M. Lote, R. Pinho, V. B. Porcionato, M. T. Passos, M. J. Francisco Neto, P. Boarini, L. R. Boarini Transduson, Carapicuiba, Sao Paulo, Brasil Introduction: Ultrasound examination has its importance increasingly pronounced in the current scenario, particularly in emergency medicine and should be known to the examiner the main pitfalls. Methods Involved: Analysis of Abdominal Ultrasound studies performed in our department, focusing on core abdominal pitfalls of urgency. Discussion: The main pitfalls of emergency abdominal examination, detailed didactic way, allowing a critical analysis of the main points of error and how to avoid them will be discussed. Conclusion of the Presentation: The ultrasound examination is essential in emergency medicine and internal medicine in diseases of the abdomen, thus knowledge of their traps this situation represents a fundamental tool for the examiner know to avoid them.

7 - Ultrasound in Gynecology PA.07.008 Sonographic Appearance of Krukenberg Tumors. Report of a Case J. J. Serrano, S. Garcia-Herreros, M. Romero, R. Moncayo Ecomedica, Quito, Ecuador Brief Description of the Purpose of the Report: To discuss ultrasound findings and color Doppler examination in a case of Krukenberg tumor secondary to gastric carcinoma. Medical History: A 67 year-old patient, G2002 presented for a postabdominal wall reconstruction ultrasound control. In January 2008, gastric carcinoma was detected for which the patient underwent subtotal gastrectomy and lymphadenectomy. Histopathology confirmed a stage IIA gastric adenocarcinoma, for which combined radiation and chemotherapy were offered to the patient, but she refused to receive it. Since then, clinical follow-up every 6 months with computed tomography (CT) + endoscopy were perfomed In July 2012, a control CT scan showed a 6cm tumor on the anterior abdominal wall, which was removed and abdominal wall reconstruction was performed. Diagnosis: Bilateral, pure solid, encapsulated and hyperechoic smooth masses, surrounded by an hypoechoic ring with clear tumor margins were observed on both ovaries. Abundant vascularization was detected, with a characteristic tree-shaped structure penetrating from the periphery of the lesion. Velocity measurement showed the low impedance of intratumoral circulation, with a diminished vascular resistance (IR 5 0.4). Discussion and Summary of the Case: Krukenberg tumors are the presence of any metastasis to the ovaries. Gastric cancer has been

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reported as the most frequent primary source responsible for 70% of them. More than 80% of cases of krukenberg tumors are bilateral, encapsulated and are typically solid and firm with various shapes. The echo structure of the ovarian masses are usually hyperechoic, with abundant vascularization and low impedance of intratumoral circulation due to active angiogenesis of these tumors. Krukenberg tumors have a poor prognosis, Webb et al reported an overall 5 year survival rate of 5.4% when stomach is the primary site of disease. PA.07.009 Degenerac¸~ ao Lipomatosa De Grande Leiomioma Subseroso Simulando Tumorac¸~ ao Anexial. Correlac¸~ao Da Ecografia Com An alise Doppler Colorido E De Amplitude Com Tomografia Computadorizada A. C. Ferreira, R. M. Ferlin, K. B. Alcantara, A. J. Reis Neto, J. F. Jord~ ao, R. C. S. Faria Instituto De Diagnostico Por Imagem, Hospital Santa Casa Ribeirao Preto, SP, Brasil Brief Description of the Purpose of the Report: We report a case of giant leiomyoma with lipomatous degeneration adjacent to the left ovary, simulating adnexal mass. Correlating to color Doppler and computed tomography (CT) of the abdomen. Medical History: Female patient, 53 years old, with left flank pain for a month. Physical examination, pelvic mass in the left flank, parenchymal consistency and smooth surface with large pain with palpation. Abdominal ultrasound was performed, which distinguished hyperechoic mass, located in the mentioned area, with no posterior acoustic phenomena and flow to Doppler. It was impossible to have a differential diagnosis between uterine or ovarian pathology. Located in the middle third of the posterior wall with a volume of 800 cm3. Afterwards, a CT of the abdomen was performed showing an enlarged uterus, expansive uterine subserosal image with fat density, showing fibrous septum, measuring 9.5 3 7.2 cm. Diagnosis: Degenerative leiomyoma. Discussion and Summary of the Case: The leiomyoma is the most common uterine tumor. Symptoms depend on the position, size and number of these tumors, the most common being the submucous. Calcification is presented with hyperechoic areas. In cystic hyaline degeneration areas are observed anechogenic. Even rarer is the lipomatous in which completely hyperechoic nodules are found due to the predominance of fatty tissue inside. PA.07.011 Sındrome De Ohvira: Correlac¸~ao Da Ecografia Tridimensional Com Resson^ ancia Magnetica: Import^ancia Do Seguimento Apos ao Cir urgica. Relato De Caso E Revis~ao Da Literatura Intervenc¸~ A. C. Ferreira, K. B. Alcantara, R. D. Ishihara, A. J. Reis Neto, J. F. Jord~ ao, R. C. S. Faria Instituto De Diagnostico Por Imagem, Hospital Santa Casa Ribeirao Preto, SP, Brasil Brief Description of the Purpose of the Report: Case report of Ohvira syndrome (OS) with their radiological aspects and clinical repercussions. Medical History: Female patient, nuligest, 13 years old, was admitted with abdominal cramping pain in the right iliac fossa for 1 year, associated with menarche. She denied having changes in menstrual cycle and urinary and gastrointestinal tracts. During physical examination she revealed pain on palpation of the right iliac fossa without abrupt decompression. In pelvic ultrasound examination, the right kidney was not visualized in its usual setting, nor elsewhere in the abdomen; uterus didelphic with body, cervix, and left adnexal region and vagina unchanged; body, cervix and right fallopian tube dilated, containing echogenic fluid inside which might consist of blood and / or pus; right

Volume 39, Number 5S, 2013 vagina not thick. Magnetic resonance imaging of the pelvis confirmed the hypothesis SO. The patient underwent a vaginoplasty to relieve the obstruction. Diagnosis: Erlyn Werner Syndrome or Syndrome Ohvira (SO). Discussion and Summary of the Case: Ohvira syndrome patients may present serious complications due to delayed diagnosis. Postoperative evaluation must be systematic because, as in the reported case, there is possibility of disease progression to acute intestinal bleeding and other complications. PD.07.001 US Findings of Exophytic Uterine Lipoleiomyoma J. C. Kim Chungnam National University Hospital, Daejeon, Korea Brief Description of the Purpose of the Study: To demonstrate ultrasonographic (US) findings of exophytic uterine lipoleiomyoma, a rare benign mesenchymal uterine neoplasm. Methods: US findings of five cases of pathologically proven exophytic uterine lipoleiomyoma were retrospectively analyzed in terms of the size, location, homogeneity, echogenecity, posterior sonic attenuation, hypoechoic ring or rind, encapsulation, associated uterine leiomyoma, etc. Main Results: All patients with exophytic uterine lipoleiomyoma were postmenopausal women. Their age ranges from 62 to 77 (mean: 66) years. The largest diameter of exophytic uterine lipoleiomyoma ranges from 4.7 cm to 10.0 cm (mean: 6.5 cm). Their location were uterine corpus (n53), right uterine cornua (n51), and uterine fundus (n51); intramural (n54) and subserosal/intraligamentary (n51). On US (n54), all were encapsulated, and heterogeneously hyperechoic with hypoechoic rim and posterior acoustic shadowing. One case is associated with ordinary uterine small leiomyoma. Due to the exophytic nature of uterine lipoleiomyoma, this fatty tumor mimicked ovarian teratoma on the US in two cases. Importance of the Conclusions: Sometimes, it may be difficult to differentiate a hyperechoic exophytic uterine lipoleiomyoma with hypoechoic rim from the much more common ovarian cystic teratoma on US. Multiplanar imaging of CT and MR imaging may help to determine the uterine origin of this encapsulated fat-containing pelvic mass especially in postmenopausal women. PD.07.002  Gestac¸a~o Topica Em Utero Didelfo, Associada a Agenesia Renal Materna F. L. Pereira, A. P. Bolinelli, B. D. Santana, A. O. Neto Hospital Estadual Vila Alpina, Seconci-SP, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Report: The purpose of this case is to demonstrate a spontaneous and topic pregnancy in a didelphic uterus, highlighting the importance of complementary evaluationof the urinary tract. Medical History: Patient with 30 years, gravida 2, para 0, abortion 1, complaining of vaginal bleeding and pelvic pain for 3 days. The medical history of the patient only demonstrated a spontaneous miscarriage 2 years ago. The gynecological and obstetric examination was normal. The transvaginal ultrasonography demonstrated two separate uterus, two impervious cervices with no intravaginal septum and topical viable pregnancy in the right uterus with estimated date of 8 weeks. The evaluation of the left uterus demonstrated endometrial thickening compatible with secretory phase of the menstrual cycle. We extended our ultrasound exam into the abdominal cavity and diagnosed right renal agenesis with left vicarious kidney. After the first trimester, the urinary tract and the uterus imaging study was complemented with MRI. Diagnosis: Didelphic uterus with pregnancy on the right side; right kidney agenesis.

Abstracts Discussion and Summary of the Case: This case illustrates the importance of understanding the different types of uterine malformations and their possible comorbidities. The correct diagnosis is extremely important for the correct conduction of the prenatal and its complementary imaging study. PD.07.006 Avaliac¸~ ao Por Ultrassonografia Com Doppler E Por Resson^ ancia Magnetica De Produtos Retidos Da Gestac¸~ao Hipervascularizados: Um Desafio Para O Radiologista Y. C. Costa, M. A. Rocha, C. V. Pinto, R. H. Baroni, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einsten, S~ao Paulo/SP, Brasil Introduction: The presence of retained products of conception (RPOC) is an uncommon childbirth and abortion complication, whether spontaneous or induced. Its variable presentation makes diagnosis a challenge for radiologists. This pictorial essay illustrates three cases of RPOC which presented in the form of heterogeneous hypervascular formations. Methods Involved: Imaging findings of three cases of RPOC are described, evaluated by Doppler ultrasonography and magnetic resonance imaging. Discussion: Several studies have demonstrated the utility in using ultrasonograhpy to detect RPOC. Findings must be evaluated on B mode, such as endometrial thickness, presence of mass and its echogenicity, and for the presence of flow on Doppler mode. The RPOC may have variable presentation; endometrial hypervascularized formations must raise suspicion for arteriovenous malformation and trofoblastic gestational disease as possible differentials. Clinical and laboratory data are of great importance for the correct interpretation of imaging findings, which may be supplemented by magnetic resonance imaging (especially when arteriovenous malformation is suspected). Conclusion of the Presentation: Ultrasonography is a method of choice for initial assessment and monitoring of RPOC. Its diagnosis, however, may be hampered by the presence of subtle or indistinguishable findings from other uterine lesions. PD.07.007 Sındrome De Herlyn-Werner-Wunderlich: Relato De Caso N. S. Campozana, J. Johnsson, L. N. Silva, G. O. Perdizes, A. Q. P. Silva, L. P. Campozana Hospital S~ ao Camilo, S~ao Paulo, S~ao Paulo, Brasil Brief Description of the Purpose of the Report: The Herlyn-WernerWunderlich syndrome usually presents after menarche with progressive pelvic pain during menses secondary to haematocolpos. It consists of an important differential diagnosis in cases of dysmenorrhea, and should be properly treated before complications occur. Medical History: The authors report a case of a 17 year old girl, a virgin, complaining of pain in the left iliac fossa with 15 days of evolution, exacerbated in the last 48 hours. Menarche at age 12. A pelvic and gynecological ultrasound showed absence of the left kidney, voluminous heterogeneous echogenic and well defined mass at the level of the vagina, with fine echoes in suspension and maximum diameter of 8 cm, allowing posterior acoustic enhancement, suggesting liquid nature, plus two uterine cavities. Diagnosis: Ultrasonography is the modality of choice for initial evaluation of suspected M€ullerian malformations. Magnetic Resonance Imaging is the preferred method for the delineation of these uterine malformations. Discussion and Summary of the Case: The Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly characterized by didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis. Due to the close relationship between the development of the urinary and repro-

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ductive systems, renal malformations should be investigated in patients with M€ullerian anomalies and vice versa. PD.07.008 Linfoma De Colo Uterino: Relato De Caso E Revis~ao De Literatura C. B. Silva, A. G. V. Bitencourt, G. G. Mendes, M. R. B. Poli, G. C. L. Machado-Porto, L. Graziano Hospital AC Camargo, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Report: Report a case of uterine cervix lymphoma (NHL), its ultrasonographic aspects, correlation with magnetic resonance and review of literature. Medical History: Female, 35 years old, asymptomatic, in wich routine transvaginal ultrasonography revealed nodule on the cervix. Physical examination detected a bulging on the left lateral fornix and parametrial fixed mass. A previous history of non-Hodgkin lymphoma treated two years ago. Diagnosis: Transvaginal US showed hypoechoic nodule near the cervix, well delimited, with rich vascularity at Doppler. Magnetic resonance (MR) imaging of pelvis revealed a cervical mass, isointense to uterine muscle on T1 and T2 weighted images and low signal in Gadoliniumenhanced MR images. A transvaginal ultrasound guided core needle biopsy was performed, and cervical uterine lymphoma infiltration confirmed diagnosis. Discussion and Summary of the Case: Although cervical lymphoma is rare, comprising less than 1% of cervical malignancies, it should be considered. Diffuse uterine cervical enlargement is the most common appearance. Less commonly, there may be a polypoidal or multinodular mass or a submucosal mass mimicking leiomyoma. CT or MR is required for staging the extent of disease, and to determinate the precise histological subtype by biopsy for treatment and prognostic purposes. Even if underused, transvaginal US-guided procedures are simple, safe and can be performed quickly and inexpensively. PD.07.009 Sonographic Markers of Pelvic Inflammatory Disease A. R. Pastore, L. T. M. Rios, R. V. B. Oliveira, M. G. Martins, L. C. L. Rios, J. M. S. Nascimento, O. M. R. Leit~ao Universidade De S~ao Paulo - USP, S~ao Paulo, SP; Universidade Federal Do Maranh~ao - UFMA, S~ao Luıs, MA Introduction: Pelvic inflammatory disease (PID) is one of the most common causes of pelvic pain in sexually active women. The diagnosis is usually based on clinical and laboratory findings. However, due to the vague and nonspecific symptoms, the diagnosis may be incorrect in about 35% of women with clinically suspected PID. Methods Involved: The cases were selected retrospectively from the personal archive of the authors, IPD cases with ultrasound images characteristics of the disease in order to illustrate the markers of the disease, ovarian tube. Discussion: When there is a clinical diagnostic setting, in the serious cases and the lack of response to initial drug therapy, ultrasound is indicated. The ultrasonographic findings depend on the severity of infection. The sonographic appearance of tubal inflammatory disease is typical and reproducible, allowing the use of ultrasonography (USG) in the diagnosis of PID optimization, providing an installation of appropriate therapy as early as possible in an attempt to decrease the incidence of irreversible consequences. Conclusion of the Presentation: Ultrasonography is an investigative method of paramount importance in the treatment of PID control, enabling change therapy according to the imaging results. The vaginal exam is critical in detecting the degree of involvement of each pelvic organ.

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PD.07.010 Role of Antral Follicle Count Ultrasonography Through as a Predictor of Success Factor in Assisted Reproduction G. M. Silva, A. L. D. Diniz, T. T. Marcolini, L. C. Perillo, W. P. Pires, S. M. Pessoa, M. J. Cruvinel, K. M. Araujo Universidade Federal De Uberl^andia-Ufu, Uberl^andia, Minas Gerais, Brasil E Fecunda-Clınica De Reproduc¸~ao Humana Brief Description of the Purpose of the Study: Identify follicle antral count (FAC) to transvaginal ultrasound is a predictor of response pattern in cycles with controlled ovarian hyperstimulation for intracytoplasmic sperm injection. Methods: Retrospective study of 200 patients analytical undergoing assisted reproduction techniques. Included are women with an indication for IVF and FSH ,10 mIU / ml on the second day of the cycle. The patients wore GnRH antagonist and underwent transvaginal ultrasound with CFA (between 2 and 8 mm). Held oocyte retrieval and transfer of embryos. Statistics: Spearman correlation coefficient and p , 0.05. Main Results: We analyzed 166 patients with a mean age of 32.4 6 5.6 years. Considering the FAC as the main variable, there was a significant positive correlation with the number of oocytes (cs 5 0.47, p , 0.01) and the number of embryos formed (cs 5 0.40, p , 0, 01). The variable age was inversely related to CFA (cs 5 -0.51), with the number of o oocitos (cs 5 -0.43) and the number of embryos (cs 5 -0.37), with a significance level 1%. Importance of the Conclusions: It was found that the higher the FAC, the greater the number of oocytes and embryos formed. Regarding age, the older, less number of follicles, oocytes and embryos. PD.07.011 Achados N~ ao Ginecologicos Do Ultrassom Transvaginal A. P. C. Moura, L. A. A. Nogueira Fleury Medicina E Saude, S~ao Paulo, SP, Brasil Introduction: Transvaginal sonography is the method of choise for the first evaluation of internal gynecologic organs. Its good spatial resolution, low cost and wide availability makes it a good complement for the gynecological examination. The main objective of this pictoral essay is to demonstrate that sonographists must be alert for pathologies that affects other non gynecolgical organs such as urinary bladder, ureteres, rectum, sigmoid colon and others pelvic structures. Methods Involved: Transvaginal sonography (TVS). Discussion: Acute or chronic pelvic pain is an extremely frequent symptom. Non gynecologic causes must be considered. Showing some interesting well documented cases such as ureter calculi, diverticulitis, intestinal polyp and a neural tumor the importance of examining others non gynecological pelvic structures not only the uterus and the ovaries will be demostrated. Conclusion of the Presentation: Sonographist must be careful and familiarezed of non gynecological pelvic pathologies. PD.07.012 Desmistificando O Exame Para a Pesquisa De Endometriose Profunda - Abordagem Em 5 Passos Para N~ao Especialistas A. P. C. Moura, L. A. A. Nogueira Fleury Medicina E Saude Introduction: Deep infiltrative endometriosis (DIE) is a high prevalence disease that affects 10 to 15% of women in reproductive age. Pelvic pain and infertility are the main symptoms related to the disease. Transvaginal sonography with bowel preparation performed by specialized professionals and magnetic ressonance imaging are larged accepted by current literature to map deep lesions and to plan cirurgical approach by a multidisciplinary team. The aim of this study is to allow the non specialized

Volume 39, Number 5S, 2013 sonographist, recognize suspected lesions of DIE during routinely sonography and refer this patients for other specific examinations. Methods Involved: Transvaginal sonography (TVS). Discussion: Delay in the diagnosis of DIE is frequent and explained by little knowledge of lesions characteristics, few specialists and a high prevalence disease. Through 5 simple steps (think about the disease, lesion characteristics, sites frequently affected, pitfalls and differencial diagnosis) we will demontrate with well illustrated cases, how easy it can be. Conclusion of the Presentation: The identification of DIE lesions by non specialists during routinely TVS without bowel preparion is possible and should be spread in our entourage. PD.07.013 Desmistificando O Exame Para a Pesquisa De Endometriose Profunda - Abordagem Em 5 Passos Para N~ao Especialistas A. P. C. Moura, L. A. A. Nogueira Fleury Medicina E Saude Introduction: Deep infiltrative endometriosis (DIE) is a high prevalence disease that affects 10 to 15% of women in reproductive age. Pelvic pain and infertility are the main symptoms related to the disease. Transvaginal sonography with bowel preparation performed by specialized professionals and magnetic ressonance imaging are larged accepted by current literature to map deep lesions and to plan cirurgical approach by a multidisciplinary team. The aim of this study is to allow the non specialized sonographist, recognize suspected lesions of DIE during routinely sonography and refer this patients for other specific examinations. Methods Involved: Transvaginal sonography (TVS). Discussion: Delay in the diagnosis of DIE is frequent and explained by little knowledge of lesions characteristics, few specialists and a high prevalence disease. Through 5 simple steps (think about the disease, lesion characteristics, sites frequently affected, pitfalls and differencial diagnosis) we will demontrate with well illustrated cases, how easy it can be. Conclusion of the Presentation: The identification of DIE lesions by non specialists during routinely TVS without bowel preparion is possible and should be spread in our entourage. TL.07.002 Use of Gaseous Spring Water for Tubal Patency Test M. Hasan Institute of Ultrasound Imaging Karachi Sindh Pakistan Brief Description of the Purpose of the Study: The purpose of this study was to try Gaseous Spring water as an alternate contrast agent in Tubal Patency test which would be easily available and to reduce the cost of the procedure. Methods: This technique is common to all procedures, regardless of the contrast agent chosen. A balloon catheter is preferred as it is less likely to dislodge and creates a better seal at the internal cervical os. Following the insertion of the catheter, the speculum is removed and the transvaginal ultrasound probe reinserted. Under Ultrasound control about 5-10 CC of echo-enhancing agent ie gaseous spring water is inserted very slowly so that Micro Air bubbles are not destroyed. Tubal patency was assessed by direct imaging of micro air bubbles at the Cornual end and by seeing the bubble constantly moving at the Cornual ean of 5 to 10 seconds to made the diagnosis of patent tube. Main Results: Out of 360 patients examined by gaseous spring water 288 patients i.e. 80% were found to have bilateral Patent Tubes. Importance of the Conclusions: The Tubal Patency assessment with gaseous spring water was found to be cost effective, safe, easily available and less time consuming then HSG. It is recommended that spring water should be used to check tubal patency in sub fertile women.

Abstracts TL.07.004 Role of Hysterosalpingosonography in Diagnosing Pyosalpinx M. Hasan Institute of Ultrasound Imaging Karachi Sindh Pakistan Brief Description of the Purpose of the Study: The purpose of the study was to distinguish hydrosalpinx/pyosalpinx from other adnexal masses by hysterosalpingosonography(HSS) using spring water. Methods: Here we report a case of 30 years old female who presented with complains of secondary infertility, previous two ultrasounds done showed endometriotic cyst/ T.O. mass. Since she had secondary infertility the gynaecologist wanted to know the status of her tubes hence advised tubal patency test. On ultrasound we found a complex mass on left side predominantly cystic with internal echoes and some solid tissue at the periphery measuring 9.0 x 8.0 cms. She was than subjected to HSS(hysterosalpingosonography) with spring water(a new technique) for testing her tubal patency. Main Results: HSS was done using spring water for testing her tubal patency and comet tail artifact of spring water were seen spurting out into the mass from the interstitial end of uterus confirming the diagnosis of pyosalpinx. This was further confirmed on laproscopy. Importance of the Conclusions: Paper will highlight the entire procedure recorded on videotape at our centre and will show the moving micro air bubbles into the adnexal mass(pyosalpinx) which was initially thought to be endometriotic cyst/ T.O. mass.

8 - Ultrasound Guided Intervention PA.08.003 Ultrasound Guided Procedures: PCD,PTBC,Central Line and Chmoport; 584 Patients D. H. Hwang, W. Y. Yoo, I. W. Kang, S. J. Min, Y. M. Han Dongtan Sacred Heart Hospital, Hallym Univeristy, Seoul, Republic of Korea Brief Description of the Purpose of the Study: Recognizing the increasing importance of ultrasonography in the evaluation and management of patients across a range of medical disciplines, this guide provides illustrative instruction on the performance and interpretation of ultrasound examinations in emergency, critical care, hospital, and outpatient settings. Methods: We evaluated 584 patients (age mean 61.14, range 1-88 years, M:F 5365:219) who underwent ultrasonoguied procedures between January 2007 and December 2012. The procedures are PCD (n5257), PTBD (n5210), central line(n588), and Chemoport (n529). Main Results: The procedural initial success rate was 99%. Punture failed in 6 cases. There were total occlusion in jugular vein, Previous many procedures and occlusion in jugular vein. We changed another site. We could punutured another site. Actually, Secondary sucess rate was 100 %. Importance of the Conclusions: Ultrasound guided procedures: PCD, PTBD, Central line and Chemoport are very safe and high sucess rate. Ultrasound is very useful and important tool for interventional procedures; PCD, PTBD central lina and Chemoport. PA.08.005 Bi opsia Percut^ anea De Les~ao Pulmonar Guiada Por Imagem: A Ultrassonografia Pode Ser Uma Ferramenta De Grande Valor B. L. Moreira, A. D. Oliveira, M. D. Guimar~aes, M. J. S. Maciel, A. G. V. Bitencourt, R. Chojniak Hospital A.C. Camargo (Fundac¸~ao Ant^onio Prudente), S~ao Paulo (SP), Brasil Brief Description of the Purpose of the Report: We report a case in which ultrasound was used properly for percutaneous biopsy of lung

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lesion. Literature review on the subject was conducted, aiming to show that the ultrasound can be a safe, cheap, fast and effective alternative method to computed tomography in appropriate cases. Medical History: Male patient, 80 years old, with a history of prostate adenocarcinoma and squamous cell carcinoma of larynx, presented on thorax CT scan solid lung lesion of approximately 36 mm in the right lower lobe. As it was peripheral and had pleural contact, with no air interposed between lesion and transducer, ultrasound was used to guide biopsy by an oblique approach, with real-time visualization of hypoechoic lesion. There were no pneumothorax or other complications. Diagnosis: Pulmonary metastasis of laryngeal carcinoma. Discussion and Summary of the Case: From this case, we seek to exemplify how ultrasound can be useful for percutaneous biopsy of lung nodes / masses. There are advantages over CT in cases of peripheral lesions that touch the parietal pleura and are visualized in real-time method, requiring less patient cooperation. Minor procedure time, lower cost and lower complication rates are among the ultrasound positive aspects. PD.08.001 Effective Treatment of Hepatocellular Carcinoma Less Than 5.6 cm by Simultaneous Radiofrequency Ablation Plus Percutaneous Ethanol Injection J. D. Liang National Taiwan University Hospital, Taipei, Taiwan Brief Description of the Purpose of the Study: Hepatocellular carcinoma (HCC) of small size can be treated effectively by radiofrequency ablation (RFA), with decreased tumor ablation rates when tumor size enlarges. Percutaneous Ethanol injection (PEI) was suggested to increase the effectiveness of RFA. A retrospective analysis of HCC treated by simultaneous RFA plus PEI was performed. Methods: Between 2009 and 2011, 26 cases (18 males, 8 females) with 31 liver tumors between 2.5 and 5.6cm (mean 3.77cm) in size were treated by simultaneous RFA plus PEI. Computed tomography or magnetic resonance imaging and alpha-fetoprotein levels were used to evaluate the treatment efficacy Main Results: Complete tumor ablation was achieved in all cases with a single ablation session. No major complication occurred. Within a follow-up period of 4.6 to 28.5 months, intra-hepatic recurrence was found in 13/26 patients (50%). No local recurrence after treatment was noted. Twenty-two of twenty-six patients (84.6%) were still alive at the end of 2011. Importance of the Conclusions: With addition of PEI during RFA, HCC less than 5.6cm can be effectively ablated in a single ablation session. PD.08.002 Characteristics of Breast Neoplasms on Contrast-Enhanced Ultrasonography and its Clinical Value Q. Si, X. L. Qian, M. H. Zhang, S. X. Huang, Y. L. Huang Department of Ultrasound, the Pla 81st Hospital, Nanjing, China Brief Description of the Purpose of the Study: To investigate the characteristics of breast neoplasms on contrast-enhanced ultrasonography (CEUS) and its clinical value. Methods: Two hurdred and twenty-five patients with breast masses unable to be diagnosed by conventional ultrasonography were examined with CEUS. The characteristics of these masses on CEUS were analyzed and compared with the results of pathology examination. Main Results: The typical features of breast cancer on CEUS were enlarged maximum diameter of the lesions on CEUS compared to pre-contrast(p 0.05), irregular shapes, heterogeneous distribution of contrast enhancement with perfusion defect or local retention of contrast signals, tortuous, massive or penetrating vessels rapidly entering and

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exporting from the lesions. The sensitivity and specificity of specificity of local retention of contrast signals for breast cancer on CEUS were 93.4% and 92.5%, respectively. Importance of the Conclusions: It is valuable for CEUS in the diagnosis and differential diagnosis of breast neoplasms clinically. PD.08.003 Ultrasound Guided Intervention for the Management of Fat Necrosis in Autologous Fat Grafting for Mammoplasty S. H. Hung Taipei City Hospital, Taipei, Taiwan, R.O.C Introduction: Breast palpable indurations are a common complication after autologous fat grafting for augmentation mammoplasty. This side effect includes different composition of fat necrosis. Minimal invasive procedures are necessary to correct these adverse events after cosmetic surgery. Methods Involved: Patients who had breast lumps after fat grafting were evaluated by ultrasound. Under ultrasound guidance, a fine needle was used to aspirate the liquefied fat of the oil cysts. For the solid masses such as fat globules and sclerotic fat necrosis, vacuum-assisted core biopsy (VACB) was performed under ultrasound guidance to excise the abnormalities. Patients were followed up clinically and radiologically. Discussion: Oil cysts could be aspirated completely and rarely recurred. Fat globules were usually accompanied by liquefaction fat, but VACB allowed for the removal of both the solid and liquid components simultaneously. The outcome of such treatment was usually good. Sclerotic lesions were also resolved through VACB; however, perhaps due to their sclerotic nature, complete elimination of such lesions sometimes required a second round of treatment. Conclusion of the Presentation: This case report describes the successful use of an ultrasound guided intervention for treatment of fat necrosis after fat grafting mammoplasty. VACB can be a safe alternative to surgery in the treatment of FN in selected cases. PD.08.004 Complications of Interventional Ultrasound Baowei Dong Department of Interventional Ultrasonography, General Hospital of Pla, Beijing 100853, China Brief Description of the Purpose of the Review of Literature: This study aims to summarize the complications of interventional ultrasound. Description(s) Condition(s), Method(s) or Technique (s): This study summarized not only the incidence of complications of ultrasoundguided biopsy in the liver, kidney, thyroid, lymph node, but the microwave and radiofrequency ablation in liver neoplasms, including pain, bleeding, infection, seeding and nerve damage and so on, and furthermore to explore its causes and methods of prevention. In addition, this study provided a few cases caused serious consequences, even death, so as to draw profound lessons from them. Conclusion: As a minimally invasive yet accurate and efficient technology, interventional ultrasound has several advantages, such as broad indications, safety and fewer complications, which provides beneficial help for clinical diagnosis and treatment. Brief Discussion of the Case: Null PD.08.005 Punc¸~ ao Aspirativa Por Agulha Fina De Les~oes Da Cabec¸a E Pescoc¸o Dirigida Por Ultrassonografia: Experi^encia De 15 Anos ao Em Uma Instituic¸~ J. H. O. Godoy, J. C. F. Godoy, C. T. Soares, M. C. Lopes, U. Frederigue, Jr. Clınica Diagnosis, Bauru, SP, Brasil

Volume 39, Number 5S, 2013 Brief Description of the Purpose of the Study: To evaluate the diagnostic potential of the fine needle aspiration biopsy tecnique on head and neck lesions with ultrasound guidance. Methods: Retrospective study based upon ultrasound guided fine needle aspiration cytology reports bettween july/1995 and july/2011. Cytologic findings were categorized in organ origin, neoplastic or non-neoplastic, their sub-categories, and non conclusive or indeterminate samples. There was also a evalution of possible local or sistemic complications of the procedures. Main Results: The study reveals the main diagnosis among cervical nodes sent to be elucidated, with histopathologic correlation, as possible, when the initial situation required further investigative ou therapeutic procedure. Considers also some comments about the tecnique and specially the practice of a four handed work crew uniting radiologist and pathologist. Importance of the Conclusions: Fine needle aspiration tecnique ultrasound guided is a highly safe and a highly efficacious method to diagnose head and neck lesions. PD.08.006 Planning Ultrasound for Percutaneous Radiofrequency Ablation to Treat Small (# 3 cm) Hepatocellular Carcinomas Detected on CT or MRI: A Multicenter Prospective Study to Assess Factors Affecting Ultrasound Visibility D. Choi, P. Y. Kim, H. Rhim Samsung Medical Center, Seoul, Korea Brief Description of the Purpose of the Study: The purpose of this study was to assess factors affecting tumor visibility on planning ultrasound (US) for percutaneous radiofrequency ablation to treat small hepatocellular carcinomas (HCCs) primarily detected on CT or MRI. Methods: The patients referred for planning US for percutaneous radiofrequency ablation between September 2008 and June 2009 were prospectively enrolled from nine institutions in Korea. The first small (# 3 cm) single HCC or new single HCC after treatment was included. HCCs which were not visible on planning US were compared with visible HCCs with respect to tumor size, the distance between the tumor and the diaphragm, subcapsular location, etiology of liver disease, liver cirrhosis, macronodular cirrhosis on US, ascites, Child-Pugh class, serum alpha-fetoprotein level, body mass index, previous treatments for HCC, previous chemoembolizations for HCC, institutions, and experience of radiologists. Main Results: Among 898 HCCs, 671 (74.7%) were visible on the planning US. In multivariate analysis, tumor size, the distance between the tumor and the diaphragm, liver cirrhosis, and macronodular cirrhosis were statistically significant factors affecting US detection (each p , 0.05). Importance of the Conclusions: Smaller tumors, subphrenic location of the tumor, liver cirrhosis, and macronodular cirrhosis were independent predictors of non-visualized tumors on planning US.

PD.08.007 Comparison of Sonographic Findings With Pathologic Results After Percutaneous Biopsy in Patients With Liver Diseases L. R. A. Coelho, G. P. Coelho, F. F. Brusasco, T. G. Abud, D. G. Abud, L. G. Abud Documenta Centro Avanc¸ado De Diagnostico Por Imagem, Ribeir~ao Preto, SP, Brasil Brief Description of the Purpose of the Study: To compare the sonographic findings with pathologic results after percutaneous biopsy in patients with liver disease. Methods: Retrospective analysis of 40 patients with liver function abnormalities, characterized by ultrasonographic change (steatosis) or

Abstracts serology for hepatitis B or C who underwent liver biopsy with subsequent histopathologic evaluation, from September 2011 to September 2012. Main Results: 52.5% (21) of patients had both sonographic as histopathology findings. 14.3% (3) of them, were carriers of hepatitis C and 85.7% (18) had some degree of steatosis on ultrasound. Thirty-five percent (14) showed normal ultrasound and histopathology findings, being that 57.1% (8) had hepatitis C, 35.7% (5) hepatitis B and 7.1% (1) hemosiderosis. Five percent (2) had ultrasonographic findings but normal histopathology. Seven and a half percent (3) of the patients had normal ultrasound and histopathological study, and all of them were carriers of hepatitis B. Importance of the Conclusions: We observed a significant correlation between sonographic and histopathology findings, especially in patients with steatohepatitis. PD.08.008 Peritoneal Carcinomatosis: Diagnostic Value of Sonographically Guided Percutaneous Fine-Needle Aspiration N. M. G. Caserta, R. Bertanha, E. M. B. Pacheco Departamento De Radiologia Da Fcm-Unicamp, Campinas, SP, Brasil Brief Description of the Purpose of the Study: To evaluate the contribuition of percutaneous fine-needle aspirations (FNA) in establishing a definite diagnosis of peritoneal lesions. Methods: 24 patients investigated by aspirates obtained with Chiba needles, guided by sonography. These patients were considered likely to have peritoneal tumor on the basis of clinical and imaging findings. Further immunocytochemical analysis was eventually performed. Main Results: In 19 cases a cytologic diagnosis was obtained (18 carcinoma, 1 lymphoma). In 5 cases the aspirates were judged as insufficient for diagnosis. Surgical, laparoscopic or core-biopsy confirmation demonstraded 1 solitary fibrous tumor, 1 neuroendocrine tumor and 1 lymphoma. Two cases have no histologic confirmation. No complications were identified. Accurate cytologic diagnosis was achieved in 79% of cases. Importance of the Conclusions: Percutaneous FNA guided by sonography is a simple, safe and accurate technique for the diagnosis of suspected peritoneal lesions. This technique may provide the initial tissue diagnosis to guide treatment in most patients with peritoneal carcinomatosis. PD.08.010 Adenocarcinoma in Prostate Biopsy: Spectrum of Disease With Power Doppler Ultrasound and Pathologic Correlation A. C. Gomes, M. C. Chammas, G. G. Cerri, I. C. C. Pimentel,  J. D. Zavariz, M. J. A. D’Avila, R. G. Franca Inrad - Hospital Das Clınicas Da Fmusp, Sao Paulo, SP, Brasil Introduction: Our aim is to discuss and illustrate the sonographic spectrum of prostate Adenocarcinoma, reinforcing correlation between areas increased sign of power Doppler and Adenocarcinoma in Prostate biopsy and demonstrate imaging findings with corresponding histopatologic features, to achieve a better comprehension about the Prostate Biopsy. Methods Involved: Normal findings in Gray-scale and power Doppler transrectal US. Adenocarcinoma Prostate findings in Gray-scale and power Doppler transrectal US. Discussion: Showing imaging findings with corresponding histopatologic features. Discussion about between US-detected neovascularity, findings in Gray-scale and its association with Adenocarcinoma prostate in our experience and reported in literature. Conclusion of the Presentation: Provide an overview for radiologists to understand the possible findings in transrectal ultrasound of prostate

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adenocarcinoma. Demonstrate Power Doppler ultrasound as adjuvant approach in prostate biopsy and demonstrate the correlation wtih histopathological features. TL.08.008 Real Time Shear Waves Elastography Monitoring of Thermal Ablation: In Vivo Evaluation in Pig Livers A. Mariani, W. Kwiecinski, M. Pernot, D. Balvay, M. Tanter, O. Clement, C. A. Cuenod, F. Zinzindohoue Inserm, UMR 970, Paris Cardiovascular Research Center - PARCC, Universite Paris Descartes, Sorbonne Paris Cite, Paris, France Brief Description of the Purpose of the Study: To assess the feasibility and accuracy of ultrasound (US) shear waves elastography (SWE) for monitoring of thermal ablation and determine the elasticity threshold predictive of coagulation necrosis. Methods: 29 in vivo thermal lesions were performed in pigs’ livers with a bipolar radiofrequency system. Ultrasound SWE and Bmode images were acquired during the procedure. Liver elasticity was quantified by using SWE data and the Young’s modulus (in kPa). After the procedure, histopathologic analyses of the treated tissues were compared to the real-time US images. The sensitivity and positive predictive value (PPV) of the SWE maps were calculated and compared with the boundaries of the pathologic coagulation necrosis areas found. Main Results: The liver mean elasticity values before and after thermal therapy were 6.4 6 0.3 and 38.1 6 2.5 kPa, respectively (p,0.0001). For a threshold of 20 kPa, sensitivity (i.e., the rate of pixels correctly detected as necrosed tissue) was 0.8 and PPV (i.e., the rate of pixels in the elastographic map over 20 kPa that actually developed coagulation necrosis) was 0.83. Importance of the Conclusions: Coagulation necrosis is significantly stiffer than surrounding tissue and SWE permits real-time detection of coagulation necrosis. SWE could allow accurate real-time monitoring of US-guided thermal ablation.

TL.08.009 Ultrasound Guided Procedures: PCD, PTBC, Central Line and Chmoport; 584 Patients D. H. Hwang, W. Y. Yoo, I. W. Kang, S. J. Min, Y. M. Han Dongtan Sacred Heart Hospital, Hallym Univeristy, Seoul, Republic of Korea Brief Description of the Purpose of the Study: Recognizing the increasing importance of ultrasoundgraphy in the evaluation and management of patients across a range of medical disciplines, this guide provides illustrative instruction on the performance and interpretation of ultrasound examinations in emergency, critical care, hospital, and outpatient settings. Methods: We evaluated 584 patients (age mean 61.14, range 1-88 years, M:F 5 365:219) who underwent ultrasoundguied procedures between january 2007 and December 2012. The procedures are PCD (percutaneous Drainage) (n5257), PTBD (Percutaneous Transhepatic Biliary Drainage) (n5210), central line (n588), and Chemoport (n529). Main Results: The procedural initial success rate was 99%. Punture failed in 6 cases. There were total occlusion in jugular vein, Previous many procedures and occlusion in jugular vein. We changed another site. We could punutured another site. Actually, Secondary sucess rate was 100 %. Importance of the Conclusions: Ultrasound guided procedures: PCD, PTBD, Central line and Chemoport are very safe and high sucess rate. Ultrasound is very useful and important tool for interventional procedures; PCD, PTBD central lina and Chemoport.

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9 - Ultrasound in Breast PD.09.001 Various Causes of Male Breast Lumps: Pictorial Review With Pathologic Correlation Y. M. Park, J. S. Park, S. J. Lee Busan Paik Hospital, Inje University, Busan, South Korea Brief Description of the Purpose of the Report: The male breast is the source of a wide variety of benign and malignant conditions. Majority of breast lesions encountered in men are benign. Malignant breast lesions accounts for less than 1% of total male breast lesions. Differentiation between benign and malignant lesions is critical because it alleviates patient anxiety and avoids unnecessary procedures. In this exhibit, we illustrate various diseases presenting palpable lumps in the male breast and correlate with pathology. Medical History: Men with palpable lumps in the breasts underwent ultrasonography. Mammography, magnetic resonance imaging, computed tomography, or positron emission tomography was also performed as needed. All were diagnosed histologically by ultrasound-guided biopsy. Diagnosis: 1. Benign conditions including gynecomastia, fibrocystic change, subareolar abscess, hemangioma, hematoma/seroma, epidermal inclusion cyst, dermatofibroma, and lipoma/angiolipoma. 2. Malignant conditions including invasive ductal carcinoma (IDC), mucinous carcinoma, papillary carcinoma, and rhabdomyosarcoma. Discussion and Summary of the Case: We reviewed a variety of male breast diseases that may present as palpable lumps. The majority of these lesions are benign. It is important for radiologists to distinguish suspicious lesions from the benign ones requiring no further work-up. PD.09.002 Missed Breast Cancers On Sonography: Reasons and Solutions Y. M. Park, J. S. Park, S. J. Lee Busan Paik Hospital, Inje University, Busan, South Korea Brief Description of the Purpose of the Report: Recently, breast sonography has widely been used as a modality for evaluating mammographically detected abnormalities, palpable abnormalities, or for screening of women with dense breast tissue. However, the diagnostic usefulness of this modality for the breast depends on many variables, such as the nature or location of the lesion, performer’s experience as well as sonography system and technique. In this article, we discuss and illustrate the reasons that can lead to missed breast cancers on sonography, and provide guidelines to help reduce them. Medical History: From our database of sonography during the past 9 years, we reviewed the cancers that had been missed on sonography. Possible causes for missed breast cancers included errors from sonography system and technique, perception errors such as poor- or non-visualization or subtle imaging features of lesions, and interpretation errors such as benign looking morphology or slow growth of a lesion. Diagnosis: Missed breast cancers including invasive ductal carcinoma, invasive lobular carcinoma, mucinous carcinoma, and ductal carcinoma in situ. Discussion and Summary of the Case: Awareness of the causes that can lead to missed breast cancers is helpful to reduce them. PD.09.003 The Useful of Pulsatility Index, Resistance Index and Maximal Velocity of Blood Flow in Diagnosis of Breast Carcinoma S.-K. Lee,1 M.-K. Gueng,1 Y.-P. Chang,1 Y.-G. Su,12 C. C.-C. Chen1 1 Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, 2Tai-An Hospital, Taichung, Taiwan

Volume 39, Number 5S, 2013 Brief Description of the Purpose of the Study: To evaluate the capability of pulsatility index (PI), resistance index (RI) and maximal velocity of blood flow in diagnosis of breast carcinoma and axillar lymph node metastasis. Methods: From 2000 Jun to 2011 Sep, 210 cases with malignant breast lesions in pathology diagnosis were collected. We evaluate them with parameters of Color Doppler sonography for solid breast masses, including: pulsatility index (PI), resistance index (RI) and maximal velocity of blood flow. The lesion size and axillary lymphadenopathy were also recorded. Main Results: Among the study population (210 patients), 175 cases(83.3%) had color flow on the Color Doppler Sonography and 135 cases (77.1%) had PI value greater than 1.4, 151 cases (86.3%) had RI value greater than 0.8. The average maximal velocity of blood flow of these cases are 33.1cm/s (range: 16.838.2cm/s). The average size of these lesion is 2.6cm (range: 0.7cm8.3cm). 171 patients (81.4%) had metastatic axillary lymphadenopathy with pathology proof. Importance of the Conclusions: The pulsatility index, resistance index and maximal velocity of blood flow are useful accompanying indicators in diagnosis of malignant breast masses, especially with consideration of axillary lymphadenopathy.

PD.09.004 Blood Vessel Distribution and Flow Pattern of Breast Carcinoma on Color Doppler Sonography M.-K. Gueng,1 S.-K. Lee,1 Y.-P. Chang,1 Y.-G. Su,12 C. C.-C. Chen1 1 Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, 2Tai-An Hospital, Taichung, Taiwan Brief Description of the Purpose of the Study: To evaluate the blood vessel distribution and flow pattern of breast carcinoma on color Doppler sonography with the capability of diagnosis. Methods: From 2000 Jun to 2011 Sep, 210 cases with malignant breast lesions in pathology diagnosis were collected. We evaluate them with some characteristics in Color Doppler Sonography of the solid breast masses, such as: distribution pattern of blood vessels and the blood flow spectrum pattern. The lesion size and axillary lymphadenopathy were also recorded. Main Results: Among the study population (210 patients), 175 cases (83.5%) had color flow on the Color Doppler Sonography. In these cases, there are 78 patients (44.6%) with penetrating vessel pattern, 32 patients (18.3%) with branching pattern and 61 patients (34.8%) with peripheral vessel distribution observed on color Doppler sonography. In the blood flow spectrum pattern evaluation, 36 patients (20.6%) had low impedance pulsatile signal, 44 patients(25.1%) had high impedance pulsatile signal and 90 patients(51.4%) had turbulent signal with high velocity. The average size of these lesion is 2.8cm (range: 0.5cm10.2cm). 163 patients (77.6%) had metastatic axillary lymphadenopathy with pathology proof. Importance of the Conclusions: Color Doppler sonography is an useful accompanying image modality in diagnosis of malignant breast masses using blood vessel distribution and flow patterns. PD.09.005 The Accuracy of Combined Mammography and Breast Ultrasound Over Ultrasound Alone in Young Women Below 40 Years H. Gewefel, D. Salama Misr University for Science and Technology, 6th of October City, Egypt Brief Description of the Purpose of the Study: The purpose of this article is to determine the accuracy of combined mammography and

Abstracts sonography correlated with the accuracy of the ultrasound alone in evaluating young women below 40 years. Methods: We retrospectively reviewed the electronic medical records identified all mammographic and ultrasonographic breast imaging examinations from March 2008 to Jan 2012 of 256 young women below 40 years presenting to our breast imaging department for screening and diagnostic setting. Records were reviewed for ultrasonographic or combined mammographic and ultrasonographic findings with BIRADS assessment and histological results. A total of 98 cases (38.2%) were evaluated by ultrasonography alone while 158 cases (61.7%) were evaluated by combined ultrasonography and mammography. Examinations rated as BI-RADS categories1,2,3 were considered negative while 4 and 5 were considered positive. Main Results: Palpable mass was the presenting symptom in 111 (43.3 %) of the cases. Biopsies were performed for 36 (14.1%) cases while follow up for one year or more was done for 223 (87.1%) of the cases. By either biopsy or follow up, 22 cases were malignant (8.6%) while 234 (91.4%) were benign. Mammograms were extremely dense (ACR4) or heterogeneously dense (ACR3) in 62 (24.2%) of patients. For the 98 cases evaluated with ultrasonography, the sensitivity was 87.5, 100% specificity, 100 % positive predictive value, and 98.9% negative predictive value. For the 158 cases evaluated with mammography and ultrasonography, there was 92.9% sensitivity, 98.6% specificity, 86.7% positive predictive value, and 99.3% negative predictive value. The accuracy measured 89.8% for ultrasonoraphy and 98.1 % for mammography. Importance of the Conclusions: Among young women below 40, ultrasonography alone accurately revealed the malignant cases that were present in our study group however performing combined mammography and ultrasonography in suspicious cases may increase the sensitivity yet with no significant difference in the negative predictive value. PD.09.007 Contrast-Enhanced Ultrasonography in the Diagnosis of Benign and Malignant Breast Mass Lesions N. Nakata, T. Ohta, T. Nishioka, Y. Miyamoto, K. Fukuda Jikei Univsersity, School of Medicine, Tokyo, Japan Brief Description of the Purpose of the Study: The purpose of this study was to evaluate the diagnostic value of contrast ultrasonography (CEUS) for classification of breast lesions as benign or malignant and the comparison of conventional B mode. Methods: This study focused on 46 pathologically proved palpable breast mass lesions of 44 patients, which were able to depict with B-mode ultrasonography, after administration of the perflubutane-based contrast agent, and enhancement patterns of micro flow imaging (MFI) of CEUS. The ultrasound equipment were GE LOGIQ7/LOGIQ E9 with the linear transducer. CEUS were performed using an intravenous bolus injection of 0.2 mL of Sonazoid. CEUS movies in the vascular phase from 0 sec to 50 sec were recorded. Main Results: Surgical pathologic analysis showed 15 benign and 31 malignant lesions. The accuracy, sensitivity, and specificity of CEUS were 91.3%, 90.3%, and 93.3%, respectively. The microvascular architecture of the 42 lesions was categorized into 3 patterns: Benign lesions mainly displayed the tree-like vessel pattern (14); malignant lesions tended to display the peripheral enhance pattern and straight/curl hair vessel pattern (28). The microvascular architecture of CEUS showed significant differences between benign and malignant lesions (p , .005). Importance of the Conclusions: CEUS is useful in the evaluation of breast mass lesions including benign and malignant tumors.

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PD.09.008 Mastite Granulomatosa - Relato De Caso H. Ramos, J. L. Spessatto, E. Wanderley, I. C. S. O. Grasel Ecomax Centro De Diagnostico Por Imagem, Blumenau, SC, Brasil Brief Description of the Purpose of the Report: To describe a case of a young patient with a benign breast disease and imaging consistent with a lesion with high suspicion of malignancy. Medical History: A 25 years-old female presenting a palpable mass associated with skin thickening in the right breast. Ultrasound showed an area of architectural distortion, hypoechoic, poorly defined, measuring approximately 63 3 30 3 30 mm, at the junction of the lateral quadrants of the right breast, associated with skin and subcutaneous tissue edema. Mamographics views demonstrated an ill-defined asymmetry associated to Cooper’s ligaments and the skin thickening on the lateral quadrants of this breast. The lesion was considered highly suspicious (BI-RADS 5) and submitted to histopathological examination after ultrasound guided core-biopsy. Diagnosis: Chronic granulomatous inflammation, compatible with granulomatous mastitis. Discussion and Summary of the Case: Granulomatous mastitis is a rare disease that can present imaging findings with highly suspicion of malignancy. It usually affects women of reproductive age, mostly related to lactation, even though previous. This possibility should be considered by the physician faced with a young patient with a history of prior or current lactation and a lesion classified as BI-RADS 5 by ultrasound. PD.09.012 Ultrasound Guided Biopsy of Breast Microcalcifications With a New Ultrasound Image Processing Technique P. Machado, J. R. Eisenbrey, B. Cavanaugh, F. Forsberg Thomas Jefferson University, Philadelphia, PA, USA Brief Description of the Purpose of the Report: The investigation of a new, commercial image processing technique (MicroPure, Toshiba America Medical Systems, Tustin, CA) for the identification of breast microcalcifications as an useful tool for real-time ultrasound (US) guided biopsy in patients with breast microcalcifications. Medical History: Three women, a total of 4 lesions, scheduled for US guided biopsy of an area with breast calcifications (identified on a prior mammogram), were enrolled in the study. The US guided biopsy was done using real-time, dual imaging with grayscale US and MicroPure using an Aplio XG scanner (Toshiba). MicroPure combines non-linear imaging and speckle suppression to mark suspected calcifications as white spots in a blue overlay image. The tissue retrieved underwent x-ray imaging to determine the presence of microcalcifications. Diagnosis: Real-time, US guided biopsy using MicroPure had the same duration as a regular US guided biopsy using grayscale imaging. The radiologist doing the procedure felt confidence with the images and that microcalcifications were seen with MicroPure. X-ray image of the retrieved tissue showed microcalcifications in all 4 lesions, confirming that the images seen during the procedure did indeed represent microcalcifications. Discussion and Summary of the Case: MicroPure imaging can be used for real-time US guided biopsy procedures with confidence, when microcalcifications are visible with this method. PD.09.013 Idiopathic Granulomatous Lobular Mastitis: Radiological and Clinico-Pathologic Findings K. Hye-Won, J. Se-Jung, C. Si-Sung Iksan, Korea

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Brief Description of the Purpose of the Review of Literature: The purpose of this exhibit is to review the radiological, clinical and histological findings of the idiopathic granulomatous lobular mastitis. Description(s) Condition(s), Method(s) or Technique(s): Idiopathic granulomatous lobular mastitis is a rare chronic inflammatory disease that usually affects women of child-bearing age. Most common symptom was palpable mass with/without painful swelling of breast. Focal asymmetry is common finding on mammography. Irregular hypoechoic mass with inflammatory reaction on US is presented in most of patient with idiopathic granulomatous lobular mastitis. The clinical and radiological findings of idiopathic granulomatous lobular mastitis mimics inflammatory breast cancer and other chronic breast inflammation. Conclusion: Granulomatous lobular mastitis has sonographic and clinical findings similar do those of inflammatory breast cancer. To proper treatment, definite histopathological diagnosis is necessary by biopsy. Brief Discussion of the Case: null PD.09.014 Sonographic Features of Superficial Breast Lesions: a Pictorial Review W. C. Jaw, K. J. Lin, C. L. Soong, L. S. Shih, B. L. Yu, C. M. Chen Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan Introduction: This presentation aims to illustrate the sonographic features of a spectrum of superficial lesions of the breast. Methods Involved: Ultrasound with optimized probe set allows localization and detection of the extent of focal superficial lesions and assessment of tissue/lesions composition such as calcifications, fat and nodule in superficial layer of the breast. It can help operator to guide aspiration cytology or biopsy. Discussion: The breast is an organ composed of skin, subcutaneous tissue, breast parenchyma, and breast stroma. The skin is composed of three layers: the epidermis, dermis, and hypodermis or subcutaneous fat layers. Superficial breast lesions may originate within each anatomic layer of the skin or superficial mammary tissue. In this pictorial review, selected patients for illustrations are divided into three groups: Dermis and Epidermis-dermal cysts, epidermal inclusion cysts, sebaceous cysts and dermal calcifications. Hypodermal lesions - (a) fat-originating: lipoma, angiolipoma, fat necrosis, (b) vascular: hemangioma, thrombosed vessel, vascular malformations, (c) lymph node or lymphatic origin, (d) neurogenic (e) anterior terminal duct lobular units (TDLUs) includes adenosis, fibroadenoma, peripheral papilloma, and superficial breast cancer. Conclusion of the Presentation: Awareness of the sonographic features and anatomic site of origin of the lesions can help diagnosis and avoid misdiagnosis. PD.09.016 Power Doppler Sonography As a Predictor Method of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer: Preliminary Study D. W. Santos, A. L. D. Diniz, P. C. Fernandes Junior Universidade Federal De Uberl^andia-Ufu, Uberl^andia, Minas Gerais, Brasil Brief Description of the Purpose of the Study: The objective of this study was to evaluate the applicability of power Doppler as a predictor method of tumor response to neoadjuvant chemotherapy in Locally Advanced Breast Cancer. Methods: Prospective study comprises 10 patients with Infiltrative Breast Carcinoma by histological analysis, locally advanced. Patients underwent power Doppler in three stages: before, after 2-3 cycles of chemotherapy, pre-surgery. Vascular density was calculated as ratio between number of colored pixels within the tumor area by total number of pixels in this area, and the response to treatment, according to

Volume 39, Number 5S, 2013 RECIST criteria, was correlated with end pathological response. Statistic analysis: Fisher’s test, Spearman coefficient, p , 0.05. Main Results: There was no statistical difference between responders and nonresponders in power Doppler sonography Response and Pathologic Response groups (p 5 0.3348), and there was no difference between Morphological and Pathological responses (p 5 0.0567), nor between morphological response and power Doppler one (p 5 0.6287). Sensitivity and specificity of vascular density were 85.7% and 50%, respectively, with negative predictive value of 50% and positive of 85.7%. Importance of the Conclusions: We present the power Doppler sonography as an imaging method with good sensitivity to the functional assessment of tumor response in locally advanced breast cancer to chemotherapy. PD.09.017 Carcinoma Dentro De Fibroadenoma: Relato De 2 Casos Desta Situac¸~ao Atıpica E Revis~ao De Literatura C. B. Silva, M. J. S. Maciel, B. L. Moreira, C. S. Guatelli, M. R. B. Poli, L. Graziano Hospital AC Camargo, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Report: Report two cases of breast carcinoma detected inside fibroadenomas, their imaging findings and literature review. Medical History: 38 years-old female patient referring palpable breast lump with progressive growth for six month. 49 years-old female with no breast complaints during screening evaluation. Both underwent imaging exams that revealed well-defined breast nodes. Diagnosis: Percutaneous core needle biopsy demonstrated histological diagnosis of fibroadenoma with in situ ductal carcinoma, and fibroadenoma with in situ lobular carcinoma. Discussion and Summary of the Case: Fibroadenoma is the most common benign tumor of the breast, presenting with epithelial and stromal components. Carcinomas arising in these lesions are rare, often below 0.5%. The incidence of in situ lobular carcinoma inside fibroadenoma represent the majority of these cases, typically in older patients than regular fibroadenomas. Despite the low frequency, radiologists and clinicians should be aware of this condition, especially in older patients and in lesions with progressive growth. Combined clinical history and imaging findings are essential to define the best practice in these cases. TL.09.001 Three Dimentional Elastography of Breast Tumor E. Takada, S. Konno, N. Ejiri, M. Tezuka, N. Takase Dokkyo Medical University, Mibu, Tochigi, Japan Brief Description of the Purpose of the Study: Real Time Tissue Elastography is capable to differeniate breast tumor whether it is malignant or benign. Authors tried to construct three dimensional elastography of breast tumors and studied whether it is possible to differentiate the tumor is benign or malignant. Methods: Three dimensional elastography was ;performed for 70 cases of breast tumor, including 51 benign and 19 malignant tumors. Ultrasonic equipment HIVISION Ascendus with automatic linear probe EUP-LV74 was used. The probe moves electric linear transducer mechanically for obtain three dimensional elastography. 3D Elastography image is superimposed on 3D B-mode image. Hard tissue is colored blue and soft tissue is read. 3D image is displayed as volume rendering. Main Results: Benign tumors, 40 out of 51 (78.5%) were shown as less blue or hard parts and while malignant tumors, 16 out of 19 (84.2%) were displayed as irregular shaped solid mas by 3D elastography.

Abstracts Importance of the Conclusions: Authors could construct 3D images of breast tumors. 3D Elastography is able to differentiate breast tumors whether it is benign or malignant. TL.09.004 Quantitative Ultrasound Elastography of Sclerotic Fat Necrosis After Autologous Fat Grafting for Augmentation Mammoplasty S. H. Hung Taipei City Hospital, Taipei, Taiwan, R.O.C Brief Description of the Purpose of the Study: Fat necrosis is a benign inflammatory process resulting from autologous fat grafting and may have several appearances at imaging. Ultrasound findings of sclerotic fat necrosis (SFN) can present as speculated mass and mimic those of malignant lesions. Virtual touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) imaging is a quantitative technique used to measure tissue stiffness. The present study was conducted to assess the usefulness of VTQ in the differentiation of SFN from malignant masses. Methods: 14 pathologically proven cases of SFN after fat grafting and 32 malignant breast masses were examined using both conventional ultrasound and VTQ. The tissue stiffness for VTQ was expressed as shear wave velocity (SWV) (m/s), and receiver operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance. Main Results: The average SWVs of the SFN cases and the malignant masses were 2.117 m/s (range: 0.61-9.00 m/s) and 4.615 m/s (range: 2.32-9.00 m/s), respectively (p , 0.001). ROC analyses indicated that the area under the curve was 0.871 (p , 0.001). Importance of the Conclusions: VTQ of ARFI imaging provides quantitative elasticity measurements of the tissue stiffness of fat necrosis. As such, VTQ could be a valuable complementary method for differentiating between SFN and malignant breast lesions. TL.09.008 Automatic BI-RADS Diagnosis of Breast Lesions by CAD (Computer-Aid Diagnosis) Wen-Hung Kuo, Shu-Chuan Chuang, Shou-Huan Yang, Ku Yung-Lung, Argon Chen, King-Jen Chang Breast Center, National Taiwan University Hospital, Taipei, Taiwan Brief Description of the Purpose of the Study: This research is to develop a robust, well-performing automatic CAD system which can provide objective suggestion for breast ultrasound BI-RADS categorization. Methods: Sonographic tumor features of 264 tissue-proved BI-RADS 3 to 5 breast lesions were collected. There are initially 30 quantitative attributes extracted automatically from one representative view by computer . 9 attributes, including 6 B-mode attributes and 3 elastography-related attributes are taken into practical model building. We randomly take 175 cases for model training and leave 89 cases as the independent test data. In both, benignancy and malignancy ratio is about 2 to 1. Using -Parameterized Three-Phased Ensemble Model-, we transform the original binary predicting result into probabilistic form so that the model can be applied to BI-RADS categorization which is based on malignancy probability. Main Results: The computer-made proportions of malignancy in each predicted BI-RADS category for 3-4A-4B-4C-5 are 0, 0.0938, 0.4118, 0.8333, 1 respectively. The clinician clinician’s performance are 0, 0.0909, 0.4166, 0.8333, 1. The overall performance of CAD auto-categorization is compatible the result made by experienced clinician. Importance of the Conclusions: This revolutionized automatic computer-aid diagnosis approach for breast ultrasound will give advise to first-line inexperienced physician for referral and provide corresponding second opinion for experiences doctor.

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TL.09.011 Sonographic Evaluation of Mammographically Asymmetric Breast Tissue Y. H. Chou, C. M. Tiu, S. Y. Chiou, H. J. Chiou, Y. C. Lai, H. K. Wang Taipei Veterans General Hospital, Taipei, Taiwan Brief Description of the Purpose of the Study: To evaluate the significance of asymmetric breast tissue on mammograms (MG) using ultrasonography (US). Methods: Of the 4,331 MGs obtained in one year, 124 patients (2.9%) were demonstrated to have asymmetric breast density. All of the patients underwent US examination on the basis of mammographic findings, and any patient having US-suspected focal pathology will undergo excisional biopsy, coarse needle biopsy, or vacuum-assisted mammotomy. All asymmetric areas with architectural distortion and clustered microcalcifications were excluded. Main Results: Among the 124 patients, US demonstrated either normal or focal dense glandular or fibroglandular tissue in 85, and in the other 39 patients there were focal abnormality on US. The final diagnosis included: fibrocystic diseases (FCC) (21), presenting as small cysts with / without focal fibrosis or sclerosing adenosis; epithelial hyperplasia (5), one of these four patient was associated with focal atypia; mixed benign pathologies (8), with both FCC and epithelial hyperplasia; and malignancies (5), with infiltrative ductal carcinoma in two, ductal carcinoma in situ (DCIS) in two, and infiltrative lobular carcinoma in one. Importance of the Conclusions: Asymmetric breast tissue on MG can be of certain clinical significance, and further evaluation should be conducted using the state-of-the-art high resolution US. TL.09.012 Sonographic and Mammographic Changes of Breasts in Women Receiving Estrogen Replacement Therapy C. M. Tiu, Y. H. Chou, Y. H. Lee, Y. C. Lai, H. K. Wang, H. J. Chiou Taipei Veterans General Hospital, Taipei, Taiwan Brief Description of the Purpose of the Study: To evaluate the morphological changes of breasts on sonography (US) and mammography (MG) in women following estrogen replacement therapy (ERT). Methods: 126 women received ERT due to ophorectomy. 100 postmenopausal women were enrolled as control group. The breast patterns were classified. All 126 women received MG follow up, and 82 women had also US study. Main Results: 17 women (13%) showed increased density on MG, significantly higher than those in control group (c2521.566, p , 0.0001). Among women having US exam, 16 (20%) showed increased breast volume and newly developed abnormal findings (with mostly fibrocystic changes), also significantly higher than the control group (c2519.571, p , 0.0001) patients with relatively fatty breast showed higher incidence of pattern changes. Importance of the Conclusions: Patients receiving ERT showed significant density changes on MG and morphological changes on US.

10 - Ultrasound in Fetal Medicine/Obstetrics PA.10.001 Encefalocele Basal Transesfenoidal: Relato De Caso Diagnosticado Em Exame Ecografico De Rotina F. P. Nobrega, N. Zerwes, A. E. G. M. T. Ferreira, F. F. Mauad, G. C. Grotti, F. S. Ramalho, K. S. Melo Escola De Ultra-Sonografia E Reciclagem Medica Ribeir~ao Preto

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Brief Description of the Purpose of the Report: The neural tube closure defects are the most common malformations of the Central Nervous Sistem. The basal encephaloceles are extra cranial herniations with cerebral content. The authors describe a case of Transsphenoidal Encephalocele and did a literature review of this rare malformation. Medical History: Female patient, 28 years old, with gestational age of 21 weeks, comes to the school to perform routine fetal ultrasound control. Diagnosis: During the examination, it was observed an opening at the base of the skull in the topography of the sphenoid bone, where noted herniation of brain parenchyma, reaching across the palate and oral cavity. Discussion and Summary of the Case: The encephaloceles has a prevalence of 1:35.000 live births. The basal type is even more rare, accounting for only 2-10% of encephalocele cases. The transsphenoidal encephalocele can commonly be associated with facial developmental anomalies, as well as malformations of the the optical system and the brain. The most found facial malformations are: hypotelorism, median cleft nose, nasal base enlarged, cleft lip or palate, cleft facial syndrome or medial frontal skull bifid. The treatment basically consists of prophylaxis with folic acid, which not only prevents defects of neural tube closure as well as facial malformations. PA.10.004 Diagn ostico De Hernia Diafragmatica Cong^enita Ao Exame Ecogr afico Confirmada Por Resson^ancia Nuclear Magnetica J. B. Rocha Home Ultrassonografia, Mucuri, Bahia, Brasil Brief Description of the Purpose of the Report: Diagnosis of fetal congenital disease using two distinct methods of picture: ultrasound and magnetic resonance imaging. Medical History: Patient 32, pregnant for the fourth time, at 27 weeks of gestational age, with three previous pregnancies with normal and healthy living children, underwent routine ultrasound in prenatal care. Diagnosis: Left congenital diaphragmatic hernia with stomach and bowel occupying the left hemithorax shifting the mediastinum and heart to the right hemithorax. Discussion and Summary of the Case: After performed the ultrasound, the patient underwent performing MRI which confirmed the diagnosis. Thus, we confirm the importance of a good screening ultrasound combined with MRI in the accurate diagnosis of fetal pathologies. PA.10.007 Ectopic Pregnancy (EP) in a Cesarean Scar: Case Report L. K. Tsukuda,1 M. Riboldi,1 E. H. Miyadahira,1,2 P. C. Serafini,1,2 E. L. A. Motta1,3 1 Huntington Medicina Reprodutiva, S~ao Paulo, Brasil, 2Universidade De S~ ao Paulo, S~ ao Paulo, Brasil, 3Universidade Federal De S~ao Paulo (UNIFESP), S~ ao Paulo, Brasil Brief Description of the Purpose of the Report: GE is characterized by the embryo implantation outside the endometrium. Due to the growing number of in vitro fertilization (IVF) treatments, it is becoming more common in patients with prior cesarean. Medical History: From june to november, 2012, we identified 180 patients who were submitted to transvaginal ultrasound to detect the gestational sac (GS) during the sixth pregnancy week. Diagnosis: There were 3 cases of EP in cesarean scar. Case 1: SG with embryo and fetal heart rate (FHR), 2: SG with no embryo and 3: 2 SG with embryos and FHR. All the cases were treated with methotrexate shots. In the cases 2 and 3, a surgical hysteroscopy was performed.

Volume 39, Number 5S, 2013 Discussion and Summary of the Case: The 3D US features a high accuracy to detect topic pregnancies and even in cases of cervical pregnancy. That seems not to be similar in EP in a prior cesarean scar, as it is located within the anterior myometrium. Early diagnosis of EP prevents complications such as bleeding and uterine rupture. Besides, the US enables to follow the b-HCG decay and, eventually, preserve the uterus for future pregnancies. PD.10.001 Como Diferenciar O Descolamento Ovular Das Fus~oes Parciais De Membrana: Ensaio Pictorico P. V. Matos, M. Q. P. Silva, C. Akiho, K. B. Calil, T. R. G. Wu, M. C. Lopes Webimagem, Sao Paulo, SP, Brasil Introduction: First trimester of pregnancy abnormalities are usually detected on routine examination or in case of abnormal vaginal bleeding. Methods Involved: High-resolution vaginal probe advent is revolutionizing our understanding of the pathophysiology and management of early pregnancy is the technique of choice for assessing the viability of the pregnancy first quarter. Discussion: Threat of miscarriage, characterized by abnormal vaginal bleeding is a common condition in the first quarter, occurring in over a third of pregnancies. Conclusion of the Presentation: In this test will demonstrate sonographic criteria diagnoses established in the literature that differentiates ovulate mergers partial detachment of the membrane ovulate in the first trimester of pregnancy. PD.10.002 Association of Progesterone, Pessary and Antibiotic (Triple Method) to Treatment of Pregnant Woman With Short Cervix: What Is the Limit of Fetal Viability? E. Araujo Junior, E. F. M. Santana, L. M. M. Nardozza, A. F. Moron Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ao Paulo-SP, Brazil Brief Description of the Purpose of the Report: The preterm delivery (PD) is the most important case of neonatal mortality, mainly before of 32 weeks of pregnancy. The short cervix is the most important quantitative marker to predict PD; however, there are other qualitative markers as cervical gland area (CGA), cervical funneling and sludge. We present a case of pregnant women diagnosed with short cervix at 14 weeks and demonstrate the use of triple treatment that collaborate to good perinatal result. Medical History: Pregnant woman 37 years-old, G3P0, was forwarded to our service at 14 weeks presenting short cervix (20 mm) and sludge (+). This woman was hospitalized to put pessary and antibiotic (clindamycin and cephalothin per 10 days). She evolved at 20 weeks with short cervix (9 mm), cervical funneling, sludge (+) and pessary in normal position. She was again hospitalized being realized amniocentesis of sludge (negative bacterioscopy), other cycle of antibiotic, oral progesterone, held pessary and Trendeleburg position. She remind hospitalized by 82 days, being at 32+1 weeks the fetus presented distress (taquicardy). The C-section, with live newborn, female, 2,180g Apgar index 8/8. Diagnosis: Short cervix syndrome. Discussion and Summary of the Case: This case report demonstrates the importance of use of three therapies to the treatment of short cervix syndrome with good perinatal result.

Abstracts

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PD.10.003

PD.10.008

Diagn ostico Pre-Natal De Gastrosquise E Os Resultados Obstetricos E Perinatais R. M. Franco, R. M. Z. Caloni, C. G. Gonc¸alves, K. C. Silva, T. P. Santalla, D. T. Hashimoto, A. Rozas Pontifıcia Universidade Catolica De S~ao Paulo, Sorocaba, SP, Brasil

Fetal Rapid Biophysical Profile and Perinatal Outcomes J. Czeresnia, E. Cordioli, E. Araujo Junior, L. M. M. Nardozza, A. F. Moron Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ao Paulo-SP, Brazil

Brief Description of the Purpose of the Study: To describe the characteristics and postoperative results of cases of gastroschisis assisted in a tertiary hospital. Methods: A retrospective study of 17 medical records of newborns with gastroschisis evaluated and operated from 2004 to 2008. It was analyzed the association among prenatal diagnosis of gastroschisis and parity, gestational age, birth weight, sex of newborn, hospital of birth and interval birth-surgery. Were used the Fisher Exact Test and T-Student. Main Results: Of the 17 medical records analyzed, ten patients had a prenatal diagnosis of gastroschisis. The interval from birth to surgery was more than 4 hours in nine newborns; the minimum was 1 hour and the maximum 120 hours. The Apgar, the gestational age and birth weight was higher in those without prenatal diagnosis. Eight of the 17 patients died, sepsis was the most common cause. All infants with prenatal diagnosis had the birth in a tertiary service and in most cases it was decided to caesarean section. Of the four infants who had no prenatal diagnosis, three died. Importance of the Conclusions: The prenatal diagnosis of gastroschisis favors the adequate prenatal care and attendance in a tertiary hospital. This allows a faster surgical approach and results in improvement in mortality rates.

Brief Description of the Purpose of the Study: The fetal rapid biophysical profile (FBPr) consists of the evaluation of only two of the five classic biophysical profile parameters: AFI and fetal movement after vibratory stimulation. The aim of this study was to compare the results of FBPr performed by trained medical student with the perinatal outcomes (pH of umbilical umblical) for analysis of the applicability of this examination in obstetric centers with high demand. Methods: 19 FBPr tests were realized and yours results of pH of umbilical cord were documented. Were considered normal: FBPr score 5 4 and pH . 7.23. Main Results: Only two of the 19 cases had the pH of umbilical cord ,7.23, both of which had scores of 2 of FBPr. A third case had score of 2 of FBPr, but pH of umbilical cord values within the reference. The others had score 4 of FBPr and normal pH of umbilical cord. For the sample in question, FBPr had a positive predictive value of 0.66 and negative predictive value of 1.00. Importance of the Conclusions: Despite of small sample size, the results suggest that FBPr is an excellent test for screening of fetal well-being, easy to perform and is a good tool for implementation in obstetric centers super-crowded.

PD.10.004 Incidence of Fetal Heart Diseases in High-Risk Pregnancies: Initial Experience With a Screening Protocol in a Tertiary Referral Center in Brazil E. Araujo J unior,1 L. A. Rocha,1 A. T. F. S. Leslie,2 F. S. B. B. Barros,1 L. C. Rolo,1 L. M. M. Nardozza,1 A. F. Moron1 1 Fetal Cardiology Unit, Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ao Paulo, SP, Brazil, 2Discipline of Neonatology, Department of Pediatrics, S~ao Paulo Federal University (UNIFESP), S~ ao Paulo, SP, Brazil Brief Description of the Purpose of the Study: To describe the epidemiological and ultrasonographic data of pregnant women submitted to a screening protocol for congenital heart disease (CHD). Methods: The data was collected using a screening protocol of the fetal heart adapted from the International Society of Ultrasound in Gynecology and Obstetrics guideline. Pregnant women were referred to the fetal cardiology outpatient obstetrics clinic of an universitary hospital. We performed a fetal echocardiogram screening for all pregnant women. According to the study protocol, the exams were classified as normal or abnormal. No inferences about the anatomical diagnosis were made. The cases considered abnormal were undergone to a postnatal echocardiogram. Main Results: Were performed 130 fetal hearts screening. The average age of the pregnant was 30 years. The mean gestational age of screening was 28 weeks. The pregnant women were referred to our fetal cardiology service due to maternal reasons (61.5%) or fetal reasons (38.5%). The incidence of abnormal screening was 10%; among these, 11 cases were alterations in cardiac anatomy, and the others were arrhythmia (1 fetus) and dextrocardia secondary to congenital diaphragmatic hernia (1 fetus). All newborns with abnormal screening were submitted to a postnatal echocardiogram (7 fetuses). Importance of the Conclusions: We observed a high rate of CHD in high-risk pregnancies.

PD.10.009 Hidranencefalia: Relato De Caso Com Revis~ao Da Literatura E Diagnostico Diferencial D. T. Nascimento, F. T. S. Mendonc¸a, M. C. A. Maia, R. E. Santos, M. G. D. Melo, C. C. A. Freitas Maternidade Nossa Senhora De Lourdes, Aracaju, Sergipe, Brasil Brief Description of the Purpose of the Report: Case report of a not common fetal CNS malformation, in which description and follow up are emphasized. Etiology is not established. Emphasis is also laid in differential diagnosis and literature review. Medical History: A 24-year-old at 32-week gestation, G 2 P 1L0, with no symptoms and normal physical examination, referred to proceed investigation after an altered routine obstetric ultrasound. Patient denied previous diseases. Diagnosis: Ultrasound exam revealed polyhydramnios, obliterated posterior fossa, hypoplastic cerebellum and signs of hydranencephaly. Patient was followed up and a caesarean section was performed. The newborn was treated in NICU where survived only for 7 days, due to complications related to basic disease. Discussion and Summary of the Case: Hydranencephaly is a congenital brain defect in which cerebral hemispheres are replaced by fluid. The hypotheses most accepted as etiologies are oclusion of internal carotid arteries causing bilateral cerebral infarction or primary neural wall agenesis. Small portions of cerebral lobes might be preserved. Cerebellum, brainstem, thalami and basal ganglia are usually present. Incidence is 1 in 10,000 births. Prognosis is guarded. Cerebral hemispheres replaced by hypoechoic fluid, and presence of falx cerebri preserved are the main sonographic findings. Fetal MRI is the best method for detailed analisis and also important to define differential diagnosis. PD.10.010 Sequestro Pulmonar: Diagnostico Ultrassonografico Intra utero M. C. N. A. Leite, N. C. M. F. Montenegro, B. Maragno, N. B. Genova, R. M. Kawano, C. A. Sinisgalli, Jr. Hospital S~ao Luiz Jabaquara, S~ao Paulo, Brasil

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Ultrasound in Medicine and Biology

Brief Description of the Purpose of the Report: Remembering the major diagnostic criteria of pulmonary sequestration, emphasizing the importance of its early detection for adequate cardio-respiratory patient assessment and search others associated malformations. Medical History: K.B.G., 33 years, female, white, 23 weeks pregnant, was referred to the team of obstetric ultrasound to morphological assessment of fetal thoracic mass, it was observed a left pyramidal hyperechogenic mass, which compresses and displaces the heart tissue to right. An aorta descending branch nurished the mass. Diagnosis: Extralobar pulmonary sequestration. Discussion and Summary of the Case: Pulmonary sequestration is a congenital malformation characterized by a mass of nonfunctioning lung tissue, separate from the tracheobronchial tree normal, vascularized by an anomalous systemic artery. The clinical presentation is variable, presenting asymptomatic or recurrent pulmonary infections and should be taken into consideration the effect of thoracic mass compressing the surrounding tissues, and other malformations, in 60% of cases, as diaphragmatic hernia, lung and heart malformations. It is necessary the early diagnosis for evaluation of the expansive effect and surgical treatment needed, being the lobectomy of the affected segment the election procedure.

PD.10.011 Sındrome De Edwards: Relato De Caso E Revis~ao Da Literatura M. L. Duarte, G. M. De Souza, F. T. Delcaro, E. R. Duarte, J. B. A. Ferreira Irmandade Da Santa Casa Da Misericordia De Santos, Santos, S~ ao Paulo, Brasil Brief Description of the Purpose of the Report: Report a syndrome whose live births prevalence is estimated in 1:6000-1:8000 and inevitably lethal. Medical History: Male patient, 05 months of age presenting with acute respiratory failure on physical examination hirsutism, micrognathia, inguinal hernia and fists with overlapping fingers in both hands. Diagnosis: Morphologic ultrasound showed a mild stomach filling and increased gallbladder with esophageal atresia being questioned-unconfirmed at birth. The suspicion of Edwards syndrome occurred at birth on physical examination. A two-dimensional echocardiogram visualized septal defect, atrial septal defect and transposition of the great vessels. The echographic aspects for trisomy 18 are detectable in 80% of affected fetuses in the second trimester. This patient was found in the remaining 20%. Discussion and Summary of the Case: Most cases of trisomy 18 is suspected on prenatal, based on screening by maternal age, screening marker in maternal serum or the detection of abnormal ultrasound findings from the 15 th -16 th week of pregnancy-ultrasound has a sensitivity of almost 100% for the visualization of structural abnormalities. The diagnosis is made by analysis of fetal chromosomal map using material obtained at amniocentesis, chorionic villus sampling or cordocentesis.

Volume 39, Number 5S, 2013 report three cases of prenatal diagnosis of peri-intraventricular hemorrhage. Medical History: Three young women were referred to our institution because of echogenic cerebral image on previous ultrasonography. There was nothing significant in their past or family history. A detailed prenatal ultrasonography revealed a ventricular echogenic image extending from the lateral ventricles to the parenchyma. No other malformation was detected. Neonatal ultrasonography confirmed the diagnosis in one case. The others died on antenatal period. Diagnosis: Antenatal intraventricular hemorrhage. Discussion and Summary of the Case: The central nervous system is the main location of congenital malformations incidence; it has high impact on mortality. The peri-intraventricular hemorrhage is the most frequent intracranial hemorrhage in newborns, especially in prematures. The hemorrhage’s origin is located in the germinal matrix. The peri-intraventricular hemorrhage diagnosed antenatal is rare. The ultrasonography is a useful method for screening and diagnosis of this condition.

PD.10.013 Obstetric Ultrasound: Errors and Pitfalls in the First Trimester of Pregnancy L. T. M. Rios, A. R. Pastore, R. V. B. Oliveira, L. C. L. Rios, E. Araujo, Jr. W. J. Hisaba, L. M. M. Nardozza, A. F. Moron Universidade De S~ao Paulo - USP, S~ao Paulo, SP; Escola Paulista De Medicina -UNIFESP, S~ao Paulo, SP; Universidade Federal Do Maranh~ao- UFMA, S~ao Luıs, MA Introduction: The pathological conditions of the first trimester of pregnancy are evident in routine ultrasound examination or when the exam is performed in the presence of vaginal bleeding. In this essay we demonstrate the possible errors and pitfalls in sonographic diagnosis of the first trimester of pregnancy. Methods Involved: The cases were selected retrospectively from the personal archive of the authors, cases and situations experienced that can lead to misinterpretation by the sonographer to illustrate and discuss the sonographic criteria involved already defined in the literature. Discussion: Some variations of normal in the first trimester of pregnancy can lead to misinterpretation. Ignorance of basic embryological landmarks to the correct diagnosis also motivates the mismanagement of some cases that are within the normal range for their gestational age. Confusions between ectopic pregnancy and topical for not considering the serum b-hCG pregnancy with embryos and between anembryonic not consider appropriate gestational age, incomplete fusion of deciduous and detachment ovulate are examples of situations that can lead to errors and traps in the first trimester of pregnancy. Conclusion of the Presentation: Ultrasonography has high specificity in various disorders. However, ignorance and lack of care with the landmarks and embryological aspects sonographic usual for their gestational age may lead to misinterpretation. PD.10.014

PD.10.012 Antenatal Sonographic Diagnosis of Intraventricular Hemorrhage L. T. M. Rios, V. S. Carvalho, M. G. Martins, R. V. B. Oliveira, E. Araujo, Jr. L. M. M. Nardozza, A. F. Moron Universidade Federal Do Maranh~ao - UFMA, S~ao Luıs, Ma; Escola Paulista De Medicina - UNIFESP, S~ao Paulo, SP, Brasil

Obstetric Ultrasound: Errors and Pitfalls in the Second Trimester of Pregnancy A. R. Pastore, L. T. M. Rios, R. V. B. Oliveira, L. C. L. Rios, E. Araujo, Jr. W. J. Hisaba, L. M. M. Nardozza, A. F. Moron Universidade De S~ao Paulo - USP, S~ao Paulo, SP; Escola Paulista De Medicina - UNIFESP, S~ao Paulo, SP; Universidade Federal Do Maranh~ao - UFMA, S~ao Luıs, MA

Brief Description of the Purpose of the Report: The peri-intraventricular hemorrhage diagnosed antenatal is rare. The present study aims to

Introduction: The majority of fetal malformations has confirmed his diagnosis in routine obstetric ultrasound examination or during the

Abstracts morphological examination of the second trimester of pregnancy. The aim of this essay is demonstrate the possible errors and pitfalls in ultrasound diagnosis in the second trimester of pregnancy with emphasis on fetal malformations. Methods Involved: The cases were selected retrospectively from the personal archive of the authors, cases and situations experienced that can lead to misinterpretation by the sonographer to illustrate and discuss the sonographic diagnostic criteria defined in the literature. Discussion: Some variations of normal in the second trimester of pregnancy, birth and choroid plexus cysts, cystic adenomatoid malformation, cystic hygroma, pelvic dilatation, changes in amniotic fluid can be resolved and lead to misinterpretation. Knowledge of this variability is crucial for the correct diagnosis. Conclusion of the Presentation: Ultrasonography is the most appropriate method of screening for abnormalities in the second trimester of pregnancy with high specificity in diagnosing malformations. However, the lack of care and embryological landmarks and sonographic aspects usual for their gestational age may lead to misinterpretation.

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in the first trimester of pregnancy. Menstrual delay, vaginal bleeding and abdominal pain are risk indicators. The diagnosis should be supplemented with serial measurements of b-hCG and transvaginal ultrasound. Methods Involved: Pictorial essay using ultrasound images to illustrate the diagnosis of unusual presentations of EP. Discussion: The most commonly found is the tubal. Other presentations less typical are cervical, cicatricial, ovarian, among others. EP cervical occurs in less than 1% of cases. Historically, the treatment was hysterectomy at considerable risk of serious bleeding. With the aid of ultrasound, it has become possible early diagnosis and conservative therapies. The pregnancies in the scar of a previous cesarean delivery are among the rarer forms of EP, occurring in 0.15% of pregnant women with previous cesareans. It represents a threat to life because the trophoblastic invasion of scar tissue can result in uterine rupture. EP ovarian remains a diagnostic challenge, and is most often done during surgery, often for suspected tubal EP or hemorrhagic corpus luteum. Conclusion of the Presentation: The importance of the study of unusual presentations of EP is to prevent progression to rupture and hemodynamic instability.

PD.10.015 Obstetric Ultrasound: Errors and Pitfalls in Fetal Growth Restriction A. R. Pastore, L. T. M. Rios, R. V. B. Oliveira, L. C. L. Rios, E. Araujo, Jr. W. J. Hisaba, L. M. M. Nardozza, A. F. Moron Universidade De S~ ao Paulo - USP, S~ao Paulo, SP; Escola Paulista De Medicina - UNIFESP, S~ao Paulo, SP; Universidade Federal Do Maranh~ ao - UFMA, S~ao Luıs, MA Introduction: Ultrasound is a method of tracking deviations fetal growth. In 75% of cases of fetal growth restriction (CIR), biological or constitutional factors are associated. Methods Involved: The cases were selected retrospectively from the personal archive of the authors, cases and situations experienced that can lead to misinterpretation by the sonographer on suspicion of CIR in order to discuss the sonographic diagnostic criteria. Discussion: The triad: amniotic fluid, placenta and fetal movement activates normal are great indicators to rule out other etiologies involved in the genesis of the CIR. The normal fetal morphology is important to exclude malformations and chromosomal defects that cause the CIR also symmetrical. The fetuses with growth restriction of symmetrical (fetal weight below the 10th percentile for gestational age referred to) have different etiologies and may be maternal (congenital infections, chromosomal disorders, chromosomal abnormalities not like gastroschisis, irradiation, teratogenic drugs) or constitutional. Conclusion of the Presentation: The sonographic identification of fetal weight below the 10th percentile for gestational age that should trigger the search for possible etiologies involved in low fetal weight. However, it is important biological and constitutional rule, which accounts for most cases, so that there is no premature termination of pregnancy.

PD.10.016 Gravidez Ect opica De Apresentac¸~oes N~ao Usuais: Ensaio Pict orico B. V. Carvalho, I. C. C. Lopes, J. B. Corr^ea, J. M. L. Abdalla, C. H. M. Silva, E. A. S. Ayub Instituto De Pesquisa E Pos-Graduac¸~ao Da Faculdade De Ci^encias Medicas De Minas Gerais / Hospital Mater Dei, Belo Horizonte, Minas Gerais, Brasil Introduction: Ectopic pregnancy (EP) is defined as pregnancy outside the uterine endometrial cavity. It is the main cause of maternal death

PD.10.017 Agenesia Do Ducto Venoso; Relato De Caso C. Cadete, L. E. Machado, K. Chagas Intro - Centro Diagnostico Por Imagem Da Bahia Brief Description of the Purpose of the Report: The ductus venosus is a venous conduit that exists during the embryonic period which conects the umbilical vein to the inferior vena cava, permitting a large amount of oxygenated blood to reach central circulation. The agenesis of the ductus venosus is a rare vascular anomaly which can have hemodynamic consequences to the fetal development. Medical History: The patient, a second trimester pregnant woman, had a routine ultrasound examination, where an intra-abdominal umbilical vein with an extrahepatic detour was visualized, flowing directly to the right atrium. Diagnosis: The ultrasound, combined with Doppler, can trace signs of fetal circulatory alterations, which will be better studied and defined by Doppler. In this case, a cardiomegaly was found. Discussion and Summary of the Case: The monitoring of the course of the intra-abdominal umbilical vein can diagnose important circulatory alterations. In this case, the fetus evolved naturally, having no significant negative repercussions in the nursery.

PD.10.018 Prenatal Diagnosis of An Aneurysm of the Vein of Galen by Three-Dimensional Power and Color Doppler Ultrasonography L. T. M. Rios, R. V. B. Martins, L. Logrado, R. V. B. Oliveira, M. S. Sousa, J. S. M. Nascimento Universidade Federal Do Maranh~ao - UFMA, S~ao Luıs, MA; Centro Especializado Em Ultrassonografia - CEUSPE, S~ao Luıs, MA Brief Description of the Purpose of the Report: Aneurism of the vein of Galen is a complex arteriovenous malformation which is of multiply communications between of the vein of Galen and the cerebral arteries. Few cases using three-dimensional (3D) power and color Doppler ultrasound have been reported in the literature. We demonstrate the main findings of 3D power and color Doppler ultrasonography in this anomaly. Medical History: We present a case of an aneurysm of the vein of Galen diagnosed at 25th week of pregnancy. A 36-year-old pregnant woman, gravida 3, para 2 was referred to our Institution because of a midline cystic mass diagnosed in a previous ultrasonography undertaken at 24 weeks’ gestation. The ultrasonographic finding consisted of a male fetus

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with a midline cystic mass, with positive flow detection by color Doppler and ventriculomegaly due to the compressive effects of the malformation. Pregnancy was interrupted at 29 weeks’ gestation because of presence of cardiomegaly. A male newborn survived for 36 hours only. Diagnosis: Aneurysm of the Vein of Galen. Discussion and Summary of the Case: The 3D color and power Doppler ultrasonography allowed us to reconstruct the architecture of the vascular malformation, and it showed the spatial relationships of aneurysm of the vein of Galen with the other structures of the brain.

Volume 39, Number 5S, 2013 Main Results: 100 pregnant women were selected, by 10 cases were excluded by artifacts impossible the volume assessment. The mean of length and area of fetal cisterna magna volume were 0.74 6 0.18 cm (range, 0.36-1.29 cm) and 2.14 6 0.93 cm2 (range, 0.65-6.14 cm2). The best regressions were a linear: fetal cisterna magna length5 0.26+ 0.02xGA (R25018) and fetal cisterna magna area5 -2.40+0.18xGA (R25 0.57). Importance of the Conclusions: Reference intervals to the length and area of fetal cisterna magna by two-dimensional ultrasound at 20 to 33+6 weeks of pregnancy were determined.

PD.10.019 Original Work and Iconographic Essay of Defects of the Central Nervous System and Associated Defects D. A. Fernandes, M. L. Barros, E. V. Melo, R. L. S. Porto, M. C. A. Maia, A. S. Godinho, T. O. Ferr~ao, C. U. Pereira Hospital Universit ario Da Universidade Federal De Sergipe (HU/ UFS), Aracaju- Se, Brasil Brief Description of the Purpose of the Study: To identify the prevalence of congenital malformations of the Central Nervous System(CNS) and associated malformations diagnosed by obstetric ultrasonography. Methods: Observational, descriptive and crosssectional study, in an institution of reference for highrisk pregnancies. Project approved by the ethics committee of institutional research. conflicts of interest declared negative. Main Results: Congenital malformations of the CNS were present without other associated malformations in 65.78%, with the distribution: hydrocephalus (37.5%), mielomeningocele (15%), encephalocele (12.5%), agenesis of the corpus callosum (12.5%), anencephaly (12.5%), holoprosencephaly (7.5%), DandyWalker (7.5%), Arnold Chiari malformation (5.0%), hydranencephaly (5.0%), meningocele (5.0%), arachnoid cyst (2.5%). Congenital malformations of other systems were related to the CNS, craniofacial (73.9%), orthopedic (65.2%), cardiovascular (34.8%), genitourinary (30.4%), gastrointestinal (30.4%), respiratory (8.7%), syndromic (8.7%), ophthalmology (4.3%). Importance of the Conclusions: The data encountered are mostly in line with the literature; should be sought by various means, the constant improvement in ultrasonography seeking the excellence in early diagnosis and screening of fetal malformations, respecting the limitations of the method.

TL.10.006 Assessment of Fetal Heart Standard Views at 12 to 14 Weeks of Pregnancy by Abdominal and Transvaginal Ultrasound Using B Mode, Color Doppler and Stic: Influence of Crown-Rump Length and Body Mass Index A. I. F. Lima,1 D. Pares, B.S.,1 E. Araujo Junior,1 L. M. M. Nardozza,1 W. P. Martins,2 A. F. Moron1 1 Fetal Cardiology Unit, Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ao Paulo-SP, Brazil, 2Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil Brief Description of the Purpose of the Study: To evaluate the influence of crown-rump length (CRL) and body mass index (BMI) in the assessment of fetal heart views by abdominal and transvaginal ultrasound. Methods: A cross-sectional study with 53 normal pregnancies at 12 to 14 weeks of pregnancy was realized. We used the abdominal and transvaginal ultrasound with B mode, color Doppler and spatio-temporal image correlation (STIC) to assess the fetal heart views: four-chamber, left and right out tract and ductal arch. We assessed the influence of CRL and BMI in obtaining of these views using unpaired t test. Main Results: To the vaginal method, the assessment of four planes was obtained in 16 patients in B mode and color Doppler; and in 24 patients using the STIC. Only the CRL had influence in the exams using the color Doppler (mean 66.78 vs. 73.54 mm; p , 0.01). To the abdominal method, the assessment of four planes was obtained in 20 patients in B mode, 21 in color Doppler and 24 in STIC. We did not observe the influence of CRL or BMI in all these methods. Importance of the Conclusions: The influence of CRL and BMI is very weak in the assessment of fetal heart views using the abdominal and transvaginal ultrasound.

TL.10.003 Reference Intervals of Length and Area of Fetal Cisterna Magna by Two-Dimensional Ultrasound - Pilot Study A. P. Passos, E. Araujo Junior, L. M. M. Nardozza, A. F. Moron Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ ao Paulo, SP, Brazil Brief Description of the Purpose of the Study: To determine reference intervals to the length and area of fetal cisterna magna by two-dimensional ultrasound at 20 to 33+6 weeks of pregnancy. Methods: A prospective cross-sectional study was realized with 90 normal pregnancies at 20 to 33+6 weeks of pregnancy. The fetal cisterna magna was assessed in the axial plane of the head at level of cerebellum diameter. The length and area of fetal cisterna magna was assessed using distance between two points and the manual trace, respectively. We calculated the mean, standard-deviation and minimum and maximum. We realized a polynomial regression between length and area of fetal cisterna magna and the gestational age (GA), with the adjustment realized by determination coefficient (R2).

TL.10.007 Cervical Length & Leading Placental Edge to Internal OS Measurements - TA vs TV S. L. Campbell Westerway, L. Henning Pedersen, J. Hyett RP Womens & Babies, Sydney University Australia, Aarhus University Denmark Brief Description of the Purpose of the Study: To compare cervical length/leading placental edge from the internal cervical os measurements obtained by both transabdominal (TA) and transvaginal (TV) approach and to assess intra / inter-observer variation for these measurements. Methods: Cross sectional study of 374 consecutive pregnancies with gestation 12 weeks to term. The cervical length was estimated as the distance from internal to external os, and the placenta / cervix distance as the leading placental edge to internal cervical os. Bland-Altman plots were used to evaluate the two methods, both overall and stratified by gestation. Test characteristics were calculated for cervix,25mm. On

Abstracts twenty of the above studies, two observers measured each of the parameters at least twice. Intra / inter-observer error was the mean deviation calculated as a percentage of the mean measurement. Main Results: Overall, TA measurements of both cervix and placental edge position were statistically different from measurements obtained TV. In second trimester, the TA cervix estimate was 2.7 mm , (95% CI 1.8-3.6) TV estimate. .24 weeks gestation, the difference between the two methods for cervix was not statistically significant, however, the TA measurements detected only 1 of 16 cervix , 25 mm with a subsequent sensitivity of 0.06. There was a large inter-observer variation seen for both parameters whilst intra-observer difference was higher for TA placental edge than for the other measurements. Importance of the Conclusions: TA estimates of cervix and placental edge position did not reflect the estimates obtained by TV assessment. As both measures are important markers of pregnancy outcome and management, the transabdominal method in the present form is insufficient in clinical management.

TL.10.008 Role of Nuchal Translucency in Detection and Management of Congenital Anomalies in First Trimester Sonography in Developing Countries K. V. N. Dhananjaya Manipal University, Mangalore, Karnataka, India

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Brief Description of the Purpose of the Study: To evaluate the placenta-fetal perfusion by analyzing the umbilical venous volume flow (UVVF) following maternal Betamethasone administration in monochorionic twins (MC) with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery (UA) Doppler. Methods: UVVF was calculated by multiplying the umbilical vein cross-sectional area at its entry into the fetal abdomen by half of the maximum velocity. Normalized UVVF was defined as UVVF/birth weight (Kg). After administration of the first dose of Betamethasone, UVVF and UA Doppler were recorded prior to (D0), 24 hours (D1) and 48 hours (D2), respectively. Intertwin perfusion ratio of normalized UVVF was defined as normalized UVVF (sIUGR) twin/normalized UVVF (appropriate for gestational age (AGA)) twin. Main Results: Six (24 %) of the 25 cases the sIUGR twin UA Doppler returned to positive end-diastolic velocity after Betamethasone administration. Both normalized UVVFs of the AGA and sIUGR twins increased at D1 and D2. The intertwin perfusion ratio of normalized UVVF did not change significantly after Betamethasone administration. Importance of the Conclusions: Antenatal corticosteroid administration increases the placenta-fetal circulation but without significant changes of the intertwin perfusion ratio in MC with sIUGR.

TL.10.012 WITHDRAWN

Brief Description of the Purpose of the Study: Variation of Nuchal Translucency (NT) measurements with increasing Crown-Rump Length (CRL). To correlate Nuchal Translucency with pregnancy outcome and clinical assessment of newborn for congenital anomalies. Methods: Antenatal ultrasound scanning done on pregnant women with singleton pregnancies and the fetal NT thickness was measured between 11 weeks and 13 weeks 6 days of gestation. Ultrasound probe used for transabdominal scanning was curvilinear probe with frequency band width of 3.5-5MHz. During the 11-13+6 weeks scan, the foetal CRL, Nuchal translucency, any structural abnormalities in the foetus, uterine anomaly, adnexa, cervix and the internal os were noted. Main Results: In our study, we have done NT scan from 11 - 13+6 weeks of gestation; the mean examination time of the NT scan was 87.97 (12weeks 3days) standard deviation (SD)5 4.832. Subject study with high NT is 186 (16.6%) with 98.6% accuracy of association with congenital anomalies. Subject study with low NT is 936 (83.4%) with 99.8% of the babies born with no congenital anomalies. Importance of the Conclusions: NT measurements increase with increasing CRL and a false positive rate increases with increasing gestational age. There is a strong association with high NT values and congenital anomalies.

TL.10.015 3D Volume Flow Measurement With the Pixelflux-Technique Demonstrate Reduced Perfusion in IUGR Fetuses Scholbach Thomas, Stolle J€org, Scholbach Jakob Chemnitz Clinics Brief Description of the Purpose of the Study: Today no true volume flow meanurement of the fetus is possible since 2D color Doppler data miss the true spatially angle-corrected flow velocities and cannot display non-circular configurations of the umbilical vein. The PixelFlux-technique overcomes these limitations and calculates true flow volumes from conventional 3D-Color Dopppler data of the umbilical cord. Methods: Fetal 3D-color Doppler of the umbilical vein PixelFluxmeasurement of each pixels true i.e. spatially angle corrected flow velocity and area. Material 736 measurements in 206 fetuses (23 - 40 gestational week) 135 normal, 27 IUGR, 47 SGA,5 hypertrophic (8 changed the group).

TL.10.009

Main Results: IUGR fetuses suffer from a significantly reduced global flow volume (141 ml/kg*min) compared to normal weight fetuses (226 ml/kg*min).

Placenta-Fetal Circulation Change After Maternal Betamethasone Administration in Monochorionic Twin With Selective Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler P. C. C. Hsieh, Y. L. Chang, S. D. Chang, A. S. Chao, C. N. Wang, T. H. Wang Department of OB/GYN, Chang Gumg Memorial Hospital, Tao-Yuan, Taiwan

Importance of the Conclusions: The PIxelFlux-technique can perform true measurements of fetal perfusion volumes. This can help to detect early stages of fetal compromise. Technical limitations of traditional Doppler techniques are overcome. The method adds a truly physiological parameter to the armamentarium of fetal diagnostics. Not blood flow velocities or Resistance Indices of vessels running away from the fetus but true blood flow volumes of the only vessel running towards the fetus are used to describe the perfusion state of the unborn.

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11 - Ultrasound in Musculoskeletal PA.11.004 Protocolo E Sistematizac¸~ao Da Avaliac¸~ao Ultrassonografica Para Investigac¸~ ao Da Displasia Do Desenvolvimento Dos Quadris-a Experi^encia Do Hospital Israelita Albert Einstein M. R. C. Silva, C. A. P. Braga, L. R. A. Camara, M. A. N. Germano, R. M. Tanaka, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil Brief Description of the Purpose of the Review of Literature: Sonography constitutes currently the main diagnostic modality for the evaluation of developmental dysplasia of the hip. This method gives information about the morphology of the acetabulum, the anatomical relationship between femoral head and acetabulum and dynamic aspects related to stability of this joint. Description (s) Condition (s), Method (s) Or Technique (s): Ultrasound evaluation using broadband linear transducers with a frequency of 5-12 MHz. We developed a protocol for examination and photographic documentation pattern based on the methodology described by Graf and Harcke. We developed also a standard report with all information necessary to the orthopedist assistant interpretation, as the inclusion of a table with data from previous studies. Conclusion: Adopting a systematic protocol for the implementation of this method is important in its uniformity and consequent reduction of interpersonal variability within the group of radiologists. It is also a facilitator for the understanding of the data by the orthopedist assistant. Brief Discussion of the Case: Null. PD.11.001 Ultrasonographic Findings of Morel-Lavallee Lesions I. Yang, A. Y. Jung, H. S. Hong, J. Y. Woo, S. K. Jeh, J. Y. Hwang, Y. N. Kim, H. M. Kim, Y. Lee Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea Brief Description of the Purpose of the Study: The purpose of this study was to review the sonographic features of Morel-Lavallee lesions by correlating US image findings with a lesion’s age. Methods: We obtained the sonography reports 20 Morel-Lavallee lesions of the hip and extremities in 18 patients with a history of trauma. US images were reviewed to characterize the echogenicity, shape, homogeneity, margins, and location of the lesions. The results were correlated with the age of the lesion and clinical histories. Main Results: All Morel-Lavallee lesions were hypoechoic or anechoic fluid collections, and located between the subcutaneous fat and underlying fascia. Regarding shape of the fluid collections, the lobular shaped lesions were all less than 14 days of lesion’s age, and the flat fluid collecionts were all greater than 1 month of age. Regarding homogeneity, the heterogeneous fluid collections were all less than 25 days of age, and the homogeneous fluid collections were all greater than 1 month of age. Importance of the Conclusions: Acute Morel-Lavallee lesions tended to be heterogenous, lobular, and became more homogeneous and flat in shape as the lesions evolved. So, ultrasound was useful for characterizing Morel-Lavallee lesions with their chronological changes. PD.11.002 Up to How Small of a Glomus Tumor of the Finger Can the High Resolutional Ultrasonography Demonstrate! I. Yang, A. Y. Jung, H. S. Hong, J. Y. Woo, S. K. Jeh, J. Y. Hwang, Y. N. Kim, H. M. Kim, Y. Lee Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea Brief Description of the Purpose of the Study: The purpose of this retrospective study is to define how small can be the size of tumor

Volume 39, Number 5S, 2013 that high resolutional ultrasound examination can demonstrate the glomus tumors of the fingers. Methods: Twenty one cases of glomus tumors of the finger were included in this retrospective study. Preoperative ultrasonography was done using a 10-12 MHz linear transducer (IU22, Philips Medical System, Bothell,WA) & a 6-15 MHz linear transducer (LOGIQ E9, GE Healthcare, Milwaukee,WI) to evaluate the location, size and vascularity of the tumor. All Ultrasound Doppler studies were performed by the same radiologist. These results were compared with operative findings. Main Results: Simple radiography showed normal in 11 cases (52%), seven cases(33%) revealed mild erosive change, and three cases (15%) demonstrated osteolytic bone destruction. Twenty cases (95%) located at subungal area, and one case (5%) showed at volar side of the finger. The mean size of the tumor was 4.5mm (from 2mm to 8mm). In all twenty one patients, ultrasound study was able to confirm the diagnosis. All tumors presented a Doppler hypersignal, and compatible with the diagnosis of glomus tumor. Importance of the Conclusions: These studies are useful for the smaller size of the mass up to 4.5mm. PD.11.003 Ultrasonographic Findings of the Peroneal Tendons and Associated Pathology Sun Joo Lee, Hye Jung Choo, Ji Sung Park, Yeong-Mi Park Inje University Busan Paik Hospital, Busan, Korea Introduction: Disorders of the peroneal tendons are common in patients with lateral ankle discomfort and knowledge of anatomy, normal variations, and pathology is essential. Methods Involved: A 10-year retrospective search of our department’s radiology archive was completed to identify pathology and variations of the peroneal tendons. Discussion: Pathologic conditions of the peroneal tendons that were identified included tendinosis, tenosynovitis, tear, dislocation, as well as injury of the superior peroneal retinaculum, intrasheath subluxation, ganglion cyst, and os peroneum fracture. A number of anatomic variants were also identified, which included hypertrophy of the peroneal tubercle, an accessory peroneus quartus muscle, and a low-lying peroneus brevis muscle. Conclusion of the Presentation: Ultrasound (US) is useful diagnostic tool prior to surgical treatment. This essay reviews the ultrasound features of peroneal tendon pathology and variations. In particular, ultrasound is emphasized for the dynamic evaluation of peroneal tendon subluxation and dislocation. The recognition of the ultrasound features of the anatomic variants and common pathology of the peroneal tendons is important to formulate a comprehensive differential diagnosis and guide treatment strategy. PD.11.004 Ultrasonographic Finding of Pilar Sheath Acanthoma in the Lower Extremity Sun Joo Lee, Hye Jung Choo, Ji Sung Park, Yeong-Mi Park Inje University Busan Paik Hospital, Busan, Korea Brief Description of the Purpose of the Report: Pilar sheath acanthoma is a rare, benign follicular hamartoma, with a level of differentiation between trichofolliculoma and dilated pore of Winer, which is a patulous follicle containing hair. It almost occurs in the face, especially upper lip and forehead. To the best of our knowledge, US finding have not been documented. We report the US finding of a case of pilar sheath acanthoma in the lower extremity. Medical History: A patient, male, 56-years old, was hospitalized to treat subcutaneous nodule with a central pore-like opening on the medial aspect of the right lower leg.

Abstracts Diagnosis: Ultrasonography showed an oval hypoechoic nodule with hypoechoic capping at the dermis and subcutaneous layer of the medial aspect of the right lower leg. This lesion showed hypervascularity on color Doppler image. It was confirmed that the nodule was pilar sheath acanthoma. Discussion and Summary of the Case: The ultrasonographic finding of pilar sheath acanthoma reveals that non-specific soft tissue nodule showing well-defined, hypoechoic nodule with hypoechoic capping and hypervascularity at the dermis and subcutaneous layer. Pilar sheath acanthoma could be considered as a possible diagnosis when a well defined superficial nodule with a central pore-like opening showed hypoechoic nodule with hypoechoic capping and hypervascularity on ultrasonography. PD.11.005 Imaging Findings of Solitary Cysticercosis in the Intermuscular Area of the Thigh Sun Joo Lee, Hye Jung Choo, Ji Sung Park, Yeong-Mi Park Inje University Busan Paik Hospital, Busan, Korea Brief Description of the Purpose of the Report: Cysticercosis is a disease caused by encysted larvae of the tapeworm Taenia solium. The purpose of this case is to characterize the US and MR imaging features of solitary intermuscuar cysticercosis involving the thigh and to correlate the imaging features with pathologic findings. Medical History: A patient, female, 54-years old, was hospitalized to treat a mass in the right thigh without trauma history. The overlaying skin was normal. Diagnosis: Ultrasonography showed a cystic mass of 2.8 cm in size located in the intermuscular area of the medial aspect of the right thigh. Lesion contained tubular, folded, worm-like structure, which is suggestive of scolex. MRI findings revealed high signal intensity mass on T2weighted image, showing hypointense on T1-weighted image and irregular thin peripheral enhancement in the medial aspect of the right thigh between gracilis and adductor muscle groups. Sagittal T2-weighted image demonstrated a tubular, hypointense structure located within the lesion corresponding to the worm-like structure seen on ultrasound. Discussion and Summary of the Case: Cysticercosis should be kept as a differential diagnosis for any case of focal myositis or subcutaneous swellings. Although it is difficult to diagnose solitary soft tissue cysticercosis, if characteristic scolex can be demonstrated with any imaging modality, the diagnosis of cysticercosis can be easier. PD.11.006 A Ultrassonografia Com Doppler Em Pacientes Com Artrite Reumat oide: Ensaio Pictorico M. F. V. L. Weber Dix Diagn ostico Por Imagem, Santa Maria, RS, Brasil Introduction: Rheumatoid arthritis is a chronic, progressive, autoimmune inflammatory disease. It affects the synovial tissue of the joints and can lead to joint deformities with functional loss. With the advent of new therapies, imaging methods capable of identifying early changes of the disease are of great importance to institute treatment as soon as possible to avoid the chronic manifestations of this debilitating disease. Methods Involved: Clinical cases in our archives were selected to demonstrate the usefullness of doppler ultrasonography. The proper technique for performing the examination and major findings such as synovitis, tenosynovitis and bone erosions are shown in these patients. Discussion: Doppler ultrasonography is an effective imaging method for diagnosing active synovitis, grading of inflammatory activity and assess patient prognosis. Bone erosions are easily identified. Inflammatory alterations in periarticular tissues such as tendons are also demonstrated. Another objective is to evaluate the therapeutic response, helping in the decision to change or modify the drug doses.

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Conclusion of the Presentation: Doppler Ultrasound is an effective method for the early diagnosis of rheumatoid arthritis, evaluating the severity of inflammatory disease and the patient prognosis as well as the response to therapy. PD.11.007 WITHDRAWN

PD.11.008 Interposic¸~ao Do Manguito Rotador Na Articulac¸~ao Glenoumeral: Uma Complicac¸~ao Rara De Les~oes Traumaticas Do Ombro P. M. Agnollitto, M. M. Lorenzato, S. C. A. Zatiti, M. H. NogueiraBarbosa Hospital Das Clınicas Da Faculdade De Medicina De Ribeir~ao Preto, Ribeir~ao Preto, S~ao Paulo, Brasil Brief Description of the Purpose of the Report: Interposition of the rotator cuff in the glenohumeral joint is a rare complication of traumatic injuries of the shoulder, especially the dislocation. In this report, we present a typical case, and review of the literature. Medical History: A 40 years old female patiente presents with a history of traumatic dislocation of the shoulder. Joint reduction was not achieved with the usual maneuvers. Diagnosis: Rotator cuff tear with tendon interposition in the glenohumeral joint. Discussion and Summary of the Case: Rotator cuff tear with tendon interposition in the glenohumeral joint is a rare complication of traumatic injuries of the shoulder, especially dislocation. Joint block following trauma or inability to reduce a dislocation are the most common clinical presentations. Joint space widening is the most characteristic finding on plain radiographs. MRI images are useful for confirmation, as it can show tendons interposition as the cause of joint space widening. Surgery is the treatment of choice and radiologists should be familiar with this entity, which can easily be overlooked, due to its rarity.

PD.11.009 The Tram-Tract Sign: A Characteristic Feature of the Polyethylene Liner Dissociation in Total Hip Arthroplasty On Sonography W. Jin, J. H. Jang, S. Y. Hwang, S. Y. Park, J. S. Park, D. M. Yang, K. N. Ryu Kyung Hee University Hospital at Gangdong, Seoul Brief Description of the Purpose of the Study: To evaluate sonographic features of liner dissociation (LD) and detect a useful sonographic finding, comparing with conventional radiography (CR) and CT. Methods: Ten patients who showed severe narrowing of superior joint space at the THR and underwent a revision THA were retrospectively reviewed by evaluating image findings on CR (10), CT (9), and sonography (10). In evaluation of the images, we put more emphasis on radiographic crescent sign, CT crescent sign, and sonographic tram-tract signWe have termed radiolucency medial to the femoral neck on CR or CT as -‘‘radiographic or CT crescent sign’’-, and also parallel double hyperechoic lines anteromedial to femoral neck on sonography as -sonographic tram-tract sign-. Main Results: On operation, 7 patients showed LD and 3 showed severe liner wearing. 8 of 10 patients (80%) on CR, and 4 of 9 patients (44%) on CT had a correct diagnosis of the presence or absence of LD. On sonography, all 10 patients (100%) had a correct diagnosis of the presence or absence of LD.

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Importance of the Conclusions: LD was easily and well visualized by sonography, than CR or CT. Additionally, sonographic tram-tract sign was a very useful sonographic feature in diagnosis of LD in patients with long-duration THA.

PD.11.010 Dynamic Ultrasound Evaluation of the Volar Plate J. P. B. Costa Lima, W. J. P. M. Silva, A. I. Brandao, D. C. Azevedo, F. H. Aoki, F. C. Miranda, M. A. N. Germano, R. M. Tanaka, R. C. Yonezaki, M. R. C. Silva, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: Volar plate is a fibrocartilaginous structure of the interphalangeal and metacarpophalangeal joints that helps sustain the articular capsule. It has an important role in stabilizing the joint, since it prevents hyperextension of the finger. This study aimed to show that lesions in the volar plate can be evaluated by dynamic ultrasound. Methods Involved: Assessment of lesions in the volar plate by dynamic ultrasound using transducer with high frequency (17 Hz) and performing hyperextension of the finger during the evaluation. High resolution movies were documented in the dynamic assessments. Discussion: Both complete and partial lesions were accurately evaluated. In the partial lesion, there were identified irregularities, thinning and some fibers retractions. In the complete lesions, there were identified all fibers retraction, not associated with scar tissue but with leakage of Intra-articular liquid beyond the limits of the corresponding synovial membrane. Conclusion of the Presentation: Ultrasound is a method with high sensitivity and specificity in the evaluation and characterization of lesions on volar plates.

Volume 39, Number 5S, 2013 PD.11.012 Usefulness of Dynamic Ultrasonography in Acetabular Labral Tear: Comparison With Mr. Arthrography and Arthroscopic Findings S. M. Lee, K. J. Lee Dongsan Medical Center, Daegu, Korea Brief Description of the Purpose of the Study: To present the usefulness of dynamic ultrasonography in acetabular labral tear. Methods: Ultrasonography(US) was performed in 18 patients (10 male, 8 female, mean age 43 years) for evaluation of acetabular labrum. US images were obtained in neutral position and during internal/external rotation of the hip. We considered the labrum was torn when there was 1) displacement, 2) hypoechoic-to-anechoic intra-labral defect extending to labral margin, 3) irregular deformity such as truncation, or 4) absence. Arthroscopy was done in seven patients and labral tear was confirmed. MR arthrography (MRA) was done in 13 patients. We also performed dynamic US in five normal patients (mean age 47 years) and compared with tear group. Main Results: In four of 18 patients (22.2%), labral tear was not seen in static US that was evident in dynamic study. In 14 patients (77.8%), dynamic US revealed labral tear more clearly than static images in neutral position-widening of tear, aggravation of distortion, or displacement of torn labral fragment. Labral tear was more confirmative than MRA in two patients. Importance of the Conclusions: Dynamic ultrasonography during internal/external rotation of the hip seems to be helpful in the diagnosis of acetabular labral tear-can give more confident information and will improve US diagnostic rate.

PD.11.013 PD.11.011 Fasceite Necrotizante Apos Injec¸ao De Lipocomposto Intramuscular D. A. Araujo Jr., G. B. G. S. Lima, A. C. S. Torres, G. G. Lima, A. M. A. Martins, K. P. Luz, P. P. Coimbra, I. M. S. Oliveira Hospital Geral De Fortaleza, Fortaleza, Ceara , Brasil Brief Description of the Purpose of the Report: The aim of this study was to report the occurrence of cases that demonstrate the harmful effects of steroid use. Medical History: Patient, 23 years old, male, weightlifter, says use of injectable intramuscular fat soluble vitamins. Seven days ago, evolving with fever and limitation of movement. Diagnosis: Pyomyositis complicated with necrotizing fasciitis after injection intrasmuscular. Discussion and Summary of the Case: The use of anabolic steroids are used by athletes aiming to improve the performance of physical activities as well as enhance and accelerate gains in muscle mass. Most often, their application is carried out without adequate sterilization, increasing the risk of local infection, which often progress to large abscesses. Early treatment is necessary to control the infection, which if not properly treated, can progress to sepsis or necrotizing fasciitis, causing local necrosis. The necrotizing fasciitis progresses rapidly and can be fatal. It is characterized by necrosis and suppuration, and is often difficult to differentiate cellulitis or pyomyositis according to the initial clinical presentation. The immediate surgical treatment is necessary to prevent a fatal outcome for patients.

Ultrasonography-Guided Percutaneous Removal of Radiolucent Foreign Body S. M. Lee, C. H. Cho Dongsan Medical Cneter, Daegu, Korea Brief Description of the Purpose of the Report: Video clips to present technique and usefulness of ultrasonography (US)-guided removal of foreign body (FB). Medical History: Case 1. A 64-year-old woman complained painful swelling of wrist with discharge for one week after slipping in kitchen. Magnetic resonance imaging (MRI) and US showed a FB with surrounding inflammatory change between palmaris longus tendon and median nerve. Case 2. A 10-year-old boy came to emergency department due to painful swelling of knee with discharge for five days. He had history of slip-down one week ago. US showed a large FB in prepatellar area. Case 3. A 54-year-old man complained painful swelling of the foot for four months. He had got a stab injury and had removed a nail immediately. US revealed a FB within abductor hallucis muscle. After local anesthesia, 5 mm skin incision was done. Hydro-dissection was performed around the FB with lidocaine for anesthesia and adhesiolysis. After then, a mosquito hemostat was introduced and the FB was removed. All procedures were performed under US-guidance. Diagnosis: A wood foreign body was removed quickly and safely in all three cases without any complication. Average procedure time was approximately 20 minutes. Discussion and Summary of the Case: US-guided percutaneous removal of radiolucent foreign body is a quick and safe method.

Abstracts PD.11.014 Congenital Hypoplasia of Medial Hallucial Sesamoid Bone With Combined Avascular Necrosis S. Lee, S. Y. Song, Y. Kim, T. H. Kim Hanyang University Hospital College of Medicine, Seoul, Korea Brief Description of the Purpose of the Report: Congenital absence or hypoplasia of hallucial sesamoid bones is very rare but we must consider it in a patient with MTP joint pain. Medical History: We present a 32-year-old female patient with pain at the plantar aspect of the right MTP joint associated with congenital hypoplasia of the medial sesamoid and avascular necrosis. There was tenderness and the range of motion was minimally restricted. She described the bilateral aching pain around both 1st MTP joints in her social life. Diagnosis: On radiographs, the medial hallucial sesamoids were absent on the left side and hyplastic on the right side. Ultrasonography of right foot showed multiple fragmentation of medial sesamoid bone with increased vascularity. On MRI, hypoplasia of medial sesamoid bone with combined avascular necrosis was shown. Discussion and Summary of the Case: Pain at the first metatarsophalangeal joint can result from inflammation, chondromalacia, flexor hallucis brevis tendinitis, osteochondritis dessecans, fracture of a sesamoid bone, avascular necrosis of sesamoids, inflamed bursae, intractable keratoses, infection, sesamoiditis, gout arthropathy, and rheumatoid arthritis. Although congenital absence of sesamoid bones is an extremely rare condition, we consider it as a cause of MTP joint pathology. PD.11.015 A Case of Atypical Fibroxanthoma of Subungual Type: Ultrasound and Magnetic Resomance Imaging Findings S. Lee, S. Y. Song, Y. Kim, T. H. Kim Hanyang University Hospital College of Medicine, Seoul, Korea Brief Description of the Purpose of the Report: Subungual atypical fibroxanthoma is a rare mesenchymal skin tumor of intermediate malignancy. In differential diagnoses of subungual tumors, glomus tumor, soft-tissue chondroma, keratoacanthoma, hemangioma, lobular capillary hemangioma, epidermal and mucoid cysts, squamous cell carcinoma and malignant melanoma have been suggested. But, atypical fibroxanthoma has not been included in differential diagnoses. Medical History: A 56-year-old man presented with a painful mass on the right fifth toe, which he had had for five months. It enlarged rapidly and caused pain and bleeding. Physical examination revealed a tender, swollen and peduncular mass on the medial and dorsal side of the right 5th toe. Diagnosis: Ultrasonography revealed a well-defined, heterogeneous and hypoechoic mass with subtle cortical erosion and partially posterior acoustic enhancement. On MRI, T1-weighted and T2-weighted coronal images showed up a subungual and peduncular mass of intermediate signal intensity in the distal phalanx.. The mass had a broad-based attachment to the distal phalangeal bone, with subtle bone erosion. Gadolinium-enhancement images showed diffuse enhancement in the mass. Discussion and Summary of the Case: We report a case of subungual AFX with pedunculation, a rare condition. Thus, if a patient has a subungual malignancy on US, AFX should be included together with squamous cell carcinoma and malignant melanoma. PD.11.016 Intrasheath Subluxation of Peroneal Tendons: Usefulness of Dynamic Ultrasonography S. M. Lee, K. S. Song Dongsan Medical Center, Daegu, Korea

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Brief Description of the Purpose of the Study: To present the role of dynamic ultrasonography in intrasheath subluxation of peroneal tendons Methods: Ultrasonography (US) was performed in seven ankles of six patients (M:F 3:3, mean age 38 years). Four adult patients complained retromalleolar pain with or without clicking. One baby, who was diagnosed as congenital metatarsus adductus, showed visible anterolateral dislocation of peroneal tendons. The other baby revealed bilateral clicking. Symptom duration was several months to three years. Short-axis static images were obtained from mid-calf to inframalleolar area to certify each tendon (peroneus longus and brevis). Dynamic short-axis images were obtained at retromalleolar area during forced eversion-dorsiflexion of the ankle. Main Results: Overt inversion trauma history was noted in only one patient. All patients showed abrupt intrasheath subluxation of the peroneus brevis during eversion-dorsiflexion. Six ankles showed normal relationship between peroneus longus and brevis in rest. Reversed tendon position even in rest was seen in one. Six were Raikin type A and one was type B. Additional findings were tedninosis, tenosynovitis, thickening of the superior peroneal retinaculum, longitudinal split of the peroneus longus, and an intrasheath ganglion. Importance of the Conclusions: Dynamic US is essential in diagnosis of intrasheath subluxation of the peroneal tendons, which can be missed with static images alone in resting state. PD.11.017 Comparison of Ultrasound Imaging of Osteomyeliltis J. B. Koo, D. J. Shin Dongguk University Ilsan Hospital, Goyang, Korea Brief Description of the Purpose of the Report: Early diagnosis is important because it allows prompt medical and surgical treatment, which can be prevent many of serious complications such as sepsis, growth arrest in children and amputation of limb. Medical History: Radiography and nuclear medicine studies have been played an important role in evaluation of osteomyelitis. Currently MRI considered the advanced imaging technique in diagnosing bone infection and its complications, which include soft-tissue and bone abscesses, physeal involvement, and septic arthritis. Diagnosis: Sonography is quick, low cost, no radiation and allows easy comparison of lesion with normal. Although it has lack of visualization of marrow lesion, recent study describe many characteristic findings of osteomyelitis in sonography. Discussion and Summary of the Case: Early diagnosis of osteomyelitis is important. Typically, the diagnosis of osteomyelitis is made by a combination of clinical findings, imaging, and mircrobiologic data. Gray-scale and CDUS signs might be useful diagnosed for osteomyelitis. PD.11.018 Do You Know Popeye or Popeye Sign? J. B. Koo, D. J. Shin Dongguk University Ilsan Hospital, Goyang, Korea Brief Description of the Purpose of the Report: Rupture of the long head of the biceps muscle is common and well known injury. ‘Popeye’ sign is a soft tissue lump in the anterior aspect of the middle arm by biceps retracted distally. The patient is amazed to see such a hypertrophied muscle in the arm which paradoxically leads to a diminished strength. In this exhibition, we show two cases which have typical photos, ultrasound images, and operative findings. Medical History: 40-year-old male. He lifted a heavy water pail up. He experienced pain associated with audible pop at right arm. He noticed different contour of both arm thereafter. 41-year-old male. He lifted a heavy load up. He heard ‘pop’ sound at right arm and experienced pain thereafter. Diagnosis: Ultrasound examination; Longitudinal US images show the retracted tendon end (arrow) and surrounding hypoechoic sheath

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effusion. Transverse US image shows an empty sheath (arrow) just distal to the bicipital groove. Discussion and Summary of the Case: US findings On short-axis scans at the intra-articular level Coracohumeral ligament: a concave profile over the humeral head due to the absence of the underlying biceps At the site of rupture The sheath of the biceps tendon may fill in with debris. Making it difficult to distinguish a torn from an irregular but intact tendon The tendon stump is retracted down into the arm and appears surrounded by fluid.

PD.11.019 Condromatose Sinovial: Relato De Caso E Revis~ao Bibliografica De Um Diagn ostico Ultrassonografico Raro B. Maragno, M. C. N. A. Leite, N. C. M. F. Montenegro, N. B. Genova, C. A. Sinisgalli Jr., Hospital S~ ao Luiz Jabaquara, S~ao Paulo, Brasil Brief Description of the Purpose of the Report: Describe the sonographic findings of synovial chondromatosis, a rare disorder and difficult to diagnose, which can go unnoticed until radiologically in 95% of cases. Medical History: MAPO, 67, female, reporting pain, swelling and restriction of movement in the right elbow for the last 8 years, with progressive worsening. Ultrasonography of the right elbow requested evidenced distension and olecranon bursa net with loose bodies inside hypoechoic, consistent with synovial chondromatosis. Diagnosis: Synovial Chondromatosis of right elbow. Discussion and Summary of the Case: Synovial chondromatosis is a benign metaplasia of the synovium, of unknown origin, leading to the formation of cartilaginous loose bodies in the joint space. The appearance of the lesion is more common in men and in people between the third and fifth decades of life, mainly affecting the knee, followed by the hip, shoulder, elbow and hand, predominantly monoarticular. Clinically, it presents with pain, swelling and blockage of the affected joint, with progressive worsening over the years. The conventional radiography is very characteristic that the loose bodies are calcified (osteochondromatosis), their interpretation is difficult when they are radiolucent (chondromatosis). At ultrasound, appear as hypoechoic nodular bodies free intra-articular, surrounded by fluid, moving to dynamic maneuvers. Total synovectomy is the treatment of choice, with low risk for chondrosarcoma.

PD.11.021 Evaluation of the Elasticity Ratio in Lipoma on Sonoelastography S. T. Kwon Chungnam National University Hospital, Daejeon, Republic of Korea Brief Description of the Purpose of the Study: To measure the elasticity ratio (ER) of the lipoma to underlying muscles on sonoelastography and to compare the ratio with B-mode sonographic findings. Methods: 29 patients (mean, 53 years) with pathologic confirmed lipoma were enrolled. The size, location, and echogenicity of the lipomas compared with subcutaneous fat were estimated. The ER of the lipoma-to-underlying muscle was calculated on transverse and longitudinal scans, respectively. The ER was obtained by two semi-automatic ROIs on elastographic images. Main Results: The mean value of the area, thickness, and volume of the lipomas were 14.6 mm2, 1.0 mm, and 14.2 mm3, respectively. Locations were subcutaneous (n523, 79%), subfacial (n55, 17%), and intramuscular (n51, 4%). Echogenicity of the lipoma showed hyperechogenicity in nine (31%), isoechogenicity in 17 (59%), and hypoechogenicity in three cases. The mean ER (mER) was 2.39. The ER increased in propor-

Volume 39, Number 5S, 2013 tion to the thickness (p 5 0.001), volume (p 5 0.005), and area (p 5 0.056). The ER was not correlated with the location (p 5 0.294). The mER was calculated as 0.81 in hyperechogenicity, 2.94 in isoechogenicity and 3.12 in hypoechogenicity (p , 0.001). Importance of the Conclusions: The ER of the lipoma to underlying muscle correlates with the degree of volume, echogenicity, and thickness of the lipoma. PD.11.022 Herniation of Infrapatellar Fat Through Defect in Lateral Retinaculum of the Knee K. N. Ryu, W. Jin, J. S. Park, S. Y. Park Kyung Hee University Hospital, Seoul, Korea Brief Description of the Purpose of the Study: The purpose of this study was to evaluate clinical features and imaging findings of herniation of the infrapatellar fat through defect in the lateral retinaculum of the knee. Methods: A total of seven knees of five patients were included in this study. The clinical data about symptoms, treatment, and follow-up were reviewed. Dynamic sonographic examination was performed in both neutral and flexion of the knee of all patients. In one patient, MR imaging was performed on neutral and flexion of the knee. Main Results: All patients were preschool-aged children. They presented with painless soft mass in anterolateral knee with knee flexion or squatting positions. On sonography, hypoechoic mass-like lesion was protruded into the subcutaneous fat layer through lateral retinacular defect in flexion of the knee and returned to the infrapatellar fat pad region in neutral of the knee. MR imaging also revealed protrusion of the fat through defect in lateral retinaculum in flexion of the knee. No fat protrusion or mass was noted in anterolateral aspect of the knee on MR imaging in neutral of the knee. One patient confirmed surgically and pathologically in both knees and underwent repair of lateral retinaculum. Importance of the Conclusions: Herniation of the infrapatellar fat through a defect in the lateral retinaculum can occur at the fully flexed knee in preschool-aged children and this can be presented as a painless soft mass. Dynamic sonography was an excellent imaging modality for diagnosis. PD.11.023 A Contribuic¸~ao Da Ultrassonografia (US) Din^amica Na Investigac¸~ao Da Displasia Dos Desenvolvimento Dos Quadris M. R. C. Silva, C. A. P. Braga, L. R. A. Camara, M. A. N. Germano, R. M. Tanaka, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil Introduction: Currently ultrasound is the best diagnostic modality in the investigation of developmental dysplasia of the hip. Beyond the static morphological evaluation, ultrasound allows the study of dynamic joint stability, in real time. Methods Involved: Ultrasound evaluation using broadband linear transducers with a frequency of 5-12 MHz. High resolution movies have been documented for dynamic evaluation. Discussion: Based on the methodology described by Harcke in 1984, we will show films to illustrate clinical cases assisted in our department of diagnostic imaging, including patients with normal findings and others with significant hip instability. Conclusion of the Presentation: Due to the ability of ultrasound in the evaluation of dynamic joint stability, this method constitutes first choice as a diagnostic test in the investigation of developmental dysplasia of the hip, especially in those cases where there is doubt on clinical examination.

Abstracts PD.11.024 The Role of Ultrasound in Sports Muscular Injuries M. Miceli, M. Piolanti, S. Galletti, A. Ziosi Radiology Dept Maggiore E S. Giovanni in Persiceto Hospital, Bologna, Italy

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Description (S) Condition (S), Method (S) Or Technique (S): Retrospective study of several cases made in service comparing with literature. Conclusion: Technological developments favored use of doppler for evaluation of Muscle-Skeletal patology in special rheumatolgy. Brief Discussion of the Case: Null.

Brief Description of the Purpose of the Study: Identification of the most relevant diagnostic and prognostic factors of ultrasound imaging of muscular injuries in athletes. Methods: 100 ultrasound examination performed in athletes. with muscular injuries were evaluated to identify the US findings most useful for diagnosis and prognosis. Main Results: Grading of muscular tear mostly depends on US percentage of muscle involved in trauma and it is the most Important prognostic factor, With medical history, inspection and palpation of the muscle, Us imaging is most valuable at the initial assessment of muscular injuries and should take place within 3 days post-trauma. Other Important prognostic factors are identifications of complications as fibrosis, sieroma, (ossi) calcification, herniation etc. MRI can be useful if clinical and US examinations disagree and areas of difficult US exploration. Importance of the Conclusions: Ultrasound examination is mandatory in the Identification of the most relevant diagnostic and prognostic factors of ultrasound imaging of muscular injuries in athletes. PD.11.025 Ultrassonografia Do Tendao Distal Do Biceps F. A. Fujiki, M. C. W. Queiroz, C. H. C. Machado, B. M. P. Gomide, G. C. Oliveira Hospital Heliopolis, Sao Paulo, SP, Brasil Introduction: The pathologic conditions of the distal biceps tendon is much less common than those occurring proximally. In addition, the anatomy of this region makes ultrasound evaluation a little bit difficult. The purpose is to illustrate the ultrasonography techniques and the most common pathologies, partial and complete tears.

PD.11.028 Muscle Hardness Measurement by Using Ultrasound Elastography R. Santos, P. Armada Instituto Politecnico De Coimbra-Escola Superior De Tecnologia Da Saude De Coimbra, Coimbra, Portugal; Universidade Tecnica De Lisboa, Faculdade De Motricidade Humana, Lisboa, Portugal Brief Description of the Purpose of the Study: Knowledge of the characteristics muscle becomes important to understand the alterations that may occur during acute or chronic overload. Some techniques for measuring hardness of muscle have been proposed. Elastography has come to occupy a prominent place in this area, however there is still much to discover. The main goal of this study is to evaluate the feasibility of elastography for investigating changes in muscle vastus laterallis hardness. Methods: Twenty healthy male volunteers, with a mean age of 25 (SD 1,6) years old, were submitted an elastography ultrasound exam by using 14-6MHZ linear array transducer combined with a stabilizer. Both images were acquired within 10 minutes. Color-coded elasticity images were obtained and analyzed through MATLAB. Main Results: Elastography results demonstrated that muscle has a higher percentage of green and blue colors, which means that the muscle has a higher percentage of hard properties. Importance of the Conclusions: With elastography can measure muscle hardness, checking in with this study that the vastus laterallis muscle has hard properties, however has some elasticity. It’s important,in the future, to understand the muscle behavior in situations of acute or chronic overload.

Methods Involved: Ultrasonography. Discussion: The distal biceps tendon is oriented obliquely, from anterior to posterior, from medial to lateral, and it attaches on the radial tuberosity. Because of this, ultrasonography imaging is best acquired on the volar aspect of the elbow, with the forearm in supination. An alternative technique identifies the tendon from the dorsal aspect, while pronation and supination movements are realised. The complete tears usually involves a large force, with the elbow flexed. US shows discontinuity of the tendon and retraction, if the aponeurosis is also disrupted. The partial tears are associated with minor trauma and preexisting degeneration, US imaging is characterized by enlargement and abnormal contour of the tendon, with peritendinous fluid. Conclusion of the Presentation: Unless the distal biceps tendon lesions are uncommon, the radiologist must be able to classify into partial or complete tear, because the clinical differentiation is difficult and it defines the choice between conservative or surgical treatment, respectively. PD.11.027 Aplicabilidade Do Ultrassom Com Doppler Em Musculoesqueletico A. R. Cavalcante, M. J. B. Costa, T. P. Tabosa, E. A. Doria Neto, F. C. Araujo Jr., E. B. Nassar Csd, Belem, Para, Brasil Brief Description of the Purpose of the Review of Literature: Show the aplicability of doppler ultrassound evaluation of several MuscleSkeletal patology in special rheumatology.

PD.11.029 Sciatic Nerve Hardness Measurement by Using Ultrasound Elastography R. Santos, P. Armada Instituto Politecnico De Coimbra-Escola Superior De Tecnologia Da Saude De Coimbra, Coimbra, Portugal; Universidade Tecnica De Lisboa, Faculdade De Motricidade Humana, Lisboa, Portugal Brief Description of the Purpose of the Study: Elastography is a recent technique, still unexplored. Only the first investigations in musculoskeletal area. This method studies the hardness of tissues, allowing to quickly detect changes. However, for this it’s important to know the hardness degree of each tissue. The The Sciatic nerve is a structure that can often present alterations that at an early stage can’t be detected. This study aims to evaluate the hardness of sciatic nerve. Methods: Twenty healthy male volunteers, with a mean age of 25 (SD 1,6) years old, were submitted an elastography ultrasound exam by using 14-6MHZ linear array transducer combined with a stabilizer. Both images were acquired within 10 minutes. Color-coded elasticity images were obtained and analyzed through MATLAB. Main Results: Elastography results demonstrated that healthy sciatic nerve has a higher percentage of blue color (hard properties). Importance of the Conclusions: The sciatic nerve hardness can be measured by elastography. With this study the sciatic nerve can be identified as a hard structure. So if there is any sciatic nerve alteration it can be identified, early.

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PD.11.030 Ultrasound Evaluation of Transient Synovitis of the Hip in Children - Pictorial Essay D. C. Azevedo, A. T. Brandao, F. H. Aoki, E. Suenaga, M. A. N. Germano, R. M. Tanaka, M. R. C. Silva, M. J. Francisco-Neto, M. B. G. Funari Departamento De Radiologia Do Hospital Israelita Albert Einstein, S~ao Paulo, SP, Brasil Introduction: Diagnose transient synovitis of the hip in children is a challenge for the clinician. Both symptoms and physical examination findings are not pathognomonic for diagnosis. It commonly occurs in children 3-6 years of age. The child feels pain in the anterior hip and thigh, can affect the knee. Patient usually limps or cannot support the lower limb in the soil. Often occurs after a viral context. Methods Involved: Ultrasound is performed with patient in the supine position, with the hip joint in a neutral position. Discussion: Ultrasound is useful in diagnosis due to its high sensitivity in the detection of intraarticular fluid, as well as differentiates the appearance of joint fluid, usually anechoic in cases of transient synovitis. Conclusion of the Presentation: Ultrasound is a good method for the diagnosis of transient synovitis, because of its benefit cost-ratio and easy to perform in children. TL.11.001 Sonographic Evaluation of Cross Sectional Area of Multifidus Muscle in Patients With Low Back Pain: Case-Control Analysis of the Effects of Stabilization Exercises Among Chronic Low Back Pain Patients in Kano, Nigeria A. Ismail, K. A. Ahmad Bayero University, Kano, Nigeria

Volume 39, Number 5S, 2013 joint derangement was scanty. The aim of this study is to determine the magnitude of association between BPE and the demographic, clinical and sonographic findings of shoulder joints. Methods: We investigated the sonographic reports in the participants with suspected shoulder disorders who received ultrasound examinations from January 2011 to January 2012. The amount of BPE was graded as absent, mild, moderate and severe by measuring its thickness (1, 1-2, 2-3, .3 mm). The associations between BPE and songraphic abnormalities were examined with logistic regression adjusted by age, gender, affected side and clinical diagnosed frozen shoulder. Main Results: Among 907 enrolled shoulders, the prevalence of absent, mild, moderate and severe BPE were 64.1%, 17.8%, 10.4% and 7.7%, respectively. Using the participants without BPE as the reference, we found that frozen shoulder was related to mild BPE (odds ratio [OR] 2.39, 95% confidence interval [95% CI] 1.05-5.44). Regarding sonographic findings, biceps tendinopathy, subdeltoid bursitis and supraspinatus full thickness tear had significant associations with the entire spectrum of BPE, while subscapularis tendon tear was significantly associated with moderate to severe BPE (OR 2.50, 95% CI 1.30-4.82 and OR 3.16, 95% CI 1.52-6.58, respectively). Severe BPE status was associated with supraspinatus tendon articular-sided partial thickness tear (OR 18.12, 95% CI 4.54-72.32), posterior recess effusion (OR 8.50, 95% CI 1.45-49.53) and biceps medial subluxation (OR 8.05, 95% CI 1.93-33.62). Importance of the Conclusions: Our study indicated that BPE was related to shoulder joint derangement and the magnitude of association varies according to different grades of BPE. TL.11.005

Brief Description of the Purpose of the Study: To investigate the effect of stabilization exercise on cross sectional area (CSA) of lumbar multifidus muscle in chronic low back pain patients using high resolution ultrasound scan. Methods: 27 subjects with low back pain were allocated randomly into experimental and control groups (with 13 and 14 participants, respectively). The physical characteristics of the subjects were measured and recorded. Stabilization exercise was administered to experimental group and Sham intervention to control group. High resolution ultrasound scan was used to measure CSA of multifidus muscle of the two groups prior to and after the intervention in both groups. Pain and functional disability levels were measured before and after intervention in both groups using visual analogue scale. Main Results: Ultrsound scan indicates a statistically significant improvement in CSA of multifidus muscle with associated reduction in pain and improved functional ability in the experimental group above the control. Importance of the Conclusions: Lumbar stabilization exercise increases the CSA of lumbar multifidus muscle, with subsequent influence on the associated pain and functional disability in chronic LBP patients. TL.11.004 Exploration of the Biological Relationship of Bicipital Peritendinous Effusion With the Clinical, Demographic and Sonographic Findings of Shoulder Joints Ke-Vin Chang, Wen-Shiang Chen, Tyng-Guey Wang, Chen-Yu Hung, Kuo-Liong Chien Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Beihu Branch,Taipei, Taiwan Brief Description of the Purpose of the Study: Evidence of the relationship between bicipital peritendinous effusion (BPE), and shoulder

Quadricipite Architecture Evaluation With Ultrasound, in an Elderly Population A. Boieiro,1 F. Mogas,1 D. Moretto,2 P. Tavares,2,3 A. Andre,1 G. Paulo1 1 College of Health and Technology Polytechnic Institute of Coimbra, 2 Faculty of Sports Sciences and Physical Education, 3Faculty of Medicine-Ibili, University of Coimbra

Brief Description of the Purpose of the Study: Aging is associated with a progressive loss of neuromuscular function that often leads to a progressive disability and loss of independence. Degenerative processes begin to limit autonomy and functionality. Those processes is sarcopenia, defined as a gradual decline in muscle mass The aim of this study was to evaluate the muscle architecture, in an elderly population that practice exercise and a sedentary group, with the purpose of investigate the process of sarcopenia. Methods: Elderly people were evaluated, this evaluation was performed with an ultrasound, with 12 Mhz transducer. We evaluate both quadricipite muscles in contraction and in rest. A questionnaire was also performed for each individual in both samples. Informed consent was done. Main Results: Our results showed some differences in the muscle architecture in both groups. The main alteration was in the pennation angle that was higher in the exercised group. These differences altered the muscle performance. Importance of the Conclusions: Muscular architecture is affected with disuse and sarcopenia. It is well known a relationship between performance, contractions and muscle architecture. Our results suggested that the atrophy directly affect muscles by reducing the volume and pennation angle. Thus, the effectiveness of strength training improves the structural and functional parameters of the skeletal muscle of elderly.

Abstracts

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TL.11.006

TL.11.008

Ultrasonographic Assessment of Medial Meniscal Extrusion: A Validation Study Using Magnetic Resonance Imaging (MRI) as the Reference Standard E. Gregio-Junior, M. H. Nogueira-Barbosa, M. M. Lorenzato, F. W. Roemer, A. Guermazi, M. D. Crema Faculdade De Medicina De Ribeirao Preto Usp E Universidade De Boston

Sciatic Nerve Hardness Measurement by Using Ultrasound Elastography R. Santos, P. Armada Instituto Politecnico De Coimbra-Escola Superior De Tecnologia Da Saude De Coimbra, Coimbra, Portugal; Universidade Tecnica De Lisboa, Faculdade De Motricidade Humana, Lisboa, Portugal

Brief Description of the Purpose of the Study: To validate the assessment of medial meniscal extrusion (ME) in ultrasound, using MRI as the reference standard. Methods: 93 consecutive patients referred for knee MRI were evaluated on ultrasound in the same day. ME was measured on ultrasound and MRI by 2 blinded radiologists, and graded as: 0 (, 2mm), 1 ($2mm and ,4mm), and 2 ($ 4mm). The agreement comparing ME measurements between ultrasound and MRI was assessed using weighted kappa (k) statistics. Intraclass correlation coefficients (ICC) were used to assess agreement using absolute values of measurements. Inter-reader reliability was assessed using k statistics. The diagnostic performance of ultrasound in the detection of ME was evaluated using MRI data as the reference. Main Results: The agreement was moderate for reader 1 (k 50.57) and substantial for reader 2 (k50.64) using ME grades. A substantial agreement was found for both readers (ICC of 0.73 and 0.70 respectively) using absolute ME measurements. Inter-reader agreement was substantial for MRI (k50.7) and almost perfect for ultrasound (k50.98). For both readers, US showed excellent sensitivity (95% and 96%) and good specificity (82% and 70%) in detecting ME. Importance of the Conclusions: Ultrasound is reliable in the assessment of ME with great diagnostic performance in the detection of ME compared to MRI. TL.11.007 Muscle Hardness Measurement by Using Ultrasound Elastography R. Santos, P. Armada Instituto Politecnico De Coimbra-Escola Superior De Tecnologia Da Saude De Coimbra, Coimbra, Portugal; Universidade Tecnica De Lisboa, Faculdade De Motricidade Humana, Lisboa, Portugal Brief Description of the Purpose of the Study: Knowledge of the characteristics muscle becomes important to understand the alterations that may occur during acute or chronic overload. Some techniques for measuring hardness of muscle have been proposed. Elastography has come to occupy a prominent place in this area, however there is still much to discover. The main goal of this study is to evaluate the feasibility of elastography for investigating changes in muscle vastus laterallis hardness. Methods: Twenty healthy male volunteers, with a mean age of 25 (SD 1,6) years old, were submitted an elastography ultrasound exam by using 14-6MHZ linear array transducer combined with a stabilizer. Both images were acquired within 10 minutes. Color-coded elasticity images were obtained and analyzed through MATLAB. Main Results: Elastography results demonstrated that muscle has a higher percentage of green and blue colors, which means that the muscle has a higher percentage of hard properties. Importance of the Conclusions: With elastography can measure muscle hardness, checking in with this study that the vastus laterallis muscle has hard properties, however has some elasticity. That’s important,in the future, to understand the muscle behaviour in situations of acute or chronic overload.

Brief Description of the Purpose of the Study: Elastography is a recent technique, still unexplored. Only the first investigations in musculoskeletal area. This method studies the hardness of tissues, allowing to quickly detect changes. However, for this it’s important to know the hardness degree of each tissue. The The Sciatic nerve is a structure that can often present alterations that at an early stage can’t be detected. This study aims to evaluate the hardness of sciatic nerve. Methods: Twenty healthy male volunteers, with a mean age of 25 (SD 1,6) years old, were submitted an elastography ultrasound exam by using 14-6MHZ linear array transducer combined with a stabilizer. Both images were acquired within 10 minutes. Color-coded elasticity images were obtained and analyzed through MATLAB. Main Results: Elastography results demonstrated that healthy sciatic nerve has a higher percentage of blue color (hard properties). Importance of the Conclusions: The sciatic nerve hardness can be measured by elastography. With this study the sciatic nerve can be identified as a hard structure. So if there is any sciatic nerve alteration it can be identified, early.

12 - Ultrasound in Nephrourology PD.12.001 The Role of Doppler Ultrasonography in Subfertile Patients With Left Subclinical Varicocele S. S. Chen Taipei City Hospital Renai Branch Brief Description of the Purpose of the Study: This study was designed to evaluate the role of Doppler ultrasonography in subfertile patients with left subclinical varicocele. Methods: Forty subfertile male patients with left subclinical varicocele were recruited for this study and divided into two groups randomly. Twenty patients who received subinguinal varicocelectomy were assigned to group1, and the other 20 subjects who received close surveillance were assigned to group 2. Sperm quality (motility, morphology and density) and the other parameters for comparison included age, body mass index (BMI), serum concentration of follicle-stimulating hormone (FSH), luteinizing hormones (LH), testosterone, scrotal temperature (ST), testicular volume (TV), peak retrograde flow (PRF) and maximal vein diameter (MVD) by color Doppler ultrasound (CDS) were evaluated before and 6 months after surgery or first evaluation for all the patients. Main Results: The average age was 28.2 years old (range form 20-45). Of the 20 patients in group 1, 4 were grade 1, 10 grade 2 and 6 grade 3, and of 20 patients in group 2, 3 were grade 1, 12 grade 2 and 5 grade 3. There was no difference of age, BMI, sperm quality, grade of varicocele, FSH, LH, testosterone, ST, TV, PRF and MVD between patients in group 1 and 2 at the initial survey. Semen quality improved in 70% (14/20) of gorup1 after surgery and deterioration of semen quality was noticed in 30 % (6/20) of group 2 during follow-up. Patients in group 1 who had improved semen quality postoperatively had significantly higher volume (14.3 6 2.5 cc vs. 13.2 6 2.0 cc) and lower PRF (27.9 6 2.2 cm/sec vs. 28.9 6 3.1 cm/sec) of left testis preoperatively than those who did not have. Additionally, patients in group 2 who had deterioration of semen quality during follow-up had significantly lower volume (13.0 6 1.8 cc vs. 14.5 6 2.4cc) and higher PRF (29.2 6 3.2

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cm/sec vs. 27.8 6 2.1 cm/sec) of left testis at initial survey than those who did not have. Importance of the Conclusions: Subfertile patients with left subclinical varicocele who received subinguinal varicocelectomy had better sperm quality than those who underwent close follow-up. In addition, subfertile patients with left subclinical varicocele who received close surveillance had higher chance of deterioration of semen quality if they initially had lower volume of left testis (,13.0cc) and higher PRF (. 29.2 cm/sec), and surgical intervention would be suggested. PD.12.002 Various Imaging Findings of Scrotal Tuberculosis on Ultrasound M Kim Asan Medical Center, Seoul, Republic of Korea Brief Description of the Purpose of the Study: Accurate and timely diagnosis of scrotal tuberculosis is crucial because it is medically curable disease. However, nonspecific symptoms and relatively low incidence of tuberculosis may lead to misdiagnosis and induce to perform unnecessary epididymo-orchiectomy. Therefore, comprehensive understanding of variable imaging findings of scrotal tuberculosis is important to radiologist. Methods: We reviewed 25 patients with surgically proven tuberculosis at our institution from January 2000 to April 2012. The age of the patients ranged from 20 to 76 years (mean, 47 years), and the mean duration of symptoms was 4.4 months (from 1 to 12 months).

Volume 39, Number 5S, 2013 PD.12.005 Benign and Malignant Intratesticular Lesions: Sonographic Features D. M. Yand, D. H. Lee, H. C. Kim, S. W. Kim Dept of Radiology, School of Medicine, Kyung Hee University, Seoul, Korea Brief Description of the Purpose of the Review of Literature: To illustrate the sonographic findings of the different types of benign and malignant intratesticular lesions. Description (S) Condition (S), Method (S) Or Technique (S): Sonography is the primary imaging modality for evaluation of the scrotum. Although most intratesticular lesions are malignant, benign intratesticular lesions are not rare. It is important for the practicing radiologists to differentiate benign intratesticular lesions and malignant intratesticular lesions to prevent unnecessary surgical exploration. We have observed various kinds of benign and malignant intratesticular lesions on sonography. A retrospective review was performed in patients with intratesticular lesions. All cases were confirmed by surgical resection, biopsy or radiological follow-up study. We classified these lesions into two groups, benign and malignant. The disease entities with benign intratesticular lesions include simple cysts, tunica albuginea cysts, epidermoid cysts, cystic transformation of the rete testis, infarction, orchitis, contusion, abscess, and hematoma, The disease entities with malignant intratesticular lesions include germ cell tumors. lymphoma, and leukemia. Conclusion: Knowledge of the sonographic findings of various kinds of intratesticular lesions may be helpful for differential diagnosis. Brief Discussion of the Case: N/A.

Main Results: Tuberculosis epididymitis without testicular involvement is the most common type (n 5 15, 60%). The number of patients with both epididymal and testicular involvements is eight (32%). Isolated tuberculosis orchitis from hematogenous spread without epididymal involvement is rare (only 2 cases in this study). Skin thickening and hydrocele were accompanied with about half of the patients.

PD.12.006

Importance of the Conclusions: If sonography shows diffuse or focal thickening of the epididymis with or without testicular lesion, tuberculous epididymitis or epididymo-orchitis should be considered, especially if an associated fistula or lack of response to the administration of antibiotics or concurrent tuberculosis in other organs are present.

Brief Description of the Purpose of the Study: The purpose of this series is to describe the sonographic findings of hydrocele and hernia of the canal of Nuck. Methods: This was a retrospective analysis of seven cases of hydrocele and hernia of the canal of Nuck. The following gray scale and color Doppler sonographic features were analyzed: the site, size, shape of hydrocele and hernia of the canal of Nuck, and the presence or absence of abdominal communication of the lesion. Main Results: Two kinds of lesions were observed: hydrocele and hernia of the canal of Nuck. Hydrocele of the canal of Nuck was observed in 4 patients and hernia of the canal of Nuck containing omental fat (n 5 2) and ovary (n 5 1) was observed in 3 patients. On sonography, the size of hydrocele and hernia of the canal of Nuck ranged from 1.5 cm to 3.4 cm (mean size, 2.3 cm). All four cases of hydrocele of the canal of Nuck had unilocular and ovoid shape. Two of the three cases hernia of the canal of Nuck containing omental fat showed hyperechoic lesions within the cysts. In patients with incarcerated hernia of the canal of Nuck containing ovary, an ovoid shaped, hypoechoic mass without internal blood flow measuring about 3.4 x 1.4 cm was seen in the right inguinal area. Importance of the Conclusions: Sonography may be helpful for a diagnosis of hydrocele and hernia of the canal of Nuck.

PD.12.004 Sonographic Findings of Epididymal Masses D. M. Yang, D. H. Lee, H. C. Kim, S. W. Kim Dept of Radiology, School of Medicine, Kyung Hee University, Seoul, Korea Brief Description of the Purpose of the Report: To illustrate the sonographic findings of the different types of epididymal mass. Medical History: Although epididymal lesions are usually benign, it is important to distinguish between complex epididymal lesions related to infection and solid and cystic epididymal masses. The sonographic literature concerning epididymal masses is limited to case reports or small series of benign epididymal masses. Our goal was to illustrate the sonographic findings of the different types of epididymal masses including benign, malignant, and inflammatory masses.

Hydrocele and Hernia of Canal of Nuck in Children: Sonographic Findings D. M. Yang, W. Jin, D. H. Lee, H. C. Kim, S. W. Kim Dept of Radiology, School of Medicine, Kyung Hee University, Seoul, Korea

PD.12.007 Diagnosis: A variety of sonographic features were identified in various epididymal masses. The disease entities include epididymal cyst, spermatocele, spermatic granuloma, adenomatoid tumor, leiomyoma, metastases, abscess, chronic inflammation, and tuberculosis. Discussion and Summary of the Case: Knowledge of sonographic findings of various epididymal masses may be helpful for differential diagnosis.

Ultrasonographic Appearance of Tumors of the Testis: Radiologic-Pathologic Correlation Y. Kim, W. K. Jeong, M. Y. Kim, S. H. Lee Hanyang University Guri Hospital, Guri-Si, South Korea Introduction: Ultrasound of the scrotum is the primary and comfortable image modality and highly accurate in differentiation between

Abstracts extratesticular and intratesticular, and differentiation between solid and cystic lesions. We analyzed correlation of sonographic and pathologic finding of the various testicular tumors. Methods Involved: The purpose of this exhibit is to correlate the US imaging features of tumors of the testis with their pathologic findings. Illustrative cases will include seminoma, mature teratoma, immature teratoma, yolk sac tumor, mixed germ cell tumor, leukemia, lymphoma, and Leydig’s cell tumor. Discussion: Testicular tumors are divided into two categories; germ cell and non-germ cell tumor. Those of germ cell origin make up 90% to 95% of primary testicular tumors and are generally highly malignant. By contrast, non-germ cell tumors are generally benign. Conclusion of the Presentation: The typical US imaging features along with the corresponding microscopic and gross pathology can be seen here. Seminoma, leukemia, and lymphoma revealed homogeneous hypoechoic mass. Leydig’s cell tumor, teratoma, and mixed germ cell tumors contained cystic lesion. Teratoma, yolk sac tumor, and mixed germ cell tumor contained calcifications. Differential diagnoses will be presented as well as the role of US imaging in characterization of these tumors. PD.12.008 Testicular Torsion: Manual Reduction Under US Monitoring H. Lee, J. Y. Kim, K. S. Lee Hallym University Sacred Heart Hospital, Anyang-Si, Kyungki-Do, Korea Brief Description of the Purpose of the Report: Torsion of the testes is a true urologic emergency, since it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. A delay in diagnosis and management can lead to loss of the testicle. Therefore, accurate diagnosis and timely intervention to effect testicular salvage is required. We report a case of adolescent testicular torsion successfully reduced following manual detorsion under ultrasound monitoring at the emergency department. Medical History: A 15-year-old adolescent male presented to our Emergency Department with sudden onset severe left inguinal and scrotal pain of six-hour’s duration. Further history elicited no history of recent trauma and no suspicion of sexually transmitted infection. Physical examination was significant for pallor, and a tender left hemiscrotum. The testis on the left was exquisitely tender and noted to be both high-riding and displayed a transverse longitudinal-axis lie. Testicluar pain was exacerbated by scrotal elevation, and the cremasteric reflex was absent. Lack of testicular perfusion was depicted on diagnostic color Doppler US. Acute left-sided testicular torsion was diagnosed on the typical clinical and US findings. The patient subsequently underwent manual detorsion of the left testis. Rotation of the testicle 720 degrees in a clockwise direction resulted in return of normal scrotal anatomy with vertical long axis orientation of the testis and complete resolution of testicular pain. Diagnosis: Adolescent testicular torsion successfully reduced following manual detorsion under ultrasound monitoring Discussion and Summary of the Case: Testiclar torsion represents a commonly encountered surgical emergency wherein accurate diagnosis and timely intervention are essential to effecting testicular salvage. Testicular survival without atrophy is a function of the duration of organ ischemia. Most testes may be salvaged that if detorsion is effected within 6-8 hours of onset. In patients with testicular torsion, the affected testis generally is twisted inward (medially). We can easily recall which direction to rotate a torsed testicle by comparing the action to opening the spine of a book. Recommendations for reduction advocate sequential rotation of the testicle by 180 degrees in one direction (initially lateral in accordance with given preponderance of medial direction of torsion), then maintaining the twist and attempting to turn the testis a further 180 degrees or more, because testicular torsion may involve rotations of 180720 degrees. Successful reduction is reliably confirmed by lengthening of the spermatic cord, restored testicular blod flow, a return to the

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anatomical position of the testicle, and near complete relief of testicular pain. Doppler ultrasound examination should be performed at the time of presentation, during and after manual detorsion to confirm the reestablishment of vascular flow to the testes. PD.12.009 Comparison of 3 Dimensional vs. 2 Dimensional Transrectal Ultrasound Prostate Volume Model Measurement S. S. Hwang, S. S. Park The Catholic University, St. Vincent Hospital, Suwon City, Gyeongi Do Brief Description of the Purpose of the Study: To compare accuracy of prostate model volume measurement in 2 dimensional (2D) and 3 dimensional (3D) ultrasonography. Methods: Sixty prostate models were made using devil’s tongue jelly and shaped by cutting the surface. To compare the accuracy of prostate model volume measurement according to the size and shape of the prostate model, 60 models were divided into four groups according to shape (ellipsoid vs. ellipsoid-intravesical prostate protrusion, IPP) and size (20-50 m[ vs. 50-80 m[). In vitro measurement of prostate models using 2D HWL method, 3D Axial mode, and 3D Sagittal mode was performed and compared. Statistical analysis including linear regression analysis, Bland-Altman plot, and paired samples t-test was performed. Main Results: The percentage of error in the measurement of ellipsoid prostate models (20 - 80 m[) was 4.50 6 2.33% (3D Sagittal mode), 4.85 6 1.66% (3D Axial mode), 7.09 6 2.60% (2D HWL method) and there was no statistically different accuracy comparing to true prostate model volume among three measurement methods. Pearson correlation coefficient revealed high positive correlation between true volume and measured volume; 0.977 (3D Sagittal mode), 0.976 (3D Axial mode), 0.964 (2D HWL method) in the ellipsoid prostate models measurement and 0.989 (3D Sagittal mode), 0.979 (3D Axial mode), 0.941 (2D HWL method) in the ellipsoid-IPP model measurement. However, the percentage of error in the measurement of ellipsoid-IPP prostate models (20 - 80 m[) was 4.87 6 2.74% (3D Sagittal mode), 7.04 6 3.36% (3D Axial mode), 23.56 6 13.63% (2D HWL method), and 2D HWL method showed significantly different volume measurement comparing to true volume (p , 0.001). In addition, there was statistically significant difference between 3D Axial mode measurement and true volume (p 50.047) in the measurement of ellipsoid-IPP prostate models (50 - 80 m[). Bland-Altman plot of 2D HWL method showed higher percentage of mean difference between estimated volume and true volume in the measurement of ellipsoid-IPP prostate models (20 - 80 m[). Importance of the Conclusions: In measuring prostate model volume, 3D Sagittal mode is better than 3D Axial mode or 2D HWL measurement, especially irregular,larger IPP prostate models. PD.12.010 Trombose Aguda Do Corpo Cavernoso - Relato De Caso / Acute Thrombosis of the Cavernous Body of the Penis-A Case Report T. A. Bagrichevsky, B. Tessarollo, A. S. A. Melo, R. G. Mendonca, A. M. T. Massa, A. H. A. Dultra, L. C. Araujo Hospital Barra D’or - Rede D’or-S~ao Luiz, Rio De Janeiro, RJ, Brasil Brief Description of the Purpose of the Report: To report a case of thrombosis of the cavernous body of the penis, making a correlation of ultrasound and MRI, and discussing the typical findings of a rare disease. Medical History: A 24 years old patient, presents with sudden pain at the base of the penis and at the scrotum, and denies trauma. There were no observable changes on ectoscopy. Ultrasound and MRI were performed. Diagnosis: Thrombosis of the right cavernous body of the penis. Discussion and Summary of the Case: Doppler ultrasonography showed recent thrombosis of the right cavernous body of the penis, and that diagnosis was confirmed by MRI. We discuss the typical imaging findings with literature review.

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13 - New Technologies in Ultrasound

Volume 39, Number 5S, 2013 Importance of the Conclusions: Only approximately 55% of the -normal- subjects could be evaluated by means of Hi-RTE.

PA.13.007 Which Are the Liver Stiffness Values Assessed by Supersonic Shear Imaging (SSI) in Subjectes Without Known Liver Pathology? R. Sirli, S. Bota, I. Sporea, A. Jurchis, A. Popescu, O. Gradinaru-Tascau, M. Szilaski Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, TimiOara, Romania Brief Description of the Purpose of the Study: To establish the liver stiffness (LS) values assessed by means of SSI in subjects without known liver pathology (-normal- subjects) and the factors that influence them. Methods: Our study included 82 subjects without known liver pathology. Reliable measurements were defined as: median value of 5 LS measurements with an interquartile range interval,30%, value expressed in kPa. Main Results: Reliable measurements were obtained in 70 subjects (85.4%). Higher BMI and older age were significantly associated with impossibility to obtain reliable LS measurements by means of SSI. The mean value of LS measurements assessed by SSI in our cohort of subjects without known liver pathology was 6 6 1.4 kPa. The mean SSI measurements (kPa) were significantly higher in men as compared with women: 6.6 6 1.5 vs. 5.7 6 1.3, p 5 0.01. The mean LS measurements by means of SSI (kPa) were higher, but not significantly so, in subjects with BMI$25kg/m2 as compared with those with BMI,25 kg/m2: 6.5 6 1.5 vs. 5.8 6 1.3 kPa, p 5 0.07. The age did not influence the mean value of SSI measurements. Importance of the Conclusions: 84.5% of the -normal- subjects could be evaluated by means of SSI. The mean LS value obtained by means of SSI in subjects without known liver pathology was 6 6 1.4 kPa, higher values being obtained in men.

PA.13.012 Which Are the Kidney Stiffness Values Assessed by Acoustic Radiation Force Impulse (ARFI) Elastography in Subjects Without Known Kidney Pathology? S. Bota,1 F. Bob,2 I. Sporea,1 R. Sirli,1 A. Schiller,2 A. Popescu,1 L. Petrica,2 M. Danila1 1 Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, 2 Department of Nephrology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Brief Description of the Purpose of the Study: ARFI elastography is very useful for liver stiffness assessment, but few information are available regarding kidney stiffness (KS). Our aim was to establish KS values in -normal- subjects. Methods: Our study included 47 subjects: 34 -normal- healthy volunteers without known kidney pathology with normal renal ultrasonography, without history of renal disease (supplementary investigations were not performed in these subjects) and 13 patients hospitalized for various diseases with normal renal ultrasonography, GFR.90ml/min/ 1.73m2 and without proteinuria or hematuria. The mean age of our subjects was 33.6 6 15.5 years (median 26), 70.2% women and 29.8% men. Five valid ARFI measurements were performed in each kidney with the subjects in left or right lateral decubitus, median values were calculated and expressed in meters/second (m/s). Main Results: Valid ARFI measurements were obtained in all subjects in both kidneys. The mean ARFI values obtained in the right and left kidney were similar: 2.48 6 0.69 m/s (median 2.49 m/s) vs. 2.52 6 0.74 m/s (median 2.62 m/s), p 5 0.78. Importance of the Conclusions: KS could be evaluated by means of ARFI in all subjects. The KS in -normal- subjects is 2.5-2.6 m/s.

PA.13.008 The Feasibility of Real-Time Tissue Elastography (Hi-RTE) for the Evaluation of Liver Stiffness in Subjects Without Known Liver Pathology O. Gradinaru-Tascau, I. Sporea, S. Bota, A. Popescu, R. Sirli, M. Danila, M. Popescu Department of Gastroenterology and Hepatology, Victor Babe University of Medicine and Pharmacy, TimiOara, Romania Brief Description of the Purpose of the Study: Real-time Tissue Elastography (Hi-RTE) is a non-invasive method liver fibrosis evaluation. The aim of our study was to establish the liver stiffness (LS) values assessed by means of Hi-RTE in subjects without known liver pathology. Methods: Our study included 82 subjects without known liver pathology. LS measurements were performed in all subjects with Hitachi Avius ultrasound system, using a 3-7MHz linear probe, in the right liver lobe, 1 cm under the liver capsule. The relative tissue elasticity is calculated and displayed as a color overlay on the conventional B-mode image. Stiffer tissue is displayed in blue, while softer tissues are displayed in red. The device displays 11 parameters, are used for calculation of Liver Fibrosis (LF) Index. Three valid measurements were performed in each subject and the mean value was calculated. Main Results: Three valid LS measurements could not be obtained in 38/82 subjects (45.8%). Higher BMI and older age were significantly associated with impossibility to obtain reliable measurements. The rate of valid LS measurements decreased significantly with BMI increase: 77.3% -normal weight subjects, 16%-overweight subjects and 0%-obese subjects. The mean value of LF Index in our cohort of subjects without known liver pathology was 1.57 6 0.47.

PA.13.013 Acoustic Radiation Force Impulse (ARFI) Elastography Measurements Should Be Performed in One or in Both Kidneys? F. Bob,1 S. Bota,2 I. Sporea,2 A. Schiller,1 R. Sirli,2 L. Petrica,1 A. Popescu,2 M. Danila2 1 Department of Nephrology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, 2Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Brief Description of the Purpose of the Study: ARFI elastography is very useful for liver stiffness assessment, but few information are available regarding kidney stiffness (KS). Our aim was to evaluate if KS differs among the two kidneys. Methods: Our study included 65 subjects (mean age 39.9 6 18.9years): 47 healthy ones and 18 with various etiologies of kidney disease. Five valid ARFI measurements were performed in each kidney in the same day, by two operators blinded to the results of previous measurements, median values were calculated, expressed in m/s. Main Results: Three subjects were excluded: one with a single kidney and 2 with unilateral hypoplastic kidney. Valid KS measurements were obtained in all subjects by both operators. In 49 subjects in whom the difference between the two kidneys’ size was less than 1.5cm, the mean KS (m/s) obtained in the right vs. left kidney were similar for both operators: 2.50 6 0.85 vs. 2.37 6 0.81,p 5 0.28, and 2.40 6 0.67 vs. 2.46 6 0.72, p 5 0.65, respectively. In 14 subjects with unequal kidneys, the mean KS values (m/s) for both operators were higher, but not significantly, in the bigger as compared with smaller kidney:

Abstracts 2.61 6 1.1 vs. 2.33 6 0.69, p 5 0.51, and 2.40 6 0.78 vs. 2.22 6 1.08, p 5 0.58, respectively. Importance of the Conclusions: For KS assessment it suffices to evaluate only one kidney by ARFI, if the kidneys are similar in size. PA.13.019 Clinical Comparison of High Level Disinfection Techniques for Reprocessing Trans-Vaginal Ultrasound Probes A. Ngu East Melbourne Ultrasound Clinic, Melbourne, Australia Brief Description of the Purpose of the Study: A clinical study was undertaken to compare the efficacy of an approved liquid high level disinfectant and the trophon EPR device in achieving HLD of ultrasound probe handles. Methods: Samples were collected from the handle of ultrasound probes used during routine trans-vaginal ultrasonography (TVUS) procedures. The transducer probe handle was sampled for bacterial growth on TSA agar as a marker of contamination at various points in the disinfection procedure. Samples were taken before any cleaning or disinfection (n510), after routine cleaning with soap and water (n510), and finally following the recommended manufacturer’s protocol for HLD with the Trophon EPR device (n520) or liquid high level disinfectant (n516). Main Results: All transducer handles were contaminated prior to cleaning (10/10) and all were also contaminated after washing with soap and water (10/10). Liquid high level disinfectant failed to achieve HLD in the majority of cases with only 25% (4/16) of probe handles showing no growth. In contrast, the Trophon EPR was completely efficacious in achieving HLD on probe handles (20/20). Importance of the Conclusions: Conventional ultrasound probe disinfection techniques that recommend immersion of the probe but not the handle failed to achieve HLD of probe handles in the majority of samples. This could potentially represent an infection risk for patients. PD.13.002 Relationship Between Ultrasound Backscattered Statistics and the Concentration of Fatty Droplets in Livers: An Animal Study M. C. Ho, Y. H. Lee, Y. M. Jeng, C. N. Chen, K. J. Chang, P. H. Tsui National Taiwan University Hospital, Taipei, Taiwan Brief Description of the Purpose of the Study: Ultrasound grayscale B-mode imaging is the most frequently used modality for examining fatty liver. Different concentrations and arrangements of fatty droplets in the liver may produce different statistical distributions of ultrasound backscatter signals, which may be treated as a useful clue for assessing the stage of fatty liver. To verify this point, we investigate the relationship between changes in backscattered statistics and the concentration of fatty droplets in the liver. Methods: Fatty liver was induced in each rat (n 5 21) fed a methioninecholine-deficient diet. Livers were excised from rats for in vitro ultrasound scanning using a single-element transducer. The envelopes of the acquired raw ultrasound signals were used for the analysis of the backscattered statistics by ultrasound Nakagami parametric imaging. Histological analyses and the measurements of triglyceride and cholesterol in the rat liver were conducted for comparison with the Nakagami parameter. Main Results: The ultrasound Nakagami parameter has an excellent correlation with the concentration of fatty droplets and the concentrations of cholesterol and triglycerides in the liver tissue. Importance of the Conclusions: Fatty liver diagnosis may be implemented by developing functional ultrasound imaging based on the dependency of the backscattered statistics on the fatty droplet concentrations.

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PD.13.003 Supersonic Shear Wave Elastography As a Non-Invasive Tool for Determining Improvement of Portal Hypertension in Cirrhotic Patients W. K. Jeong, Y. Kim, J. Kim, S. Lee, T. Y. Kim, J. H. Sohn Hanyang Univ. Guri Hospital, Guri-Si, Gyeonggi-Do, Korea Introduction: To investigate whether it is feasible to estimate the change of hepatic venous pressure gradient (HVPG) using Supersonic shear wave elastography (SWE) in the patients with portal hypertension. Methods Involved: Twenty-three consecutive patients who were diagnosed with portal hypertension on initial HVPG measurement and who underwent follow-up measurement to evaluate response to treatment were enrolled in this retrospective study. Liver stiffness measurement was performed in all of the subjects, followed by HVPG measurement. The relationship between the HVPG and liver stiffness on initial measurement and on follow-up was investigated. Furthermore, we evaluated whether a change in the HVPG (DHVPG) was correlated with a change in the liver stiffness (DLS). The subjects were subdivided into the group with clinical improvement and not. The performance to determine improvement of portal hypertension was investigated. Discussion: Liver stiffness was significantly correlated with HVPG at initial and follow-up measurements (r50.501 and 0.527, respectively). The mean rate and difference of DLS were strongly correlated with DHVPG (r50.863 and 0.707, respectively). To determine the improvement of portal hypertension, the area under the ROC curve was 0.79 of rate of DLS, and 0.78 of difference of DLS. Conclusion of the Presentation: Supersonic SWE is feasible method to determine improvement of portal hypertension in cirrhotic patients. PD.13.004 Estimation of Methods for Measuring the Volume of Atherosclerotic Plaque According by 3D-Ultrasound M. V. Koshurnikova, T. V. Balakhonova, M. I. Tripoten, A. N. Rogoza, Y. A. Karpov Russian Cardiology Research Center, Moscow, Russian Federation Brief Description of the Purpose of the Review of Literature: According to foreign clinical studies the volume of atherosclerotic plaque (ASP) - a more accurate parameter to evaluate the prognosis of cardiovascular disease compared to a conventional ultrasound, such as the percentage of stenosis. The purpose of this study was to investigate interobserver reproducibility of methods for determining the volume of ASP by a three-dimensional ultrasound scanning. Description (S) Condition (S), Method (S) Or Technique (S): The study included 20 heterogeneous ASP with a smooth surface, identified by duplex scanning of the carotid and femoral arteries, by ultrasound scanner Philips iU-22 (3D mechanical sensor VL13-5). Conclusion: Methods of "contour" and "ellipse" in measurement of the volume of the plaque in the semi-automatic mode by 3D ultrasound are comparable, well reproducibility and can be used in clinical practice. Brief Discussion of the Case: null PD.13.005 Design and Production of Three-Dimensional Acoustic Field to Control Distribution of Microbubbles by Using a Multiple Sound Sources K. Masuda, N. Hosaka, N. Shigehara, R. Koda, S. Onogi, T. Mochizuki Tokyo University of Agriculture and Technology, Koganei, Tokyo, Japan Brief Description of the Purpose of the Study: Nowadays therapeutic applications using microbubbles under ultrasound exposure have been proposed, which are improvement of thermal efficiency in HIFU, and gene or drug delivery. However, because of the diffusion of

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microbubbles in vivo, it is difficult to enhance the density of microbubbles near the desired target area. Methods: To control the local concentration of microbubbles, the primary and secondary acoustic forces were introduced, where the former propels microbubbles to the vessel wall and the latter forms aggregation of microbubbles. Here we have examined with not only single element transducers but also a matrix array transducer, which can produce multiple focal points of continuous wave and steer them. Also artificial blood vessels, which include multiple bifurcations, were used. Microbubbles has a shell made of poly(vinyl chloride) with average diameter of 4 mm. Main Results: As the result, wider acoustic field has an advantage to trap microbubbles, where higher concentration of acoustic energy does not result more aggregation. The dispersion of acoustic energy is important because there was a relation in the trapping performance to the acoustic area in flow and concentration. Importance of the Conclusions: We have confirmed that there is a relation in the trapping performance to the acoustic area in flow and concentration.

PD.13.006 Bladder Cancer: Sonographic Evaluation Method With Fly Thru Technology A. C. Gomes, T. N. Oliveira, L. Barreto, M. J. D’Avila, R. Franc¸a, I. Clausius, M. C. Chammas, A. Crippa, M. Dall’Oglio, M. Srougi, G. G. Cerri Hospital Das Clinicas De S~ao Paulo - Inrad - Faculdade De Medicina DA USP Brief Description of the Purpose of the Study: Bladder cancer is the most common malignancy of the urinary system and the ninth in malignancy. Cystoscopy is the gold standard for detection of bladder cancer. Cystoscopy computed tomography seeks to reproduce the benefits of a direct examination in the evaluation of bladder cancer without instrumentation. Methods: The aim of this study was to determine the diagnostic performance of the method fly thru in patients with bladder cancer, assessing the size, shape and contour of the lesion, estimating its distance to the ureteral and urethral meatus. Twenty patients with a history of bladder cancer underwent conventional cystoscopy, and then fly thru examined by technology, with equipment Toshiba Aplio 500. The proper preparation of the patient only included the maximum bladder filling. Image acquisition was performed by experienced professionals in the field of ultrasound in urology, with specific training on the technology in question. The estimated time of sonographic examination was 20 minutes on average. Main Results: Statistical analysis of the results showed that the method is effective for three-dimensional visualization of the lesions (size, shape, contours and distance of ureteral and urethral meatus). Importance of the Conclusions: We conclude that this new technology may be useful in monitoring and surgical planning.

PD.13.007 Acoustic Radiation Force Impulse Elastography (ARFI) Assessment of Chronic Pancreatitis T. N. Oliveira, L. Barreto, M. J. D’Avila, R. Franc¸a, I. Clausius, M. C. Chammas, G. G. Cerri Hospital Das Clınicas - Inrad- Faculdade De Medicina DA USP Brief Description of the Purpose of the Study: Endoscopic ultrasonography or real-time elastography has been applied for the diagnosis of chronic pancreatitis. Acoustic radiation force impulse (ARFI) imaging is another tissue strain imaging technology, and recent techno-

Volume 39, Number 5S, 2013 logical advances have enabled quantification of the stiffness of some tissues by measuring the shear wave velocity (SWV) during routine B-mode ultrasonography. Methods: ARFI elastography was performed in 10 healthy volunteers and 10 patients with chronic pancreatitis. SWV was measured in the head, body, and tail of the pancreas. Main Results: SWV in patients with chronic pancreatitis was significantly higher than that in healthy volunteers in each part of the pancreas, although the measurement was difficult in the tail of the pancreas. Importance of the Conclusions: ARFI elastography of the pancreas showed high elasticity in chronic pancreatitis compared to findings in the normal pancreas. This modality is feasible to use for the diagnosis of chronic pancreatitis.

PD.13.008 Computer-Assisted Analysis of Ultrasonographic Features of Calcified Thyroid Nodules J. S. Park, K. G. Kim, Y. J. Lee Hanyang University, College of Medicine, Seoul, Republic of Korea Brief Description of the Purpose of the Study: to determine computerized US features of calcified thyroid nodules that are useful in the differentiation between malignant and benign lesions. Methods: Digital US images of 99 pathologically-proven thyroid nodules with calcifications (malignant: benign 5 78: 21) were evaluated. We designed and implemented a CAA scheme to quantitatively analyze the 24 US features of the calcified thyroid nodules based in two categories: morphology and calcification. We performed Student’s t-test and discriminant analysis and generated receiver operating characteristic (ROC) curves and the corresponding areas under the curve (AUC) in order to compare morphology, calcification and combined features. Main Results: Among the 24 analyzed features, 10/12 (83.3%) morphology and 7/12 (58.3%) calcification features showed significant differences between malignant and benign thyroid nodules (p , 0.05). The AUC values for morphology, calcification and combined features were 0.81 (95% CI, 0.75-0.86), 0.79 (95% CI, 0.73-0.84), and 0.86 (95% CI, 0.81-0.91), respectively. The combined features showed a significantly higher AUC value than morphology or calcification features alone (p , 0.05). Importance of the Conclusions: Combined morphology and calcification features from CAA had a significantly higher diagnostic performance in differentiating malignant from benign calcified thyroid nodules when compared to the use of morphology or calcification features alone.

PD.13.009 Fibrosis Quantification in Chronic Liver Disease: A Comparative Study Using Two Different Elastographic Technologies Vibration Controlled Transient Elastography Shear Wave Elastography (VCTE - SWE) P. Zoumpoulis, I. Mastorakou, I. Theotokas, C. H. Kranidioti, K. Pahou, L. Kaklamanis, E. Panteleakou, E. Vafeiadi Hellenic Society of Ultrsound In Medicine and Biology Brief Description of the Purpose of the Report: To assess two different methods of liver elastography: Vibration Controlled Transient Elastography (VCTE-Fibroscan) and Shear Wave Elastography (SWE) in the study of liver fibrosis in chronic liver disease and cirrhosis. Medical History: In this prospective study two different populations were included: A population with normal liver function as tested using clinical history and biochemical results (liver enzymes) (N1560) and a population in different stages of chronic liver disease of various causes

Abstracts (N25130), verified by blood tests of hepatic enzymes (all patients), serial ultrasound examinations and liver biopsy (82 patients). Both populations had a complete ultrasound and color Doppler examination of the liver performed. Assessment of liver tissue stiffness using VCTE and SWE was carried out: Three consecutive measurements were made with each method and mean values were recorded. Additionally, the findings were compared for fibrous liver staging which was pathologically classified using liver biopsy, where biopsy was available. A strict protocol of study respecting concrete US and Elastographic criteria was applied. Diagnosis: There was a statistically significant difference (p , 0,01) between the elastography values of normal and diseased subjects with both VCTE and SWE methods. There was a good correlation when the values of the two methods were compared between each other and each one with the liver biopsy, where available. In addition, intra- and inter-observer variability was low with both methods, if the adequate strict protocol of study was applied. VCTE showed 84.6% sensitivity and 70,6 % specificity in diagnosing liver cirrhosis at a cut-off value of 8.9 kPa. SWE showed 89.5% sensitivity and 78.4% specificity in diagnosing liver cirrhosis at a cut-off value of 8.9 kPa. Discussion and Summary of the Case: Although the number of patients included in this prospective study is small, it was shown that VCTE and SWE can definitely differentiate normal from fibrotic liver tissue. There is also differentiation with SWE between F1-F2 stages of fibrosis and F3-F4 appearing more evident comparing with discrimination offered by VCTE (Fibroscan). Larger number of patients is needed in order to investigate whether VCTE and SWE are able to differentiate between various stages (F1, F2, F3, F4) of fibrotic liver disease.

PD.13.010 Shear Wave Elastography of the Common Carotid Artery: The First Experience of Application T. V. Balahonova, L. Sh. Hamchieva, O. A. Pogorelova, M. I. Tripoten, A. N. Rogoza Cardiology Research Complex, Moscow, Russia

Brief Description of the Purpose of the Study: Shear wave elastography (SWE) - a new technology, which in addition to ultrasound imaging provides quantitative information about tissue elasticity. Application of SWE in the study of vessels has not been studied. The purpose of this study is to assess the possibility of SWE in the investigations of the carotid arteries and to evaluate a reproducibility of quantitative measurement of elasticity of the carotid arteries by this method. Methods: The study included 15 healthy subjects aged 23-40 years without cardiovascular risk factors. The study was held with the aid of ultrasound system «Aixplorer» (SuperSonic Imagine, France) in B-mode, color mapping flow mode and SWE-mode. We assessed local elasticity of the common carotid artery (CCA) in kPa and evaluated intraobserver and interobserver reproducibility of the method. Main Results: The elasticity of normal CCA ranged from 17 to 45 kPa. The coefficient of variation of interobserver reproducibility for the local elasticity of CCA was 29.4%. The coefficient of variation of intraobserver or time-based reproducibility of CCA elasticity (kPa) was 13.3%. Importance of the Conclusions: Application of SWE to determine the local stiffness of the carotid arteries is restricted by low reproducibility parameters. It is necessary to further improve the technology for its introduction into clinical practice.

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PD.13.012 A Dicom and Non - Dicom Mini-Pacs (Picture Archiving and Communicating System) With Automated Dictation Report Printing and CD Burning Application Specialized for the Ultrasound Department S. Zoumpoulis, D. Dalakostas, I. Theotokas, I. Mastorakou, S. Zoumpoulis, E. Theodorakopoulou Echodiagnostic Tomography, Kifissia Athens, Greece Introduction: To elaborate a user-friendly software solution for archiving, printing and reporting ultrasound examinations. To increase workflow and the efficiency of the administrative department with this novel software for archiving, printing and reporting ultrasound Examinations. Methods Involved:  An image and video grabber for connecting US equipment with a PC.  An examiner-managed, software tool for reporting with ready to use categorized texts  Text and rich-text tools.to insert logo, names of doctors and additional texts prepared and easily applied by the user  HTML templates for printing the US images, reports and conclusions.  CD burning facility containing all the US images, texts and videos.  External Dictaphone directly connected to the PC so as to convey US reports to the medical assistant. Discussion: The inter-graded hardware and software tool contains:  Image and video grabber connected via PC joy pad and USB adaptor with the US equipment assuring a user-friendly pathway  Voice recorder/player for completing US reports by remotely connecting the examiner with the secretary  Text editing.  Printing and CD burning facility. Conclusion of the Presentation: A PC Windows-based self-managed and easy to install software tool, conceived and tested for Ultrasound department: it is ergonomic and increases productivity.

TL.13.001 Doppler Ultrasound Velocimetry of Middle Cerebral Arteries of Patients With Sickle Cell Disease At Aminu Kano Teaching Hospital: A Preliminary Report A. M. Tabari, A Ismail Bayero University, Kano, Nigeria Brief Description of the Purpose of the Study: This study evaluates the patients’ characteristics, common indications and findings on Doppler ultrasound in the middle cerebral arteries of sickle cell patients performed at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Methods: This is a preliminary report of an ongoing review of the TCD scans done at AKTH. The records of all patients, the indications for Doppler examination and major findings on the middle cerebral arteries were documented. Main Results: There are 30 patients, consisting of 13 males and 17 females. Their ages range from 1.5 to 41.0 years, with mean of 11.68 years + 8.50. Majority of the patients are asymptomatic (26.7%). Those with head ache constituted 23.3% while those with past cerebral syndrome constituted 16.7%. Other indications include hemi paresis (10.0%) and transient ischemic attack (6.7%). The mean peak systolic velocity (PSV) of the middle cerebral artery (MCA) measured 181.62 cm/sec (+ 85.19) and 204.08 cm/sec (+ 76.46) on the respective right and left side. Female patients tend to have higher PSV values compared males; though the difference was not statistically significant. Importance of the Conclusions: There is relatively high PSV of the MCA is the sickle cell patients. There is relatively higher PSV in the left MCA compared to the right.

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TL.13.002 Research On Paclitaxel-Carrying Nanometre Microbubbles Preparation and Characteristics Qiao Wang, J. I. Xiaojuan, Jingyu Chen, Ruling Yang, Jun Guo Children’s Hospital of Chongqing Medical University, Chongqing, China Brief Description of the Purpose of the Study: To prepare paclitaxelcarrying nanometre microbubbles(PNM) modified with human serum albumin(HSA) and study the Characteristics. Methods: The HSA modified PNM was prepared by thin-film dispersion method and mechanical vibration, the appearance,concentration,mean diameter,zeta potential and the entrapment efficiency were detected. The normal rabbit’s iliac artery contrast imaging was observed. Main Results: This modified PNM had a good shape. The mean diameter was(772.9 6 6.2)nm, the concentration of bubble was (8.64 6 1.38)3109/ml, zeta potenital was(-13.2 6 0.3)mv, the entrapment efficiency of the modified bubble was (93.51 6 2.07)%, which was higher than that of no modified bubble (84.88 6 4.14)%(p , 0.05). It could make the rabbit iliac artery enhancement. Importance of the Conclusions: The HSA modified PNM was stable and effective, with smaller size and higher encapsulation efficiency.

TL.13.003 Electrocardiogram Monitoring of Microlesion Induction by Contrast-Enhanced Pulsed Ultrasound for Therapeutic Myocardial Reduction D. L. Miller, C. Dou, G. E. Owens, O. D. Kripfgans University of Michigan, Ann Arbor MI, USA

Volume 39, Number 5S, 2013 fibrosis evaluation. The aim of our study was to assess the feasibility ("intend to diagnose") of the 3 shear waves elastographic methods (Transient Elastography-TE, Acoustic Radiation Force Impulse-ARFI and SuperSonic Shear Imaging-SSI). Methods: Our study included 332 subjects, with or without hepatopathies, in which liver stiffness (LS) was evaluated by means of TE, ARFI and SSI. Reliable measurements were defined as: median value of 10 (TE, ARFI) or 5 (SSI) LS measurements with a success rate$60% and an interquartile range interval,30%, values expressed in kPa (TE, SSI) or m/s (ARFI). Main Results: Reliable LS measurements were obtained in a significantly higher percentage of subjects by means of ARFI elastography as compared with TE and SSI: 92.1% vs. 72.2%, (p , 0.0001) and 92.1% vs.71.3%, (p , 0.0001), respectively. The rate of reliable LS measurements was similar for TE and SSI: 72.2% vs. 71.3%, (p 5 0.86). For both TE and SSI, older age and higher BMI were associated with the impossibility to obtain reliable measurements, while the presence of chronic hepatopathies influenced the rate of reliable measurements only for SSI. For ARFI, no factor was identified to be associated with the impossibility to obtain reliable measurements. Importance of the Conclusions: The most feasible shear-waves ultrasound elastographic method is ARFI.

TL.13.006 Is Supersonic Shear Imaging (SSI) a Reliable Method for Liver Fibrosis Evaluation? I. Sporea, A. Popescu, S. Bota, A. Jurchis, O. Gradinaru-Tascau, R. Sirli Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania

Brief Description of the Purpose of the Study: Myocardial contrast echocardiography can induce premature electrocardiogram complexes that are associated with myocardial microlesions. The objective was to assess the feasibility of utilizing this bioeffect for therapeutic myocardial reduction. Methods: The hearts of anesthetized rats were treated with 1.5 MHz ultrasound pulses in the presence of contrast-agent, guided by 8 MHz imaging. Five cycle pulses in eight pulse bursts were triggered at 1:4 heartbeats for 5 min. ECGs were monitored for premature complexes (PCs) to assess the rate and severity of induced cardiac injury, and Evans blue dye was used to indicate microlesions in 1 day samples. Main Results: The percentage of triggers inducing PCs was 0 in shams, 41 6 11 at 2 MPa rarefactional pressure (p , 0.02) and 68 6 13 at 4 MPa (p , 0.02). In addition, the rate of PCs declined significantly with time at 2 MPa, but not at 4 MPa, suggesting that the saturation effect seen for diagnostic ultrasound can be avoided in therapy. Evans blue staining showed scattered microlesions that corroborated the ECG indications of tissue injury. Importance of the Conclusions: Ultrasonic induction of microlesions can produce measured tissue reduction, which may be a more favorable method, than, for example, alcohol septal ablation, for the treatment of hypertrophic cardiomyopathy.

Brief Description of the Purpose of the Study: Aim: to evaluate if SSI is a reliable tool for liver fibrosis evaluation, considering Transient Elastography (TE) as the reference method. Methods: 332 subjects were evaluated by means of TE and SSI. Reliable measurements were defined as: median value of 10(TE) or 5(SSI) LS measurements with a success rate$60% and an interquartile range interval,30%, values expressed in kPa. To discriminate between various stages of fibrosis by TE we used the liver stiffness (LS) cutoffs (kPa) proposed in the most recently published meta-analysis (Tsochatzis, J Hepatol 2011): F1-6, F2-7.2, F3-9.6 and F4-14.5. Main Results: Our subjects were: healthy volunteers-16.9%; patients with chronic hepatitis B and C -44.8%;with non-viral chronic hepatopathies-27.4%; and with liver cirrhosis-10.9%. The rate of reliable LS measurements was similar for TE and SSI: 72.2% vs. 71.3%,p 5 0.86. Reliable LS measurements by both elastographic methods were obtained in 55.4% of patients. The distribution of liver fibrosis in this cohort of patients, using TE prespecified cut-off values were: F040.2%, F1-13.1%, F2-20.1%, F3-14.1%, F4-12.5%. The AUROC of SSI for predicting F$1, F$2, F$3 and F54 were: 0.818, 0.851, 0.889 and 0.910, while the SSI cut-off values (kPa) were: 7.1, 7.8, 8.6 and 11.5. Importance of the Conclusions: SSI is a reliable method for noninvasive evaluation of liver fibrosis.

TL.13.005

TL.13.007

Which Elastographic Method Is More Feasible for Non-Invasive Evaluation of Liver Fibrosis? I. Sporea, S. Bota, A. Jurchis, O. Gradinaru-Tascau, A. Popescu, R. Sirli Department of Gastroenterology and Hepatology, -Victor BabesUniversity of Medicine and Pharmacy TimiOara, Romania

Usefulness and Limitations of the VirtuTRAXTM Instrument Navigator in Assisting RFA: A Pilot Study H. Tanaka, N. Ikeda, T. Takashima, K. Iwata, K. You, A. Ishii, N. Aizawa, Y. Sakai, Y. Iwata, H. Enomoto, M. Saito, S. Nishiguchi, H. Iijima Hyogo College of Medicine, Nishinomiya, Japan

Brief Description of the Purpose of the Study: Ultrasound based elastographic methods are increasingly used in clinical practice for liver

Brief Description of the Purpose of the Study: The VirtuTRAXTM Instrument Navigator is an exciting new advancement, which uses

Abstracts electromagnetic technology to visually track the instrument tip in real time. This intuitive device is compatible with imaging systems using navigation technology and allows physicians to accurately track the tip of an Radiofrequency ablation (RFA) probe. In this pilot study, we evaluated the usefulness and limitations of the VirtuTRAXTM system in assisting RFA. Methods: Between September 2012 and November 2012, 10 patients were treated by RFA performed using VirtuTRAX at our center. RFA was performed with the GE Logiq E9 system by using a C1-5 probe. Main Results: The VirtuTRAX allowed the needle tip to be precisely detected during the ablation, enhancing patient safety in all cases. Most patients could be easily treated using the system. For example, a 67-year-old woman had a 20-mm metastatic liver tumor. Following application of the VirtuTRAX system to plan the best puncture line in real time, freehand needle insertion was extremely easy and helped avoid some major vessels. The position of the needle tip was always observable during the procedure. Importance of the Conclusions: VirtuTRAX system accurately and easily show the needle tip, and thus may become essential in ensuring safe and reliable RFA treatment.

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treated with adriamycin or sterile saline by intraperitoneal injection. Ultrasonic radio-frequency (RF) data was collected with a clinical available ultrasound scanner. Linear regression parameters (slope, intercept and midband-fit) of calibrated power spectra from the RF signals were tested to monitor tumor response to treatment. The section equivalent to ultrasound imaging plane was stained with Hematoxylin and Eosin to allow for assessment of tumor cellularity. Main Results: Treatment with adriamycin significantly reduced tumor growth in comparison to the control group (p ,0.05). Significant changes were observed in ultrasonic parameters of the treated vs. untreated tumors. Slope increased by 48.5%, from -10.66 6 2.96 to -5.49 6 2.69; midband-fit increased by 12.8%, from -57.10 6 7.68 to -49.81 6 5.40; intercept decreased by 429.6% from 5.36 6 19.98 to -17.67 6 12.42. Treated tumors were associated with a significant decrease in tumor cell density as compared with control tumors (p , 0.001). Importance of the Conclusions: Ultrasonic spectral analysis can detect the changes of tumor microstructure after chemotherapy, which will be helpful to early evaluate tumor response to chemotherapy.

TL.13.011 TL.13.009 Localization of Cancer in Prostate Gland Using Innovative Ultrasound Method - Histoscanning A. Fedorova, N. Burdelova, E. Emelyanova, N. Sazonova, A. Zubarev, S. Alferov, I. Ponomarenko President Medical Center Brief Description of the Purpose of the Study: The purpose of this study was to compare results of histoscanning with pathomorphological data, received during prostate biopsy. Methods: We examined 55 patients with suspicion of prostate cancer at the age of 55 - 84 years. All pts underwent DRE, a blood test for PSA, B-mode US, angiography, sonoelastography, histoscanning and target biopsy. 10 pts subsequently underwent radical prostatectomy. Mean PSA was 8.6 ng/ml. As a reference value for histoscanning we used a volume of pathological signal intensity 0.5 cc. Histoscanning results were compared with pathomorphological data, received after biopsy and radical prostatectomy, based on the presence and location of the tumor. Main Results: Prostate cancer was diagnosed in 29 pts (53.7% of total pts). In 18% of cases we received true negative results, 25% - of false positive, and 4% - false negatives. The greatest interest to us was to identify tumor cells in central part of the prostate, so we decided to analyze statistics separately for peripheral and central part of prostate. For a central part, we received 88,8% Se, 40% Sp, 71,4% Ac, that exceeds similar parameters of B-mode and sonoelastography. Importance of the Conclusions: Histoscanning with great accuracy determined the location of tumor areas, also located in the central part of the prostate.

TL.13.010 Ultrasonic Spectrum Analysis for in Vivo Characterization of Tumor Microstructure Changes After Chemotherapy in a Murine Breast Cancer Model Anhua Li, Jianhua Zhou, Chunyi Lin, Jianwei Wang, Yao Chen Sun Yat-Sen University Cancer Center, Guangzhou, China Brief Description of the Purpose of the Study: The purpose of this study was to determine the feasibility of ultrasonic spectral analysis in the evaluation of tumor microstructure changes after chemotherapy. Methods: Experiments were aproved by the regional animal care committee. Twenty-four MCF-7 breast cancer bearing nude mice were

Spatially-Angle Corrected Fetal Three-Dimensional Volume Flow Measurements Scholbach Thomas Chemnitz Clinics Brief Description of the Purpose of the Study: Three-dimensional measurement of global fetal perfusion with automatic spatial angle correction is demonstrated Medical potential is shown Comparisons between IUGR (growth rretarded) and normal fetuses arte made. Methods: 3D color Doppler ultrasound of the umbilical vein PixelFlux measurement of the flow volume irrespective of shape and spatial angle of the umbilical cord. Main Results: For the first time fetal volume flow measurement becomes feasible A novel algorithm of automatic correction of shape and velocity of the color pixels of the umbilical vein is presented Fetal perfusion differs significantly between normal and IUGR fetuses. Importance of the Conclusions: This is the first method of sonographic fetal volume flow measurement from 3D data The method is a principal novel way to use 3D color Doppler data for any kand of large vessel perfuiosn measurement.

TL.13.013 Acoustic Radiation Force Impuse Elastography for Focal Hepatic Tumors: Usefulness for Differentiating Hemangiomas From Malignant Tumors J. E. Kim, J. Y. Lee, K. S. Bae, J. K. Han, B. I. Choi Department of Radiology, Seoul National University Hospital, Seoul, Korea Brief Description of the Purpose of the Study: To investigate whether acoustic radiation force impulse (ARFI) elastography was useful for differentiating hepatic hemangiomas from malignant hepatic tumors. Methods: 101 tumors in 74 patients were included: 28 hemangiomas, 26 HCCs, three cholangiocarcinomas (CCCs), 20 colon cancer metastases and 24 other metastases. ARFI elastography was performed in all tumors. The mean shear wave velocity (SWV) of the tumors and adjacent liver and their mean SWV difference were compared among the tumor groups. The ARFI 2D images were compared with B-mode images regarding the stiffness, conspicuity and size of the tumors. Main Results: The mean SWV of the hemangiomas was significantly lower than malignant hepatic tumor groups: hemangiomas, 1.80 6 0.57 m/sec; HCCs, 2.66 6 0.94 m/sec; CCCs, 3.27 6 0.64 m/sec; colon

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cancer metastases, 3.70 6 0.61 m/sec; and other metastases, 2.82 6 0.96 m/sec (p , 0.05). Az value of the mean SWV for differentiating hemangiomas from malignant tumors was 0.86, with sensitivity of 96.4% and specificity of 65.8% at cut-offvalue 2.73 m/sec (p , 0.05). In ARFI 2D images, the malignant tumors except HCCs were stiffer and more conspicuous than hemangiomas (p , 0.05). Importance of the Conclusions: ARFI elastography might be useful for differentiating hepatic hemangiomas from malignant hepatic tumors. TL.13.016 Point Quantification Elastography As a Non-Invasive Technique for Quantification of Liver Fibrosis in Patients With Viral Chronic Hepatitis: Preliminary Results E. Fiorini, E. Mazzotta, S. Righi, C. De Molo, M. C. Iacopini, R. Di Donato, R. Vukotic, P. Andreone, C. Serra St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy Brief Description of the Purpose of the Study: To measure liver stiffness(LS) with point quantification elastography(PQE) in patients(pts) with viral chronic hepatitis(VCH) and to find a correlation with the staging of disease according to liver biopsy(LB). Methods: Between September2012 and December2012, 35pts(17males,18females,mean age47 6 13[standard deviation],range22-68) with VCH were prospectively evaluated with ultrasound(US) scanning completed by PQE. All pts underwent US-guided percutaneousLB for evaluation of fibrosis(F). Examinations were performed with a iU22 scanner(Philips,Bothell,WA,USA) using a convex probe(C5-1). PQE is a new shear wave-based elastography technique. LS is expressed in Young’s modulus(kilopascals,kPa). With the patient in dorsal decubitus, quiet breathing stopped, the probe was placed in the intercostal spaces with the best visualization of parenchyma, the same used for needle access. 10measurements were recorded in 2different spaces(exploring 5th,6th or 7th segment); averageLS(ALS) was calculated. Staging of LB was classified following Metavir score. Correlation ALS-F was analyzed by using Spearman correlation coefficient(SCC). Main Results: 23pts were HCVpositive,6HCV-HIV,4HBV and 2HBVHDV. 1patient hadF0, 26ptsF1, 3ptsF2, 3ptsF3, 2ptsF4. SCC showed a significant correlation between ALS and F(rho50.460,p 5 0.005). For 15pts, transient elastography(TE) data were also available, correlation ALS-TE was also significant(rho50.777,p 5 0.001). Importance of the Conclusions: PQE can be a useful tool for a noninvasive evaluation of F in pts with VCH, anyway more cases are needed to confirm these data.

14 - Ultrasound in Pediatrics PA.14.003 Febre Maculosa - Ricketsiose Achados De Imagem, Revis~ao De Literatura E Alerta Epidemiologico M. J. Iani, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, M. G. Gasparini, F.F. Pegoraro, M. B. M. J. Francisco Neto, G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, SP, Brasil Introduction: Spotted fever is an acute infectious zoonotic disease caused by Rickettsia rickettsii, a gram negative intracellular bacterium, transmitted by ticks and whose morbimortality can vary considerably. In Brazil, lethality is reported as close to 30% and may reach 80% in serious cases. The clinical course can range from mild to extremely severe.

Volume 39, Number 5S, 2013 Methods Involved: In this report, we present radiological findings, collected in our service, from the early signs and symptoms up to definitive diagnosis, which are rare in the literature. Discussion: The disease can mimic other clinical conditions, which may delay the correct diagnosis and treatment. Severe cases may present with myocardial involvement. Myocarditis and multifocal myocardial necrosis are determinants for prognosis. Studies about rickettsiosis and its imaging findings are rare in the literature, even those that considered chest radiograph only. Conclusion of the Presentation: It is important to be aware of the existence of spotted fever, and to be familiar with the imaging findings, and include rickettsiosis among the differential diagnoses, since the delay in starting the treatment can be fatal.

PA.14.004 How to Reach the Tuberous Sclerosis Diagnosis in Neonates by Sonographic Findings? V. N. Marcos, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, F. F. Gasparini, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: Tuberous sclerosis (TS) is an autosomal dominant multisystem disease caused by mutations in TSC1 and TSC2 genes. The classic clinical presentation includes the triad of mental retardation, epilepsy and sebaceous adenoma. The diagnosis is based on clinical and radiological major and minor criteria. Ultrasonography has a fundamental role as a neonate diagnostic tool due to no ionizing radiation and no sedation required. Methods Involved: Sonographic studies performed at neonatal ICU of a private hospital fulfilling criteria for TS diagnosis. Discussion: The age of manifestation of clinical and radiological findings of TS is quite varied. Two major criteria or one major and two minors are required for the definitive diagnosis. The subependymal nodules and cardiac rhabdomyomas (major criteria) and multiple renal cysts (minor criterion) are changes that may arise during the fetal period, so easily characterized in neonatal sonographic study. Early diagnosis allows pediatricians and parents prepare themselves for possible TS complications, and arrange for early subspecialty care. Conclusion of the Presentation: Ultrasonography must always be employed as an initial TS diagnostic tool in neonates for being the safest and enable an early diagnosis.

PA.14.005 Controle Evolutivo Das Hemorragias De Matriz Germinativa Graus III E IV De Papile Pela Medida Dos Indices Ventriculares E Indices De Resist^encia Nas Arterias Cerebrais Ao Estudo Ultrassonografico Transfontanelar Com Doppler M. J. Iani, F. M. Deus, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, F. F. Gasparini, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, Sao Paulo, SP, Brasil Brief Description of the Purpose of the Study: The incidence of intracranial hemorrhage has been increasing due to better survival rates of preterm infants (PI) and transfontanellar Doppler sonography (DS) is essential to its diagnosis and control. We show the evolution of Papile’s grade III and IV germinal matrix hemorrhage (GMH), using as parameters ventricular index (VI) and anterior cerebral arteries (ACA) resistive index (RI) determined by US. Methods: We performed a retrospective study of preterm infants, weighting less than 1500 g, admitted to neonatal ICU of a private hospital.

Abstracts Main Results: Among 233 preterm infants weighting less than 1500 g that were admitted, 205 were included in our study: 128 (61.8%) without hemorrhage, 43 (20.8%) had grade I hemorrhage, 16 (7.7%) had grade II, 8 (3.9 %) had grade III and 10 (4.9%) had grade IV. Seven preterm infants died and six required ventriculoperitoneal shunt. Comparing groups with ventricular dilatation requiring intervention (G2) and mild ventricular dilatation (G1): the maximum VI average value was 0.41 in G1 and 0.69 in G2. The RI average in ACA was 0.81 in G1 and 0.90 in G2. Importance of the Conclusions: Higher VI and higher ACA RI values are sensitive and specific predictors of unfavorable outcome of PI with Papile grade III and IV GMH.

PA.14.008 Pancreatite Aguda Relacionada a L upus Eritematoso Sist^emico Juvenil: Caracterıstica Ao Ultrassom F. D. Consolo, A. C. R. Ribeiro, D. R. Roveda Jr., C. P. R. Oliveira, M. A. Leite Irmandade De Santa Casa De Misericordia De S~ao Paulo, S~ao Paulo, S~ ao Paulo, Brasil Brief Description of the Purpose of the Report: Report a case of acute pancreatitis related to childhood systemic lupus erythematosus, rare disease, with high mortality and a treatment that diverge from the usual pancreatitis, emphasizing on the ultrasound aspects. Medical History: 14 year old girl, with previous diagnosis of Childhood SLE. In a crisis, presented in strong abdominal pain and 4kg weight loss during 5 days. Incially, was investigated to hepatitis due the medication for ESL, submitted to an ultrasound, observed edema and heterogenic texture of the head of the pancreas and abnormal increase of its size (3,7cm), but normal pancreatic body and tail. The corticoid therapy lead to a clinical improvement and was discharged from UCI. Diagnosis: Childhood systemic lupus erythematosus. Discussion and Summary of the Case: The physiopathology that leads to the pancreatitis on lupic patients is not well known, its treatment is different from the usual pancreatitis and the percentage of the lupic patients that show abdominal pain is close to 50. Considering the concerning to ionic radiation in childhood patients, the ultrasonography of this kind of patient is very important and the correct identification of the pathology will lead to the correct and fast treatment, due to its mortality and reserved prognosis it will represent an increased chance of survival.

PA.14.010 Cisto De Nuck L. D. Olival, A. F. Francisco, M. A. P. Figueiredo, N. L. Leal, C. Fernandez, C. D. Adriano Hospital S~ ao Luiz Jabaquara, S~ao Paulo, Sao Paulo, Brasil Brief Description of the Purpose of the Report: Nuck cyst is a benign, but the diagnosis should be need for adequate surgical therapy. This pathology is an important differential diagnosis with other abnormalities of the inguinal region. Medical History: Children 4 years and 5 months, male, came to our clinic complaining of painless bulging in the right inguinal region for several days. Diagnosis: Nuck cyst channel. Discussion and Summary of the Case: The peritoneal-vaginal canal is an extension of the embryonic peritoneal cavity which descends in the male, the testes to the scrotum, resulting in the tunica vaginalis and, in females, for the big lip. Lack of closure of this channel enables communication between the peritoneal cavity and the tunica vaginalis, resulting in accumulation of liquid (hydrocele), retention of the testis in the

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inguinal canal (cryptorchidism) in cyst Nuck and the inguinal hernias (indirect); these conditions may be associated with each other, and their treatments are identical.

PD.14.001 Usefulness of Pelvis US to Differentiate Central Precocious Puberty From Atypical Premature Lim GY, Chung MH,Kim YJ The Catholic University of Korea, Seoul, Korea Brief Description of the Purpose of the Study: The differentiation of central precocious puberty (CPP) from atypical premature thelarche (PT) is based on physical examination, bone age, and a gonadotropin-relasing hormone (GnRH) stimulation test. It is difficult to distinguish between early stages of CPP and PT. The purpose of this study is to determine various US parameters of pelvic internal genital organs using transabdominal US, that can be useful for distinguishing central precocious puberty (CPP) and atypical PT. Methods: Sixty female patients with diagnosed CPP and 38 females with atypical PP underwent transabdominal pelvis US. The diagnosis was based on clinical criteria. Pelvic US parameters analyzed were: (1) uterus: fundal anteroposterior (AP) diameter, cervical AP diameter, the ratio between the fundal and cervical diameter (FCR), and length; (2) ovaries: diameter, volume, and maximal diameter of the largest follicle. Main Results: The girls with CPP had a significantly greater uterine fundal AP diameter (1.04 6 0.35 vs. 0.76 6 0.26, p ,0.0001) and FCR (1.52 6 0.44 vs. 1.23 6 0.38, p 5 0.001) than the girls with PT. For the ovary, differences were noted in length (1.96 6 0.53 vs. 1.65 6 0.41, p 5 0.02) and maximal diameter of the largest follicle (0.62 6 0.20 vs. 0.54 6 0.23, p 5 0.02) between the girls with CPP and PT. Cut-off points predictive for CPP were as follows: uterine fundal AP diameter . 0.9 cm (sensitivity, 60%; specificity, 81.6); FCR .1.2 (sensitivity, 70%; specificity, 63.2%); maximal diameter of the largest follicle . 0.5 cm (sensitivity, 70%; specificity, 50 %); length .1.9 cm (sensitivity, 58.3%; specificity, 73.7 %). Importance of the Conclusions: Our results suggest that pelvic US may be a successful complementary modality for distinguishing between CPP and PT in patients with an equivocal response on the GnRH stimulation test.

PD.14.003 Fıstula Arterio-Portal Cong^enita Em Crianc¸a - Relato De Caso M. Vilanova, E. Just, A. Sampaio, T. Guedes, H. Gomes, B. Maranh~ao Imip, Recife, PE, Brasil Brief Description of the Purpose of the Report: Description of a case of congenital arterioportal fistula associated with portal vein aneurism, an unusual disease. Medical History: A six years old male, in a diagnostic investigation because of diarrhea, abdominal distention, malnutrition and anemia. He did an utrasound that made the diagnose, posteriorly confirmed with MRI. The child was treated with embolization, being in good clinical condition. Diagnosis: Congenital arterioportal fistula. Discussion and Summary of the Case: Abnormal vascular connections within the hepatic parenchyma are unusual malformations. The patients may be symptomatics or it may be an incidental diagnosis. Arterioportal fistula is a comunication between the hepatic artery and the portal venous system, chenging the arterial flow, that goes to a focal region on a portal branch, that gets enlarged. Portal flow becomes arterialized, whit more pulsatility and the arterial flow suffers fall in its resistance index. This finds are classic and were found in this case described. On abdominal ultrasound, a cystic lesion was seen, with a "ying Yang"

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flow inside. MRI was performed and showed the same cystic image with flow void on T2-Weight sequences, finds that suggest vascular malformation. Clinical features asociated with this entity are portal hypertension and intestinal malabsortion, wich probably was related with this child. Liver function can declines with time.

different grades, although some less common processes involving infratentorial structures were also studied.

PD.14.005

Discussion and Summary of the Case: Knowledge of normal sonographic anatomy of midbrain and posterior fossa structures is of paramount importance to the evaluation of diseases involving the infratentorial compartment of neonatal brain.

Mirror-Image Artifact Mimicking Epidural Hematoma: Usefulness of Graded Compression J. Y. Kim, K. H. Byun Cha Gumi Medical Center, Cha University, Gumi, Korea, of Republic

Diagnosis: MF is located at the junction of temporal, parietal and occipital bones, and provides a wide acoustic window to scanning anatomical structures and pathological processes of the midbrain and posterior fossa.

PD.14.008 Brief Description of the Purpose of the Report: During sonographic examination, a mirror- like interface can scatter the ultrasound beam, producing mirror-image artifacts. Color Doppler sonography can enable correct identification of the artifact by demonstrating vascular structures within the artifact. We describe a case of right parietal cephalhematoma in the parietal region of a 3-day-old neonate that demonstrated no vascular structure on Color Doppler sonography and then mimicked epidural hematoma. The artifact was identified by graded compression technique and proved by brain CT. Medical History: A 3-day-old neonate presented with right parietal cephalhematoma and showed an anechoic structure resembling epidural hematoma in the right parietal region on the gray-scale coronal sonograms. Color and power Doppler sonography showed no vascular flow in the lesion mimicking epidural hematoma and then we could not exclude the epidural hematoma. We tried graded compression over the cephalhematoma and then we identified that the anechoic structure in the right parietal region was decreased in the height during graded compression, thus permitting identification of the mirror-image artifact. Brain CT was performed and the ultrasound findings were confirmed. Diagnosis: Right parietal cephalhematoma with mirror-image artifact mimicking epidural hematoma. Discussion and Summary of the Case: Graded compression technique can enable correct identification of mirror-image artifact mimicking epidural hematoma on gray-scale and Color Doppler sonography.

PD.14.006 Mastoid Fontanelle Imaging in Neonatal Neurosonography: Usefulness of An Important Supplemental Acoustic Window in the Evaluation of Midbrain and Posterior Fossa-A Pictorial Review A. C. V. Teixeira, U. S. Torres, F. D. C. Braojos, E. P. Oliveira, F. Gual, M. R. Rodero, A. S. Souza Faculdade De Medicina De S~ao Jose Do Rio Preto,S~ao Jose Do Rio Preto, S~ ao Paulo, Brasil Brief Description of the Purpose of the Report: Cranial ultrasonography has been the most used imaging method for studying the neonatal brain. Traditionally, anterior (AF) and posterior (PF) fontanelles acoustic windows are employed to approach the supratentorial compartment. However, they have a poor accuracy in demonstrating posterior fossa abnormalities and do not allow studying the whole ventricular system, because of the increased distance between the transducer and these anatomical structures. This pictorial review aims to demonstrate the utility of mastoid fontanelle (MF) in evaluating the normal anatomy of midbrain and posterior fossa and in the diagnosis of some diseases occurring in these sites. Medical History: Standard ultrasound examinations were performed using coronal and sagittal scans through AF and MFs. We generally used a phased-array, multiple-foci 5.0 MHz sector transducer. The most common evaluated disease was germinal matrix hemorrhage in

Acute Abdomen in Children; Diversity of Diseases Depends On Age Y. Kim, W. K. Jeong, M. Y. Kim, S. H. Lee Hanyang University Guri Hospital, Guri-Si, South Korea Introduction: Acute pediatric abdomen is a very common clinical problem. Clinical and laboratory findings, however, are nonspecific or confusing in many instances. The role of diagnostic imaging is to determine whether the acute abdominal pain is due to a surgically or medically treated disease and if possible to diagnose the exact nature of the ailment. Methods Involved: We divided pediatric age into three groups (before one year, two to five years, over six years). A variety of diseases are discussed in this exhibit; such as before one year (intussusception, midgut volvulus, incarcerated hernia, congenital biliary dilatation, gastroenteritis), two to five years (appendicitis, mesenteric lymphadenitis, HenochSchonlein purpura, trauma) over six years (pancreatitis, cholecystitis, hemorrhagic ovarian cyst, ovarian torsion). Discussion: This exhibit focuses on strategy in diagnosing acute pediatric abdomen depends on age. Age is a key factor in evaluating the cause; the incidence and symptoms of different conditions vary greatly over the pediatric age spectrum. Conclusion of the Presentation: In pediatric patient, among the variable diseases resulting in acute abdominal pain, there may diseases more predominantly occur in certain age group. Age correlation may help presume the diagnosis and ease the sonographic approach. Ultrasonography is essential to ensure prompt management and can provide specific diagnoses.

PD.14.009 Sonographic Findings of Diseases Causing Lower Abdominal Pain in Children Y. Y. Jung Eulji Hospital, Eulji University School of Medicine, Seoul, Repulic of Korea Introduction: Ultrasonography (US) is the primary imaging modality for the diagnosis of abdominal pain in children. Also, US is preferred rather than other imaging modalities due to no risks of radiation in children. Methods Involved: I provides a sonographic findings of conditions causing lower abdominal pain in children and a brief review of diseases. Discussion: Some differences in causes of lower abdominal pain exist between children and adults. Therefore, understanding the sonographic findings of conditions causing lower abdominal pain in children is important. Conclusion of the Presentation: Understanding the sonographic features of diseases causing lower abdominal pain in children helps to accurate diagnosis and proper treatment.

Abstracts PD.14.011 Risk Factors for Peri-Intraventricular Hemorrhage in Newborns Weight # 1500G L. B. D. Deus, L. T. M. Rios, M. G. Martins, R. V. B. Oliveira, L. C. L. Rios, V. M. F. Sim~oes, V. S. Carvalho Universidade Federal Do Maranh~ao - UFMA, S~ao Luıs, MA Brief Description of the Purpose of the Study: Evaluate the incidence of peri-intraventricular hemorrhage and its association with the mode of delivery, birth weight, APGAR score, sex, New Ballard and leukomalacia. Methods: A cross-sectional study in our institution from January 2008 to December 2010. The Chi-square test was used in the study of relationships between two categorical variables. The Mann-Whitney test was used when comparing the Apgar score and presence of PIVH. The study included 334 newborns weighing less than or equal to 1500 g, transfontanellar evaluated by ultrasonography and classified according to severity criteria of Papile. Main Results: We diagnosed 77 (23.05%) cases of PIVH. There was a statistically significant (p , 0.05) vaginal delivery (p 5 0.04), weight less than 1000g (p , 0.001), coefficient of the first minute Apgar score (p 5 0.01) and fifth minute (p 5 0.02), New Ballard score below 32 weeks (p 5 0.004) and presence of leukomalacia periventricular (p , 0.001). The kind of sex did not show significance with the presence of PIVH (p 5 0.68). Importance of the Conclusions: The frequency of PIVH was 77 (23.05%). Factors associated with hemorrhage were vaginal delivery, weighing less than 1000g, New Ballard score below 32 weeks, Apgar score of the first minutes and fifth minutes and periventricular leukomalacia. PD.14.012 Atresia De Vias Biliares: Achados Ultrassonograficos Tipicos E Atıpicos L. Panizza, S. M. S. Rocha, F. V. Rodrigues, A. L. Ferme, E. M. Ribeiro, L. A. N. Oliveira Instituto Da Crianc¸a Do Hospital Das Clınicas Da Faculdade De Medicina Da Universidade De S~ao Paulo - SP, Brasil Introduction: Biliary Atresia (BA) is a congenital obstructive cholangiopathy of unknown etiology, which must be considered in the differential diagnosis of prolonged jaundice in neonates. Ultrassound signs suggest the diagnosis noninvasively and early. Methods Involved: The incidence of this entity in the pediatric population treated at our department in the last 10 years is recorded and sonographic typical and atypical image patterns of BA are presented. Discussion: Findings associated with BA were: triangular cord sing; morphological and wall changes of the gallblader or even it’s absence; cystic perihilar lesions; hypertrophy of hepatic artery; presence of subcapsular arterial flow; portal hypertension; chronic hepatopathy findings; other associated malformations such as situs inversion and polysplenia. Conclusion of the Presentation: Biliary atresia, although rare, is the most common cause of obstructive cholestasis in neonates. Ultrassound findings contribute to the early diagnosis of the disease, which favorable prognosis depends on surgical intervention in the first three months of life. PD.14.013 Sonographic Features of Extracranial Cytomegalovirus (CMV) Infection in Infants and Children H. J. Lee, M. J. Kim, S. H. Kim Keimyung University School of Medicine, Daegu, Korea

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Brief Description of the Purpose of the Study: To evaluate sonographic features of extracranial CMV infection in children. Methods: Sonographic findings of 65 patients (2 days - 13 years) with extracranial CMV infection were retrospectively evaluated. The lesions consisted of 49 hepatobiliary dysfunction, 19 cervical lymphadenopathies, and seven genitourinary pathology. Hepatobiliary ultrasonography was analyzed by gallbladder abnormality (atretic, small, elongated, edema), the presence of the ‘triangular cord’ (TC) sign, and periportal lymphadenopathy. Cervical lymphadenopathy was analyzed by shape, echogenicity, and pattern of vascularity. Other ancillary findings of the body were evaluated. Main Results: Forty-nine of hepatobiliary dysfunction consisted of five(10%) of biliary atresia (BA), 28(57%) of neonatal hepatitis (NH), and 16(33%) of hepatic dysfunction in children. Five BA revealed four atretic gallbladders and the TC signs. None of NH revealed TC sign. The most common abnormal sonographic finding of CMV hepatitis was edematous wall of the gallbladder in 12(24%). Periportal lymphadenopathy was demonstrated in six(12%). All of the cervical lymphadenopathy revealed findings of reactive hyperplasia. Genitourinary tract revealed five nephrocalcinosis and two scrotal edemas. CMV infection predominantly involved hepatobiliary system and GUT in infants, whereas cervical lymphadenopathy was commonly seen in children. Importance of the Conclusions: The most common extracranial CMV infection was hepatobiliary dysfunction(75%), followed by cervical lymphadenopathy(29%) and GUT(11%).

PD.14.014 Sonographic Features of Cytomegalovirus (CMV) Hepatitis in Young Infants and Children: ‘Double Wall’ Sign of the Gallbladder H. J. Lee, M. J. Kim, S. H. Kim Keimyung University School of Medicine, Daegu, Korea Brief Description of the Purpose of the Study: To evaluate sonographic features of CMV hepatitis in pediatrics. Methods: Sonographic findings of 49 CMV hepatitis (2 days -13 years) were retrospectively evaluated. The patients presented with neonatal jaundice in 33(67%) young infants (mean, 1.8 months) or hepatic dysfunction in 16 (33%) children (mean, 3.5 years). Hepatobiliary sonography was evaluated by the size, shape, contractility and ‘double wall’ sign of the gallbladder, which was defined as echogenic mucosa and echolucent submocosal wall, the presence of the ‘triangular cord’ (TC) sign, and periportal lymphadenopathy. Main Results: Forty-nine patients were confirmed as five(10%) of biliary atresia (BA), 28(57%) of neonatal hepatitis (NH), and 16(33%) of hepatic dysfunction. Five BA revealed four atretic gallbladders and TC signs. None of NH revealed the TC sign. The most common abnormal finding of the gallbladder in CMV hepatitis was ‘double wall’ sign in 12 patients (24%) including five NH and seven hepatic dysfunction. Periportal lymphadenopathy was demonstrated in six (12%) patients including NH(1) and BA(1), and hepatic dysfunction(4). Importance of the Conclusions: CMV hepatitis can cause BA(10%) or NH(57%) in young infants, and hepatic dysfunction(33%) in children. The most common abnormal sonographic finding of CMV hepatitis was ‘double wall’ sign of the gallbladder, accounting for 24%.

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15 - Ultrasound in Small Parts

Volume 39, Number 5S, 2013 Dept. of Ultrasound of Union Hospital of Fujian Medical University, Fuzhou, Fujian, China

PA.15.001 Tromboflebite Da Veia Dorsal Do Penis (Doenc¸a De Mondor): Relato De Caso J. A. Sicca, A. J. Falanga, L. R. L. Ferraz Climed, Clınica De Ultrasonografia, Jaboticabal, SP, Brasil Brief Description of the Purpose of the Report: Brief discussion of a non-routine event that requires special attention from ultrasonografista for the final diagnosis. Medical History: We present the case of a young man of 30 years, newlywed on honeymoon, lodged in our service by reporting the appearance of hard lump on the dorsal surface of the penis during erection of which had intense pain, patient reports tembem intense sexual activity on their honeymoon. On physical examination it was found nodulation hardened and elongated, located at the base of the penis, without signs of inflammation associated with the skin. Performed ultrasound that characterized superficial dorsal vein of the penis increased in size, uncompressed and intermingled with echogenic material without vascular flow at color Doppler and spectral. Diagnosis: Thrombophlebitis superficial dorsal vein of the penis (Mondor’s disease). Discussion and Summary of the Case: The superficial thrombophlebitis of the dorsal vein of the penis it is a rare disease, but is well diagnosed benign course, the main cause is still related to penile trauma, pathogenesis is summarized by Virchow’s triad, and the main differential diagnosis is Peyronie’s disease and sclerosing lymphangitis. PD.15.001 The Ultrasonic Diagnosis of Epididymis Dysplasia E. S. Xue, S. Chen, R. X. Liang, X. D. Lin, J. J. Guo Dept. of Ultrasound of Union Hospital of Fujian Medical University, Fuzhou, Fujian, China Brief Description of the Purpose of the Study: To discuss the ultrasonic performance of epididymis dysplasia and its clinical significance. Methods: The scrotal high-frequency ultrasonography was employed to detect and analyze the sonographic performance of 103 patients with epididymis dysplasia. Main Results: Of the 103 patients, 143 dysplastic epididymides were detected. According to the sonographic performance, epididymis dysplasia could be classified into four types: hypogenesis (29.3%), abnormal attachment (9.1%), abnormal location (9.1%) and abnormal shape (9.1%). In hypogenesis, the epididymis had general intact shape, normal location, and smaller size than normal. Dysplasia was also present in the ipsilateral testicle. In abnormal attachment, the head, the body and tail, the tail, or the whole of epididymis was separate from the ipsilateral testicle. In abnormal locationthe head and tail of epididymis were located in the bottom and root of the scrotum respectively. In abnormal shape, the absence or coarctation of part of epididymisthe head, the body and tail, or the tailand the irregular epididymis were present. The detectable rate of epididymis dysplasia were 1.1% 103/9689 with ultrasound. Importance of the Conclusions: The high-frequency ultrasonography can be employed to detect and classify epididymal dysplasia, contributing to the treatment of infertility.

Brief Description of the Purpose of the Study: To assess the protective effect of ischemic postconditioning in different ways after rabbit’s testis completely torsion and detorsion and to assess the value of CEUS in it. Methods: White rabbits were divided into randomly: a control, directly perfusion group (R), ischemic postconditioning groups IP1 IP2 and IP3, with 8 in each. The acute testicular hemodynamic disorder models were established in RIP1IP2IP3 groups by completely blocking the left testicular blood flow for 4hours, then group R was directly subjected to perfusion, group IP1 was subjected to 15 sec release and 15 sec occlusion (15s/15s), IP2 was subjected to 30s/30s, IP3 was subjected to 45s/ 45s,each group was taken 3 cycles. All the groups underwent CEUS before operation, examined for the histology of the testicular tissue. Main Results: The CEUS parameters of DT/2 was extended significantly in all operation groups comparing with group S (p , 0.05), but the PBD were increased in group IP1 and IP2, comparing with group S, (p , 0.05). Johnsen’s score,apoptosis index showed significantly differences in group IP1 IP2 comparing with group R and IP3 (p , 0.05). Importance of the Conclusions: Microcirculation of the complete torsion testicular was significantly improved by ischemic postconditioning after reperfusion, and the effects of ischemic postconditioning could be evaluated by CEUS. PD.15.003 BethesdaÒ Thyroid Ultrasound - Correlation Between the Bethesda System of Reports of Cytopathology and Sonographic Image of Thyroid Nodule L. J. O. Andrade, L. S. Franc¸a, W. A. Neto, M. H. F. Andrade, M. Margotto Faculdade De Medicina, UESE, Itabuna, Bahia, Brazil Introduction: Several ultrasonographic characteristics have been proposed to identify nodules benign and malignant. The Bethesda System for Reporting Thyroid Cytopathology is a brainchild of the multidisciplinary National Cancer Institute Thyroid Fine Needle Aspiration State of The Science Conference, held in Bethesda-USA, in 2007. Present the correlation between cytological classification system Bethesda and the ultrasonographic image of thyroid nodule. Methods Involved: Based on the ultrasonographic image the thyroid nodule was classified into 6 categories of diagnosis correlating with the 6 categories of Bethesda System for Reporting Thyroid Cytopathology. It is presented a pictorial essay of thyroid nodules based in Bethesda System for Reporting Thyroid Cytopathology. The results are shown correlating the ultrasound image with the image cytological. Discussion: Currently no modality imaging test can accurately predict the nature neoplasm of thyroid nodule. The ultrasound examination is a readily available and effective in detecting nodules and presents characteristics that are highly specific for benignity or malignancy in nodules. An important tool to stratify the risk of malignancy of thyroid nodules is fine-needle aspiration cytology guided by ultrasound, that associated with ultrasound exam provides an important diagnostic accuracy. Conclusion of the Presentation: At the ultrasound thyroid nodules present imaging characteristics which may correlate with the Bethesda System for Reporting Thyroid Cytopathology. PD.15.004

PD.15.002 The Value of Contrast-Enhanced Ultrasonographic in Evaluating the Protective Effect of Ischemic Postconditioning After Rabbit’s Testis Compltely Torsion and Detorsion E. S. Xue, Y. Wang, Y. Zhang, Q. Q. Chen, R. X. Liang, S. Chen

Ocular Sonographic in Diabetic Retinopathy L. J. O. Andrade, L. S. Franc¸a, W. A. Neto, A. M. V. Bittencourt, C. S. Franc¸a Faculdade De Medicina, Universidade Estadual De Santa Cruz, Ilheus, Bahia, Brazil

Abstracts Brief Description of the Purpose of the Study: Observational study demonstrating ophthalmic ultrasound findings of patients with DR in your different grades. Methods: Study in which are presented the sonographic aspects in a group of patients with DR in your different grades. We studied both eyes of individuals with DR by ocular sonography. The diagnostic of DR was based on the clinical and retinography examinations performed. The DR was classified according to the modified Airlie House system on the basis of stereoscopic fundus examination with a 90 diopter lens. Main Results: The individuals examined had some degree of DR, level 20 to 85 of the Early Treatment of Diabetic Retinopathy Scale. The diagnosis of DR was accomplished when at least four or more microaneurysms were present in the retinography, with or without hard or soft exudates, in the absence of other known diseases, being presented the sonographic features of these complications. Importance of the Conclusions: Ocular sonography is very useful diagnostic tool in detection and evaluation of DR complications, because shows the nature and extent of lesions in eyes with vitreous opacification, which is usually not visualized on ophthalmoscopy, helping to determine the clinical treatment or timing of surgery, and to predict the visual outcome and it may serve as a useful extension of the initial investigation of the symptomatic or not patient.

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featuring a complex issue, in that we get sometimes overlapping patterns of images for the benign and malignant processes. Description (S) Condition (S), Method (S) Or Technique (S): The proper follow-up of lymphadenopathy also requires the examiner detailing and topographical description of the relevant aspects ultrasound. We reviewed the literature in order to highlight the ultrasonographic criteria more significant. The aspects evaluated were: number, shape, central echogenic hilum, echotexture / echogenicity, presence of calcifications, necrosis and / or internal bleeding, size, shape, pattern of vascularity and spectral analysis-resistivity index and pulsatility index. Conclusion: In the case of lymph nodes with neoplastic infiltration should be found a set of data that add up and are not mutually exclusive, yet this set of signals close not sure of the diagnosis, but appoint a histopathological study as fine-needle puncture. Brief Discussion of the Case: Null

PD.15.007 Avaliac¸a~o Ultrassonografica Dos Carcinomas De Cisto Tireoglosso A. V. C. Luiz, M. J. A. Davila, T. N. Oliveira, M. C. Chammas, A. B. O. Santos, L. G. Brandao, M. D. G. Bescia, R. A. Moyses Inrad Hc FMUSP, S~ao Paulo, Brasil

PD.15.005 Usefulness of Panoramic Ultrasonography Imaging in the Evaluation of the Superficial Lesions I. Yang, A. Y. Jung, H. S. Hong, J. Y. Woo, S. K. Jeh, J. Y. Hwang, Y. N. Kim, H. M. Kim, Y. Lee Kangnam Sacred Heart Hospital Hallym University, Seoul, Korea Brief Description of the Purpose of the Study: To evaluate the usefulness of panoramic ultrasonography imaging (PUI) in improving overall superficial lesion documentation. Methods: Eighty patients with superficial lesions on various parts of the bodies were evaluated with PUI (Philips) in addition to routine traditional 2 dimensional ultrasonography. If the diagnosis could not be made without the PUI, it was considered diagnostic. We also evaluated whether PUI improved spatial resolution, identified other associated abnormalities, usefulness of contralateral side image for comparison, usefulness on follow up evaluation. Finally we asked the clinicians if the PUI helped in global identification of lesion. Main Results: By using PUI, 70 musculoskeletal, four breast, three inguinal, and three abdominal wall lesions were documented successfully as a single image. Nevertheless, no new cases were diagnosed solely based on the PUI. PUI was considered helpful for spatial orientation in all cases (100%), for comparing the contralateral side in 71 cases (88.8%), and identifying other associated abnormalities in 62 cases (77.5%). It was useful for follow up evaluation in 27 cases (33.8%). Majority of the clinician answered that PUI was helpful than 2D images. Importance of the Conclusions: PUI was useful in demonstration spatial orientation, associated abnormalities, comparison with the contralateral side, and follow-up evaluation. The clinicians preferred PUI than routine 2D imaging.

PD.15.006 Papel Do Ultrassom Na Avaliac¸~ao Dos Linfonodos Cervicais Com Infiltrac¸~ ao Neoplasica - Criterios C. Akiho, M. Q. P. Silva, T. R. G. Wu, P. V. Matos, M. C. Lopes, K. B. Calil Webimagem, Sao Paulo, SP, Brasil Brief Description of the Purpose of the Review of Literature: Evaluation of cervical lymph nodes poses a dilemma for the sonographer,

Brief Description of the Purpose of the Study: Identify sonographic appearance of thyroglossal cyst carcinoma, seeking characteristics that allow its distinction from benign. Methods: Retrospective analysis of 76 patients who underwent surgery to remove thyroglossal cyst, and underwent prior ultrasonography (11/1998-09/2010). To confirm the cyst nature, ultrasound characteristics were related to pathological. Main Results: 6,5% were malignant, all had an anterior cervical cystic mass with parietal solid component. The cystic area showed thick content with debris and septa in 80% and 20% of anechoic content. In the solid part, microcalcification was present in 20% and all showed vascularization, being that in 40% the resistive index was $ 0.8. Benign cyst showed no vegetation in 97%, presenting cystic area ranging from thick content (52%), anechoic (32%) and debris-septa (16%). With respect to volume, malignant was larger and averaged 29.6 mL, while benign average was 4.8 mL. The same occurred to the parietal vegetation, which had an average of 12, 1 mL in carcinoma and 0.001 mL in benign cyst. Importance of the Conclusions: Carcinoma should be suspected in the cyst that present an average volume of 30 mL, parietal vegetation and cystic part with thin septa or debris. The main appearance of the benign cyst is a thick content or anechoic without vegetation.

PD.15.008 Penis: Up and Down O. C. Saito, M. T. P. Souza, S. M. Tochetto, M. C. Chammas, G. G. Cerri FMUSP, S~ao Paulo, Brasil Brief Description of the Purpose of the Review of Literature: The penile disorders affect a large portion of men, and ultrasound and MRI can diagnose a large portions of these pathologies. Description (S) Condition (S), Method (S) Or Technique (S): The objectives include: to review the embryology and anatomy of the penis, illustrate the imaging findings of common and uncommon disorders such as: shunt after traumatic penile fracture, thrombosis superficial veins, arteries and venous disorders, Peyronie, tumors of penis, penile metastasis, and injection methacrylate and describe the unusual urethral injuries detected by ultrasound (stenosis, calculations and diverticulum).

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Conclusion: The purpose of this educational exhibit is describe the imaging findings of penis disordes, emphasizing the main diagnosis in the emergency room and in daily practice. Brief Discussion of the Case: null PD.15.009 Ultrassonograria Duplex - Doppler Colorido Da Gl^andula Tire oide Em Pacientes Com Doenc¸a De Graves Antes E Ap os Radioiodoterapia (131-I) T. Adler, M. T. P. Souza, M. C. Chammas, G. G. Cerri FMUSP, S~ ao Paulo, S~ ao Paulo Brief Description of the Purpose of the Study: Graves’ disease (GD) is an autoimmune disease of the thyroid, of unknown etiology, with genetic predisposition and influenced by several factors such as content of iodine in the diet, stress, drugs and infections. Diagnosis is made through laboratory tests, measurements of antibodies and hormones, clinical examination and Doppler ultrasonography of the thyroid. Methods: The objective of this project is to compare the sonographic and Doppler ultrasound of the thyroid parenchyma and their inferior thyroid arteries in patients suffering from proven DG before and after radioiodine (131I) for clinical follow-up of the disease. During the period of 1 year, patients were selected in both sexes, regardless of age, holders of DG, without prior radiodoterapia presenting clinical and laboratory disease. This examination was performed before starting treatment and after 3 months. Main Results: Statistical analysis shows that with radiodoterapia, there was a significant reduction (p , 0.01) of total thyroid (45.5% average) and the flow velocity in the thyroid arteries significantly decreased (35.2% artery and right 21.7% on the left). Importance of the Conclusions: These results confirm the beneficial effect of radioiodine therapy in these patients and establish the parameters and Doppler ultrasound of patients with GD. PD.15.010 Sonographic Findings of Groin Lesions Dal Mo Yang, Dong Ho Lee, Hyun Cheol Kim, Sang Won Kim Dept of Radiology, School of Medicine, Kyung Hee University, Seoul, Korea Brief Description of the Purpose of the Review of Literature: To illustrate the sonographic findings of the various kinds of groin lesions. Description (S) Condition (S), Method (S) Or Technique (S): We retrospectively reviewed the sonographic findings of various kinds of groins lesions. All sonographic examinations were performed with high frequency linear arrary transducers. All cases were confirmed by surgical resection, biopsy or radiological follow-up study. A variety of sonographic features were identified in various groin lesions. The disease entities include hernia, hydrocele of canal of Nuck, undescended testis, endometriosis, Kimura’s disease, round ligament varices, benign tumors (lipoma and epidermoid cyst), lymph nodes, malignant tumors (liposarcoma, synovial sarcoma, lymphoma, and metastases), chronic inflammation, abscess, and hematoma. Conclusion: Although there was substantial overlap of sonographic findings in the various inguinal masses, clinical history and sonographic details can assist in making the correct diagnosis. Brief Discussion of the Case: Null. PD.15.011 Ultrasonographic Features of Metastatic Lymph Node in Papillary Thyroid Microcarcinoma (PTMC): Comparison With Macrocarcinoma Y. G. Shin, K. S. Oh Kosin University Gospel Hospital, Busan, Korea

Volume 39, Number 5S, 2013 Brief Description of the Purpose of the Study: To analyze the US features of metastatic LN in PTMC compared with macrocarcinoma. Methods: We identified 676 patients with pathologically confirmed papillary thyroid carcinoma who underwent US between January 2009 and May 2012. US findings of the pathologically confirmed metastatic LN in 273 patients with PTC who were suspected of having metastatic LN on US were reviewed. The differences of US features of metastatic LN between PTMC and macrocarcinoma were compared. Main Results: Of 273 patients with PTC, 87 patients were identified with PTMC and 186 patients were identified with macrocarcinoma. Of 87 patients with PTMC, 29 patients had metastatic LN in the lateral neck. The US features consisted of round shape (n573, 84%), loss of hilum (n538, 44%), presence of hyperechogenicity (n535, 40%), cystic change (n513, 15%) and calcification (n58, 9%). There were no significant differences of US features in the lateral metastatic LN between PTMC and macrocarcinoma. Round shape is the more frequent finding than other four findings in central LN metastasis of both PTMC and macrocarcinoma (p , 0.001). Importance of the Conclusions: There were no significant differences of the US features of metastatic LN between PTMC and macrocarcinoma. Therefore, we should carefully evaluate the metastatic LN, even with the PTMC in the thyroid gland. PD.15.013 Aspectos Ultrassonograficos Do Tumor De Kuttner E Seu Diferencial Nas Patologias Cervicais N. B. Genova, M. C. N. A. Leite, N. C. F. M. Montenegro, B. Maragno, C. A. Sinisgalli Jr., Hospital S~ao Luiz Jabaquara, S~ao Paulo, Brasil Brief Description of the Purpose of the Report: To describe the clinical and radiological aspects of Kuttner’s tumor, emphasizing the discussion of the differential diagnosis of cervical pathologies. Medical History: RM, 29 years old, male, complaining of pain and increase in volume of the left submandibular region 1 month ago, with reports of previous similar episodes. For diagnostic cervical ultrasonography was performed which revealed left submandibular gland with increased dimensions, lobulated, diffusely heterogeneous echotexture associated with images consistent with calculations in the region proximal to the duct of Wharton. A biopsy revealed lymphocytic infiltration periductal glandular, ductal ectasia and irregular sclerosis. Diagnosis: Chronic sclerosing Sialoadenitis (Kuttner tumor). Discussion and Summary of the Case: Chronic sclerosing sialadenitis, also called Kuttner tumor, is a unusual salivary gland chronic inflammatory fibrosing. It mainly affects the submandibular, with the highest incidence between 30 and 70 years, regardless of sex, predominantly unilateral. Clinically increase and hardening of the gland with or without pain, recurrent. This sialolithiasis ductal associated with the end portion by 30 to 85% of cases. The main differential diagnoses are Kimura disease, lymphoma, sarcoidosis and Sjogren’s Syndrome. Definitive diagnosis is by histopathology. The prognosis is favorable and there are no reports of malignant transformation. PD.15.014 Citologia Bethesda IV - Nodulos Tireoideanos / Bethesda Cytology IV - Thyroid Nodules R. D. G. Franc¸a, O. C. Saito, T. N. D. Oliveira, G. G. Cerri, M. C. Chammas HCFMUPS - INRAD, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Study: Ultrasonography (US) is the most sensitive test to identify thyroid nodules, but low specificity. Several B-mode ultrasonographic characteristics are associated with malignancy, however no finding singly or when combined are

Abstracts adequately specific and/or sensitive. In turn, cytology is the most accurate method to exclude the diagnosis of malignancy preoperatively. The aim of this study is to evaluate the percentage of thyroid nodules classified as Class IV through Bethesda System (I-VI) in our service and its features to B-mode US, compared with histology. Methods: This retrospective study analyzed the results of 754 patients between cytological 2009-2011. We analyzed aspects of US B-mode (echogenicity, microcalcifications, contours, halo, echotexture) and histopathological results obtained in those classified as class IV of Bethesda. Main Results: The second system Bethesda cytological results were: I-3.7%, II-56.1% III-19.7%, IV-10.8% V-5.3%, VI-4.3%. Of the 59 patients who underwent thyroidectomy, 27.1% (16/59) were malignant. Among the aspects ultrasound, and the hypoechogenicity microcalcifications showed a statistically significant difference in distinguishing between benign and malignant nodules. Importance of the Conclusions: The findings of this study are in agreement with those published in the literature, the presence of malignancy is within the range expected for Bethesda IV as well as the most relevant findings for malignancy B-mode.

PD.15.016 ~es Da Ultrassonografia Intraoperatoria Na Recidiva Do Aplicac¸o C^ ancer De Tireoide D. R. Nery, A. Rahal, F. A. C. O. Vieira, R. G. Garcia, A. Maurano, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brasil Introduction: Recently, there has been significant progress in the use of intraoperative ultrasonography. Its application has been increasingly in the evaluation of thyroid cancer recurrence by providing the surgeon with real-time information of the diagnosis and staging of lesions. The purpose of this pictorial essay is to describe and illustrate the indications and applications of in the recurrent differentiated thyroid carcinomas. Methods Involved: Review of cases of intraoperative ultrasonography performed in our department in the investigation of recurrent differentiated thyroid carcinomas. Imaging findings are illustrated and discussed. Discussion: The differentiated thyroid carcinomas is responsible for the majority of thyroid cancers, although it is typically indolent and with a high cure rate, recurrence is common even in the early stages of the disease. Intraoperative ultrasonography is a useful method for evaluation of locoregional recurrence of differentiated thyroid carcinomas particularly in patients who have had previous radiation therapy, due to its high sensitivity in localizing small lesions, allowing the anatomical dissection. Conclusion of the Presentation: Intraoperative ultrasonography can be of significant help in the identification of differentiated thyroid carcinomas recurrences, in particular when lesion dimensions are small and can facilitate the excision of the tumor in a surgical field were anatomical landmarks can be altered by previous radiation therapy.

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is proportional to the square root of the tissue elasticity, that is, the stiffer the tissue the faster the shear wave propagates and higher speed measured. Malignant nodules tend to be more rigid while benign nodules are usually soft. Diagnosis: The authors report a case of solitary nodule in a male patient, solid, hypoechoic, with predominant flow in the central region (Chammas et al. classifications, score V), indicating elastography with soft nodules and with low shear wave velocity. Discussion and Summary of the Case: The results are compared with the pathology.

TL.15.004 Computerized Quantification of Ultrasound Heterogeneity in Thyroid Nodules K. Y. Chen, C. N. Chen, M. H. Wu, M. H. Ho, H. C. Tai, A. Chen, K. J. Chang National Taiwan University Hospital, Taipei, Taiwan Brief Description of the Purpose of the Study: In order to test whether the computerized quantification of ultrasonic heterogeneity can aid the diagnosis of thyroid malignancy, we evaluate ultrasound heterogeneity by an objective and quantitative computerized method in a prospective setting. Methods: A total of 347 participants with 400 nodules were evaluated. There were 271 benign thyroid nodules and 129 malignant thyroid nodules. Patient clinical data were collected, and the grading of heterogeneity on conventional gray scale ultrasound images was retrospectively reviewed by a thyroid specialist. Quantification of ultrasound heterogeneity was performed by a proprietary program. Main Results: The ultrasound heterogeneity index (HI) between benign and malignant nodules showed a significant difference (p , 0.001, AUC50.714). To determine the relationship of the HI with conventional method, we compared HI to ultrasound heterogeneity evaluated by human investigators. In this study, the marked heterogeneity of ultrasound heterogeneity(US-H) showed higher HI than homogeneous US-H did. The US-H evaluated by human investigators did not show significant difference between benign and malignant thyroid nodules. Importance of the Conclusions: This new computer-aided diagnosis method to evaluate the sonographic heterogeneity of thyroid nodules is an objective and quantitative method. This new computerized heterogeneity index can aid in the diagnosis of thyroid malignancy better than traditional US-H evaluated by human investigator.

16 - Ultrasound in Peripheral Vascular PD.16.001 Avaliac¸a~o Por Imagem De Alterac¸~oes Vasculares Apos Procedimentos Invasivos E Tratamento A. E. P. G. Miranda, J. M. A. Miranda Med Imagem - H. Benefic^encia Portuguesa, S~ao Paulo, SP, Brasil

PD.15.021 ARFI Elastography. Thyroid Nodule Hypervascularized and Softer Than the Parenchyma. Case Report R. L. S. Muniz, C. Fainstein, A. B. G. Muniz, R. B. G. Muniz Clinica Rm, Niter oi, RJ, Brasil Brief Description of the Purpose of the Report: Elastography ARFI (Acoustic Radiation Force Impulse) is a diagnostic method that involves mechanical stimulation of tissue using short-duration acoustic pulses to generate localized displacements. Medical History: The acoustic pulses generate displacements in the tissue that can be measured by a shear wave whose propagation speed

Introduction: The vascular invasive procedures are routinely performed by vascular surgeons, interventional cardiologists and interventional physicians, so that the vascular changes after these procedures, may not occur with a frequency so low because of the high number of surgeries performed by them. Methods Involved: Evaluation of upper and lower limbs by color Doppler sonography in patients with suspected complications after invasive procedures (example: cardiac catheterization, cardiac angioplasty, arterial vascular stents in members). Discussion: The correct and early diagnosis of vascular abnormalities after invasive procedures, as well as the treatment of some of them by

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the sonographer at the time of the exam, change the course of disease and patient prognosis. Conclusion of the Presentation: Vascular changes after invasive procedures are not uncommon, and medical sonographer must be prepared in addition to early diagnosis, also be able to perform the treatment in selected cases, contributing to favorable cases.

PD.16.002 ~o Ecogr Avaliac¸a afica Dos Componentes E Dos Contornos Das Placas Ateromatosas (Classificac¸~ao) Auxiliando No Tratamento Clinico: Ensaio Pict orico P. V. Matos, M. Q. P. Silva, C. Akiho, K. B. Calil, T. R. G. Wu, M. C. Lopes Webimagem, Sao Paulo, SP, Brasil Introduction: Ultrasound has the peculiar ability to evaluate the composition, extent, severity translated by plate thickness and degree of stenosis by Doppler study and follow-up of atherosclerotic plaque. Methods Involved: In this test, the objective is to demonstrate by ultrasound assessment of types of plates (stable and unstable) based on its components and contours in order to perform characterization of the plates at low, medium or high echogenicity and as homogeneous or heterogeneous. Discussion: In this test, the objective is to demonstrate by ultrasound assessment of types of plates (stable and unstable) based on its components and contours in order to perform characterization of the plates at low, medium or high echogenicity and as homogeneous or heterogeneous. Conclusion of the Presentation: This data will help in clinical treatment of atherosclerosis, slowing their development or reducing their severity.

PD.16.003 Duplex Scan Study of Duplicated Lower Extremity Deep Vein Thrombosis B. Vojnovic, V. Vujovic Angio Vascular Medicine Consulting Rooms, Belgrade, Serbia Introduction: Anatomical variation of duplicated leg veins mainly involves the superficial femoral and popliteal vein. On the other hand, calf deep veins are usually paired. Therefore, deep vein thrombosis of one duplicated vein, with normal duplex scan finding of the other, in the absence of clinical signs of thrombosis might lead to unrecognised disease and inadequate therapy. In such cases there is an increased risk of pulmonary thromboembolism and postthrombotic and eventually operative complications. Methods Involved: Duplex scan of leg veins using multifrequent linear array transducer from 5 to 11 MHz, mostly 7 MHz is the method of choice. Discussion: Careful evaluation of all patients by means of venous duplex scan is essential for early diagnosis and treatment, and the examination should routinely include searching for possible duplicated or bifed deep veins variation. Conclusion of the Presentation: Adequately set B-mode image, Colour-flow and Power Doppler can accurately define lower extremity deep venous system.

PD.16.004 Uso Da Ultrassonografia Com Doppler Na Avaliac¸~ao De Dispositivos Endovasculares Carlos A. P. Ventura, Nunes, V. M. Caio, Chammas, G. G. C. Cerri Universidade De S~ ao Paulo, S~ao Paulo, SP, Brasil

Volume 39, Number 5S, 2013 Introduction: Currently there has been significant increase in the treatment of arterial diseases through endovascular procedures with results that are closer to conventional techniques. The ultrasound Doppler examination is widely available which can be used together for assessing endovascular devices, such as "stents" and endoprostheses used in these procedures. Methods Involved: We selected institutional cases that are illustrative of ultrasound evaluation of some endovascular devices and their correlation with other imaging methods for assessing the functionality and potential complications. Discussion: Ultrasonography has a role in the imaging evaluation of endovascular devices with some advantages following immediately after the procedure, allowing an accurate and repeated assessment, allowing detect complications in its initial phase. Conclusion of the Presentation: Echo-Doppler ultrasound is a useful tool in monitoring for the endovascular devices allowing evaluation of structural, functional and detection of complications.

PD.16.005 Preval^encia De Les~oes Estenoticas Carotıdeas Em Pacientes Com Isquemia Crıtica Dos Membros Inferiores L. H. C. Souto Maior, Petribu, L. H. C. Nsouto Maior, N. C. L. Petribu, M. Soares, J. F. Amaral, E. R. Vieira, J. M. A Junior, M. A. Cavalcanti, E. M. Baima Hospital Bar~ao De Lucena, Recife, Pernanbuco, Brasil Brief Description of the Purpose of the Study: The primary objective of the present work is to analyze the prevalence of carotid atherosclerotic disease in patients with critical lower-limb schemia through ultrasonographic method. Methods: This was a prospective observational analysis that involved 25 patients aged 43-82 years (12 males and 13 females) with diagnosis of critical lower-limb schemia. The patients were submitted to ultrasound graphic study with color flow Doppler aiming to estimate the degree of stenosis. Project submitted for approval by an ethics committee (CAAE 02041212.9.0000.5197). Main Results: The study showed that 80% of the arteries presented some type of stenosis with predominance of plaques without any hemodynamic repercussions. Three (16%) out of the patients with hemodynamically significant stenosis presented degree of stenosis ranging from 51 to 69%, and one had degree of stenosis over 70%. In this population 68% were diabetic and hypertensive, 52% were smokers, 40% had dyslipidemia, 28% and 3% were obese and coronary past possessed of stroke. Importance of the Conclusions: According to the results obtained from the present study based on the literature data, we concluded that carotid atherosclerosis has mostly affected the population at risk analyzed when associated with several established risk factors.

17 - Ultrasound in Veterinary PA.17.005 Transcranial Ultrasonography and Computed Tomography in a Dog With Cerebral Hemorrhage and Splenic Hemangiosarcoma C. O. Ghirelli, C. B. Lorigados, D. B. Calvo, L. N. Torres, A. C. B. C. Fonseca Pinto FMVZ-USP, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Report: O AVC e uma alterac¸~ao cerebral aguda resultante da isquemia cerebral ou hemorragia intracerebral espont^anea. C~aes com hemangiossarcoma podem apresentar

Abstracts les~ oes intracranianas devido a presenc¸a de metastases cerebrais que podem estar associadas a hemorragia, ou devido a presenc¸a de infarto e hemorragia, sem evid^encias de celulas neoplasicas. Medical History: Um c~ao apresentando manifestac¸~oes neurologicas de inıcio s ubito foi submetido a ultrassonografia transcraniana e abdominal  USDTC foi identificado les~ao hiperecoica dorsoe a TC da cabec¸a. A caudal ao terceiro ventrıculo e oındice de resistividade da arteria basilar  TC foram identificadas les~oes de aspecto multifocal aferido foi 0,66. A hiperatenuante e hipoatenuante que n~ao sofreram realce apos o contraste intravenoso. Ao US abdominal foram identificadas formac¸~ao espl^enica e lıquido livre. Diagnosis: O animal foi eutanasiado, e a necropsia e exame histopatol ogico revelaram: hemorragia abdominal, hemangiossarcoma espl^enico, hemorragia, isquemia e malacia do SNC, porem sem evid^encias de celulas metastaticas. Discussion and Summary of the Case: O exame ultrassonografico transcraniano nesse caso se mostrou uma ferramenta diagnostica util e de baixo custo, porem a TC forneceu maior detalhe anat^omico e possibilitou a identificac¸~ao de outros focos de les~ao. A mensurac¸~ao do IR da arteria basilar n~ao auxiliou nesse caso, pois o valor encontrado estava dentro dos padr~ oes estabelecidos.

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Methods: A prospective study was performed in twenty adult isogenic rats divided into two groups: control and experimental. In both groups acquisition of the data was performed weekly at the same regions of interest (ROI) during 6 weeks. It was used an acoustic structure quantification (ASQ) software installed in an ultrasound equipment to analyzing images. Histological analyses provide information about fibrosis development during the weeks. Main Results: The average of the histogram values (Cm2) at ROI was 103.50 (SD 6 21.70) for normal animals or fibrosis grade F0, it was 128.70 (SD 6 18.46) for rats with fibrosis grade F1, 156.87 (SD 6 19.67) for rats with grade F2, and 189.66 (SD 6 5.27) for those with grade F3. A significant increase in the histogram value was observed according to the progress of fibrosis grade. Importance of the Conclusions: This algorithm correlated well with fibrosis grade in this experimental model.

PD.17.002 Elastography and Contrast-Enhanced Ultrasonography Improves Early Detection of Hepatocellular Carcinoma in an Experimental Model of Non-Alcoholic Steatohepatitis C. F. Carvalho, M. C. Chammas, B. Cogliati, C. P. M. S. Oliveira Inrad, S~ao Paulo, S~ao Paulo, Brazil

PA.17.006 ~o De Lobo Pulmonar Em Um C~ao - Diagnostico Atraves Da Torc¸a Radiografia E Tomografia Computadorizada K. G. Requiao, R. L. Carneiro, M. J. M. H. D’Assis, J. G. T. Requi~ao, L. G. T. Requi~ ao Salvador, Bahia, Brasil Brief Description of the Purpose of the Report: This paper reports a diagnosis of lung lobe torsion (LLT) cranial left in a dog by radiography and computed tomography. Medical History: Canine, Shih tzu, male, 7 years, treated at a veterinary hospital with dry cough, pain and underactive three days ago. On clinical examination there was mild tachypnea and decreased breath sounds on the left. Were performed laboratory tests, chest radiography and computed tomography. Diagnosis: Spontaneous lung lobe torsion of the left cranial. Discussion and Summary of the Case: LLT is a disease of rare occurrence in dogs, which constitutes the axial rotation of a lung lobe and its bronchovascular pedicle. In our case the lobe was compromised left cranial and agrees with the literature that mentions this lobe as the second most affected by LLT. Thoracic and abdominal surgery, thoracic trauma, pleural effusion and pneumothorax may predispose to its occurrence, but torsion uncorrelated with previous events are said to be spontaneous. Clinical manifestations and laboratory tests proved nonspecific, stressing the importance of imaging in the diagnosis of LLT. Despite thoracic radiographs suggest torsion, computed tomography was decisive for the diagnostic conclusion.

PD.17.001 Quantification of Experimental Liver Fibrosis With an Algorithm Method Based On Statistical Analysis of Signals C. F. Carvalho, M. C. Chammas, B. Cogliati, C. P. M. S. Oliveira Inrad, S~ ao Paulo, S~ ao Paulo, Brazil Brief Description of the Purpose of the Study: Ultrasonography is sensitive to detect changes in the texture of tissues. It is difficult to detect mild diffuse liver disease and follow-up patients with chronic liver diseases. The objective was to evaluate the development of liver fibrosis in an experimental model, by use of a method to quantify the homogeneity of the tissue texture.

Brief Description of the Purpose of the Study: The early detection of focal hepatic lesions using ultrasound scanning is challenging, and this challenge becomes even greater in the presence of a diffuse parenchymal disease. This study aimed to evaluate the diagnostic performance of elastography and contrast-enhanced ultrasonography (CEUS) in the early detection of hepatocellular carcinoma (HCC) lesions in an experimental rat model of nonalcoholic steatohepatitis (NASH). Methods: B-mode and Doppler ultrasonography was performed weekly in 30 rats divided into a NASH group (n 5 20) and a group without liver disease (n 5 10). The animals underwent elastography and CEUS and were then euthanized. Liver nodules were assessed by histopathology. Main Results: Elastograms of positive lesions showed areas of high stiffness, which were indicative of malignancy. This malignancy was confirmed by the histologic evaluation, with a sensitivity of 90% and a specificity of 60%. Early wash-in was significantly associated with malignancy (sensitivity of 88% and specificity of 67%). Importance of the Conclusions: Both techniques allow for the correct diagnosis of well-differentiated to moderately differentiated HCC with good accuracy in an experimental rat model of NASH.

PD.17.003 Technical Failure Rate in Ultrasonography - Pitfalls of Ultrasound Scanning in Small Animals M. Zanini, C. F. Carvalho Provet, Sao Paulo, S~ao Paulo, Brasil Brief Description of the Purpose of the Study: Technical condition for an optimal ultrasound exam depends on the operator, equipment and patient related factors. When supplemented by the Doppler device, some of these factors can become crucial. The purpose of this study was to determine the leading causes of technical failure and their percent distribution. Methods: Digital images and 1500 reports of different ultrasound modalities in small animals were reviewed. The examinations were performed according to the literature. It was considered as technical failure the partial or total inability to perform the examination, as well as the difficulty in obtaining the sonographic images and/ or Doppler mapping for analysis and documentation. Main Results: Results demonstrated that in our population sample, factors related to the patient, such as inappropriate behavior and

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respiratory pattern, were the most frequent causes of technical failure. Although the gastrointestinal completion, the obesity and the inadequate repletion of the urinary bladder have also been scored, these factors were less frequently a problem. Importance of the Conclusions: Our findings point out the patient related factors and reinforce medical training and knowledge. Thus, they have clear implications for scientists, veterinarians and other professionals who constitute the biomedical ultrasonic community and must know about the technical limitations of ultrasonographic examinations in small animals.

Volume 39, Number 5S, 2013 Main Results: Hepatic vein flow was preserved in 90% of healthy dogs versus 52% of dogs with chronic hepatitis. The frequency of altered flow pattern was higher in animals with more extend degree of fibrosis (A: 25%; B: 30%; C: 100%). Statically significant difference was detected among groups control and C (p , 0.001). Importance of the Conclusions: Altered hepatic vein flow pattern was associated with the presence of cirrhosis in dogs. More studies are necessary to evaluate the clinical significance of this data in the prognosis of hepatic chronic diseases.

PD.17.007 PD.17.004 Quantitative Ultrasonography in Hepatic Fatty Degeneration and Chronic Hepatitis in Dogs R. Sartor, M. J. Mamprim, M. Tsunemi School of Veterinary Medicine and Animal Science, S~ao Paulo State University, Botucatu, S~ao Paulo, Brazil Brief Description of the Purpose of the Study: Aiming to minimize the subjectivity of ultrasound exam and to evaluate quantitatively the echogenicity and echotexture changes in liver parenchyma, in dogs with chronic hepatitis or hepatic fatty degeneration, the histogram has been performed. Methods: The study included 30 dogs with histopathologic diagnosis of chronic hepatitis or hepatic fatty degeneration, which underwent ultrasound assessment; and a control group of 10 healthy dogs. Logic 3 equipment and a convex multifrequency transducer (3.5 to 5 MHz) were used. Presets were standardized. After storing the image in a compact disc, 3 regions of interest were selected to perform the histogram by software, Photoshop CS4. Echogenicity of hepatic parenchyma was assessed by Lmean; echotexture through relationship Nmost/Nall and SD. Statistical tests were nonparametric Kruskal Wallis and Dunnet multiple comparison. Main Results: It was noted, quantitatively, increased echogenicity in both, hepatic fatty degeneration (Lmean 76.4) and chronic hepatitis (Lmean 86.0), while heterogeneity of the parenchyma was visualized only in chronic hepatitis (Nmost/Nall: 17.7; SD: 12.9), when compared to the control group (Lmean: 59.0; Nmost/Nall: 30.5, SD: 6.1). Importance of the Conclusions: Quantitative analysis of ultrasound images by the histogram assisted in the differentiation of normal hepatic parenchyma, chronic hepatitis and fatty degeneration in dogs, minimizing the subjectivity of sonographic findings.

PD.17.005 Doppler Ultrasonography of Hepatic Veins in Dogs With Chronic Hepatitis and Several Degrees of Hepatic Fibrosis R. Sartor, M. J. Mamprim, M. Tsunemi School of Veterinary Medicine and Animal Science, S~ao Paulo State University, Botucatu, S~ao Paulo, Brazil Brief Description of the Purpose of the Study: Doppler ultrasonography has been widely used in medicine to assess chronic hepatitis. The aim of this study was to evaluate hepatic vein flow pattern by spectral Doppler in dogs with chronic hepatitis and several degrees of hepatic fibrosis. Methods: The study included 25 dogs with histopathologic diagnosis of chronic hepatitis, grouped based on the extent of fibrosis (A: slight fibrosis, B: moderate fibrosis, C: cirrhosis), which underwent ultrasound assessment and a control group of 10 healthy dogs. The hepatic vein of the caudate hepatic lobe was assessed by color and spectral Doppler and its flow pattern was classified as preserved (triphasic) or altered (monophasic or biphasic). Statistical analysis was performed by Fisher test.

The Use of A-Mode and B-Mode Ultrasound for Ocular Biometry in Domestic Cats T. G. Baraldi, R. Sartor, M. J. Mamprim, C. V. S. Brand~ao, C. S. Perches, C. L. Ackermann School of Veterinary Medicine and Animal Science, S~ao Paulo State University, Botucatu, S~ao Paulo, Brazil Brief Description of the Purpose of the Study: Ultrasonographic ocular biometry has its value well established, however, regarding domestic cats, some data are incomplete in the literature. The objectives of this study were to perform ocular biometry in domestic cats by two different ultrasound modes, and to compare the results. Methods: This study included 15 adult cats, totaling 30 eyes without macroscopic changes. Rostrocaudaly measurements of the eyeball (EB), anterior chamber (AC), lens (L) and vitreous chamber (VC) were made by A-mode and B-mode ultrasonography, using sagittal plane and transcorneal technique. Statistical analysis was performed by tukey test (5%). Main Results: Means and standard deviations of the measurements obtained by A-mode and B-mode ultrasound, respectively, in millimeters: EB: 19.83 6 0.52, 20.11 6 0.81; AC: 4.20 6 0.48, 3.95 6 0.47; L: 6.98 6 0.34, 8.12 6 0.43; VC: 7.98 6 0.39, 7.13 6 0.63. Statistical difference was observed among the measurements of L and VC when comparing the two sonographic methods. Importance of the Conclusions: The values of ocular biometry in healthy cats presented in this study are important bases for diagnosing of diseases. However, the differences in the values obtained by Amode and B-mode ultrasound, highlights the need for further studies to determine which method provides more reliable measurements.

PD.17.008 Abscesso Intra-Abdominal Secundario a Perfurac¸~ao Intestinal Por Corpo Estranho A. F. Belotta, M. J. Mamprim, E. G. M. Siqueira, V. R. Babicsak, H. S. Oliveira, L. R. Inamassu, C. V. S. Brand~ao Faculdade De Medicina Veterinaria E Zootecnia, Universidade Estadual Paulista "Julio De Mesquita Filho", Campus Botucatu, S~ao Paulo, Brasil Brief Description of the Purpose of the Report: Importance of ultrasonography in guiding clinical case in which the inicial suspicion was dyschezia for prostatic enlargement. Medical History: Dog, male, 7 years old, presenting tenesmus, aquesia, vomiting and anorexia for 3 days and marked leukocytosis with neutrophilia, was sent to Diagnostic Imaging sector for abdominal radiographies and ultrasound. Diagnosis: On radiographies there was gas dilation of descending colon and inscreased radiopacity in prostatic topography. Ultrasound showed oval structure with hiperechoic capsule and dense heterogeneous content, without Doppler vascularity, located dorsally to the bladder displacing it ventrally with the colon. In aortic bifurcation, part of structure was compressing left distal ureter causing ueretrohydronephrosis

Abstracts proximally. Prostate was not visualized due to the shadow. Animal was referred for exploratory laparotomy, confirming presence of abscess dorsal to colon with areas of adhesion and presence of a toothpick within the abdominal cavity. Discussion and Summary of the Case: Foreign body intestinal perforation often leads to generalized peritonitis and acute abdomen. Ultrasonography was essential for visualization of a mass suggestive of abscess. However, absence of history of foreign body ingestion only allowed definition of the cause during surgery.

PD.17.009 Pielonefrite Bilateral Cr^onica Em Um Porquinho Da India - Aspecto Ultrassonografico V. R. Babicsak, M. J. Mamprim, L. C. Vulcano, H. S. Oliveira, A. F. Belotta, G. D. P. Soares, C. R. Teixeira Universidade Estadual Paulista, Botucatu, S~ao Paulo, Brasil Brief Description of the Purpose of the Report: The purpose of this report is the description of the sonographic appearance of chronic pyelonephritis in a guinea pig, not previously reported, and important by the growing presence of these animals in the clinical routine. Medical History: A 2-year-old female animal of the specie Cavia porcellus with a history of recurrent cystitis was referred for ultrasound due to suspicion of pyelonephritis. Diagnosis: Ultrasonography revealed kidneys with preserved dimensions and well-defined and regular borders, when compared to exams of healthy animals of the same specie. During the examination, there were marked increase in echogenicity of the medullar region and bilateral renal pelvis dilation, which measured 0.38 and 0.41 cm in diameter in the left and right kidney, respectively. Discussion and Summary of the Case: Patients affected by acute pyelonephritis may present hyperechogenic focal areas in medullar region or irregular hypoechoic and/or hyperechoic areas in renal cortex. In the animal of this report, however, a generalized increase in echogenicity of the medullar region was identified, possible due to the chronicity of pyelonephritis. The dilation of the renal pelvis observed on the ultrasound of this patient also contributed to the diagnosis of chronic pyelonephritis since in most acute cases, this alteration is not detected.

PD.17.010 Adenocarcinoma Intestinal Atıpico Em Um Felino - Aspecto Ultrassonogr afico V. R. Babicsak, M. J. Mamprim, L. C. Vulcano, A. F. Belotta, H. S. Oliveira, M. Tebaldi, L. H. A. Machado Universidade Estadual Paulista, Botucatu, S~ao Paulo, Brasil Brief Description of the Purpose of the Report: The aim of this report is to describe an atypical sonographic appearance of an intestinal adenocarcinoma in a cat. Medical History: A 10 year old mixed breed female cat was referred for ultrasonography due to the history of vomiting and appetite loss. Diagnosis: In abdominal ultrasonography, was observed in right mesogastric and hypogastric regions, a severe thickening of the muscular layer of an intestinal segment, resulting in luminal stenosis and consequent cranial dilation. The muscular layer presented a symmetrical thickening of approximately 0.4 cm in its entire circumference. Discussion and Summary of the Case: Sonographically, intestinal adenocarcinoma usually is observed as a symmetric or asymmetric thickening in association with loss of intestinal layers definition, with expansion to the outer part of the intestine. In the animal of this report, however, adenocarcinoma did not result in loss of stratification of the intestinal layers, alteration usually related to benign cases. Furthermore, the intestinal tumor appeared as constrictive with minimal exterior

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expansion. These two factors differ from sonographic aspects of intestinal adenocarcinoma often reported in the literature, indicating that this tumor type should not be excluded from the differential diagnosis of expansive intestinal lesions. PD.17.011 Transcranial Ultrasonography in Healthy Dogs: Technique Standardization and Anatomic Description C. T. F. Cintra, C. F. Carvalho, J. C. Canola, A. C. Nepomuceno Universidade Estadual Paulista - UNESP, Jaboticabal, S~ao Paulo, Brasil Brief Description of the Purpose of the Study: Transcranial ultrasonography (TCUS) has the advantage of being a non-invasive and low cost method when compared to Magnetic Resonance Imaging. This work goal to correlate TCUS images obtained through the temporal and occipital windows with healthy dog’s encephalic anatomy, identifying the brain structures in the image and standardizing the technique in veterinary medicine. Methods: TCUS was performed in 30 animals in vivo and seven cadavers using convex transducer positioned at the temporal bone to obtain caudal and cranial dorsal oblique planes. Longitudinal and dorsal planes were also performed at occipital window. The cadaver’s heads were sectioned according to the insonation angle and the sonographic images were correlated to the corresponding anatomical plane for identification and quantification of the brain structures visualized in TCUS. Main Results: After statistical analysis the number of brain structures visualized in the TCUS in vivo, when compared to that observed in the anatomical planes of cadavers, did not have significant diferences (p . 0.05) for cranial dorsal oblique planes through the temporal window and also for the planes visualized through the occipital window. Importance of the Conclusions: TCUS was able to obtain detailed images with good definition to evaluating brain’s dogs weighting until 10kg, without the need to anesthetize the patient. PD.17.013 Assessment of Cortical Sulci Formations and Diagnosis of Lissencephaly in Three Dogs Using Transcranial Ultrasound T. C. F. Cintra,1 C. F. Carvalho,2 J. C. Canola,1 A. C. Nepomuceno1 1 Universidade Estadual Paulista-Unesp, Jaboticabal, S~ao Paulo, Brasil, 2 Inrad-Universidade De S~ao Paulo, S~ao Paulo, S~ao Paulo, Brasil Brief Description of the Purpose of the Study: Lissencephaly is a congenital malformation characterized by total or partial absence of cortical sulcus and gyrus with relevant neurological signs. Temporal bone has been used as an acoustic window for transcranial ultrasound (TCUS) in humans and dogs. The objectives of this study were to standardize thickness measurements of the marginal and coronal encephalic sulci, and to describe the sonographic aspects in three cases of lissencephaly. Methods: TCUS was performed in 30 healthy adult dogs, using convex transducer positioned perpendicularly to the temporal bone. Marginal and coronal sulci were measured in dorsal oblique planes. Also a prospective study was performed in 104 dogs between January of 2010 and April of 2011. Main Results: In experimental group both marginal and coronal sulci were visualized as linear hyperechogenic structures within the hypoechoic parenchyma in all 30 dogs and identified according to the anatomy. TCUS clinical study revealed three dogs with absence of sulci images, and one of them also presented dilation of lateral ventricles. Lissencephaly was confirmed by necropsy in 2 dogs and by Magnetic Resonance Imaging in one. Importance of the Conclusions: Our study demonstrates that marginal and coronal sulci can be visualized in normal dogs through TCUS and this method was used to diagnostic of lissencephaly.

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Volume 39, Number 5S, 2013

PD.17.017

PD.17.019

Ultrassonografica No Modo-B E Dopller Nos Tumores Malignos Da Gl^ andula Mamaria De Cadelas P. M. Souza, M. J. Mamprim, M. D. Lopes Universidade Estadual Paulista, Botucatu, S~ao Paulo, Brasil

Ultrassonografia Abdominal Em C~ao Com Abscesso Hepatico V. R. Babicsak, A. F. Belotta, H. S. Oliveira, L. C. Vulcano, M. J. Mamprim Universidade Estadual Paulista, Botucatu, S~ao Paulo, Brasil

Brief Description of the Purpose of the Study: This paper aims to describe the sonographic features in B-mode and Doppler of malignant tumors of the mammary gland of bitches.

Brief Description of the Purpose of the Report: The purpose of this report is the sonographic description of a liver abscess and other abdominal findings in a dog.

Methods: A total of 117 breast with breast cancer. The tests were performed on the model LOGIC 3 (GE Health Care’s Brand Brasi), with a linear, 6-10MHz. We used the B-mode, color Doppler, and spectral Doppler Amplitude. The sonographic data were correlated according to the type of tumor that defined by histopathological examination, considered the "gold standard." Main Results: The main sonographic features of breast tumors were malignant calcification in 44% (macro and microcalcification), heterogeneous (94%), cavitary lesions (44%), and strengthening or acoustic shadowing (69%). The presence of vascularity identified by color Doppler and Doppler Amplitude determined that different types of tumors in the neovascularization were present in 84%. In spectral Doppler general measures of different types of malignant tumors to systolic maximum speed was 46.02 cm / sec least 15.53 cm / s. The average was 0.66 IR and IP of 1.45. Importance of the Conclusions: Being a technique that aids in the characterization of malignant lesions demonstrating their value in diagnostic routine veterinary.

Medical History: A 5 years old mixed breed male dog was referred for the ultrasound due to leukocytosis and history of vomiting. Diagnosis: Ultrasonography showed a partially defined structure in the medial right hepatic lobe containing an anechogenic liquid and gas in is interior. The liver parenchyma showed an increase in its size and a decrease in its echogenicity. Mild abdominal effusion, regional lymphadenopathy and a hyperechogenicity of peri-hepatic fat were also observed. Discussion and Summary of the Case: Typically, abscesses present an anechogenic or hypoechogenic liquid content, and may also contain gas inside, as identified in this animal. In dogs, an increased frequency of liver abscess occurs in the left region, however, in this case, the abscess was found on the right side of the gallbladder, as commonly observed in humans due to the frequent biliary origin of the abscesses. In this animal, ultrasonographic alterations of the liver parenchyma were also observed, suggesting an acute hepatitis, disease often found in association with abscesses. Other alterations such as hyperechogenicity of peri-hepatic fat, regional lymphadenopathy and abdominal effusion can also be verified, all of which observed in this dog.

PD.17.018 ~o De Guia Ultrassonografico Na Biopsia Percut^anea Utilizac¸a  Por Agulha Jamshidi Em Neoplasia Ossea Canina - Relato De Casos. Utilization of Ultrasonographic Guidance in Jamshidi Needle Percutaneous Biopsy in Canine Bone Tumor - Case Report C. B. Amaral,1 M. A. P. Rom~ao,2 A. M. R. Ferreira2 1 Universidade Federal Do Espırito Santo, Alegre, ES, Brasil, 2 Universidade Federal Fluminense, Niteroi, RJ, Brasil Brief Description of the Purpose of the Report: The object of the present paper is to evaluate the utilization of ultrasonographic guidance to obtain percutaneous needle biopsy samples from four dogs presenting radiographic imaging compatible with bone tumor, pointing its advantages and limitations. Medical History: Four female dogs, one without specific breed and three Rottweillers with age range from 3 to 11 years, presented lameness, pain and swelling of pelvic (one case) and thoracic limb (other three).

PD.17.020 Mesotelioma Em T unica Vaginal Testicular Em Um C~ao Resultando Em Invas~ao Abdominal E Provavel Infiltrac¸~ao Metastatica - Avaliac¸~ao Ultrassonografica V. R. Babicsak, A. F. Belotta, T. Kievitsbosch, P. E. Kobayashi, M. D. Lopes, R. L. Amorim, L. C. Vulcano, M. J. Mamprim Universidade Estadual Paulista, Botucatu, S~ao Paulo, Brasil Brief Description of the Purpose of the Report: This report aims to describe the sonographic aspect of mesothelioma in tunica vaginalis testis of a dog resulting in abdominal invasion and probable metastasis, a rare disorder. Medical History: An 8 year old west highlander white terrier male dog was referred for ultrasound due to a left scrotum enlarged.

Diagnosis: Radiographically, monostotic lesions were noticed, with lytic and proliferative bone areas and loss of cortical integrity of radius (two cases), femur and humerus metaphyses, suggestive of primary bone tumor. For confirmation, percutaneous biopsy with Jamshidi needle 11 G was performed under ultrasonographic guidance. Histopathology revealed osteosarcoma in all cases.

Diagnosis: In ultrasonography, left hydrocele was observed in association to hypoechogenic nodular structures attached to the tunica vaginalis. A hypoechogenic image extending into the abdominal cavity and culminating in an irregular structure with similar echogenicity, which measured 4 centimeters in diameter, was also noted. Surgical resection of the mass was performed, however, tumor recurrence was identified in the ultrasonography. An enlargement and a hypoechogenicity of the abdominal lymph nodes were also verified in the examination.

Discussion and Summary of the Case: Ultrasound allowed visualization of the lesions without significant acoustic shadowing due to cortical bone violation, besides needle tracking in the biopsied area, avoiding not viable tissue. Other advantages include portability and not using ionizing radiation. Its main limitation is sclerotic and proliferative bone lesions that block sound waves. Taking that on account, its guidance modality can be used in Veterinary Medicine usual practice, being an important diagnostic tool to be explored.

Discussion and Summary of the Case: Mesothelioma is often observed as an irregular thickening of the tunica vaginalis or as nodules adhered in this structure, which occasionally results in abdominal invasion, as identified in this case. Ultrasonographic alterations were also observed in the lymph nodes, indicating metastatic infiltration. In a previous study, it was suggested that the surgical removal of the tumor could result in cure due to the rare occurrence of metastasis, however, in this case, tumor recurrence and probable metastatic infiltration were verified.

Abstracts PD.17.023 Retrospective Study of Ultrasonographic Aspects Compatible With Pancreatitis in Dogs by Diagnostic Imaging of Universidade J ulio de Mesquita Filho - UNESP Botucatu M. G. S. Charlier, M. J. Mamprim Faculdade De Medicina Veterinaria E Zootecnia, Universidade Estadual Paulista "J ulio De Mesquita Filho", Campus Botucatu, S~ ao Paulo, Brasil Brief Description of the Purpose of the Review of Literature: The present study aims to correlate the ultrasonographic aspects of dogs diagnosed with pancreatitis during the last two years by diagnostic imaging of Universidade Julio de Mesquita Filho - UNESP Botucatu. Description (S) Condition (S), Method (S) Or Technique (S): Pancreatitis is the main disease of the exocrine pancreas in dogs. The presumptive diagnosis can be made based on clinical, biochemical and Hematological profiles, specific pancreatic markers urinalysis and image, but the pancreatic biopsy is the only definitive diagnostic tool. The therapy is distinct for each clinical presentation and prognosis is variable. The ultrasound is the preferred imaging technique of choice to search suspected canine pancreatitis. Ultrasound examination of the pancreas can provide specific information as size, shape and the homogeneity of the parenchyma, thus in acute pancreatitis, the organ presents itself raised, lumpy, hipoechogenic and the surround region might be hiperechogenic; In the case of chronic pancreatitis, we can observe more heterogeneous parenchyma predominantly hiperechogenic. 23 ultrasonographic reports were reviewed with pancreatopathy and the description of the amendment was divided in body size and alteration of echogenicity. Conclusion: We found that the majority (73%) of animals with suspected pancreatitis showed significant increase in organ, but of these, 52% also had a decrease in echogenicity and 23% had also increased echogenicity. Brief Discussion of the Case: Null. PD.17.024 Ultrasonographic and Tomographic Aspects of Chronic Lung Lobe Torsion in a Dog A. C. B. C. Fonseca Pinto, S. C. F. Hagen, K. M. Zardo, C. M. Martin, A. Sendyk-Grunkraut, J. M. Matera Faculdade De Medicina Veterinaria E Zootecnia Da Universidade De S~ ao Paulo, SP, Brasil Brief Description of the Purpose of the Report: Lung lobe torsion (LLT) is a rare condition in small animals resulting in airways obstruction and pulmonary congestion. It can be developed spontaneously or due to trauma, pleural effusion or lobectomy. Early diagnosis is important due to high morbidity and mortality, and image exams are mandatory. The purpose of this study is to describe the tomographic and ultrasonographic aspects of chronic LLT (CLLT) in a dog. Medical History: An adult female Shetland Shepherd presenting previous history of pleural effusion and suspicion of pulmonar neoplasia was submitted to computed tomography (CT) pre and pos contrast. The CT findings suggested CLLT and the ultrasonographic exam was performed to confirm the diagnosis. Diagnosis: CT showed pleural effusion, consolidation of the middle lobe, very sutil and heterogeneous contrast enhancement, bronchial trapping and abnormal position. Ultrasonographically this lobe was predominantly consolidated, hypoecogenic, without vascular flow. An anechoic tubular structure suggestive of fluid bronchogram ran down the middle of the lobe. The aspects were compatible with CLLT and were confirmed with thoracotomy. Discussion and Summary of the Case: In cases of CLLT, the chronic aspects may hamper the interpretation of CT findings. Thus, lobe

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consolidation and no vascular flow, observed by ultrasonography, make it an important tool for establishing the definitive diagnosis. PD.17.026 Contribuic¸~ao Do Exame Ultrassonografico No Diagnostico De Mucocele Retrobulbar Em C~ao: Relato De Caso H. S. Oliveir, V. R. Babicsak, A. F. Belotta, N. B. Merlini, C. V. S. Brand~ao, P. M. Souza, J. M. Mamprim FMVZ - UNESP, Botucatu, S~ao Paulo, Brasil Brief Description of the Purpose of the Report: Mucoceles are classified as extravasation or retention, where retention consists of mucocele be retained in the lining fabric and the overflow content if observable by adjacent connective tissues. The present report describes the changes found in ultrasound diagnosis of aiding mucocele of extravasation. Medical History: A dog of breed Lhasa-Apso with principle of exophthalmos was forwarded to the ultrasound examination for evaluation of retrobulbar region. The linear multifrequency transducer was used examination frequently between 6-10 MHz, following the examination as to the examination according to Spaulding, 2008. Diagnosis: Has been viewed in retrobulbar region a cystic structure with irregular edges filled with anecog^enico some content cellular by moving the eyeball rostrally. This same structure extending laterally to the masseter muscle region leading to the increase in volume in the region. Due to the large increase in volume was attempted puncture of this content guided by ultrasound, Obtained a discreet amount of mucosal content managed to being diagnosed as a salivary mucus concluding the diagnosis. Discussion and Summary of the Case: The most common are mucoceles those extravasation, being the same aspects that it sorts in the present report. With the anatomical aspect and the extension of the structure indicated-as affected the zygomatic gland. PD.17.027 Classificac¸~ao E Padronizac¸~ao Ultrassonografica Pelo Metodo Bi-RadsÒ Nos Tumores Malignos Da Gl^andula Mamaria Em Cadelas P. M. Souza, M. J. Mamprim, M. D. Lopes UNESP, Botucatu, S~ao Paulo, Brasil Brief Description of the Purpose of the Study: The objective classify breast tumors according to BI-RADSÒ (Breast Imaging Reporting and Data System) protocol classification and standardization of reports of female breast ultrasound, proposed by the American College of Radiology (ACR). Methods: Was studied 117 breast if bitches. Were evaluated by ultrasonography and classified by BI-RADSÒ category and the modified BIRADSÒ modified (categories 1-5). The parameters for these techniques were: Lesion size, shape, orientation with respect to baseline, margins, echogenicity pattern; echogenic points, a characteristic acoustic later; surrounding tissue, area fibrosis, calcification: macrocalcificac¸~ao (.5mm), microcalcification or combined pattern; Vascularization (absent or present-called neovascularization) (PI, RI, maximum and minimum speed) or not. Main Results: A description of the modified BI-RADSÒ showed significant for classification according to malignancy and in different types of tumors by the system in ascending order as: the presence of microcalcifications within the nodule, the heterogeneity, echogenic dots, posterior acoustic shadowing, margin and shape, orientation not parallel, changes in surrounding tissue. Importance of the Conclusions: Conclusion that the technique BI-RADSÒ is a new proposal for breast sonographic classification, compared to a standard test for the diagnosis of breast cancer.

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Scientific Papers – Oral Presentation 1 - Abdomen Ultrasound TL.01.001 Comprehensive Ultrasound Diagnosis Value of Hepatocellular Adenoma Wenping Wang, Fen Mao, Beijian Huang Department of Diagnostic Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin RD, Shanghai 200032, China Brief Description of the Purpose of the Study: To evaluate the comprehensive diagnosis value in hepatocellular adenoma of gray scale ultrasound (US), color Doppler ultrasound (CDFI) and contrastenhanced ultrasound (CEUS). Methods: The study focused on 11 consecutive patients (male 3, female 8, mean age, 28.0 years 6 13) from Sep 2004May 2012. All lesions were pathologically proved. For each lesion, a three-step examination, including US, CDFI and CEUS were performed. CEUS was performed using a dose of 1.5-2.4 ml of SonoVueÒ. A difference was considered statistically significant with p , .05. Main Results: Spotty calcifications were found in 27.3% (3/11) lesions. CDFI detected centripetal bulky color flow in 63.6% (7/11) lesions. After SonoVue administration, a bulky and tortuous artery can be detected under the capsule of 45.5% (5/11) lesions. Intra-tumoral hypoechoic areas can be detected in 18.2% (2/11) lesions. The overall diagnostic accuracy of HCAs was 72.7% (8/11), which was higher than single diagnosed by US (27.3%, 3/11), CDFI (63.6%, 7/11) or CEUS (45.5%, 5/11). Importance of the Conclusions: When specific US, CDFI and CEUS features were associated, we could improved early and accurate preoperation diagnosis of HCAs.

Volume 39, Number 5S, 2013 Brief Description of the Purpose of the Study: To evaluate if IOCEUS and CCE allow a differentiation between malignant and benign liver lesions in comparison to histopathology. Methods: Retrospective evaluation of digitally stored intraoperative CEUS examinations. IO-CEUS and CCE of 49 liver lesions were compared to histopathology following surgical resection. Examinations were performed by one experienced examiner using a multifrequency linear probe (6-9 MHz, LOGIQ E9/GE). Loops of CEUS were evaluated during the arterial (15-45s), the portal venous (60-90s) and the latevenous phase (2-5 min). Characterization of the CCE using digital cine-loops .10 s, based upon a color coding system. Semi-quantitative evaluation of the lesions’ stiffness based upon a default scaling of 0-6 (0 low up to 6 high) using 7 ROIs (2 in the center, 5 in the marginal zone). Main Results: Lesion diameter from 7 - 54 mm, mean 2,5 cm. All 44 malignant lesions (13 HCCs, 8 CCCs, 23 metastases) displayed a portal venous washout. 3 lesions that could not be characterized definitely using IO-CEUS and CCE, were found to be a partially thrombosed hemangioma, a granuloma and a dystrophic fibrosis by histopathology. 2 lesions were correctly diagnosed as complicated cysts using IOCEUS. Overall accuracy of IO-CEUS was 90%, specificity was 96%. Using CCE, malignant lesions were found to be inhomogenous, only partially indurated in 12 lesions, with a scaling of 5. Only in 8/49 lesions central indurations were visible (scaling 4-6). Overall accuracy was 69%, specificity was 94%. Importance of the Conclusions: IO-CEUS offers clear benefits for localization and characterization of liver lesions. CCE only partly allows a correct characterization of lesions. TL.01.004 Trans-Anal Ultrasound in Patients With Fecal Incontinence H. J. Jeon, U. C. Park, Y. J. Kim, H. S. Park, S. I. Jung, S. J. Park School of Medicine Konkuk Univ, Seoul/Chungju/Goheungkirea

TL.01.002 Sonographic Appearance of Ascaris and Typical Serpentine Movement M. Hasan Institute of Ultrasound Imaging, Karachi, Sindh, Pakistan Brief Description of the Purpose of the Study: The aim of this study was to share the experience of serpentine movement of ascaris at different places in the abdomen. Methods: Ascaris worm is very common in Pakistan especially in children and infects the human bowels. In our experiences, we have seen ascaris in bowels, Stomach, CBD, intra-hepatic duct and gallbladder on ultrasonography. Some of these ascaris were alive, and they had typical serpentine movement. We recorded these cases on our video which will be shown during the presentation. The patient had various signs and symptoms ranging from acute intestinal obstruction, intermittent jaundice, right hypochondrium discomfort, mimicking to acute appendicitis. Main Results: we saw ascaris in bowel, stomach, CBD, intreahepatic ducts, and gallbladder, and recorded their serpentine movement on video tape. Importance of the Conclusions: This paper will highlight the sonographic features and will show on video the typical serpentine movement. TL.01.003 Intraoperative Contrast Enhanced Ultrasound (IO-CEUS) and Color Coded Elastography (CCE) for Characterization of Liver Lesion Before Surgical Resection N. Platz B. Da Silva, M. Loss, J. Rennert, A. G. Schreyer, S. Farkas, C. Stroszczynski, E. M. Jung Department of Radiology, Department of Surgery, University Medical Center, Regensburg, Germany

Brief Description of the Purpose of the Study: Purpose is to give the ultrasound(US) images and the concordance between USand surgical findings of incontinence. Methods: 53 patients performed anal US, manometry and pudendal nerve terminal motorlatency(PNTML) during current 5years. Excluding idiopathic cases(n5101),27myogenic incontinence with obstetric injuries (GroupA) and 25 neurogenic incontinence (GroupB) were categorized. Based on sonographic images -Type 0-(no injury to anal & pelvic sphincter muscles),-Type I- (injury to the internal anal sphincter), -Type II-(extending into the external anal sphincter, mixed injuries to the both muscles)and-TypeIII-(extending into the other perineal muscles) injuries. Main Results: ContinenceGradingScore was 10.6 (range, 4-20). Most obstetric injury was the external anal sphincter (92.6%, n5 25). Compared to the 27 operative findings, the agreement rate for sphincteric injuries was in 86% of type I, in 95% of type II, and in 60% of type III patients. The thickness of internal sphincter(control, 2.43 6 0.85 vs. patients with obstetric injuries, 2.30 6 0.71, p . 0.05) and external sphincter(control, 7.33 6 1.56 vs. patients with obstetric injuries, 8.23 6 2.10, p . 0.05) were not different statistically between control and groupA. Sonographic findings with Group A, no significant defect or injuries (-Type 0- finding) in Group B. Importance of the Conclusions: US is useful for preoperative assessment of incontinence with obstetric injuries. TL.01.005 Value of Ultrasound Attenuation Index in Noninvasive Quantitative Estimation of Hepatic Steatosis K. W. Kim, H. J. Kwon, S. J. Lee, S. Y. Kim, J. S. Lee, H. J. Kim, G. Song, S. A. Kim, E. S. Yu, J. Lee, S. Hwang, S. G. Lee Asan Medical Center, Seoul, Korea

Abstracts Brief Description of the Purpose of the Study: To evaluate value of ultrasound-attenuation-index (USAI) in estimation of hepatic steatosis and to determine optimal cutoff-value of USAI for severe steatosis in potential living liver donors. Methods: 240 potential living liver donors underwent US-guided biopsy. Target site was scanned with 4MHz and 8MHz. On US image, observer drew ROIs in superficial and deep areas. USAI was defined as difference between superficial and deep echogenicity, divided by superficial and multiplied by 100. On pathology, steatosis was evaluated on a percentage-scale. Severe steatosis was defined as macrovesicular fatty change over 30%. Spearman test was used to determine correlation-coefficients between USAI and hepatic steatosis; ROC analysis was performed to determine optimal cutoff-value for severe steatosis. Main Results: Median degree of hepatic steatosis was 3%. Severe steatosis was found in 10. USAI with 4MHz ranged 227.4-36.6(median, 4.0) and USAI with 8MHz, 218.0-78.1(median, 14.5). There was significant moderate correlation between hepatic steatosis and 8MHzUSAI (Spearman r50.669, p , .001 for total; Spearman r50. 645, p , .001 for macrovesicular steatosis). Optimal cutoff value of USAI for severe steatosis at 8MHz was 31. Importance of the Conclusions: USAI with 8MHz is a useful indicator in noninvasive quantitative estimation of hepatic steatosis and in diagnosis of severe steatosis in potential living liver donors.

TL.01.006 Effect of Respiration On the Registration of US-CT Fusion Imaging for Accurate Localization of Small Focal Hepatic Lesions W. J. Lee, J. Y. Lee, H. Rhim, M. W. Lee Samsung Medical Center, Seoul, Republic of Korea Brief Description of the Purpose of the Study: To evaluate effect of respiration during acquisition of CT data on accurate localization of small focal hepatic lesions(FHLs) by comparing US performed during inspiration and expiration with fused CT images obtained during inspiration and expiration. Methods: Twenty-five patients(M:F57:18, mean age545 years) with 42 FHL(,3cm) such hemangiomas(n529) and cysts(n513) were collected. They underwent three-phase liver CT; arterial and portal phases were obtained during inspiration, while equilibrium phase was were obtained during expiration. Portal phase(inspiration CT5ICT) and equilibrium phase(expiration CT5ECT) images were uploaded separately in LOGIQ E9 equipped with Volume Navigation, After uploading ICT, plane and point registration were done during performing US during inspiration(inspiration US5IUS) and expiration(expiration US5EUS), respectively. The same process was repeated after uploading ECT. Accuracy of localization of each lesion was graded with threepoint score according to size difference between CT and US(concordance ratio5CR). CR between CT/US in all combinations of respiration was compared. Main Results: CRs of ICT/IUS vs. ICT/EUS were significantly different(p 5 .0005). Respiration state of US seemed not to affect CR when using ECT(p 5 .117). CRs were significantly lower in EUS than in IUS(p 5 .0007). Importance of the Conclusions: Respiration state during obtaining CT might affect accurate localization of small FHLs. Accurate localization could be worse when US was performed during expiration.

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3 - CEUS (Contrast Agents) TL.03.006 Contrast Enhanced Ultrasound As First Line Imaging Method for the Evaluation of Focal Liver Lesions - A Large Monocentric Experience I. Sporea, A. Martie, A. Popescu, R. Sirli, M. Danila, M. Ardelean, S. Bota Department of Gastroenterology and Hepatology, ‘‘Victor Babes’’ University of Medicine and Pharmacy Timisoara, Romania Brief Description of the Purpose of the Study: Aim: To assess the utility of Contrast Enhanced Ultrasound (CEUS) in characterization of focal liver lesions (FLLs) in clinical practice, as first line imaging method. Methods: We performed a single centre retrospective study during 37 months (September 2009 - October 2012), in which we evaluated 1254 FLLs in the Department of Gastroenterology and Hepatology from Timisoara. Main Results: From all 1254 FLLs, 34.1% lesions were observed on patients with chronic liver disease, while 65.9% were found on patients without chronic hepathopaties. For the patients with chronic liver disease, CEUS was conclusive for a correct diagnosis in 316/428 cases (73.8%) and for those without chronic liver disease 714/826 (86.4%) cases were conclusive. Overall, this method characterized correctly 1030 FLLs, being conclusive in 82.1% cases, while in 17.9% cases were needed additional imaging methods. Also, the malign and benign nature of the lesions was established in 1111cases (88.6%). Importance of the Conclusions: Our study proves that CEUS can be the first line imaging method for FLLs diagnosis, providing in our experience a correct diagnosis in 82.1% cases. Also, the method can be used successfully to establish the benign/malign nature of a FLL, allowing a correct characterization in 88.6% cases. TL.03.008 Assessment of Early Tumor Response to Cytotoxic Chemotherapy With Dynamic Contrast-Enhanced Ultrasound in Human Breast Cancer Xenografts Jianhua Zhou, Jianwei Wang, Wei Zheng, Yao Chen, Anhua Li State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China Brief Description of the Purpose of the Study: This study was to quantify tumor perfusion changes with dynamic contrast-enhanced ultrasound (CEUS) in the evaluation of early tumor response to cytotoxic chemotherapy. Methods: Sixty nude mice bearing with MCF-7 breast cancer were administrated with either adriamycin or sterile saline. CEUS was performed on days 0, 2, 4 and 6 of the treatment, in which time-signal intensity (SI) curves were obtained and four perfusion parameters including peak enhancement (PE), area under the curve of wash-in (WiAUC), wash-in rate (WiR) and wash-in perfusion index (WiPI) were calculated from perfusion curves. Histopathological analysis was conducted to evaluate tumor cell density, microvascular density (MVD), proliferating cell density and tumor perfusion (Hochest 333342 stain). Main Results: Significant decreases of four perfusion parameters were noticed between adriamycin-treated and control groups (p , 0.01) 2 days after therapy. There were significant differences of tumor volumes between control and treated groups on days 6 (p , 0.001) while there were no significant differences in tumor volume on days 0, 2 and 4 (p . 0.05). Significant decreases of tumor cell density, MVD, proliferating cell density and tumor perfusion were seen in adrianycin-treated group compared to control group since day 2 (p , 0.001).

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Importance of the Conclusions: Dynamic CEUS for quantification of tumor perfusion could be used for early detection of cancer response to cytotoxic chemotherapy prior to notable tumor shrinkage. TL.03.009 The Value of Contrast-Enhanced Sonography With Quatification in Evaluation of Tumor Targeted Therapy: Preliminary Results in China Anhua Li Guanghzou City, Cjina Brief Description of the Purpose of the Study: The purpose of this study was to evaluate contrast-enhanced sonography (CEUS) with quantification as a predictor of early response in antiangiogenic treatment. Methods: 12 patients (112 tumors) with metastases or a recurrence from malignancies were prospectively included in this study. Targeted drugs included imatinib (Glivec, Novartis, Switzerland) and Sunitinib (Pfizer, USA) in gastrointestinal stromal tumors (GISTs), Avastin (Roche, Switzerland) and KH903 (phase I clinical trial) in intestinal cancer, M2ES, CA4P in Phase I clinical trial and PPD+5-Fu+Sorafenib (Bayer, Germany), Endostatin +Paclitaxel + Carboplat in Phase II clinical trial for nasopharyngeal carcinoma and lung cancer. The local ethics committee approved the study and all subjects gave written informed consent. A total of 531 contrast-enhanced sonography (CEUS) examinations were performed at the day before (D0) treatment and the days 3, 7, 14, 30, 60, and 6 months after treatment. Main Results: For ME2S (Endostatin, China) with phase I trial, nine cases (9/15, 60%) were poor responders (SD) and other 6 cases (6/15, 40%) were noresponders according to RECIST, CEUS can detect a interesting change of tumor perfusion in poor responders, from tumor perfusion decrease at Day+3, to increase at Day+7, to decrease again at Day+8 (the firs day after 2nd cycle). For other targeted drugs, decrease of contrast agent uptake at day 7-14 was predictive of the future RECIST response. In addition, 4D-CEUS with quatification had much more rich raw linear data information than 2D-CEUS. Importance of the Conclusions: CEUS is a noninvasive imaging technique that allows the early prediction of tumor response in targeted drugs treatment.

TL.03.013 Contrast-Enhanced Intraoperative Ultrasound and Microvessel Density in Patients With Different Pathological Grades of Cerebral Gliomas Y. Y. Duan, J. Wang, L. J. Yuan, Y. Wang, X. Liu Tangdu Hospital, Xi’an, China Brief Description of the Purpose of the Study: To investigate the value of contrast-enhanced intraoperative ultrasound (CE-IOUS) in patients with different pathological grades of cerebral gliomas by comparison with microvessel density (MVD). Methods: Thirty-three patients with different pathological grades of cerebral gliomas for surgery were included. Aloka SSD-a10 or Acuson Sequoia 512 ultrasound instruments equipped with UST-9120 or 4C1 probes were employed. CE-IOUS with peripheral bolus injection of 2.4 ml SonoVue were performed. Quantitative parameters of CEIOUS were obtained and compared with the tumor MVD counted by immunohistochemistry with anti-CD34. Main Results: After the injection, the signals were significantly enhanced in blood vessels of the tumors. Time-intensity curves showed that time to peak intensity was much longer in lower grades of gliomas compared to those in higher grade of gliomas (40.9 6 6.2s, vs. 29.8 6 7.5s (p , 0.05). MVD value was much lower in lower grades of gliomas compared to those in higher grades of gliomas (46.1 6 5.5 vs. 63.5 6

Volume 39, Number 5S, 2013 6.6, p , 0.05). The time to peak density showed negative correlation with MVD in different grades of cerebral gliomas (r5-0.79 p , 0.05). Importance of the Conclusions: CE-IOUS could facilitate intraoperative real-time navigation and assessment of the cerebral gliomas vasculatures, and may be a sensitive marker for reclassification of grades of gliomas and lead to a more appropriate surgical procedure. TL.03.014 WITHDRAWN

4 - Echocardiography TL.04.001 The Difference of Left Atrial Function Between Ischemic and Dilated Cardiomyopathy: A Two Dimensional-Speckle Tracking Imaging Study R. Q. Guo, S. Cao Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China Brief Description of the Purpose of the Study: This study was conducted to elucidate the difference of left atrial(LA) function in patients with ischemic cardiomyopathy(ICM) and dilated cardiomyopathy(DCM) by two dimensional-speckle tracking imaging(2D-STI). Methods: 22 patients with ICM, 26 DCMs and 32 controls were studied. The volume(LAVmax, LAVmin, LAVp) of LA were measured, calculated the expansion index(AEI), active emptying fraction(LAEF). The strain and SR during systole and late of diastole(Ss, SRs, Sa and SRa) were measured at all LA wall. The correlation of LA function and SR were analysed. Main Results: No significant differences were found at age, HR and E wave during all groups. Compared with the controls, A wave, DT and LVEF decreased in ICM and DCM groups(p . 0.05), while the LAD, LVEDD and E/A increased(p , 0.05), but there were no significant differences between them(p . 0.05). The LAVmax increased, AEI and LAEF decreased ,the Ss, SRs, Sa and SRa reduced in ICM and DCM(p , 0.05), even worse in the latter(p , 0.05). The AEI had a positive correlation with SRs(r50.765, p , 0.01), also was the LAEF and SRa(r50.830, p , 0.01). Importance of the Conclusions: The accumulation and active emptying function of LA are both lower in ICM and DCM, even worse in DCM.

TL.04.003 Prediction of Left Ventricular Function Improvement of Acute Myocardial Infarction After Percutaneous Coronary Intervention by Speckle Tracking Imaging R. Q. Guo, B. Hu Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China Brief Description of the Purpose of the Study: We found out that some parameters of speckle tracking imaging (STI) were strong predictors for LV function improvement. The clinical value of STI in prediction was discussed. Methods: 75 patients who had AMI for the first time and had been treated by primary PCI and examined in the follow-ups were enrolled. Dynamic images were analyzed for longitudinal peak systolic strain (LPSS), radial peak systolic strain (RPSS) and circumferential peak systolic strain (CPSS) values by STI. According to the comparison of left ventricular ejection fraction (LVEF) before PCI and 6 months after PCI, patients were divided into left ventricular function improved group (DLVEF$5%) and not-improved group.

Abstracts Main Results: In single parameter mode of receiver operator characteristic curve (ROC curve) analysis, the area under the ROC curve (AUC) (0.867), sensitivity (94.7%) and specificity (74.4%) of CPSS were relatively higher; In multiple parameters united mode of ROC curve analysis, AUC (0.897), sensitivity (94.7%) and specificity (74.4%) of LPSS, RPSS and CPSS united were the highest. Importance of the Conclusions: CPSS was a strong predictor for LV function improvement 6 months after PCI of AMI patients among all the STI parameters and was an effective indicator for the assessment of LV function improvement of AMI patients.

TL.04.004 Improvement of Diastolic Function in Patients With Congestive Heart Failure After Cardiac Resynchronization Therapy by Echocardiography J. L. Chen, R. Q. Guo Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China Brief Description of the Purpose of the Study: The aims were to evaluate the diastolic function in CHF after CRT by conventional echocardiography or Doppler tissue imaging (TDI) and supply information for clinical therapy. Methods: 31 patients with CHF were divided into responders (Group R) and non-responders (Group R) according standard of a decline in LV end-systolic volume $10% 6 months after CRT. All the patients received echo examination 1-3 days before CRT and 6 month after CRT. Color M-mode echocardiography indices included Vp, E/Vp. TDI indices included the peak velocity in early diastole (e) at 4 sites of mitral annulus, E/e, time to peak velocity in systole (Ts), Ts-SD and maximum difference of Ts (Ts-Dif) among 12 segments. Main Results: Compared with before CRT, Ts-SD and Ts-Dif significantly shortened in Group R; Vp increased significantly, E/e at each 4 site and mean value at 4 sites of mitral annulus, E/Vp decreased significantly; but there were no significant difference in Group N. There were significant positive correlation between mean value at 4 sites of E/e, E/Vp and Ts-SD in Group R. Importance of the Conclusions: The diastolic function in responders to CRT improved, which was associated with the decreased LV filling pressure and improved LV relaxation.

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where the correlation coefficient was 0.91 and average error was 5.32%. Furthermore, the calculation results of ejection fraction were agreed with that of conventional method by professional sonographers. Importance of the Conclusions: We developed a new method to detect LV cavity by processing successive echograms automatically.

TL.04.007 Comparison Between Coronary Flow Reserve Obtained by Doppler and Myocardial Blood Flow Reserve Obtained by Myocardial Contrast Echocardiography in Patients With Dilated Cardiomyopathy M. F. Lima, W. Mathias Jr., J. C. Sbano, E. A. Bocchi, J. M. Tsutsui Heart Institute (INCOR)- University of Sao Paulo Medical School, S~ao Paulo, Brasil Brief Description of the Purpose of the Study: To evaluate the ability of 2 different techniques to assess flow reserve in patients with nonischemic dilated cardiomyopathy (DCM): coronary flow velocity reserve (CFVR) and myocardial contrast echocardiography (MCE) in three coronary artery territories. Methods: 195 patients with DCM (left ventricular ejection fraction ,35%) underwent dipyridamole-stress MCE. CFVR was calculated as the ratio of hyperemic to baseline peak diastolic velocities in distal LAD. The replenishment velocity (b) reserve, plateau of acoustic intensity (A) reserve and MBFR (Ax b) were derived from quantitative MCE. Main Results: CFVR was feasible in 97% patients, MBFR and b reserve in 99%. A reserve was 1.05 6 0.09, b reserve was 2.05 6 0.39, MBFR was 2.15 6 0.48 and CFVR was 2.07 6 0.52. There was no difference between CFVR and b reserve (2.07 6 0.52 versus 2.05 6 0.39; p 5 NS), with good correlation between them (r50.80, p , 0.001). No difference was observed in LAD, right coronary or left circumflex territories for A reserve(1.05 6 0.15, 1.03 6 0.14 and 1.06 6 0.16;p 5 0.741), b reserve(2.08 6 0.25, 2.03 6 0.05 and 2.04 6 0.94;p 5 0.581) or MBFR(2.20 6 0.19, 2.10 6 0.10 and 2.15 6 0.11;p 5 0.085). Importance of the Conclusions: In patients with DCM no differences were observed in parameters of myocardial blood flow obtained by MCE in all coronary artery territories. b reserve holds the better correlation with CFVR and may be obtained as a global or regional parameter using quantitative MCE.

TL.04.008 TL.04.005 Full Automatic Boundary Detection of Left Ventricle Cavity in Both Views of Short-Axis and Four-Chamber by Processing Successive Echograms K. Masuda, S. Takeshima, S. Onogi Tokyo University of Agriculture and Technology, Koganei, Tokyo, Japam Brief Description of the Purpose of the Study: Many kinds of researches to recognize left ventricular (LV) cavity were developed. However, most of these techniques require initial settings to indicate initial region or points of interest of the examiner. Therefore, we have developed a full automatic software to detect LV cavity without initial settings. Methods: The software is divided into two processes. The first process is the recognition of inner area of LV, which includes calculation of the motion vectors from ventricular wall and the intersection points from multiple combinations of vectors. The second process is the detection of LV cavity, which includes the approximation of the shape of LV to ellipsoid without mitral valves and nipple muscle. The series of the methods is applied to not only short-axis view but also to four-chamber view. Main Results: We have applied this algorithm to 40 normal hearts and 113 diseased hearts. As the result, the proposed method correctly recognized left ventricular cavities throughout all of the recorded frames,

Effects of Insulin Resistance On Myocardial Blood Flow and Arterial Peripheral Circulation in Patients With Polycystic Ovary Syndrome A. L. Ribeiro, A. Scapinelli, I. Kowatsch, S. Tamanaha, T. Aoki, J. M. Tsutsui, W. Mathias Jr., J. M. Aldrighi Department of Obstetrics and Gynecology, Faculdade De Ci^encias Medicas Da Santa Casa De S~ao Paulo, Brazil and Heart Institute (INCOR), University of Sao Paulo Medical School, Brazil Brief Description of the Purpose of the Study: To study the effects of insulin resistance (IR) on myocardial microcirculation and peripheral artery function in patients with polycystic ovary syndrome (PCOS). Methods: We studied 55 women (28 with PCOS, 18 with PCOS+IR and 11 controls) who underwent high-resolution vascular ultrasound and real-time myocardial contrast echocardiography(RTMCE). Intimamedia thickness (IMT) and brachial-artery flow-mediated dilation (FMD) were evaluated at rest followed by dipyridamole stress RTMCE. The replenishment velocity (b), plateau of acoustic intensity (A) and myocardial blood flow reserve (MBFR). Main Results: ß reserve in group PCOS+IR was lower than control (2.34 6 0.55 vs 3.60 6 0.6;p , 001) and than PCOS (2.34 6 0.55 vs 3.17 6 0.65;p , 001). MBFR (A x ß reserve) in PCOS did not differ from control

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(4.59 6 1.59 vs 5.30 6 1.64;p 5 0.07) or from PCOS+IR (4.59 6 1.59 vs 3.70 6 1.47;p 5 0.22). When comparing with control group, patients with PCOS + IR had lower MBFR (5.30 6 1.64vs 3.70 6 1.47;p 5 0.01). No significant differences were found between control group, patients with PCOS and PCOS + IR for FMD (0.18 6 0.05, 0.15 6 0.04 and 0.13 6 0.07; p 5 NS) or IMT 0.48 6 0.05, 0.47 6 0.05 and 0.49 6 0.07; p 5 NS). Importance of the Conclusions: Women with PCOS and IR had depressed ß and MBFR as demonstrated by quantitative RTMCE, but no alteration in endothelial dysfunction or IMT. PCOS without IR showed only depression in ß reserve, probably a earlier marker of myocardial flow abnormality.

5 - Education in Ultrasound TL.05.001 Female-Male Birth Gender Ratios Among Asians in California: Potential Correlation With Keepsake Ultrasound G. S. Lin Advanced Imaging Associates, Fremont, California, USA Brief Description of the Purpose of the Study: Proliferation of keepsake ultrasound raises concerns about the decline in birth gender ratios (BGRs, females per 1000 males live births), possibly involving genderselective abortion (GSA) decisions aided by ultrasound. This study examines Asian subpopulations in Santa Clara County, whose population is 27.3 per cent Asian. Methods: BGRs were computed from birth statistics from the California Department of Public Health database by county, race, and gender of child for 1995-2010. Birth statistics by country of birth of the mother were obtained from the Santa Clara County Public Health Department. The establishment of keepsake ultrasound centers was tracked in the metropolitan area. Main Results: In Santa Clara County, mothers born in China had a mean BGR of 935 (range 784-1040). Mothers born in India had a mean of 937 (803-1006). Mothers born in Pakistan had a mean of 988 (747-1279). Mothers born in Viet Nam had a mean of 937 (868-973). The mean BGR for the general population was 951. Keepsake ultrasound centers, starting in 1999, have increased to some 20 in the metropolitan area now. Importance of the Conclusions: Abnormally low BGRs for mothers born in China, India, and Viet Nam are suggestive of GSA in Santa Clara County, and may be correlated with growth in keepsake ultrasound.

Volume 39, Number 5S, 2013 aneurysms) were investigated. The superficial veins (great and minor saphenous) were analyzed and the persistency of the embryonic lateral marginal vein was researched on the lower limbs. The arteriovenous fistulas were researched throughout the whole extension of the AABs, from the muscle to the fat tissue. Thrombosis, venous insufficiency and lymphatic cysts in the fat tissue were investigated. Importance of the Conclusions: The systematization employed optimized the duration of the exam and allowed to identify all anomalies described in the literature and unpublished sonographic findings. We conclude that this approach facilitated morphologic and hemodynamic diagnosis of vascular malformations in KTWS, essential for therapeutic planning.

TL.05.003 The Role of Radiographer in Sonography At International Level R. Santos, G. Paulo, D. Bento, S. Gomes Instituto Politecnico De Coimbra-Escola Superior De Tecnologia Da Saude De Coimbra, Coimbra, Portugal Brief Description of the Purpose of the Study: Currently, ultrasound is a diagnostic exam performed by various health professionals. The Radiographers, based on their training, also have some knowledge on this area, acquiring skills in order to perform such exams. However, several factors preclude their professional activities, including legislation that exists in that country or the lack of authority to certify the skills of Radiographers. The aim is to know if the basic training in Radiography is suitable for performing ultrasound and if health authorities are able to certify these professionals. Methods: An enquiry was created on an online survey with several questions concerning the qualifications and tasks of Radiographers. It was answered by representatives of associations and trade unions from 10 countries of the European Union, and subsequently was taken a strategy of critical evaluation. Main Results: After analysing the results there was a significant discrepancy regarding the number of hours in the theoretical and practical lessons in ultrasound. For this reason, it is understood that the majority of countries noticed that the Radiographers do not perform some types of diagnostic exam. Importance of the Conclusions: The Radiographers’ skills, in ultrasound, differ according to the country and the basic formations. Therefore, it is necessary to invest on a certified training and an internationally recognized career.

TL.05.002 Ultrassonografia Doppler Na Sındrome De Klippel-TrenaunayWeber: Como Eu Fac¸o Ultrasound Doppler in KlippelTrenaunay-Weber Syndrome: How I Do It N. H. F. Carvalho, J. L. Orlando, M. C. Chammas Instituto De Radiologia Do Hospital Das Clınicas Da Faculdade De Medicina Da Universidade De S~ao Paulo, Clınica Ibirapuera, Clınica Angiodiagn ostico, S~ ao Paulo, SP, Brasil Brief Description of the Purpose of the Study: The Klippel-Trenaunay-Weber Syndrome (KTWS) is a rare congenital disease that presents complex vascular malformations that affects venous, arterial and lymphatic systems, especially in the limbs. The goal of this paper is to present a protocol for Ultrasound Doppler, developed to facilitate the diagnosis and therapeutic planning in patients with KTWS. Methods: Between June 2009 and November 2012, 80 patients with KTWS were examined. Main Results: The research began with the identification of anomalous arterial branches (AABs) originated from the main arteries. Next, intramuscular venous malformations, venous lakes, phlebolits and anomalies in deep veins (agenesia, hipoplasia, anatomic variations and venous

6 - Ultrasound in Emergencies TL.06.001 Endovaginal Sonoelastography (EVSE) in the Different Diagnosis of Acute Lower Abdomen Pain in Gynecology N. A. Vorontsova, V. E. Gazhonova, S. O. Churkina, I. S. Belozerova, M. Y. Kapanadze, I. A. Ponomorenko, A. V. Zubarev Radiology Chair, Postgraduate Medical Education & Research Center, Moscow, Russia Brief Description of the Purpose of the Study: The purpose of this study was to evaluate the possibilities of EVSE in different diagnosis of acute lower abdomen pain in gynecology. Methods: We have observed 107 patients with complaints of acute lower abdomen pain and admitted to a Hospital urgently. All patients underwent conventional EVSE on HI VISION Preirus with endocavity transducer 8-4 MHz frequency. We used modified Tsukuba SE classification for evaluation of the SE data. 78 diagnostic laparoscopies were performed with morphological study of the received material. US data were assessed by comparing the findings with surgery results. US data

Abstracts were retrospectively reviewed by 2 radiologists. Statistical analysis included Se, Sp and Ac. Inter-observer agreement was calculated. Main Results: Pathomorphological examination revealed 26/ectopic pregnancy , 43/functional cysts with blood content, 56/ blood content in Douglas , 19/tuboovarial complex, 18/myoma with sign of malnutrition . Se reached 84%, Sp - 81%, Ac - 76%. SE showed good to moderate interobserver agreement by scoring SE. Kappa 0,92 - that was established as a good result. Importance of the Conclusions: EVSE increased the diagnostic confidence of US in emergency gynecological pathology, especially in the cases with ectopic pregnancy, haemorrhagic cysts, tuboovarial complex, and free blood in the Douglas pouch

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was assessed by direct imaging of micro air bubbles at the Cornual end and by seeing the bubble constantly moving at the Cornual ean of 5 to 10 seconds to made the diagnosis of patent tube. Main Results: Out of 360 patients examined by gaseous spring water 288 patients i.e. 80% were found to have bilateral Patent Tubes. Importance of the Conclusions: The Tubal Patency assessment with gaseous spring water was found to be cost effective, safe, easily available and less time consuming then HSG. It is recommended that spring water should be used to check tubal patency in sub fertile women.

8 - Ultrasound Guided Intervention TL.08.001

7 - Ultrasound in Gynecology TL.07.001 Sonoelastography in Differentiation of the Benign and Malignant Small Sized Ovarian Tumors A. E. Khalmukhamedova, V. E. Gazhonova, I. S. Belozerova, N. A. Voroncova, A. V. Zubarev Postgraduate Medical Education & Research Center, Moscow, Russia Brief Description of the Purpose of the Study: The objective of this study was to evaluate the diagnostic possibilities of sonoelastography to differentiate benign from malignant small sized ovarian tumors Methods: In 46 patients(aged 21-74 years) with ovarian tumors less than 3 sm conventional TVU on HI VISION Preirus was performed. Elasticity of the ovaries with the tumor was obtained during compressions of the tissue. Tsukuba sonoelastography classification was used for evaluation of the elasticity score. US results were compared with surgical and hystomorphological data, MRI, CT, PET-CT data and abdominal fluid aspiration results. Main Results: Based on the data of sonoelastography, 10 hysterectomies, 8 isolated resections of the tumors and 28 right or left ovariectomies were performed. 35 benign and 11 malignant ovarian tumors were revealed by means of final histopathology. Sonoelastography increased the sensitivity (from 87% to 94,8%) and specificity (from 83% to 93%) of US scanning. Sonoelastography showed accurate differentiation of mucinous, serous and haemorrhagic cysts that appeared equal on B-mode imaging. The method of sonoelastography cannot itself determine the diagnosis, but in 32% cases it helped differentiating the nature of the tumor, firstly revealed with B-mode imaging. Importance of the Conclusions: Real-time sonoelastography is a valuable tool that increases diagnostic confidence in differentiation of the benign and malignant ovarian tumors.

TL.07.003 Use of Gaseous Spring Water for Tubal Patency Test M. Hasan Institute of Ultrasound Imaging Karachi Sindh, Pakistan Brief Description of the Purpose of the Study: The purpose of this study was to try Gaseous Spring water as an alternate contrast agent in Tubal Patency test which would be easily available and to reduce the cost of the procedure. Methods: This technique is common to all procedures, regardless of the contrast agent chosen. A balloon catheter is preferred as it is less likely to dislodge and creates a better seal at the internal cervical os. Following the insertion of the catheter, the speculum is removed and the transvaginal ultrasound probe reinserted. Under Ultrasound control about 5-10 CC of echo-enhancing agent ie gaseous spring water is inserted very slowly so that Micro Air bubbles are not destroyed. Tubal patency

Midterm Results of Percutaneous Microwave Ablation Under Ultrasound Guidance Versus Retroperitoneal Laparoscopic Radial Nephrectomy for T1A Renal Cell Carcinoma P. Liang, J. Yu, X. L. Yu, Z. G. Chneg, Z. Y. Han, X. Zhang, J. Dong, M. J. Mu Chinese PLA General Hospital, Beijing, China Brief Description of the Purpose of the Study: To retrospectively review intermediate-term clinical outcomes of microwave ablation (MWA) compared to those after open radial nephrectomy (ORN) in T1a renal cell carcinoma (RCC) patients. Methods: A total of 163 patients with T1a RCC measuring #4 cm were included from April 2006 to March 2012. 65 patients underwent MWA and 98 patients ORN. Main Results: The RCC-related survival (97.1% at 5 years) after MWA was comparable to those following ORN (97.8% at 5 years, p 5 0.78). There was one local tumor progress at 32 months after MWA and none occurred after ORN. The major complication rates was comparable (p 5 0.81) between two techniques (2.5% in MWA vs 3.1% in ORN). MWA group needed less operative time (p , 0.0001), estimated blood loss (p 5 0.000), postoperative hospitalization (p , 0.0001). The multivariate analysis showed age (p 5 0.014), tumor type (p 5 0.003), postoperative urea nitrogen (P50.042), co-morbid disease (p 5 0.005) and treatment modality (p 5 0.000) may become predictors related to the survival rate. Importance of the Conclusions: In the intermediate term, ultrasoundguided percutaneous MWA and ORN provide comparable results in oncologic outcomes. MWA appears to be a safe and effective technique for the management of T1a RCC patients with less invasion.

TL.08.002 Correlation Between Ablation and CT TSD in HIFU on Advanced Pancreatic Body Cancer G. E. Huiyu Ultrasound Department Peking University Third Hospital, Beijing, P.R. China Brief Description of the Purpose of the Study: To explore the correlation between ablation effect and CT Target Skin Distance (TSD) of advanced pancreatic body carcinoma in High Intensity Focused Ultrasound (HIFU) therapy. Methods: Positive ablation associated with HIFU was the tumor ablated over 30%(Group A) ; otherwise, it was negative ablation(Group B). The study analyzed the correlation between ablation effect and CT TSD based on 20 cases of adenocarcinoma of pancreatic body in the late stage that received HIFU therapy from March 2007 to December 2009. Main Results: The difference of CT TSD between group A and group B was significant(p , 0.05). Increase of CT TSD by 1cm would cause reduction of tumor ablation effect by 30.7%. The ROC curve predicted

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that when CT TSD was 7.15cm, the sensitivity and specificity of ablation effect was 80% and 70% respectively and AUC was 0.810 (p value 5 0.019). With reference to clinical practice, the study set 7cm as the critical value for CT TSD in HIFU therapy. The sensitivity and specificity of tumor ablation effect was 77.8% and 72.7% respectively, OR59.333. Importance of the Conclusions: Tumor ablation effect was negatively related to CT TSD in HIFU therapy for pancreatic body carcinoma. 7cm of CT TSD can be set as the critical value for HIFU indications.

TL.08.003 Ultrasound-Guided Percutaneous Laser Ablation in Patients With Primary Hyperparathyroidism Y. N. Patrunov, S. N. Pamputis, A. N. Sencha, M. S. Mogutov Yaroslavl Railway Clinic, Yaroslavl, Russian Federation Brief Description of the Purpose of the Study: To assess the efficacy of ultrasound-guided percutaneous laser ablation (US-PLA) of abnormal parathyroid gland in patients with primary hyperparathyroidism (PHPT). Methods: Thirty six patients with PHPH underwent 2-4 sessions of US-PLA for a single abnormal parathyroid gland, probably a parathyroid adenoma (PA), with the diode medical laser of 1030nm wavelength. PA were detected with ultrasound, proven with SPECT and exhibited high PTH (588-4929 pg/ml) in the needle washout after fine needle aspiration biopsy. The size of PA ranged from 33937mm to 6310322mm. Follow-up period was 1month - 1 year after US-PLA. Main Results: PA was not sonographically detected in 6 cases after USPLA. The rest 30 cases demonstrated 4.5 times decrease in volume (from 0.32 6 0.12 cm3 to 0.07 6 0.01cm3) in 1 month after US-PLA. All detected PA were avascular with color and power Doppler imaging. Blood intact parathyroid hormone (iPTH) decreased 3.4 times in general from 183 6 56 pg/ml to 53 6 5 pg/ml and blood ionized calcium from 1.30 6 0.06 mmol/l to 1.11 6 0.06 mmol/l. The size of PA and iPHT level exhibited staged changes with increase during first days after US-PLA followed by their gradual decrease. Importance of the Conclusions: US-PLA can be used as an alternative treatment modality in selected patients with PHPT.

TL.08.005 Guidance and Control of Percutaneous Biopsy in Pancreatic Lesions With Contrast Enhanced Ultrasound X. L. Yu, Y. Wei, Z. G. Cheng, Z. Y. Han, J. Yu Chinese PLA General Hospital, Beijing, China Brief Description of the Purpose of the Study: To investigate the clinical value and security of contrast enhanced ultrasound (CEUS) guided biopsy for diagnosis of pancreatic lesions. Methods: 49 patients with 50 pancreatic lesions which could not be guided clearly by conventional ultrasound received CEUS guided biopsy using 18 Gauge needle. Satisfactory sampling was defined as the acquired tissues which were large enough to give a definite diagnosis. Pathological diagnosis or follow-up (at least 6 months) were taken as the final diagnosis. Main Results: Biopsy of this group had a success rate of 98.0% with the mean puncture times of 2. 8. Qualitative diagnosis was obtained in 47 of 49 cases, resulted a qualitative diagnosis rate of 95.9% (47/ 49). 46 of 47 cases were corresponding to the final diagnosis and the coincidence rate was 97.9% (46/47). The sensitivity and specificity of biopsy was 97.9% and 100% respectively. Complications occurred in 1 case (2%) of biliary peritonitis.

Volume 39, Number 5S, 2013 Importance of the Conclusions: For pancreatic lesions which could not be clearly guided by conventional ultrasound, CEUS guided percutaneous biopsy could not only improve the accuracy and sensitivity, but increase the success and effective rate of puncture. With lower incidence of complication and better security, CEUS guided biopsy is an effective method in characterizing pancreatic lesions. TL.08.006 Real-Time Grey Scale Contrast-Enhanced Ultrasonography in Diagnosis of Gallbladder Cancer Q. Si, X. L. Qian, F. Wang, S. X. Huang, X. S. Liu, W. Yang Department of Ultrasound, The PLA 81st Hospital, Nanjing, China Brief Description of the Purpose of the Study: To explore the clinical value and characteristics of contrast-enhanced ultrasound(CEUS) in diagnosis of gallbladder carcinoma. Methods: 384 patients with benign and malignant gallbladder disease were examined by CEUS. The characteristics of CEUS were analyzed and compared with pathological examination. Main Results: (1) The CEUS patterns of gallbladder carcinomas showed quick and heterogeneous hyper-enhancement at the early arterial phases. The CEUS shape of the gallbladder carcinomas were irregular. The wall of gallbladder was irregular thicken and interrupted by the mass. The basement of lesions were wide and connected with the gallbladder wall. Almost all the gallbladder carcinomas showed washout from hyper-enhancement to hypo-enhancement quickly after contrast agent administration. (2) It was significant different between benign and malignant gallbladder diseases of CEUS characteristics(p 0.05). (3) Compared with pathological examination, the sensitivity, specificity and accuracy of CEUS in gallbladder carcinomas diagnosis was 96.6%(28/29), 99.4%(353/355), 99.2%(381/384), respectively. Importance of the Conclusions: CEUS has an important clinical value in diagnosis of gallbladder carcinoma.

TL.08.007 Effects of Percutaneous Microwave Ablation in 141 Cases of Adenomyosis J. Zhang, Z. Y. Han, X. Ma, H. Y. Zhou, F. Wang, R. F. Xu, Y. Yang, Y. L. Hao Chinese PLA General Hospital, Beijing, Beijing, China Brief Description of the Purpose of the Study: To evaluate the effects of percutaneous microwave ablation (MWA) for treatment of uterus adenomyosis. Methods: One hundred and forty one consecutive patients with MRI and ultrasound (US) proven adenomyosis with dysmenorrhea or menorrhagia (anemia) were treated by US-guided percutaneous MWA. One or two cooled-shaft needle microwave antennae were percutaneously inserted into the lesion for ablation under US guidance. The treatment was completed when the most of lesion was ablated. The size of uterus, hemoglobin levels and degree of dysmenorrhea were evaluated before and 3, 6 and 12 months after ablation. The side effects and complications were evaluated during and after ablation. Main Results: The ablated percentage of lesion was 65%80% (75%). 3 months after ablation the uterus size shrink significantly compared with that before ablation (p , 0.01), the score of dysmenorrhea decreased from average 8.8 to 2.8 (p , 0.01) , the hemoglobin levels increased from average 9.1 to 12.2 g/l (p , 0.01). No any severe complications were observed in the period of 12 months after treatment. Vaginal blood fluid in 90% patients disappeared in 3-15 days after treatment. Importance of the Conclusions: US-guided percutaneous MWA for treatment of symptomatic adenomyosis can be an effective method on the basis of intact uterus.

Abstracts TL.08.010

TL.09.003

Value of Contrast-Enhanced Ultrasound in Fusion-ImagingGuided Radiofrequency Ablation of Sonographically Inconspicuous Nodules in the Liver J. Y. Lee, S. H. Kim, J. M. Lee, J. K. Han, B. I. Choi Department of Radiology, Seoul National University Hospital, Seoul, Korea

Characterization of Breast Papillary Neoplasm on Automated Breast Ultrasound Q. L. Zhu, J. Zhang, X. J. Lai, H. Y. Wang, M. S. Xiao, Y. X. Jiang Peking Union Medical College Hospital, Beijing, China

Brief Description of the Purpose of the Study: To evaluate the value of contrast-enhanced ultrasound (CEUS) in performing percutaneous radiofrequency ablation (RFA) using fusion imaging for completely inconspicuous hypervascular nodules in the liver on ultrasound. Methods: From Aug. 2009 to Dec. 2011, 18 patients who were treated with RFA using CEUS due to hepatocellular carcinomas (HCCs) that were completely inconspicuous on US were retrospectively included in this study. Fusion imaging was performed with an US machine equipped with a dual sensor positioning navigation system and CEUS was performed with SonoVue. Tumor size, location, distance from liver surface, targeting accuracy of reference point (registration error), mistargeting rate, and local recurrence were evaluated. Main Results: Mean tumor size was 13 mm (range, 6mm to 20mm). Registration error was 8.6mm (range, 2mm to 25mm). Complete ablation with single session RFA was achieved in 14 cases (78%). Mistargeting that needed reablation or retreatment occurred in 4 cases (22%). Local recurrence occurred in 2 cases, 1 year after RFA. Importance of the Conclusions: CEUS may be helpful to recognize and apply registration error of fusion imaging during RFA of completely inconspicuous nodules in the liver

Brief Description of the Purpose of the Study: The objective of this study is to characterize the appearance of breast papillary neoplasm at ABVS, and determine whether it could contribute to correctly classifying lesions as papillary nature. Methods: We retrospectively reviewed breast sonographic findings of 24 surgically proven benign papillomas and 5 papillary carcinomas. All patients underwent ABVS before surgery. Two radiologists independently reviewed the ABVS images of the breast. Interpretation of the ABVS findings was based on evaluation of the configuration, internal echo, and presence or absence of dilated ducts associated with the lesion. Main Results: Papillary neoplasms of the breast were classified into 3 types on ABVS: single lesion in 16(51.7%), multiple lesions in 7(24.1%) and occult lesion in 6(20.7%). On coronal views, all 7 multiple lesions, including 2 papillary carcinomas and 5 papillomas, demonstrated as a characteristic coral sign which was protrusion of papillary nodulars attached to several dilated duct walls. 60.9% (14/23) of cases were visualized as dilatation of ducts association with a mass indicating breast papillary neoplasm nature. Importance of the Conclusions: Most papillary neoplasm may be correctly characterized by better presenting dilated ducts and cystic components associated with the lesions on ABVS.

9 - Ultrasound in Breast

TL.09.013

TL.09.002

Evaluation of a New Image Processing Technique for the Identification of Breast Microcalcifications P. Machado, J. R. Eisenbrey, B. Cavanaugh, F. Forsberg Thomas Jefferson University, Philadelphia, PA, USA

Identification of Breast Microcalcifications Using a New Ultrasound Image Processing Technique on Patients Prior to Biopsy P. Machado, J. R. Eisenbrey, B. Cavanaugh, F. Forsberg Thomas Jefferson University, Philadelphia, PA, USA Brief Description of the Purpose of the Study: Evaluate new commercial image processing technique (MicroPure, Toshiba America Medical Systems, Tustin, CA) for identify breast microcalcifications in patients undergoing stereotactic or ultrasound (US) guided biopsies compared to x-ray of tissue retrieved. Methods: Twenty-two women scheduled for stereotactic biopsy or US guided biopsy of an area with breast calcifications were enrolled in the study. Patients underwent US real-time dual imaging of grayscale US and MicroPure using Aplio XG (Toshiba). Four independent and blinded readers analyzed 48 digital clips to determine number of calcifications seen with MicroPure and provide subjective view on level of suspicious (LOS). Xrays were analyzed by a radiologist that counted number of microcalcifications. This number was compared to the mean number from the readers. The LOS was compared with pathology findings using ROC analysis. Main Results: The mean number of microcalcifications seem on MicroPure was 6.99 (0.0-14.5). These values show an excellent agreement with the mean number of microcalcifications seem on X-ray image of the tissue retrieved (8.74; p 5 0.29). ROC analysis of readers LOS scores compared to pathology findings produced areas under the curve of 0.55 to 0.73. Importance of the Conclusions: MicroPure identified microcalcifications at target area as confirmed by X-ray of tissue retrieved, but was less useful for characterization.

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Brief Description of the Purpose of the Study: Evaluate new commercial image processing technique (MicroPure, Toshiba America Medical Systems, Tustin, CA) for identify breast microcalcifications in patients and surgical specimens compared to grayscale ultrasound (US), using mammography and x-ray of the surgical specimens as reference. Methods: 36 women were enrolled in the study. 20 had breast calcifications, underwent US and MicroPure using AplioXG scanner (Toshiba America Medical Systems). 16 were scheduled for surgical excision of area with calcifications, retrieved surgical specimens underwent US and MicroPure using the same scanner. Digital clips were acquired usingUS and MicroPure. Independent and blinded readers analyzed 203 digital clips to determine number of calcifications. Number of calcifications was compared using paired t-tests, ANOVA and ICC. Mammogram and x-ray of the specimen were analyzed by 2 radiologists that counted number of microcalcifications. Main Results: The readers saw significantly more calcifications with MicroPure than with grayscale US (p , 0.001). For patients agreement improved between mammography and MicroPure (13.2-34.0%) compared with mammography and US (3.4-6.9%). That was also seen for surgical specimens where agreement improved between x-ray and MicroPure (29.1-114.3%) compared with x-ray and US (3.5-22.5%). Importance of the Conclusions: MicroPure identified more breast microcalcifications than grayscale US when compared to the mammogram of the patients and x-ray of surgical specimens.

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Volume 39, Number 5S, 2013

10 - Ultrasound in Fetal Medicine/Obstetrics

TL.10.004

TL.10.001

Nomogram of Fetal Cisterna Magna Area by Three-Dimensional Ultrasonography Using the Rendering Mode - Preliminary Study A. P. Passos, E. Araujo Junior, L. M. M. Nardozza, A. F. Moron Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ao Paulo, SP, Brazil

Correlation Between Fetal Vertebral Body Areas by 3D Ultrasound Using VCI Omniview and Growth Parameters in Normal Fetuses L. H. Martinez, E. Araujo Junior, L. C. Rolo, L. M. M. Nardozza, A. F. Moron Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ ao Paulo-SP, Brazil Brief Description of the Purpose of the Study: To assess the correlation between fetal vertebral body areas by 3D ultrasound using VCI Omniview and growth parameters in normal fetuses. Methods: An observational cross-sectional study was conducted on 576 normal pregnant women at gestational ages of 20 weeks to 34 weeks + 6 days. VCI Omniview was used to measure vertebral body area (L1 to L5, S1 and S2) by positioning a curve line along the fetal lumbosacral spine. To assess the correlation between vertebral body areas and growth parameters (head circumference - HC, biparietal diameter - BPD, abdominal circumference - AC; femur length - FL and fetal estimated weight - FEW), first-degree linear regression models adjusted by coefficient of determination (R2) were created. Main Results: We observed a strong correlation between vertebral body areas and HC, BPD, AC and EFW, mainly to the lumbar vertebrae (R2 . 0.82 to all lumbar vertebrae and R2 . 0.66 to the sacral vertebrae). To the FL the correlation was weak, mainly to the lumbar vertebrae (R2 . 0.35 to all lumbar vertebrae and R2 . 0.28 to the sacral vertebrae).

Brief Description of the Purpose of the Study: To determine a nomogram to the area of fetal cisterna magna by three-dimensional ultrasonography at 20 to 33+6 weeks of pregnancy using the rendering mode. Methods: A prospective cross-sectional study was realized with 90 normal pregnancies at 20 to 33+6 weeks of pregnancy. The fetal cisterna magna was assessed in the axial plane of the head at level of biparietal diameter. To assess the area in the rendering mode the green line (ROI region of the interest) was put in the superior BOX in the coronal plane. We realized a polynomial regression between area of fetal cisterna magna and the gestational age (GA), with the adjustment realized by determination coefficient (R2). Main Results: 100 pregnant women were selected, by 10 cases were excluded by artifacts impossible the volume assessment. The mean of area of fetal cisterna magna in the rendering mode was 2.97 6 1.75 cm2 (range, 0.46-9.37 cm2). The best regression was a linear: fetal cisterna magna area5 -5.93+0.35xGA (R250.63). Importance of the Conclusions: Nomogram of fetal cisterna magna area by three-dimensional ultrasound at 20 to 33+6 weeks of pregnancy using the rendering mode was determined. TL.10.005

Importance of the Conclusions: The fetal vertebral body areas by 3D ultrasound using VCI Omniview showed great correlation with growth parameters in normal fetuses, mainly to the lumbar vertebrae, with exception of FL.

Ophthalmic Artery Doppler Velocimetry Values in Pregnant Women at Risk for Preeclampsia D. S. Matias, R. F. Costa, B. S. Matias, L. Gordiano, L. C. L. Correia Escola Bahiana De Medicina E Saude Publica

TL.10.002

Brief Description of the Purpose of the Study: To describe the ophthalmic artery (OA) Doppler parameters in pregnant women at risk for preeclampsia in the second trimester, and compare them to reference values described in women with healthy pregnancies; to evaluate the influence of gestational age ranges on the Doppler parameters. Methods: This is an observational study with prospective data collection, in which measurements of seven of the OA Doppler parameters were performed in 274 women at 20-28 weeks’ gestation with clinical risk factors for preeclampsia. The observed Doppler values were compared with reference values by one sample t-test. To test for linear association between gestational age and Doppler parameters, Pearson’s correlation coefficient was used. Main Results: Significantly higher OA Doppler velocimetry parameters were observed when compared to the reference values. There was no correlation between the Doppler parameters and gestational age. Importance of the Conclusions: The Doppler parameters of the OA in pregnant women at risk for developing preeclampsia are significantly higher than reference values reported for pregnant women without risk factors, in the ranges of GA examined. These values did not change with the evolution of pregnancy in this population and in these ranges of GA, opposed to would be expected, by decreased physiological peripheral resistance of pregnancy.

Reference Range of Fetal Cisterna Magna Volume by ThreeDimensional Ultrasound Using Vocal Methods - Preliminary Results A. P. Passos, E. Araujo Junior, L. M. M. Nardozza, A. F. Moron Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ ao Paulo, SP, Brazil Brief Description of the Purpose of the Study: To determine the fetal cisterna magna volume by three-dimensional ultrasound at 20 to 33+6 weeks of pregnancy using the virtual organ computer-aided analysis (VOCAL) method. Methods: A prospective cross-sectional study was realized with 90 normal pregnancies at 20 to 33+6 weeks of pregnancy. The fetal cisterna magna was assessed in the axial plane of the head at level of cerebellum diameter. The fetal cisterna magna volume was assessed using the VOCAL method with 30 (six consecutive planes). We calculated the mean, standard-deviation and minimum and maximum. We realized a polynomial regression between fetal cisterna magna volume and the gestational age (GA), with the adjustment realized by determination coefficient (R2). Main Results: 100 pregnant women were selected, by 10 cases were excluded by artifacts impossible the volume assessment. The mean of fetal cisterna magna volume was 2.61 6 1.72 cm3 (range, 0.46-9.16 cm3). The best regression was a linear: fetal cisterna magna volume5 -6.23+0.35xGA. Importance of the Conclusions: Reference range of fetal cisterna magna volume by three-dimensional ultrasound at 20 to 33+6 weeks of pregnancy was determined.

TL.10.010 Valor Preditor Da Dopplervelocimetria Da Arteria Oftalmica Em Relac¸~ao Ao Desenvolvimento De Pre-Ecl^ampsia / Predictive Value of Ophthalmic Artery Doppler Velocimetry in Relation to the Development of Preeclampsia D. S. Matias, R. F. Costa, B. S. Matias, L. Gordiano, L. C. L. Correia Escola Bahiana De Medicina E Saude Publica, Salvador, Bahia, Brasil

Abstracts Brief Description of the Purpose of the Study: To test the hypothesis that ophthalmic artery (OA) Doppler velocimetry predicts the development of preeclampsia. Methods: This is a prospective cohort study including 347 pregnant women between 20 and 28 weeks of gestation at risk for preeclampsia, in which seven Doppler parameters of OA were assessed concerning the prognostic value in relation to the development of preeclampsia. Main Results: Comparison of mean values of OA Doppler parameters in women with and without preeclampsia showed statistically significant differences with respect to the parameters peak systolic velocity, enddiastolic velocity, mean velocity, peak diastolic velocity (PDV) and peak ratio. After adjustment for confounding variables, only the elevation of PDV remained statistically significant (p , 0.001), with C statistic of 0.73. The best cutoff point to predict preeclampsia was PDV.22,11 cm/s, with Sensitivity: 70%, Specificity: 75%, Positive Likelihood Ratio: 2.8; Negative Likelihood Ratio: 0.4. There was an increase in C statistic from 0.72 to 0.78 when PDV was incorporated into clinical model, showing that this marker increases the discriminatory ability of the final model. Importance of the Conclusions: The elevation of PDVof the OA in the second trimester of pregnancy is an independent predictor of preeclampsia and increases the discriminatory ability when associated with clinical markers.

TL.10.011 Perinatal Outcome of Pregnant Women With ‘‘Sludge’’ Signal in the Amniotic Fluid A. R. Hatanaka, R. Mattar, M. S. Franc¸a, T. E. Kawanami, L. C. Rolo, E. Araujo J unior, L. M. M. Nardozza, A. F. Moron Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ ao Paulo-SP, Brazil Brief Description of the Purpose of the Study: Preterm delivery (PD) occurs in 10% of pregnancies, and it is responsible by 70% of perinatal mortality and several neurologic deficits a long-term. Objective: To assess the incidence and perinatal outcome in pregnant women with ‘‘sludge’’ signal in the amniotic fluid. Methods: A prospective observational study was realized with 243 pregnant women between 12 and 24 weeks. The patients were assessed by transvaginal ultrasound to measure the cervix length and the presence of ‘‘sludge’’ signal. The patients with ‘‘sludge’’ signal were divided in two groups: high (110) and low (133) risk to PD. Main Results: The ‘‘sludge’’ signal was present in 43 women (18%) from 243. The ‘‘sludge’’ signal was present in 18 (14%) and 25 (23%) of low and high risk groups, respectively. In patients with ‘‘sludge’’ signal the mean of cervix length was 25.9mm; while in patients without this signal the mean of cervix length was 32.2mm. In low and high risk groups the mean of gestational age of delivery and the weight of newborn were 37+3 weeks; 2,969g; 33+1 weeks; and 2,154g; respectively. Importance of the Conclusions: The ‘‘sludge’’ signal associated a short cervix length is an important marker to prediction of PD, mainly in high risk pregnancies.

TL.10.013 Desenvolvimento De Uma Central De Ultrassom Para Rastreamento De Malfomac¸~oes Cardıacas Fetais L. P. R. Barros, A. C. C. Carvalho, M. M. Zamith, E. M. B. Barros Jr., M. Schlosser, E. R. F. L. Moraes Universidade Federal De S~ao Paulo, S~ao Paulo, S~ao Paulo, Brasil

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Brief Description of the Purpose of the Study: The goal of this research is to develop a system that allows transmission of ultrasonography taken on pregnant women to a central facility where a group of specialized physicians would identify fetal cardiovascular malformations in early stages. Methods: As a complex technological solution, the work was based on informatics studies, research on hospital routines, ultrasound devices and exams plus, a considerable number of tests on compression algorithms and data transfer using different network infrastructures. Main Results: As a result it is possible to highlight the lossy compression algorithm which means images without any quality loss, the conception of a screening strategy for ultrasound exams, the pre-set for different ultrasound devices and the creation of some computational tools to compose the final work. Importance of the Conclusions: We believe this work innovates while it creates a national model for ultrasound central in which all society can benefit from, including meaningful cost savings, enhancing services and help to decrease the high infant mortality rate.

TL.10.014 Analysis of Congenital Heart Diseases in a Tertiary Referral Center of Brazil: A 7-Months Initial Experience E. Araujo Junior,1 L. A. R. Amorim,1 A. T. F. Leslie,2 L. C. Rolo,1 L. M. M. Nardozza,1 A. F. Moron1 1 Department of Obstetrics, S~ao Paulo Federal University (UNIFESP), S~ao Paulo-SP, Brazil, 2Discipline of Neonatology, Department of Pediatrics, S~ao Paulo Federal University (UNIFESP), S~ao Paulo-SP, Brazil Brief Description of the Purpose of the Study: To perform a descriptive analysis of the congenital heart diseases (CHDs) in a tertiary center. Methods: This is a prospective observational study realized from May to November 2012. The pregnant women of obstetrics clinic with any risk factor were referred to the fetal cardiology unit. Fetuses with CHDs were followed until neonatal period. Postnatal echocardiogram study was performed to confirm all prenatal diagnosis of CHDs. Main Results: We performed 154 echocardiographic screening tests. CHDs were found in 13% (21 fetuses). In these cases, the mean maternal age was 29.3 years (19-41), and the mean gestational age was 28.5 weeks (22-39). The most common referral reason was suspicion of CHD during routine ultrasound performed by obstetricians or fetal echocardiography in other centers (90%). Structural CHDs, when categorized due to severy, showed 45% of cases defined as complex, 20% as significant and 10% as minor cardiac anomalies. The mean gestational age of delivery was 37 weeks (32-40). The survival rate at one month was 45.4%. The mortality rate was 54% and it was higher in complex defects (66.7%). Importance of the Conclusions: The mortality rate in our series is high, which can probably be related to the high incidence of complex congenital heart disease.

TL.10.016 Carotid Intima-Media Thickness and Arterial Stiffness in Preeclampsia by Analysis With a Radio-Frequency Ultrasound Technique L. J. Yuan, D. Xue, Y. Y. Duan, T. S. Cao, N. Zhou Tangdu Hospital, Xi’an, China Brief Description of the Purpose of the Study: To characterize the common carotid arterial (CCA) intima-media thickness (IMT) and mechanical properties in women with preeclampsia (PE) by employing a radio-frequency ultrasound technique.

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Methods: Twenty-two PE and 28 age- and gestational-week matched normotensive pregnant (NP) women were included. All subjects were nulliparas. All women underwent right CCA measurements with MylabTwice ultrasound instrument equipped with Automatic Quality IMT (QIMT) and Quality Arterial Stiffness (QAS) packages. Carotid IMT and arterial stiffness were evaluated. Follow up study was performed.

Yuanpei University, Hsinchu, Taiwan, 4Department of Computer Science and Information Engineering, National Taipei Univ

Main Results: Carotid IMT (459 6 95 mm vs. 351 6 85 mm, p 5 0.0001) , internal diameter (7.8 6 0.5 mm vs. 7.2 6 0.4 mm, p , 0.0001), pulse wave velocity (7.1 6 1.7 m/s vs. 6.0 6 1.1 m/s, p 5 0.024), augmentation index (7.1 6 8.8% vs. -5.6 6 7.3%, p , 0.0001) and CCA wall tension (55.0 6 6.5 mmHg/cm vs. 38.6 6 4.9 mmHg/cm, p , 0.0001) were greater, and the distensibility coefficient (0.020 6 0.009 1/kPa vs. 0.029 6 0.011 1/kPa, p 0.006) was significantly in PE compared to NP and remained after adjusting for BMI and carotid pressures. Eighteen months after parturition, carotid diameter, pressure and wall tension was still greater in women with history of PE.

Methods: 49 patients with CTS and 48 healthy volunteers were consecutively recruited. Each subject received physical examinations and nerve conduction studies of the upper extremities. Doppler ultrasonography was performed to evaluate the gliding of the median nerve and the flexor tendon when subject continuously moved his/her index finger, under rest and abduction positions of the thumb respectively.

Importance of the Conclusions: Carotid remodeling and arterial stiffening occur in preeclampsia and and may be partially recovered postpartum. QIMT and QAS techniques together could provide a comprehensive assessment of the CCA remodeling. TL.10.017 Are There Orbital Perfusion Changes in Pregnant Women After Cigarettes Consumption? Ophthalmic Artery Doppler Study M. M. B. M. Paes, A. L. D. Diniz, A. P. L. Jorge Universidade Federal De Uberl^andia-UFU, Uberl^andia, Minas Gerais, Brasil Brief Description of the Purpose of the Study: To compare orbital perfusion of pregnant smokers and nonsmokers by ophthalmic artery (OA) Doppler . Correlate these with the interval of last cigarette, cigarettes per day, years smoking carbon monoxide expired (COex). Methods: Transversal study involving 70 pregnant smokers subdivided: 33 who smoked until two hours: A group (AG), B group (BG): 37 who smoked between 2 to 24 hours before test. Control group (CG) : 51 pregnant nonsmokers. Indexes assessed: PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity), PI (Pulsatility Index), RI (Resistance Index) and PR (Peak Ratio). Statistic analysis: ANOVA, Kruskal-Wallis, Student’s t test, Mann-Whitney and Pearson’s correlation coefficient, p , 0.05. Main Results: RI and PI were higher (p , 0.01, PSV and EDV were lower (p , 0.05) in B group compared to other groups. A group presented higher PR (p , 0.01) compared to control. AG presented years of smoking , cigarettes per day, COex greater than BG and lower interval of last cigarette than BG. Importance of the Conclusions: There are changes in vascular orbital pregnant smokers demonstrated by ophthalmic artery Doppler biphasic pattern correlated with the time of the last cigarette consumption. It is observed signs of vasoconstriction and hypoperfusion to tobacco exposure between 2 and 24 hours and hyperperfusion to acute exposure.

11 - Ultrasound in Musculoskeletal

Brief Description of the Purpose of the Study: To evaluate the gliding of the median nerve and the flexor tendon in patients with carpal tunnel syndrome (CTS) and healthy volunteers under rest and abduction positions of the thumb.

Main Results: Significant differences were found between the patients and the healthy controls in the results of physical examinations and nerve conduction studies. Gliding of the median nerve in CTS patients was significantly smaller than that in healthy control; however, excursion of the flexor tendon was larger in CTS patients. Both groups got significant improvements in the gliding of the median nerve and the flexor tendon while thumb was moved into abduction from rest position. Importance of the Conclusions: Reduced gliding of the median nerve was found in CTS patients. Excursions of both median nerve and flexor tendon were improved while abducting the thumb, a position frequently performed during nerve gliding exercise. TL.11.003 Changes of Plantar Fascia Stiffness After Shock Wave Therapy for Plantar Fasciitis: One-Year Follow-Up by Sonoelastography C. H. Wu, Y. Y. Lin, W. S. Chen, T. G. Wang Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan Brief Description of the Purpose of the Study: To evaluate serial changes of plantar fascia stiffness in plantar fasciitis patients undergoing extracorporeal shock wave therapy (ESWT) by sonoelastography. Methods: Seven plantar fasciae of 7 plantar fasciitis patients completed the one-year follow-up. Severity of heel pain was evaluated with visual analogue scale (VAS) of 0-100. Thickness and stiffness of the plantar fasciae were measured with B-mode sonography and sonoelastography. For objective evaluation of sonoelastogram, hue histogram analysis was used (value: 0-255, from stiffer to softer). All evaluations were recorded before ESWT, 1 week, 1 month, 6 months and 12 months after ESWT. Paired t tests were used for comparison of evaluations between preESWT and different timings post-ESWT. Main Results: At different timing of measurements (pre-ESWT, and 1 week, 1 month, 6 months and 12 months post-ESWT), pain VAS was 57 6 21, 49 6 31, 30 6 25, 7 6 7, and 4 6 4. The plantar fascia thickness was 6.0 6 1.2mm, 6.1 6 0.9mm, 5.9 6 1.3mm, 5.3 6 0.9mm, and 4.4 6 0.7mm. The hue value for sonoelastogram was 19 6 7, 39 6 16, 32 6 12, 27 6 8, and 14 6 7. Importance of the Conclusions: After ESWT for plantar fasciitis, heel pain intensity and the plantar fascia thickness decreased gradually. Plantar fascia became softer initially but became stiffer than preESWT at one-year follow-up.

TL.11.002 Gliding of the Median Nerve and the Flexor Tendon Under Rest and Abduction Positions of the Thumb: A Comparison Between Patients With Carpal Tunnel Syndrome and Healthy Volunteers Y. S. Horng,1,2 C. J. Chen,3 S. K. Lin,1,2 D. H. Liu,1 Y. W. Wang4 1 Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan, 2 Department of Medicine, Tzu Chi University; Hualien, Taiwan, 3 Department of Computer Science and Information Engineering,

12 - Ultrasound in Nephrourology TL.12.001 Renal Transplant Elasticity Ultrasound Imaging: Correlation Between Normalized Strain and Renal Cortical Fibrosis J. Gao, W. Weitzel, J. M. Rubin, J. Hamilton, J. Lee, R. Min Weill Cornell Medical College, New York, NY, USA

Abstracts Brief Description of the Purpose of the Study: After transplantation, over a widely variable time course the cortex of the transplanted kidney becomes stiffer as interstitial fibrosis develops and renal function declines. Elasticity ultrasound imaging (EUI) has been used to assess biomechanical properties of tissue that changes in hardness as a result of pathological damage. Methods: We prospectively assessed the hardness of the renal cortex in renal transplant allograft subjects using a normalized ultrasound strain procedure measuring quasi-static deformation, which was correlated with the grade of renal cortical fibrosis. To determine the cortical strain, we used two-dimensional speckle-tracking software to perform offline analysis of the stored deformation sequence of renal cortex and its adjacent soft tissue. Normalized strain is defined as the mean developed in the renal cortex in relation to the mean applied strain resulting in the soft tissue from the abdominal wall to pelvic muscles. Using the Banff scoring criteria for renal cortical fibrosis as gold standard, 20 of renal transplant allograft were classified into two groups, Group 1 (n510) with mild (,25%) renal cortical fibrosis and group 2 (n510) with moderate (26-50%) renal cortical fibrosis. T-test was used to determine the statistical difference in strains between mild and moderate renal cortical fibrosis subjects. Receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of developed strain and normalized strain in predicting moderate renal cortical fibrosis. Main Results: The reference strain between the two groups was not significantly different (p 5 0.10). However, developed renal cortical strain in the group 1 with mild fibrosis was higher than that in Group 2 with moderate fibrosis (p 5 0.025). The normalized strain in the group 1 with mild fibrosis was also higher than that in Group 2 with moderate fibrosis (p 5 0.001). The areas under ROC curves for developed strain and normalized strain were 0.78 and 0.95, respectively. The optimal cutoff for distinguishing moderate renal cortical fibrosis was -0.08 for developed strain (sensitivity 0.50 and specificity 1) and 2.5 for normalized strain (sensitivity 0.80 and specificity 1). Renal cortex strain is strongly correlated with the grade of renal cortical fibrosis. The normalized strain is superior to developed strain in distinguishing moderate from mild renal cortical fibrosis. Importance of the Conclusions: We conclude that free hand real-time strain EUI may be useful in assessing progression of cortical fibrosis in renal transplant allograft.

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our research, SE in 45,7% cases helped to change the diagnosis, in 54% helped to more easily diagnose the tumor but didn’t change the diagnosis. Importance of the Conclusions: Sonoelastography can help in differential diagnosis of scrotum diseases,using SE we can more reliably say about the presence or absence of a tumour.

TL.12.003 Intra-Operative Ultrasound During Partial Nephrectomy: Does it Alter Surgical Management and Patient Survival? P. Bhosale, D. G. Bedi, R. Ernst University of Texas MD Anderson Cancer Center Brief Description of the Purpose of the Study: Intraoperative ultrasound (IOUS) during partial nephrectomy for cancer can alter the surgical treatment. Methods: IOUS was performed on 198 consecutive undergoing partial nephrectomy for locally invasive renal cell cancer, recording the extent of the primary lesion and presence of additional lesions. Ultrasound findings were compared to pre-operative CT or MR imaging to determine if the IOUS changed surgical management. Patients were followed for a minimum of 5years to correlate survival and measure recurrence rates. Main Results: Thirteen patients of 198 (7%) had additional findings on IOUS not seen on preoperative imaging. Surgery was modified in 7 of the 13 (54%). Surgery was modified in 8 of 185 (4%) cases with no additional findings; the difference in these two groups of modified surgery is statitically significant (p value 5 0.0004 by Fisher’s exact test). These findings were additional lesions or lesions invading the renal sinus requiring additional resection. Five year event free survival was 71%; some deaths due to unrelated causes. Importance of the Conclusions: IOUS demonstrates additional findings compared to pre-operative imaging, that alter surgical management during partial nephrectomy for renal cancer by a significant margin. The high event free survival also suggests that IOUS guided partial nephrectomy is an optimal procedure for renal cancer.

TL.12.004 TL.12.002 Possibilities of Sonoelastography in Diagnosis of Scrotum Diseases A. Fedorova, N. Burdelova, T. Eremenko, A. Zubarev, S. Alferov President Medical Center Brief Description of the Purpose of the Study: The goal of current study was to evaluate diagnostic possibilities of sonoelastography in diagnosis of scrotum diseases. Methods: This study is based on complex ultrasound and clinical research of 35 pts. The most common presenting complaint was pain (59%), then swelling (33%) and erythema (52%). Physical examination was followed by greyscale US, US-angiography and sonoelastography (SE) of scrotum. The Elasto-score was established using Tsukuba classification. Main Results: The range of diagnoses found in our study included: 7 pts (20%) had intratesticular lesions ; 15 pts (42,8%) hydrocele; 21 (60%) cysts; 13 pts (37,1%) - orchitis; 23 pts (65,7%) had epididymitis. SE found mixed dense-elastic or elastic pattern in cases of epididymitis. As for hydrocele, we received typical cystic RGB pattern. Dense elastography pattern was present in 6 cases of 7 identified testicular tumours. Histopathological correlation, available in 5 pts, revealed testicular cancer (seminomas). Two patients did not have surgery. As a result of

Dynamic Tissue Perfusion Measurement Reveals Microvascular Perfusion Loss in Kidneys of Children With Diabetes Mellitus Type 1 (DM1) Scholbach Thomas, Vogel Christian, Bergner Nils Chemnitz Clinics, Germany Brief Description of the Purpose of the Study: Nowadays, microalbuminuria is the first overt sign of renal damage in diabetic patients. Earlier detection of diabetic nephropathy (DNP) is wanted to prevent sequelae as long as the functional and morphological changes are still reversible. Methods: We measured slicewise the renal cortical perfusion in 93 children and adolescents (4 - 18 years) with DM1 without microalbuminuria and 71 healthy ones of comparable ages were included. Main Results: We found a significantly reduced renal cortical perfusion intensity in DM1 compared to healthy children. The proximal cortex was by 21 % the distal cortex by 50% less perfused. Moreover, in addition to the lesser overall perfusion, the decline of perfusion from the central to peripheral cortex was significantly increased by 34% in DM1. The TRI correlated significantly with age (r 5 0.246, p 5 0.017), duration of DM1 (r 5 0.260, p 5 0.012), systolic blood pressure (r 5 0.237, p 5 0.022) and serum-creatinine (r 5 0.230, p 5 0.028). Importance of the Conclusions: PixelFlux-measurements might help to detect renal microvascular damage at an very early state by means of a simple, quantitative color Doppler investigation. This could help

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to prevent manifest renal damage and to postpone the onset of irreversible diabetic nephropathy.

TL.12.005 ~o Ultra-Sonografica De Rins Transplantados: Avaliac¸a Estabelecendo Um Protocolo R. M. Mendonc¸a, I. X. C. R. Rebouc¸as, J. C. D. Oliveira, E. A. Q. Lisboa, M. A. Borba, A. A. L. Liguori, Z. J. Queiroz, J. B. Almeida Hospital Universit ario Onofre Lopes, Natal, Rio Grande Do Norte, Brasil Brief Description of the Purpose of the Study: Kidney transplantation is an important therapy in chronic kidney disease and anticipate the urological/vascular/functional complications is crucial in maintaining graft. The Doppler ultrasonography (USG-Dp) plays an important role in this follow-up, being requested to patients with clinical intercurrences. This study aims to define a protocol of USG-Dp routine, even for patients with adequate evolution, will show benefits, anticipating behaviors in patients with subclinical changes. Methods: Receptors patients underwent two tests routinely performed by the same sonographer in the 2nd and 7th postoperative day. Registered ultrasound findings, clinical outcome and was noted if the USG-Dp modified behavior. Main Results: Included 29 patients (mean age 43.14), 27 cadaver donor receivers. 75.8% (22) were classified as clinical expected, considering postoperative acute tubular necrosis related to ischemic time. Of the total, 24.1% (07) had significant ultrasound findings, altering therapy applied. Isolating only those patients with postoperative compatible course, which would not be assessed at this time, 18.2% (04) had the follow-up clinical modified/anticipated based on this USG-Dp, implemented as a routine. Importance of the Conclusions: Based on the results it is essential to establish protocol USG-Dp in transplant patients, even within the normal clinical course, providing basis for behavior change in 24.1% of cases, helping to prevent tragic outcomes.

13 - New Technologies in Ultrasound PD.13.001 WITHDRAWN

TL.13.012 Micro/Nano Silica Shell Particle for Ultrasound Imaging Z. Wu, A. Liberman, H. P. Martinez, Y. Kono, R. Mattrey, W. Trogler, A. Kummel University of California, San Diego CA, USA Brief Description of the Purpose of the Study: We develop a gas filled silica shell particle as a novel ultrasound contrast agent. There is an increased need for submicron ultrasound contrast agents with extended period of lifetime for various reasons. The micro/nano shells (M-NSs) can be injected via IV or subcutaneously and imaged up to 7 days post injection. The particle’s acoustic behavior is studied and in vivo imaging is demonstrated. Methods: We manufactured hollow silica particles in sizes ranging from 100 nm to 2000 nm and filled them with perfluoropentane vapor. The M-Ns are imaged with SEM and TEM for their morphology and size distribution. They are also observed by contrast specific (CPS mode) ultrasound and Doppler ultrasound in vitro. For in vitro studies, 100nm, 500nm, and 2um diameter particles are dispersed

Volume 39, Number 5S, 2013 in degassed water and placed in a thin wall plastic chamber. A Siemens Sequoia scanner was used to scan the sample at various Mechanical Indexes (MI). A minimum MI for each type of particles was determined by observing a minimally visible signal with the ultrasound imaging system. Main Results: SEM and TEM images for two different sizes of hollow microshells that have been prepared. The high degree of reproducibility of the gas-filled microshells in the bulk sample and their dispersal from one another were documented. In the in vitro study, under the CPS mode with a transmit frequency of 7MHz, a minimum MI is found to excite this particle to render visible signals. Strong ultrasound enhancement in the peritoneal cavity is observed when a rat is injected with 200ug of 500nm particles intrapertoneally and imaged at high MI up to 72hr post injection. Importance of the Conclusions: We have developed a novel submicron silica shell particle which lasts days in tissue with strong signals in CPS mode. This is the first demonstration of an ultrasound contrast agent which can persist for several days in tissue.

TL.13.015 New Computer Technology - Real-Time Virtual Sonography : First Experience of Combination of Ultrasound, CT and MRI A. Zubarev, A. Fedorova, N. Fedorova, S. Churkina President Medical Centre Brief Description of the Purpose of the Study: The objective of this study was to determine diagnostic capabilities and accuracy of virtual sonography in combination with CT and MRI data. Methods: Real-time virtual sonography (RVS) allows to receive simultaneous ultrasound image on the monitor to get a computer image on ultrasound device, corresponding CT or MRI slices. We gained the first clinical experience of RVS in difficult diagnostic cases, when it was necessary to interpret examination data based on different methods of diagnosis. We have examined more than 20 patients, for whom combined examination using CT, MRI and US of liver, kidneys and pelvis, was of a great interest. Main Results: Using technology RVS, we received key information in determining the nature of volume formations in large number of cases. Application of RVS provided additional information and significantly improved diagnostic accuracy. With the possibility of multiple repetition of diagnostic studies, we can combine ultrasound method and CT, performed only once. Thus, in some cases we were able to manage without use of contrast agents in CT and get an equivalent information by ultrasound. Importance of the Conclusions: Combination of different methods, using RVS technology, raises the level of objectivity of ultrasound to a new level, while ultrasound does not lose its main advantages.

TL.13.017 Broadband Attenuation and Size Measurements of Ultrasound Contrast Agents J. L. Raymond,1 K. J. Haworth,1 K. B. Bader,1 K. Radhakrishnan,1 S.-L. Huang,2 D. D. Mcpherson,2 C. K. Holland1 1 University of Cincinnati, Cincinnati, Ohio, USA, 2University of Texas Health Science Center At Houston, Houston, Texas, USA Brief Description of the Purpose of the Study: Echogenic liposomes (ELIP) are under development as an ultrasound contrast agent (UCA) for image-guided, targeted drug delivery. The aim of this study was to investigate the effect of the lipid formulation and type of encapsulated gas on the acoustic response of ELIP under physiologic conditions. The

Abstracts influence of temperature and diluent on the measured attenuation coefficients was investigated for ELIP as well as the commercial lipid-based UCA Definity. Methods: Broadband attenuation spectra were obtained for agents diluted either in whole blood or in saline solution containing 0.5% bovine serum albumin (BSA) at 25 C and 37 C. The spectra and particle size distributions obtained using a Coulter counter were compared with scattering theory to estimate the properties of the lipid shell stabilizing the microbubbles. Main Results: Dilution of ELIP or Definity in either whole blood or BSA solution did not affect the measured attenuation coefficients. However, the temperature and gas saturation of the diluent were found to impact the attenuation spectra significantly. Importance of the Conclusions: The attenuation spectra of UCAs are strongly impacted by temperature and gas saturation relative to physiologic values. Knowledge of the acoustic properties and size distribution of these agents under physiologic conditions will allow for their safe use in vivo.

14 - Ultrasound in Pediatrics TL.14.002 Renal Parenchymal Thickness as a Measure of Renal Growth in Low-Birth-Weight Infants Versus Normal Birth Weight Infants S. Brennan The Townsville Hospital, Townsville, Queensland, Australia Brief Description of the Purpose of the Study: Low birth weight (LBW; , 2500 g) infants have smaller kidneys, and therefore a reduced number of glomeruli and nephrons. Renal ultrasound remains the primary technique for assessing renal growth. We carried out a study to see if a new measurement, renal parenchymal thickness, can be used to detect any differences in renal growth between LBW and normal birth weight (NBW; 2500-4500 g) infants. Methods: This study was conducted over a 12-month period from August 2010 at The Townsville Hospital. Renal ultrasounds were performed on 38 full-term infants who had no underlying renal problems. Renal parenchymal thickness, length, transverse diameter and anteroposterior diameter were measured. Main Results: Thirty-eight infants were evaluated (11 LBW and 27 NBW). The mean kidney volume and mean renal parenchymal thickness in LBW infants are significantly lower than they are in NBW infants. Renal parenchymal thickness is found to be closely correlated with an increase in renal volume (r 5 0.76; p , 0.0001). Importance of the Conclusions: The mean renal parenchymal thickness in LBW infants is significantly lower than it is in NBW infants. Renal parenchymal thickness is a single, easily performed measurement that could potentially be a more useful and accurate approach to monitoring renal growth than renal volume.

15 - Ultrasound in Small Parts TL.15.001 Trans-Orbital Sonographic Measurement of Normal Optic Nerve Diameter at Aminu Kano Teaching Hospital, Kano, Nigeria A. Ismail Bayero University, Kano, Nigeria Brief Description of the Purpose of the Study: This study is aimed at determining the optic nerve diameter (OND) by ocular ultrasonography in normal Nigerian adults.

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Methods: This prospective study was conducted at Aminu Kano Teaching Hospital. The OND was measured at 3 mm posterior to the globe using a 7.5 MHz linear transducer on the closed eyelids of 400 healthy adults in supine position. Three repeated measurements were obtained on each optic nerve to reduce intra-observer variability. Main Results: The study subjects consisted of 192 males and 208 females. Their mean age was 36.94 6 16.63 years. The mean OND were 4.18 + 0.49 mm and 4.17 + 0.44 mm on the respective right and left sides. The mean OND of the right and left were 4.18 mm and 4.16 mm among males and 4.17 mm on each optic nerve among females. There was no statistically significant variation in OND between the right and left sides (p 5 0.12) and also between males and females (p 5 0.296 and 0.745 for the respective right and left OND). Importance of the Conclusions: In this study, transorbital sonographic measurements of the OND show no correlation with side (right and left), age and sex. The normogram of OND measurements is therefore presented as diagnostic aid in clinical settings.

TL.15.002 Ultrasound Technologies of Qualitative and Quantitative Stiffness Evaluation in Diagnosis of Thyroid Malignancies A. N. Sencha, Y. N. Patrunov, M. S. Mogutov, E. D. Sergeeva Yaroslavl Railway Clinic, Yaroslavl, Russian Federation Brief Description of the Purpose of the Study: To assess the value of ultrasound elastography and acoustic radiation force impulse (ARFI) technologies in diagnosis of thyroid carcinoma. Methods: Retrospective analysis of complex ultrasound examinations of 141 patients from 19 to 85 years of age operated for highly differentiated thyroid cancer (papillary - 75.2% and follicular - 24.8%) was performed with ultrasound scanner Siemens ‘‘Acuson S2000’’. Qualitative (elastography) and numeric parameters (ARFI) of the stiffness of thyroid carcinoma along with conventional ultrasound features were analyzed. Main Results: Malignant nodules demonstrated hard (blue) color pattern with elastography in 81.6% of cases and mixed (blue-greenred) pattern in 6.4%. The pattern was heterogeneous and irregular in 68.8% of lesions. Elastography failed to differentiate 12.8% of lesions, all smaller than 1 cm. Elastography supplied additional data to conventional ultrasound in 37.5% of cases. Its sensitivity in diagnosis of thyroid carcinoma was 87.5% with specificity of 75.0%. ARFI revealed the increased average share wave velocity within malignant thyroid lesions (3.7m/s; 2.9-4.3m/s), as compared with normal thyroid parenchyma (2.8m/s; 1.7-3.5m/s). The sensitivity of ARFI in diagnosis of thyroid carcinoma was 86.1% with specificity of 82.1%. Importance of the Conclusions: Malignant thyroid lesions often exhibit high grades of tissue strain with elastography and high share wave velocity with ARFI.

TL.15.005 TIRADS: An Effective Proposal for Classification and Stratification of Risk in Thyroid Nodules M. J. Francisco Neto, R. G. Garcia, A. Rahal Jr., J. P. B. Costa Lima, A. Maurano, F. A. C. Vieira, D. R. Nery, M. G. B. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Brief Description of the Purpose of the Study: Thyroid nodules are common sonographic findings, occurring in up to 70% of patients. In the literature, there is no consensus on standardizing sonographic nodule features to predict their malignancy risk. For this purpose, the TIRADS

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model, similar to BIRADS for breast lesions, proposed classification in levels of malignancy risk. Methods: From November 2011 to august 2012, there were evaluated sonographic examinations of thyroid nodules features and TIRADS classification. Afterwards, the results of fine needle biopsies were checked and related to the previous assessment. Main Results: There were evaluated 227 patients and 286 nodules. Of these, 22 were excluded because biopsies had insufficient material, were indeterminate or not performed. Among 264 selected, 56 had nodules TIRADS 2 with 1 case of malignancy (1.8%), 95 TIRADS 3 with 02(2,1%), 99 TIRADS 4 with 22(22,4%), and 15 TIRADS 5 with 14(93,3%). The results went through Fisher’s exact test, considering a significance level(a) of 5%, which showed correlation between the TIRADS evaluation and cytological results. Importance of the Conclusions: The percentages of nodules suggestive of malignancy by cytological evaluation were similar to the ones of the consecrated method BIRADS. Therefore, the TIRADS model showed in this study that it is appropriate for the evaluation of thyroid nodules.

Volume 39, Number 5S, 2013 tification of venous aneurysms, unpublished sonographic findings in KTWS. Methods: Between June 2009 and November 2012, 80 patients with clinical diagnosis of KTWS (ages ranging from 5 months to 45 years, 61% women, 75% in the lower limbs, 15% in upper limbs, 10% bilateral) underwent Ultrasound (US) Doppler. Main Results: 28 patients (35%) presented persistence of the embryonic lateral marginal vein. 12 patients (15%) presented 20 aneurisms, with an average diameter of 18mm, localized in the following veins: popliteal (5); great saphenous (2); minor saphenous (2); Giacomini (2); basilic (2); cephalic (2); embryonic lateral marginal (5). Anomalous Arterial Branches were identified in 96% of the patients and AVFs were found in 88%, confirmed by angiography in 100% of the treated patients (12). 7 (35%) of the 20 identified venous aneurisms presented AVFs in the regions of the dilatations. Importance of the Conclusions: We can conclude that venous aneurisms are unpublished findings in KTWS and that US-Doppler is important in the hemodynamic evaluations, especially when associated with anomalous arterial branches and AVFs, allowing adequate treatment of these lesions. TL.16.003

16 - Ultrasound in Peripheral Vascular TL.16.001 The Relationship Between Artery Stiffness and Left Ventricular Diastolic Function in Patients With Multiple Cardiovascular Risks Miao Liying Ultrasound Department Peking University Third Hospital, Beijing, P.R. China Brief Description of the Purpose of the Study: To evaluate the relationship between artery stiffness and left ventricular diastolic function. Methods: A total of 79 patients with multiple cardiovascular risks were recruited and divided into two groups according to the value of E/Em: diastolic dysfunctional group (E/EmS10, n525) and control group (E/Em,10, n554). The arterial stiffness parameters of carotid artery and endothelium-independent dilation (EID) of brachial artery were evaluated by ET for two groups. Main Results: The arterial stiffness parameters of carotid artery and EID of brachial artery in diastolic dysfunctional group were higher than that in controls (p . 0.05), and were associated to diastolic function parameters of left ventricular (p , 0.05). Importance of the Conclusions: The arterial stiffness is closely related to the diastolic function of left ventricular, and maybe an important factor to impact on it. The increased arterial stiffness is useful in predicting left ventricular diastolic dysfunction in patients with multiple cardiovascular risks.

TL.16.002 Aneurismas Venosos: Achado Ultrassonografico Inedito Na Sındrome De Klippel-Trenaunay-Weber Venous Aneurysms: Unpublish Sonographic Findings in Klippel-Trenaunay-Weber Syndrome N. H. F. Carvalho, J. L. Orlando, M. C. Chammas Instituto De Radiologia Do Hospital Das Clınicas Da Faculdade De Medicina Da Universidade De S~ao Paulo, Clınica Ibirapuera, Clınica Angiodiagn ostico, S~ ao Paulo, SP, Brasil Brief Description of the Purpose of the Study: Klippel-TrenaunayWeber Syndrome (KTWS) is characterized by the presence of complex vascular malformations, including venous, arterial and lymphatic anomalies and arteriovenous fistulas (AVFs). Objective: To describe the iden-

Fıstulas Arteriovenosas: Achado Ultrassonografico Inedito Na Sındrome De Klippel-Trenaunay-Weber Arteriovenous Fistulas: Unpublished Sonographic Findings in KlippelTrenaunay-Weber Syndrome N. H. F. Carvalho, J. L. Orlando, M. C. Chammas Instituto De Radiologia Do Hospital Das Clınicas Da Faculdade De Medicina Da Universidade De S~ao Paulo, Clınica Ibirapuera, Clınica Angiodiagnostico, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Study: The Klippel-Trenaunay-Weber Syndrome (KTWS) is characterized by the presence of vascular malformations, including arteriovenous fistula (AVFs), which although described in the literature, are not habitually identified. The objective of this research is to report the efficiency of the non-invasive AVFs diagnosis in KTWS utilizing Ultrasound (US) Doppler. Methods: Between June 2009 and November 2012, 80 patients with clinical diagnosis of SKTW (ages ranging from 5 months to 45 years, 61% women) were examined. High-frequency linear transducers (512Mhz) were used to research AVFs from anomalous arterial branches (AAB) identified in the region in which the patients reported pain. Main Results: The AAB are tortuous, form angles of approximately 90 degrees with the trunk branch, extend from the muscle to the fat and present low resistance flow (spectral biphasic pattern). AVFs can be found along the path of the AAB. These signs made possible to identify the origins of the AAB (96%) and also to locate AVFs (88%), findings confirmed by angiography in 100% of 12 treated cases. Importance of the Conclusions: We conclude that AVFs are frequent findings in KTWS, and US-Doppler contributed significantly to its localization, allowing adequate therapeutic planning.

TL.16.004 Sındrome De Klippel-Trenaunay-Weber: Estudo De 80 Casos Klippel-Trenaunay-Weber Syndrome: Study of 80 Cases N. H. F. Carvalho, J. L. Orlando, M. C. Chammas, J. H. Curado, H. G. A. Campos, F. Ramos Instituto De Radiologia Do Hospital Das Clınicas Da Faculdade De Medicina Da Universidade De S~ao Paulo, Clınica Ibirapuera, Clınica Angiodiagnostico, S~ao Paulo, SP, Brasil Brief Description of the Purpose of the Study: Klippel-TrenaunayWeber Syndrome (KTWS) is a rare congenital disease. The clinical diagnostic criteria consists of the classic triad: capillary malformations

Abstracts in the skin, bone or soft tissue hypertrophy and vascular malformations. Complex vascular anomalies may occur (venous, arterial, lymphatic) as well as arteriovenous fistulas (AVFs), a frequent cause of pain. The purpose of this study is to report clinical and sonographic findings encountered in KTWS. Methods: Between June 2009 and November 2012, 80 patients (ages ranging from 5 months to 45 years, 61% women) with a clinical diagnosis of KTWS were examined. Clinical evaluation and usual Ultrasound (US) Doppler techniques were used with an exam protocol developed for KTWS. Main Results: Main clinical findings: port-wine skin patches(80%);lesions on lower limb(78%); on upper limb(18%); bilateral(10%), on all limbs(5%); increase in the length of the limb (50%); increase of limb volume (72%). Main sonographic findings: deep venous malformations (49%); lateral marginal vein (35%); anomalous arterial branches (96%); AVFs (88%); venous aneurisms (23%, among which 35% with AVFS); thrombosis (15%) and lymphatic cysts (19%). Importance of the Conclusions: When performed sistematically, the US-Doppler provides morphologic and hemodynamic evaluation of complex vascular malformations, especially of AVFs, indispensable in the treatment of KTWS. TL.16.005 Achados Ultrassonograficos Ineditos Na Sındrome De Maffucci: Fıstulas Arteriovenosas Unpublished Sonographic Findings in Maffucci Syndrome: Arteriovenous Fistulas N. H. F. Carvalho, J. L. Orlando, M. C. Chammas Instituto De Radiologia Do Hospital Das Clınicas Da Faculdade De Medicina Da Universidade De S~ao Paulo, Clınica Angiodiagnostico, S~ ao Paulo, SP, Brasil Brief Description of the Purpose of the Study: Maffucci Syndrome (MS) is a rare congenital mesodermal dysplasia characterized by the association of discondroplasias and vascular malformations. In the bones of the hands and feet and on the metaphysis of long bones, enchondromas that lead to pathologic fractures and deformities are frequently found. Vascular malformations are generally low-flow, venous ectasias forming lakes and eventually phleboliths. Methods: We report a case of MS with high-flow vascular malformation and arteriovenous fistulas (AVFs), a finding not described in the literature. Male, caucasian, 25 years, with typical clinical signs of MS with multiple enchondromas on extremities and bone deformities, complained of significant pain in the right leg inframalleolar medial region with no apparent lesion. The radiological study and MRI did not elucidate the cause of pain. Main Results: The Ultrasound (US) Doppler showed an area of intramuscular arteriovenous malformation in the region of the pain, an anomalous branch of the posterior tibial artery, its origin and course to the lesion and the presence of AVFs. The patient was submitted to arterial embolization for treatment of AVFs, with disappearance of pain. Importance of the Conclusions: These unpublished aspects associated to MS, evidenced by US-Doppler allowed the appropriate therapeutic planning and effective treatment of AVFs, benefiting the patient.

17 - Ultrasound in Veterinary PD.17.006 Hemodynamic Changes in Dogs With Diffuse Hepatic Neoplasia Detected by Doppler Ultrasonography R. Sartor, M. J. Mamprim, M. Tsunemi

S95

School of Veterinary Medicine and Animal Science, S~ao Paulo State University, Botucatu, S~ao Paulo, Brazil Brief Description of the Purpose of the Study: For the purpose of conferring additional information to B-mode ultrasound in the diagnosis of diffuse hepatic diseases, this study aimed to assess liver hemodynamics by Doppler ultrasonography in dogs with diffuse hepatic neoplasia. Methods: Were included 11 dogs with histopathologic diagnosis of hepatic neoplasia (7 lymphoma, 4 hepatocellular carcinoma), and diffuse echotexture and echogenicity changes, without detectible nodular lesions in ultrasound. Intrahepatic vascularization, main portal vein and hepatic artery flow were assessed by color and spectral Doppler. A control group of 10 healthy dogs was included. Statistical analysis was performed by Fisher test. Main Results: Comparing clinical and control group, it was observed that hemodynamic changes associated with diffuse hepatic neoplasia, detected by Doppler ultrasonography, were: common hepatic artery dilation (p 5 0.035) and altered intrahepatic vascular pattern by color Doppler mapping (p 5 0.001), such as hypervascularity with chaotic distribution of vessels, luminal compression and vascular deviation course, associated or not, with the presence of aliasing. Spectral Doppler showed arterial flow with high systolic peak or low resistivity index. Importance of the Conclusions: Intrahepatic hemodynamic changes detected by Doppler ultrasonography may help to identify diffuse hepatic neoplasia in dogs, adding information to B-mode exam. More studies with great number of animals are necessary to confirm these data. PD.17.012 Cerebellum Ultrasonographic Features and Transcranial Ultrasonography Application for the Diagnosis of Cerebellar Hypoplasia in Dogs T. C. F. Cintra,1 C. F. Carvalho,2 J. C. Canola,1 A. C. Nepomuceno,1 J. P. Andrade Neto3 1 Universidade Estadual Paulista-UNESP, Jaboticabal, S~ao Paulo, Brasil, 2Inrad-Universidade De S~ao Paulo, S~ao Paulo, S~ao Paulo, Brasil, 3Clınica Veterinaria Alto Da Lapa, S~ao Paulo, S~ao Paulo, Brasil Brief Description of the Purpose of the Study: Cerebellar hypoplasia is a congenital nervous system anomalie characterized by reduced dimensions of the cerebellum. Temporal bone has been used as an acoustic window for transcranial ultrasound (TCUS) in humans and dogs. The objectives of this study were to standardize measurements of the dimensions of the cerebellum, and to describe the ultrasonographic aspects of cerebellar hypoplasia in three dogs. Methods: TCUS was performed in 30 healthy adult dogs using a convex transducer (4-7MHz) initially positioned perpendicularly to the temporal bone. Measurement of the cerebellum was performed in cranial oblique plane. Subsequently a clinical prospective study was performed in 104 dogs underwent to TCUS between 01/2010 and 04/2011. Main Results: In the experimental group the cerebellum were visualized as a rounded hypoechoic area bounded cranially by the osseous tentorium of the cerebellum. Ventro-lateral diameter of the cerebellum ranged from 1.87cm to 2.75cm (mean of 2.24cm), and cranio-caudal diameter ranged from 1.78cm to 3.00cm (mean of 2.36cm). TCUS clinical study revealed three dogs with reduced dimensions of the cerebellum. Cerebellar hypoplasia was confirmed by necropsy and/or Magnetic Resonance Imaging. Importance of the Conclusions: Our study demonstrates that cerebellum can be visualized in normal dogs through TCUS and this method was used to diagnostic of hypoplasia cerebellar.

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Ultrasound in Medicine and Biology

TL.17.001 Doppler Assessment of Hepatic Veins in Fatty Liver Disease C. F. Carvalho, A. Vargas, M. M. Jerico, B. Cogliati, M. C. Chammas Inrad, S~ ao Paulo, S~ ao Paulo, Brazil Brief Description of the Purpose of the Study: The goal of this study was to document the progressive effects of fatty infiltration of the liver on hepatic veins (HVs) by measuring Doppler waveforms in rats and dogs. Methods: It was used in two groups of animals: a) rats (10 healthy adult rats as controls, and a group of 10 rats had fatty infiltration of the liver) and b) dogs (a clinical group of 15 obese dogs and a control group of 10 healthy dogs). All of the groups underwent hepatic B-mode, duplex Doppler sonography and hepatic biopsy or cytology. B-mode fatty infiltration was classified into four degrees corresponding to increasing degrees of hepatic echogenicity for all groups: (0) absent, (1) mild, (2) moderate, and (3) severe fatty infiltration. The Doppler sonography spectra of HVs were classified into three groups: normal or triphasic waveforms, biphasic waveforms, and monophasic or flat waveforms. Main Results: Obese dogs and rats with fatty infiltration of the liver presented abnormal right HV Doppler waveforms. There was a statistically significant difference in the waveforms of HV flow between the obese and control group of dogs. Importance of the Conclusions: These findings are clinically relevant because changes in waveforms could be used as a tool to monitor fatty liver disease. TL.17.002 Ultrasound-Guided Anesthetic Block of Hind Limb Nerves in Dogs D. F. Echeverry,1 A. Agut,2 F. Laredo,2 F. Gil3 1 Departament of Animal Health, Faculty of Veterinary Medicine and Zootechny, University of Tolima, Ibague, Colombia, 2Departament of Medicine and Surgery, Faculty of Veterinary, Murcia University, Murcia, Spain, 3Departament of Anatomy and Embriology, Faculty of Veterinary, Murcia University, Spain Brief Description of the Purpose of the Study: The usefulness of ultrasound as neurolocation technique for the anesthetic block (AB) of the sciatic (ScN), femoral (FN), obturator (ON) and lateral femoral cutaneous nerves (LFCN) was evaluated in dogs. Methods: The morphological features of these nerves were studied by anatomical dissection performed in 12 canine cadavers. The usefulness of the ultrasound for the AB of these structures was assessed in 27 cadavers by an ultrasound-guided ink injection around these nerves

Volume 39, Number 5S, 2013 and the subsequent assessment of the staining pattern obtained. Additionally, the utility of the ultrasound for the AB of the ScN and FN was evaluated in 9 experimental Beagles by motor deficit through the ultrasound-guided block of these nerves. Main Results: The ScN was blocked in all cases by a lateral thigh approach. The FN was blocked in 50% of cases by the femoral triangle approach. The FN and ON nerves were blocked in all the cases by a suprainguinal approach. The LFCN was not blocked in any case. Importance of the Conclusions: The results of this study validate the usefulness of ultrasound as a neurolocalization technique for anesthetic block of ScN, FN and ON in the dog.

TL.17.003 Initial Study of Ultrasound Evaluation on Artery Stenosis in Young Rabbits Xiaojuan Ji, Gengsheng Yu, Jun Guo, Qijian Yi, Yonghong Bai, Qiao Wang, Tang Yi Children’s Hospital of Chongqing Medical University, Chongqing, China Brief Description of the Purpose of the Study: To analysis the value of ultrasonography in the evaluation of the model of iliac artery stenosis in young New Zealand rabbit. Methods: 48 Young New Zealand rabbitsaged (60 6 15) dayswere randomly divided into normal group, operation group. The vascular endothelial of the rabbits iliac artery in the operation group was injuried by balloon expansion through femeral artery, when no treatment have been done to the control group. The lumen diameter, tunica intima thickness and related hemodynamic parameters were calculated by the ultrasound each week after the operation respectively, The narrow rate have been calculated, and compared with the pathology result. Main Results: The lumen of blood vessel in the operation group was narrower than that in the nomal group after 1 week of the operation (narrow ratio 13.43%). There was a significant correlation between the narrow ratio and the time of follow-up (P,0.05). The tunica intima thickness was increased obviously in the operation group. The flow velocity was changed with the change of the lumen area. The resistance index (RI) and the diastolic to systolic velocity ratio (DSVR) was in inverse proportion to the flow velocity, but in direct proportion to the lumen area. Importance of the Conclusions: It was feasible to evaluate the young rabbit’s model of artery stenosis with ultrasonography noninvasivly and dynamicly.

Ultrasound in Med. & Biol., Vol. 39, No. 5S, pp. S97–S108, 2013 Copyright Ó 2013 World Federation for Ultrasound in Medicine & Biology Printed in the USA. All rights reserved 0301-5629/$ - see front matter

doi:10.1016/S0301-5629(13)00641-8

d

Author Index Arizumi T. PD.01.017 Armada P. PD.11.028, PD.11.029, TL.11.007, TL.11.008 Assirati L. PA.09.005 Ayala M.D. PA.17.002 Ayub E.A.S. PD.10.016 Azevedo D.C. PD.11.010, PD.11.030

A Abdalla J.M.L. PD.10.016 Abdo F.M.P. PD.01.015, PD.06.001, PD.06.006 Abud D.G. PD.08.007 Abud L.G. PD.08.007 Abud T.G. PD.08.007 Ackermann C.L. PD.17.007 Adler T. PD.15.009 Adriano C.D. PA.14.010 Agnollitto P.M. PD.11.008 Agut A. PA.11.002, PA.17.002, TL.17.002 Ahmad K.A. TL.11.001 Aizawa N. TL.13.007 Akiho C. PD.01.007, PD.10.001, PD.15.006, PD.16.002 Alcantara K.B. PA.07.010, PA.10.010, PA.10.011, PA.10.012, PA.15.005, PA.01.011, PA.07.009, PA.07.011 Aldrighi J.M. TL.04.008 Alferov S. TL.13.009, TL.12.002 Alla A.B. PA.01.012 Almeida A.P.F. PA.05.004 Almeida J.B. TL.12.005 Almeida T.C. PA.06.009 Alvarez I.D. PA.17.009 Amaral C.B. PD.17.018 Amaral J.F. PD.16.005 Amorim L.A.R. TL.10.014 Amorim R.L. PD.17.020 Andrade L.J.O. PD.15.003, PD.15.004 Andrade M.H.F. PD.15.003 Andrade Neto J.P. PD.17.012 Andre A. TL.11.005 Andreone P. PA.13.017, TL.13.016 Aoki F.H. PD.11.010, PD.11.030 Aoki T. TL.04.008 Aoki Y. PD.05.004 Arai K. PA.03.003, PA.03.004 Araujo D.A. PD.11.011 Araujo D.G.L. PA.08.002 Araujo E. PD.10.012, PD.10.013, PD.10.014, PD.10.015 Araujo F.C. PD.11.027 Araujo Junior E. TL.10.003, TL.10.006, PD.10.002, PD.10.004, PD.10.008, TL.10.001, TL.10.002, TL.10.004, TL.10.011, TL.10.014 Araujo K.M. PD.07.010 Araujo L.C. PD.12.010 Araujo M.A. PA.17.011 Ardelean M. PA.03.005, PA.13.010, PA.03.006, TL.03.006

B Babicsak V.R. PD.17.009, PD.17.010, PD.17.019, PD.17.020, PD.17.026, PD.17.008 Bader K.B. TL.13.017 Bae K.S. TL.13.013 Baek S.Y. PD.01.011 Bagrichevsky T.A. PD.12.010 Bai Y. TL.17.003 Baima E.M. PD.16.005 Balahonova T.V. PD.13.010 Balakhonova T.V. PD.13.004 Baldoni C.N. PD.06.004 Balvay D. TL.08.008 Ban A.H. PD.01.004, PD.05.003 Banahan C. PA.13.018 Baraldi T.G. PD.17.007 Barbcsak V.R. PD.01.012 Barbosa R.G. PA.07.007 Barcellos C. PA.08.002 Bari A.K.M.F. PA.16.001 Baroni R.H. PD.07.006 Barreto L. PD.13.006, PD.13.007 Barros A.C. PD.06.005 Barros E.M.B. TL.10.013 Barros F.G.L. PA.06.009, PD.01.018 Barros F.S.B.B. PD.10.004 Barros L.P.R. TL.10.013 Barros M.L. PD.10.019 Barros N. PA.09.005 Bashir M.D. PA.16.001 Baumgarten M.N. PD.05.001 Bedi D.G. TL.12.003 Belda E. PA.17.002 Belotta A.F. PD.17.009, PD.17.010, PD.17.019, PD.17.020, PD.17.026, PD.17.008 Belozerova I.S. TL.06.001, TL.07.001 Bento D. PD.05.007, TL.05.003 Bertanha R. PD.08.008 Bescia M.D.G. PD.15.007 Bevilacqua E.B. PA.05.003

The following Abstracts were withdrawn before the publication of this Book of Abstracts: PA.03.001, TL.10.012, PD.11.007, TL.03.014 and PD.13.001. S97

S98

Ultrasound in Medicine and Biology

Bezerra M.M. PD.01.018 Bhosale P. TL.12.003 Bitencourt A.G.V. PA.06.009, PA.11.005, PA.12.005, PD.07.008, PA.08.005 Bittencourt A.M.V. PD.15.004 Boarini L.R. PD.01.015, PD.06.001, PD.06.006 Boarini P. PD.01.015, PD.06.001, PD.06.006 Bob F. PA.13.014, PA.13.012, PA.13.013 Bocchi E.A. TL.04.007 Bohrer Y.C. PA.06.004 Boieiro A. TL.11.005 Bolinelli A.P. PD.01.006, PD.07.002 Borba M.A. PA.01.013, PA.12.002, PA.12.004, TL.12.005 Borges H.L. PA.13.015 Bortolazzi D.B.N. PA.05.004, PA.06.002, PA.06.004, PA.14.011 Bota S. PA.01.008, PA.03.005, PA.03.007, PA.13.003, PA.13.004, PA.13.005, PA.13.006, PA.13.010, PA.13.014, PA.13.007, TL.13.005, PA.13.008, TL.13.006, PA.13.012, PA.13.013, TL.03.006 Braga C.A.P. PA.11.004, PD.11.023 Branco M. PA.09.003 Brandao A.I. PD.11.010 Brandao A.T. PD.11.030 Brand~ao C.V.S. PD.17.026, PD.17.007, PD.17.008 Brandao L.G. PD.15.007 Braojos F.D.C. PD.14.006 Brennan S. TL.14.002 Brito G.S. PA.15.004 Brodosi L. PA.13.017 Brown P. PA.13.018 Brusasco F.F. PD.08.007 Burdelova N. TL.13.009, TL.12.002 Buritica E.F. PA.17.009 Buttros D.A.B. PA.09.003 Byun J.Y. PD.05.006 Byun K.H. PD.14.005 C Cadete C. PD.10.017 Caio V.M. PD.16.004 Calil K.B. PD.01.007, PD.10.001, PD.15.006, PD.16.002 Caloni R.M.Z. PD.10.003 Calvo D.B. PA.17.005 Camara L.R.A. PA.05.004, PA.11.004, PD.11.023 Campbell Westerway S.L. TL.10.007 Campos H.G.A. TL.16.004 Campozana L.P. PD.07.007 Campozana N.S. PD.07.007 Canola J.C. PD.17.011, PD.17.013, PD.17.012 Cao S. PA.04.004, TL.04.001 Cao T.S. TL.04.006, TL.10.016 Carneiro R.L. PA.17.006 Carvalho A.C.C. TL.10.013 Carvalho A.P. PA.05.001 Carvalho B.V. PD.10.016 Carvalho C.F. PA.17.001, PD.17.011, PD.17.013, PD.17.001, PD.17.002, PD.17.003, PD.17.012, TL.17.001

Volume 39, Number 5S, 2013

Carvalho D.C.C. PA.17.012 Carvalho E.J. PD.01.005 Carvalho J.L. PA.17.012 Carvalho N.H.F. TL.05.002, TL.16.002, TL.16.003, TL.16.004, TL.16.005 Carvalho V.S. PD.10.012, PD.14.011 Caserta N.M.G. PD.08.008 Castro F.S. PA.09.005 Castro S. PA.09.005 Caststro M.C.N. PD.01.019 Cavalcante A.R. PD.11.027 Cavalcanti M.A. PD.16.005 Cavanaugh B. PD.09.012, TL.09.013, TL.09.002 Cerqueira W.S. PA.11.005 Cerri G.G. PA.05.003, PA.06.006, PA.09.005, PA.15.004, PA.15.006, PD.03.001, PD.05.003, PD.08.010, PD.13.006, PD.13.007, PD.15.009, PD.15.014, PD.15.008 Cerri G.G.C. PD.01.004, PD.16.004 Cervantes G.M. PD.01.018 Cesario B.F.C. PD.06.005 Chagas K. PD.10.017 Chala L. PA.09.005 Chalek C.L. TL.03.002, TL.03.004 Chammas M.C. PA.05.003, PA.06.006, PA.15.004, PA.15.006, PD.01.004, PD.03.001, PD.05.003, PD.08.010, PD.13.006, PD.13.007, PD.15.009, PD.15.014, PD.15.007, PD.15.008, PD.16.004, PD.17.001, PD.17.002, TL.05.002, TL.16.002, TL.16.003, TL.16.004, TL.16.005, TL.17.001 Chang J.K. PD.04.007 Chang K.-J. TL.09.008 Chang K.-V. TL.11.004 Chang K.J. PD.13.002, TL.15.004 Chang S.D. TL.10.009 Chang Y.-P. PD.09.003, PD.09.004 Chang Y.L. TL.10.009 Chao A.S. TL.10.009 Chao Z. PD.03.002 Charlier M.G.S. PD.17.023 Chen A. TL.09.008, TL.15.004 Chen C.C.-C. PD.09.003, PD.09.004 Chen C.J. TL.11.002 Chen C.M. PD.09.014 Chen C.N. PD.13.002, TL.15.004 Chen J. TL.13.002 Chen J.L. TL.04.004 Chen K.Y. TL.15.004 Chen Q.Q. PD.15.002 Chen S.S. PD.12.001, PD.15.001, PD.15.002 Chen W.-P. PD.04.008 Chen W.-S. TL.11.004 Chen W.P. PD.04.009 Chen W.S. TL.11.003 Chen Y.-L. PD.04.008, TL.13.010, TL.03.008 Chen Z.-K. PA.13.001, PA.13.002 Cheng T.Y. PA.08.001 Cheng Z.G. TL.08.004, TL.08.005 Chengyu S. PD.03.002 Chien K.-L. TL.11.004 Chiou H.J. TL.09.011, TL.09.012

Author Index

S99

Chiou S.Y. TL.09.011 Chneg Z.G. TL.08.001 Cho C.H. PD.11.013 Cho E.S. PD.01.001 Choi B.I. PD.01.014, TL.13.013, TL.08.010 Choi D. PD.08.006 Choi G.C. PD.06.002 Choi J.I. PD.05.006 Chojniak R. PA.06.009, PA.11.005, PD.01.018, PA.08.005 Choo H.J. PD.11.003, PD.11.004, PD.11.005 Chou Y.H. TL.09.011, TL.09.012 Christian V. TL.12.004 Chuang S.-C. TL.09.008 Chung E.M.L. PA.13.018 Chung J.J. PD.01.001 Chung M.H. PD.14.001 Churkina S.O. TL.06.001, TL.13.015 Cintra C.T.F. PD.17.011 Cintra T.C.F. PD.17.013, PD.17.012 Clausius I. PD.13.006, PD.13.007 Clement O. TL.08.008 Coelho G.P. PD.08.007 Coelho L.R.A. PD.08.007 Cogliati B. PD.17.001, PD.17.002, TL.17.001 Coimbra P.P. PD.11.011 Conceic‚~ao R.D.O. PD.01.010 Consolo F.D. PA.14.008 Conti F. PA.13.017 Cordioli E. PD.10.008 Cornu N. PA.03.005, PA.13.010 Corr^ea J.B. PD.10.016 Correia L.C.L. TL.10.005, TL.10.010 Costa F.S. PA.10.010, PA.10.011, PA.10.012, PA.01.011 Costa Lima J.P.B. PD.11.010, TL.15.005 Costa M.J.B. PD.11.027 Costa R.F. TL.10.005, TL.10.010 Costa Y.C. PD.07.006 Crema M.D. TL.11.006 Crippa A. PD.13.006 Cruvinel M.J. PD.07.010 Cuenod C.A. TL.08.008 Curado J.H. TL.16.004 Czeresnia J. PD.10.008

De Oliveira F.L.A. PA.06.001 De Pina L.C. PA.17.001 De Souza G.M. PD.10.011 Delcaro F.T. PA.06.001, PD.10.011 Deleanu A. PA.03.005, PA.13.005, PA.13.010 Deng Y.B. PD.04.001, PD.04.002 Deus F.M. PA.14.005 Deus L.B.D. PD.14.011 Dhananjaya K.V.N. TL.10.008 Di Donato R. TL.13.016 Diniz A.L.D. PD.07.010, PD.09.016, TL.10.017 Do Olival L.D. PA.01.012 Dong B. PD.08.004 Dong J. TL.08.001 Doria Neto E.A. PD.11.027 Dou C. TL.13.003 Dourado A.C. PD.01.006 DAlessandro P. PA.01.001 Duan Y.Y. TL.04.006, TL.03.013, TL.10.016 Duarte E.R. PA.06.001, PD.10.011 Duarte M.L. PA.06.001, PD.10.011 Dultra A.H.A. PD.12.010 Dutenhefner E.E. PA.14.001, PA.14.002, PA.14.007, PA.14.011, PA.14.003, PA.14.004, PA.14.005

D

Fainstein C. PD.15.021 Falanga A.J. PA.15.001 Faria R.C.S. PA.15.005, PA.01.011, PA.07.009, PA.07.011 Farkas S. TL.01.003 Fedorova A. TL.13.009, TL.12.002, TL.13.015 Fedorova N. TL.13.015 Fei Y. PD.03.002 Feng W. PD.03.002 Ferlin R.M. PA.07.010, PA.10.010, PA.10.011, PA.10.012, PA.07.009 Ferme A.L. PD.14.012 Fernandes D.A. PD.10.019 Fernandes Junior P.C. PD.09.016 Fernandez C. PA.01.012, PA.14.010 Ferraciolli S.F. PD.01.004, PD.05.003 Ferr~ao T.O. PD.10.019

D’Alessandro P. PD.01.003 D’Assis M.J.M.H. PA.17.006 D’Avila M.J. PD.13.006, PD.13.007  D’Avila M.J.A. PD.03.001, PD.08.010 Dai Q. PA.09.002 Dalakostas D. PD.13.012 Dall’Oglio M. PD.13.006 Dam C. PA.01.003 Dan I. PA.03.005, PA.13.005, PA.13.010 Danila M. PA.01.008, PA.03.007, PA.13.003, PA.13.004, PA.13.010, PA.13.014, PA.03.006, PA.13.008, PA.13.012, PA.13.013, TL.03.006 Davila M.J.A. PD.15.007 De Molo C. PA.13.017, TL.13.016

E Echeverry D.F. PA.17.009, TL.17.002 Eisenbrey J.R. TL.03.002, TL.03.004, PD.09.012, TL.09.013, TL.09.002 Ejiri N. TL.09.001 Elias L.N. PA.01.009 Emelyanova E. TL.13.009 Endo E. PA.09.005 Enomoto H. TL.13.007 Enze Q. TL.03.001 Eremenko T. TL.12.002 Ernst R. TL.12.003 Eroshenko O. PD.04.006 Esberard E.B.C. PA.01.015 Evans D.H. PA.13.018 F

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Ferraz L.R.L. PA.15.001 Ferreira A.C. PA.07.010, PA.10.010, PA.10.011, PA.10.012, PA.15.005, PA.01.011, PA.07.009, PA.07.011 Ferreira A.E.G.M.T. PA.10.001 Ferreira A.M. PA.17.011 Ferreira A.M.R. PD.17.018 Ferreira F.R. PA.05.003 Ferreira J. PA.01.014 Ferreira J.B.A. PA.06.001, PD.10.011 Ferreira M.A. PA.15.006 Ferreira V.C.S. PA.09.005 Ferreira V.F.L. PD.01.015, PD.06.001, PD.06.006 Figueiredo M.A.P. PA.01.012, PA.14.010 Figueiredo R. PD.06.005 Filho B.K.D. PA.15.005 Fiorini E. PA.13.017, TL.13.016 Fleming F.C.F. PA.05.004 Fonseca Pinto A.C.B.C. PA.17.004, PA.17.005, PD.17.024 Forsberg F. TL.03.002, TL.03.004, PD.09.012, TL.09.013, TL.09.002 Franc‚a C.S. PD.15.004 Franc‚a L.S. PD.15.003, PD.15.004 Franc‚a M.S. TL.10.011 Franca P.M.V. PD.06.005 Franc‚a R. PD.13.006, PD.13.007 Franc‚a R.D.G. PD.15.014 Franca R.G. PD.08.010 Francisco A.F. PA.14.010 Francisco L.D.R. PD.01.015, PD.06.001, PD.06.006 Francisco Neto M.B.M.J. PA.14.003 Francisco Neto M.F. PD.06.001 Francisco Neto M.J. PA.01.009, PA.06.002, PA.06.006, PA.14.001, PA.14.002, PA.14.007, PD.01.010, PD.01.015, PD.01.004, PD.05.003, PD.06.006, PD.07.006, PA.11.004, PD.11.010, PD.11.023, PA.14.004, PA.14.005, PD.15.016, TL.15.005 Francisco-Neto M.J. PD.11.030 Franco R.M. PD.10.003 Franscisco Neto M.J. PD.06.004 Frederigue U. PD.08.005 Freitas C.C.A. PD.10.009 Freitas T. PD.01.012 Fujiki F.A. PD.11.025 Fukuda K. PD.09.007 Funari G. PA.14.003 Funari M.B.G. PA.01.009, PA.05.004, PA.06.002, PA.14.001, PA.14.002, PA.14.007, PA.14.011, PD.01.010, PD.07.006, PA.11.004, PD.11.010, PD.11.023, PD.11.030, PA.14.004, PA.14.005, PD.15.016 Funari M.G.B. TL.15.005

G Galletti S. PD.11.024 Gao J. TL.12.001 Garcia R.G. PA.01.009, PA.08.002, PD.15.016, TL.15.005 Garcia-Herreros S. PA.07.008 Garrard J.W. PA.13.016

Volume 39, Number 5S, 2013

Gasparini F.F. PA.14.001, PA.14.002, PA.14.007, PA.14.011, PA.14.004, PA.14.005 Gasparini M.G. PA.14.003 Gazhonova V.E. TL.06.001, TL.07.001 G^enova N. PA.01.012 Genova N.B. PD.10.010, PD.11.019, PD.15.013 Germano M.A.N. PA.11.004, PD.11.010, PD.11.023, PD.11.030 Gewefel H. PD.09.005 Ghirelli C.O. PA.17.004, PA.17.005 Giglio R.F. PA.17.007 Gil F. PA.11.002, PA.17.002, TL.17.002 Gobbo R. PD.06.004 Godinho A.S. PD.10.019 Godoy J.C.F. PD.08.005 Godoy J.H.O. PD.08.005 Gomes A.C. PD.03.001, PD.08.010, PD.13.006 Gomes H. PD.14.003 Gomes S. PD.05.007, TL.05.003 Gomide B.M.P. PD.11.025 Gonc‚alves C.G. PD.10.003 Gordiano L. TL.10.005, TL.10.010 Gradinaru-Tascau O. PA.01.008, PA.13.003, PA.13.004, PA.13.007, TL.13.005, PA.13.008, TL.13.006 Grasel I.C.S.O. PD.09.008 Grassi D.C. PD.01.015, PD.06.001, PD.06.006 Graziano L. PA.12.005, PD.07.008, PD.09.017 Gregio-Junior E. TL.11.006 Grotti G.C. PA.10.001 Gual F. PD.14.006 Guarana T. PA.01.015 Guariglia S.N. PD.01.010 Guatelli C.S. PD.09.017 Guedes T. PD.14.003 Gueng M.-K. PD.09.003, PD.09.004 Guermazi A. TL.11.006 Guerrini G.T. PA.15.004 Guerrini R.R. PA.15.004 Guimar~aes M.D. PA.08.005 Guo J. PA.04.005, TL.13.002, TL.17.003 Guo J.J. PD.15.001, TL.17.003 Guo R.Q. PA.04.001, PA.04.002, PA.04.003, PA.04.005, PA.04.006, PA.04.007, PA.04.004, TL.04.002, TL.04.001, TL.04.003, TL.04.004 H Hagen S.C.F. PD.17.024 Hagiwara S. PD.01.017 Hairong Z. PD.03.002 Hamchieva L.S. PD.13.010 Hamilton J. TL.12.001 Han J.K. PD.01.014, TL.13.013, TL.08.010 Han Y.M. PA.08.003, TL.08.009 Han Z.Y. TL.08.001, TL.08.005, TL.08.007 Hao L.D. PA.04.002, PA.04.003 Hao Y.L. TL.08.007 Haro P. PA.17.002 Hartshorne T.C. PA.13.016

Author Index

Hasan M. TL.07.002, TL.07.004, TL.01.002, TL.07.003 Hashimoto D.T. PD.10.003 Hatanaka A.R. TL.10.011 Haworth K.J. TL.13.017 Henning Pedersen L. TL.10.007 Hirose M.A. PD.01.015, PD.06.001, PD.06.006 Hisaba W.J. PD.10.013, PD.10.014, PD.10.015 Ho M.C. PD.13.002 Ho M.H. TL.15.004 Holland C.K. TL.13.017 Hong G.S. PD.01.021 Hong H.S. PD.11.001, PD.11.002, PD.15.005 Horng Y.S. TL.11.002 Hosaka N. PD.13.005 Hsieh K.S. PD.04.007 Hsieh P.C.C. TL.10.009 Hsieh S.J. PA.09.005 Hu B. TL.04.002, TL.04.003 Huang B. TL.01.001 Huang D.C. PD.04.007 Huang J. PA.04.007 Huang S.-L. TL.13.017 Huang S.X. PD.08.002, TL.08.006 Huang Y.L. PD.08.002 Huiyu G.E. TL.08.002 Hung C.-Y. TL.11.004 Hung S.H. PD.08.003, TL.09.004 Hwang D.H. PA.08.003, TL.08.009 Hwang J.I. PD.01.009 Hwang J.Y. PD.11.001, PD.11.002, PD.15.005 Hwang S.S. PD.01.020, PD.12.009, TL.01.005 Hwang S.Y. PD.11.009, TL.01.005 Hye-Won K. PD.09.013 Hyett J. TL.10.007 I Iacopini M.C. TL.13.016 Iani M.J. PA.14.007, PA.14.003, PA.14.005 Iijima H. PA.01.004, TL.13.007 Ikeda N. TL.13.007 Inamassu L.R. PD.17.008 Inoue S. PD.04.003 Inoue T. PD.01.017 Ishi K. PD.05.004 Ishihara R.D. PA.07.011 Ishii A. TL.13.007 Islam R. PA.16.001 Ismail A. TL.11.001, TL.13.001, TL.15.001 Iwanaga S. PD.04.003 Iwata K. TL.13.007 Iwata Y. TL.13.007 J Jacinto B.T. PA.09.005 Jakob S. TL.10.015 Jang J.H. PD.11.009 Janus J. PA.13.018

S101

Jaw W.C. PD.09.014 Jeh S.K. PD.11.001, PD.11.002, PD.15.005 Jeng Y.M. PD.13.002 Jeon H.J. TL.01.004 Jeong W.K. PD.12.007, PD.13.003, PD.14.008 Jerico M.M. TL.17.001 Ji X. TL.17.003 Jiang M.-S. PD.04.008 Jiang Y.X. PA.09.002, TL.09.003 Jie S. PD.03.002 Jin W. PD.11.009, PD.11.022, PD.12.006 Johnsson J. PD.07.007 Jord~ao J.F. PA.01.011, PA.07.009, PA.07.011 Jordao J.F. PA.07.010, PA.10.010, PA.10.011, PA.10.012 J€ org S. TL.10.015 Jorge A.P.L. TL.10.017 Jung A.Y. PD.11.001, PD.11.002, PD.15.005 Jung E.M. TL.01.003 Jung S.E. PD.05.006 Jung S.I. TL.01.004 Jung W.S. PD.01.001 Jung Y.Y. PD.06.003, PD.14.009 Junior A.R. PA.06.004 Junior C.A.S. PA.01.012 Junior E.A. PD.05.002 Junior J.M.A. PD.16.005 Jurchis A. PA.13.003, PA.13.004, PA.13.006, PA.13.007, TL.13.005, TL.13.006 Just E. PD.14.003 K Kaklamanis L. PD.13.009 Kalil Filho J. PA.15.004 Kamikawa L. PA.17.004 Kaneko S. PA.03.003, PA.03.004 Kang I.W. PA.08.003, TL.08.009 Kapanadze M.Y. TL.06.001 Karkoshko T. PD.04.006 Karpov Y.A. PD.13.004 Kawamoto A. PD.05.004 Kawanami T.E. TL.10.011 Kawano R.M. PD.10.010 Khalmukhamedova A.E. TL.07.001 Kievitsbosch T. PD.17.020 Kim H.C. PD.01.008, PD.12.004, PD.12.005, PD.12.006, PD.15.010 Kim H.J. PD.01.013, PD.01.021, TL.01.005 Kim H.M. PD.11.001, PD.11.002, PD.15.005 Kim J.C. PD.07.001, PD.13.003 Kim J.E. TL.13.013, PD.13.003 Kim J.H. PD.01.001, PD.01.021, PD.13.003 Kim J.Y. PD.12.008, PD.13.003, PD.14.005 Kim K.G. PD.13.008 Kim K.W. PD.01.021, TL.01.005 Kim M.H. PA.14.001, PA.14.002, PA.14.007, PD.12.002, PA.14.003, PA.14.004, PA.14.005 Kim M.J. PD.14.013, PD.14.014 Kim M.Y. PD.12.007, PD.14.008

S102

Ultrasound in Medicine and Biology

Kim P.Y. PD.08.006 Kim S.A. TL.01.005 Kim S.H. PD.14.013, PD.14.014, TL.08.010 Kim S.W. PD.01.008, PD.12.004, PD.12.005, PD.12.006, PD.15.010 Kim S.Y. TL.01.005 Kim T.H. PD.05.005, PD.11.014, PD.11.015 Kim T.Y. PD.13.003 Kim Y. PD.05.005, PD.11.014, PD.11.015, PD.12.007, PD.13.003, PD.14.008 Kim Y.J. TL.01.004, PD.14.001 Kim Y.N. PD.11.001, PD.11.002, PD.12.007, PD.13.003, PD.14.008, PD.15.005 Kirillova E.R. PD.04.004 Kitai S. PD.01.017 Kitamura Y. PD.04.003 Kobayashi E.S. PD.01.005 Kobayashi M. PD.04.003 Kobayashi P.E. PD.17.020 Koda R. PD.13.005 Kodaira S.K. PA.15.004 Konno S. TL.09.001 Kono Y. TL.13.012 Koo J.B. PD.11.017, PD.11.018 Koshimura E.T. PA.14.001, PA.14.002, PA.14.007, PA.14.011, PA.14.003, PA.14.004, PA.14.005 Koshurnikova M.V. PD.13.004 Kowatsch I. TL.04.008 Kranidioti C.H. PD.13.009 Kripfgans O.D. TL.13.003 Kudo M. PD.01.017, TL.03.012 Kummel A. TL.13.012 Kuo W.-H. TL.09.008 Kwiecinski W. TL.08.008 Kwon H.J. TL.01.005 Kwon S.T. PD.11.021 L Lai X.J. TL.09.003 Lai Y.C. TL.09.011, TL.09.012 Lam Q. PA.07.002 Laredo F.G. PA.17.002, TL.17.002 Latorre R. PA.11.002 Leal N.L. PA.01.012, PA.14.010 Lee D.H. PD.01.008, PD.12.004, PD.12.005, PD.12.006, PD.15.010 Lee H. PD.12.008 Lee H.J. PD.14.013, PD.14.014 Lee J.K. PD.01.011, TL.01.005, TL.12.001 Lee J.M. PD.01.014, TL.01.005, TL.08.010, TL.12.001 Lee J.S. PD.01.021, TL.01.005, TL.12.001 Lee J.Y. PD.01.014, TL.13.013, TL.01.005, TL.01.006, TL.08.010, TL.12.001 Lee K.J. PD.11.012 Lee K.S. PD.12.008 Lee M.W. TL.01.006 Lee S.-K. PD.09.003, PD.09.004, PD.11.014, PD.11.015, PD.13.003

Volume 39, Number 5S, 2013

Lee S.G. TL.01.005 Lee S.H. PD.12.007, PD.13.003, PD.14.008 Lee S.J. PD.09.001, PD.09.002, PD.11.014, PD.11.015, PD.11.003, PD.11.004, PD.11.005, PD.13.003, TL.01.005 Lee S.K. PD.01.009, PD.05.005, PD.05.006, PD.11.014, PD.11.015, PD.13.003 Lee S.M. PD.11.012, PD.11.013, PD.11.014, PD.11.015, PD.11.016, PD.13.003 Lee S.R. PA.15.002, PD.05.005, PD.05.006, PD.11.014, PD.11.015, PD.13.003 Lee W.J. TL.01.006 Lee Y.H. TL.09.012, PD.11.001, PD.11.002, PD.13.002, PD.15.005 Lee Y.J. PA.15.002, PD.11.001, PD.11.002, PD.13.008, PD.15.005 Leit~ao O.M.R. PD.07.009 Leite M.A. PA.14.008 Leite M.C.N.A. PD.10.010, PD.11.019, PD.15.013 Leslie A.T.F.S. PD.10.004, TL.10.014 Lessa D.A.B. PD.01.019 Li A. TL.13.010, TL.03.008, TL.03.009 Li L. PD.03.002 Li P.-C. PD.04.008, PD.04.009 Liang C.-J. PD.04.008 Liang J.D. PD.08.001 Liang P. TL.08.004, TL.08.001 Liang R.X. PD.15.001, PD.15.002 Liberman A. TL.13.012 Liguori A.A.L. TL.12.005 Lijuan G.U. PD.01.002 Lim G.Y. PD.14.001 Lima A.I.F. TL.10.006 Lima F.O. PA.06.006 Lima G.B.G.S. PD.11.011 Lima G.G. PD.11.011 Lima M.F. TL.04.007 Lin C.C. PD.04.007, TL.13.010 Lin G.S. TL.05.001 Lin J.T. PA.08.001 Lin K.J. PD.09.014 Lin L.-C. PD.04.009 Lin L.-W. PA.13.001, PA.13.002, PD.03.002 Lin S.K. TL.11.002 Lin X.D. PD.15.001 Lin Y.Y. TL.11.003 Lira L.F. PD.01.018 Lisboa E.A.Q. PA.01.013, PA.12.002, PA.12.004, TL.12.005 Liu D.H. TL.11.002 Liu F.Y. TL.08.004 Liu L.I. PA.11.003 Liu X. TL.03.013 Liu X.S. TL.08.006 Liu Y. PA.04.003 Liying M. TL.16.001 Logrado L. PD.10.018 Lopes I.C.C. PD.10.016 Lopes M.C. PD.01.007, PD.08.005, PD.10.001, PD.15.006, PD.16.002 Lopes M.D. PD.17.017, PD.17.020, PD.17.027

Author Index

Lorenzato M.M. TL.11.006, PD.11.008 Lorigados C.A.B. PA.17.004 Lorigados C.B. PA.17.005 Loss M. TL.01.003 Lote F.M. PD.01.015, PD.06.001, PD.06.006 Lu T. TL.08.004 Luiz A.V.C. PD.15.007 Luo H. PA.09.001 Luz K.P. PD.11.011 M Ma X. TL.08.007 Machado C.H.C. PD.11.025 Machado J.C. PA.13.015 Machado L.E. PD.10.017 Machado L.H.A. PD.17.010 Machado P. TL.03.002, TL.03.004, PD.09.012, TL.09.013, TL.09.002 Machado-Porto G.C.L. PD.07.008 Maciel M.J.S. PA.06.009, PA.08.005, PD.09.017 Magalh~aes M. PA.14.007 Magalhaes R.P.V. PA.07.007 Maia M.C.A. PD.10.019, PD.10.009 Majumder T.K. PA.16.001 Mamprim J.M. PD.17.026 Mamprim M.J. PA.17.008, PD.01.012, PD.17.009, PD.17.010, PD.17.017, PD.17.019, PD.17.020, PD.17.023, PD.17.027, PD.17.004, PD.17.005, PD.17.007, PD.17.008, PD.17.006 Mangusheva M.M. PD.04.004 Mao F. TL.01.001 Maragno B. PD.10.010, PD.11.019, PD.15.013 Maranh~ao B. PD.14.003 Marcolini T.T. PD.07.010 Marcos V.N. PA.14.002, PA.14.004 Margotto M. PD.15.003 Mariani A. TL.08.008 Marin L.R.P. PA.06.006 Mariotti G. PA.06.002, PD.06.004 Marsico F.L.F. PA.15.005 Martie A. PA.03.007, PA.13.004, PA.03.006, TL.03.006 Martin C.M. PD.17.024 Martinez H.P. TL.13.012 Martinez L.H. PD.05.002, TL.10.001 Martinez M.J. TL.03.003, TL.03.010 Martins A.M.A. PD.11.011 Martins M.G. PD.07.009, PD.10.012, PD.14.011 Martins R.V.B. PD.10.018 Martins W.P. PD.05.001, PD.05.002, TL.10.006 Massa A.M.T. PD.12.010 Mastorakou I. PD.13.009, PD.13.012 Masuda K. PD.13.005, TL.04.005 Matera J.M. PD.17.024 Mathias W. TL.04.007, TL.04.008 Matias B.S. TL.10.005, TL.10.010 Matias D.S. TL.10.005, TL.10.010 Matos P.V. PD.01.007, PD.10.001, PD.15.006, PD.16.002 Mattar R. TL.10.011

S103

Mattrey R.F. TL.03.002, TL.13.012 Matushita J.P.K. PD.06.005 Mauad F.F. PA.10.001 Maurano A. PA.01.009, PA.06.004, PA.08.002, PD.15.016, TL.15.005 Mazzotta E. PA.13.017, TL.13.016 Mazzucato F.L. PA.05.003 Mcpherson D.D. TL.13.017 Medeiros M.M. PA.12.005 Medrado D.G.O.A. PA.05.003, PA.15.006 Melo A.S.A. PD.12.010 Melo E.V. PD.10.019 Melo K.S. PA.10.001 Melo M.G.D. PD.10.009 Mendes G.F. PA.08.002 Mendes G.G. PD.07.008 Mendonc‚a F.T.S. PD.10.009 Mendonca R.G. PD.12.010 Mendonc‚a R.M. PA.01.013, PA.12.002, PA.12.004, TL.12.005 Merlini N.B. PD.17.026 Merton D.A. TL.03.002, TL.03.004 Mezzetti A. PA.01.001, PD.01.003 Miceli M. PD.11.024 Miller D.L. TL.13.003 Min R. TL.12.001 Min S.J. PA.08.003, TL.08.009 Min T.T. PA.11.005 Minami Y. PD.01.017 Miranda A.E.P.G. PD.01.005, PD.16.001 Miranda F.C. PD.11.010 Miranda J.M.A. PD.01.005, PD.16.001 Mirzayan E. PD.04.006 Miyadahira E.H. PA.10.007 Miyague A.H. PD.05.001, PD.05.002 Miyamoto Y. PD.09.007 Mizukoshi E. PA.03.003, PA.03.004 Mochizuki T. PD.13.005 Mogas F. TL.11.005 Mogutov M.S. TL.08.003, TL.15.002 Moncayo R. PA.07.008 Montenegro N.C.F.M. PD.15.013 Montenegro N.C.M.F. PD.10.010, PD.11.019 Moraes E.R.F.L. TL.10.013 Moraes P.H.D.M. PA.06.006 Moreira B.L. PA.06.009, PA.11.005, PA.12.005, PD.01.018, PA.08.005, PD.09.017 Moreira F.C. TL.03.003, TL.03.010 Moreira Neto M. PA.01.013 Moretto D. TL.11.005 Morgunov M. PD.04.006 Moron A.F. PD.10.012, PD.10.013, PD.10.014, PD.10.015, TL.10.003, TL.10.006, PD.10.002, PD.10.004, PD.10.008, TL.10.001, TL.10.002, TL.10.004, TL.10.011, TL.10.014 Motta E.L.A. PA.10.007 Moura A.P.C. PD.07.011, PD.07.012, PD.07.013 Moyses R.A. PD.15.007 Mu M.J. TL.08.001 Muniz A.B.G. PD.15.021

S104

Ultrasound in Medicine and Biology

Muniz R.B.G. PD.15.021 Muniz R.L.S. PA.01.015, PD.15.021 N Nable L.E. PA.14.002 Nakamura I. PD.04.003 Nakata N. PD.09.007 Nardozza L.M.M. PD.10.012, PD.10.013, PD.10.014, PD.10.015, TL.10.003, TL.10.006, PD.10.002, PD.10.004, PD.10.008, TL.10.001, TL.10.002, TL.10.004, TL.10.011, TL.10.014 Nascimento D.T. PD.10.009 Nascimento J.M.S. PD.07.009 Nascimento J.S.M. PD.10.018 Nascimento T.L. PA.13.015 Nassar E.B. PD.11.027 Nastri C.O. PD.05.001 Navarro D.U. TL.03.010 Naylor A.R. PA.13.016 Nduwayo S. PA.13.016 Nelassov N. PD.04.006 Nepomuceno A.C. PD.17.011, PD.17.013, PD.17.012 Nery D.R. PD.15.016, TL.15.005 Neto A.O. PD.01.006, PD.07.002 Neto M.J.F. PA.05.003, PA.05.004, PA.06.004, PA.14.011 Neto W.A. PD.15.003, PD.15.004 Ng G.A. PA.13.018 Ngu A. PA.13.019 Nils B. TL.12.004 Nishida N. PD.01.017 Nishiguchi S. PA.01.004, TL.13.007 Nishimura J. PA.01.004 Nishioka T. PD.09.007 Nobrega F.P. PA.10.001 Nogueira L.A.A. PD.07.011, PD.07.012, PD.07.013 Nogueira-Barbosa M.H. TL.11.006, PD.11.008 Nsouto Maior L.H.C. PD.16.005 Nunes PD.16.004 O Ogawa C. TL.03.012 Oh K.S. PD.15.011 Ohta T. PD.09.007 Ojeda-Fournier H. TL.03.002 Olival L.D. PA.14.010 Oliveir H.S. PD.17.026 Oliveira A.C. PD.03.001 Oliveira A.D. PA.08.005 Oliveira C.P.M.S. PD.17.001, PD.17.002 Oliveira C.P.R. PA.14.008 Oliveira C.R. PA.17.007 Oliveira E.P. PD.14.006 Oliveira G.C. PD.11.025 Oliveira H.S. PD.17.009, PD.17.010, PD.17.019, PD.17.008 Oliveira I. PA.17.011 Oliveira I.M.S. PD.11.011 Oliveira J.C.D. PA.01.013, PA.12.002, PA.12.004, TL.12.005 Oliveira L.A.N. PD.14.012

Volume 39, Number 5S, 2013

Oliveira R.V.B. PD.07.009, PD.10.012, PD.10.013, PD.10.014, PD.10.015, PD.10.018, PD.14.011 Oliveira T.N. PD.13.006, PD.13.007, PD.15.007 Oliveira T.N.D. PD.15.014, PD.15.007 Onodera M. PA.01.006 Onogi S. PD.13.005, TL.04.005 Orlando J.L. TL.05.002, TL.16.002, TL.16.003, TL.16.004, TL.16.005 Owens G.E. TL.13.003 P Paccapelo A. PA.13.017 Pacheco E.M.B. PD.08.008 Paes M.M.B.M. TL.10.017 Pahou K. PD.13.009 Pamputis S.N. TL.08.003 Pan B.-J. PD.04.008 Panerai R.B. PA.13.016 Panizza L. PD.14.012 Panteleakou E. PD.13.009 Pardo M.H. PA.05.003 Pares D. TL.10.006 Park C.K. PA.15.002 Park D.W. PA.15.002 Park H.S. TL.01.004 Park J.S. PD.09.001, PD.09.002, PD.11.009, PD.11.022, PD.11.003, PD.11.004, PD.11.005, PD.13.008 Park M.Y. PD.05.006 Park S.J. TL.01.004 Park S.S. PD.01.020, PD.12.009 Park S.Y. PD.11.009, PD.11.022 Park U.C. TL.01.004 Park Y.-M. PD.11.003, PD.11.004, PD.11.005 Park Y.M. PD.09.001, PD.09.002 Passos A.P. TL.10.003, TL.10.002, TL.10.004 Passos M.T. PD.01.015, PD.06.001, PD.06.006 Passos T.M. PA.17.012 Pastore A.R. PD.07.009, PD.10.013, PD.10.014, PD.10.015 Patel N. PA.13.018 Patrunov Y.N. TL.08.003, TL.15.002 Paulo G. PD.05.007, TL.11.005, TL.05.003 Pavan T.Z. PD.05.002 Pedersen M.R. PA.01.003 Pegoraro F.F. PA.14.003 Peixoto B.L. PA.07.010 Perches C.S. PD.17.007 Perdizes G.O. PD.07.007 Pereira C.T. PA.17.007 Pereira C.U. PD.10.019 Pereira F.L. PA.15.006, PD.07.002 Perepechai I. PD.04.006 Perillo L.C. PD.07.010 Pernot M. TL.08.008 Pessoa S.M. PD.07.010 Petribu PD.16.005 Petribu N.C.L. PD.16.005 Petrica L. PA.13.014, PA.13.012, PA.13.013 Phillips R. PA.07.002

Author Index

Pimentel I.C.C. PD.08.010 Pinho R. PD.01.015, PD.06.001, PD.06.006 Pinto C.V. PD.07.006 Piolanti M. PD.11.024 Pires W.P. PD.07.010 Platz B. Da Silva N. TL.01.003 Pogorelova O.A. PD.13.010 Polanski L.T. PD.05.001, PD.05.002 Poli M.R.B. PA.12.005, PD.07.008, PD.09.017 Pollo P. PA.01.015 Ponomarenko E. PD.04.006 Ponomarenko I. TL.13.009 Ponomorenko I.A. TL.06.001 Popescu A. PA.01.008, PA.03.005, PA.03.007, PA.13.003, PA.13.004, PA.13.006, PA.13.010, PA.13.014, PA.03.006, PA.13.007, TL.13.005, PA.13.008, TL.13.006, PA.13.012, PA.13.013, TL.03.006 Popescu M. PA.01.008, PA.13.008 Porcionato V.B. PD.01.015, PD.06.001, PD.06.006 Porto R.L.S. PD.10.019 Q Qian X.L. PD.08.002, TL.08.006 Queiroz M.C.W. PD.11.025 Queiroz Z.J. PA.01.013, PA.12.002, PA.12.004, TL.12.005

S105

Rios L.C.L. PD.07.009, PD.10.013, PD.10.014, PD.10.015, PD.14.011 Rios L.T.M. PD.07.009, PD.10.012, PD.10.013, PD.10.014, PD.10.015, PD.10.018, PD.14.011 Ripolles T. TL.03.003, TL.03.010 Robinson T.G. PA.13.016 Rocha B.A. PA.09.005 Rocha J.B. PA.10.004 Rocha L.A. PD.10.004 Rocha M.A. PA.14.001, PD.07.006 Rocha S.M.S. PD.14.012 Rodero M.R. PD.14.006 Rodrigues F.V. PD.14.012 Rodrigues V.I. PA.17.012 Rodriguez D.M. PA.17.008 Roemer F.W. TL.11.006 Rogoza A.N. PD.13.010, PD.13.004 Rolo L.C. PD.10.004, TL.10.001, TL.10.011, TL.10.014 Rom~ao M.A.P. PD.17.018 Romera V. PA.09.003 Romero M. PA.07.008 Rosa P.T.C.R. PA.13.015 Roveda D.R. PA.14.008 Rozas A. PD.10.003 Rubin J.M. TL.12.001 Rudner M. PA.09.005 Rui W.J. TL.03.001 Ryu K.N. PD.11.009, PD.11.022

R Racean S. PA.13.003 Radhakrishnan K. TL.13.017 Rafaelsen S.R. PA.01.003 Rahal A. PA.08.002, PD.06.004, PD.15.016, TL.15.005 Rahal Junior A. PA.01.009 Rahal Junior A. PA.06.002 Rainne-Fenning N.J. PD.05.001, PD.05.002 Ramalho F.S. PA.10.001 Ramnarine K.R. PA.13.016 Ramos F. TL.16.004 Ramos H. PD.09.008 Ramos M.G.S.N. PD.01.019 Raymond J.L. TL.13.017 Rebouc‚as I.X.C.R. PA.01.013, PA.12.002, PA.12.004, TL.12.005 Regina S.T. PA.07.007 Reis Neto A.J. PA.07.010, PA.10.010, PA.10.011, PA.10.012, PA.15.005, PA.01.011, PA.07.009, PA.07.011 Ren H.R. TL.04.006 Rennert J. TL.01.003 Requi~ao J.G.T. PA.17.006 Requiao K.G. PA.17.006 Requi~ao L.G.T. PA.17.006 Rhim H. PD.08.006, TL.01.006 Ribeiro A.C.R. PA.14.008 Ribeiro A.L. TL.04.008 Ribeiro E.M. PD.14.012 Riboldi M. PA.10.007 Righi S. PA.13.017, TL.13.016

S Saito M. TL.13.007 Saito O.C. PD.03.001, PD.15.014, PD.15.008 Sakai Y. TL.13.007 Salama D. PD.09.005 Sameshima Y.T. PA.14.001, PA.14.002, PA.14.007, PA.14.011, PA.14.003, PA.14.004, PA.14.005 Sampaio A. PD.14.003 Santalla T.P. PD.10.003 Santana B.D. PD.01.006, PD.07.002 Santana E.F.M. PD.10.002 Santilli F. PA.01.001 Santos A.B.O. PD.15.007 Santos D.W. PD.09.016 Santos M.C.S. PA.17.011, PD.01.019 Santos R. PA.01.014, PD.05.007, PD.11.028, PD.11.029, TL.11.007, TL.11.008, TL.05.003 Santos R.E. PD.10.009, PD.11.028, PD.11.029, TL.11.007, TL.11.008, TL.05.003 Sarria R. PA.11.002 Sarto C.G. PA.17.008 Sartor R. PD.01.012, PD.17.004, PD.17.005, PD.17.007, PD.17.006 Sazonova N. TL.13.009 Sbano J.C. TL.04.007 Scapinelli A. TL.04.008 Schiavone C. PA.01.001, PD.01.003 Schiller A. PA.13.014, PA.13.012, PA.13.013 Schlosser M. TL.10.013

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Schreyer A.G. TL.01.003 Se-Jung J. PD.09.013 Seda M.A.V. PA.07.007 Sencha A.N. TL.08.003, TL.15.002 Sendroiu M. PA.03.007, PA.13.004, PA.13.006 Sendyk-Grunkraut A. PD.17.024 Serafini P.C. PA.10.007 Sergeeva E.D. TL.15.002 Serra C. PA.13.017, TL.13.016 Serrano J.J. PA.07.008 Shamsutdinova N.G. PD.04.004 Shibatouge M. TL.03.012 Shigehara N. PD.13.005 Shih L.S. PD.09.014 Shimizu C. PA.09.005 Shin D.J. PD.11.017, PD.11.018 Shin Y.G. PD.15.011 Shukun L. PD.03.002 Si Q. PD.08.002, TL.08.006 Si-Sung C. PD.09.013 Sicca J.A. PA.15.001 Silva A.Q.P. PD.07.007 Silva C.B. PD.07.008, PD.09.017 Silva C.H.M. PD.10.016 Silva G.M. PD.07.010 Silva K.C. PD.10.003 Silva L.N. PD.07.007 Silva L.U.M.A. PA.07.007 Silva M.Q.P. PD.01.007, PD.10.001, PD.15.006, PD.16.002 Silva M.R.C. PA.11.004, PD.11.010, PD.11.023, PD.11.030 Silva O.A.C. PA.07.007 Silva R.A.P. PD.06.005 Silva W.J.P.M. PD.11.010 Silverio P.R. PD.06.004 Sima A. PA.13.005 Simionato L.C. PA.09.003 Sim~oes V.M.F. PD.14.011 Sinisgalli C.A. PD.10.010, PD.11.019, PD.15.013 Siqueira E.G.M. PD.17.008 Sirli R. PA.01.008, PA.03.005, PA.03.007, PA.13.003, PA.13.004, PA.13.005, PA.13.006, PA.13.010, PA.13.014, PA.03.006, PA.13.007, TL.13.005, PA.13.008, TL.13.006, PA.13.012, PA.13.013, TL.03.006 Soares C.T. PD.08.005 Soares G.D.P. PD.17.009 Soares G.M.T. PD.06.005 Soares M. PD.16.005 Sohn J.H. PD.13.003 Soler M. PA.11.002, PA.17.002 Soletti R.C. PA.13.015 Song C.F. PA.04.006 Song G. TL.01.005 Song H.N. PA.04.001, PA.04.002 Song K.S. PD.11.016 Song S.Y. PD.05.005, PD.11.014, PD.11.015 Soong C.L. PD.09.014 Soto D.B. PA.11.005 Sousa M.S. PD.10.018 Souto Maior L.H.C. PD.16.005

Volume 39, Number 5S, 2013

Souza A.M. PD.01.019 Souza A.S. PD.14.006 Souza M.T.P. PD.15.009, PD.15.008 Souza P.M. PA.17.008, PD.17.017, PD.17.026, PD.17.027 Spessatto J.L. PD.09.008 Spiers J.D. PA.13.018 Sporea I. PA.01.008, PA.03.005, PA.03.007, PA.13.003, PA.13.004, PA.13.005, PA.13.006, PA.13.010, PA.13.014, PA.03.006, PA.13.007, TL.13.005, PA.13.008, TL.13.006, PA.13.012, PA.13.013, TL.03.006 Sridharan A. TL.03.002, TL.03.004 Srougi M. PD.13.006 Stovgaard C.E. PA.01.003 Stroszczynski C. TL.01.003 Su Y.-G. PD.09.003, PD.09.004 Suenaga E. PD.01.010, PD.11.030 Sultana N. PA.16.001 Sun J. PD.04.001, PD.04.002 Suseanu D. PA.13.003, PA.13.004 Szilaski M. PA.13.007 T Tabari A.M. TL.13.001 Tabone V.A. PD.01.010 Tabosa T.P. PD.11.027 Tai H.C. TL.15.004 Takada E. TL.09.001 Takaguchi K. TL.03.012 Takase N. TL.09.001 Takashima T. TL.13.007 Takeshima S. TL.04.005 Takita M. PD.01.017 Talans A. PD.01.004, PD.05.003 Tamanaha S. TL.04.008 Tana C. PA.01.001, PD.01.003 Tana M. PA.01.001, PD.01.003 Tanaka H. PA.01.004, TL.13.007 Tanaka R.M. PA.11.004, PD.11.010, PD.11.023, PD.11.030 Tang Q.Y. PD.04.001, PD.04.002 Tanter M. TL.08.008 Tavares P. TL.11.005 Tebaldi M. PD.17.010 Teixeira A.C.V. PD.14.006 Teixeira C.R. PD.17.009 Tessarollo B. PD.12.010 Tezuka M. TL.09.001 Theo Z.P. PD.05.001 Theodorakopoulou E. PD.13.012 Theotokas I. PD.13.009, PD.13.012 Thomas S. TL.10.015, TL.13.011, TL.12.004 Thomenius K.E. TL.03.002, TL.03.004 Timar R. PA.13.005 Tiu C.M. TL.09.011, TL.09.012 Tochetto S.M. PD.15.008 Torres A.C.S. PD.11.011 Torres L.N. PA.17.005 Torres U.S. PD.14.006 Toyota R.A.S.M. PA.17.007

Author Index

Trancoso T.A.L. PD.01.019 Tripoten M.I. PD.13.010, PD.13.004 Trogler W. TL.13.012 Tsugu T. PD.04.003 Tsui P.H. PD.13.002 Tsukuda L.K. PA.10.007 Tsunemi M. PD.17.004, PD.17.005, PD.17.006 Tsutsui J.M. TL.04.007, TL.04.008 U Ueshima K. PD.01.017 V Vafeiadi E. PD.13.009 Valente M. PD.01.006 Vargas A. TL.17.001 Ventura C.A.P. PA.06.002, PA.06.004, PD.16.004 Vicentini J.R.T. PA.05.003, PA.06.006, PA.15.006 Vieira E.R. PD.16.005 Vieira F. PA.06.002 Vieira F.A.C.O. PD.15.016, TL.15.005 Vilanova M. PD.14.003 Vilar L.N. TL.03.010 Villamonte-Chevalier A. PA.11.002 Vincler M.A.F. PA.17.012 Vlad A. PA.13.005 Vojnovic B. PD.16.003 Voroncova N.A. TL.07.001 Vorontsova N.A. TL.06.001 Vujovic V. PD.16.003 Vukotic R. TL.13.016 Vulcano L.C. PD.17.009, PD.17.010, PD.17.019, PD.17.020 W Wallace K. TL.03.002, TL.03.004 Wanderley E. PD.09.008 Wang C.N. TL.10.009 Wang F. TL.08.006, TL.08.007 Wang H.K. TL.09.011, TL.09.012 Wang H.P. PA.08.001 Wang H.Y. TL.09.003 Wang J. TL.13.010, TL.03.008, TL.03.013 Wang K. TL.04.006 Wang Q. TL.13.002, TL.17.003 Wang T.-G. TL.11.004 Wang T.G. TL.11.003 Wang T.H. TL.10.009 Wang W. TL.01.001 Wang Y. PD.15.002, TL.03.013 Wang Y.W. TL.11.002 Wang Z. TL.04.006 Weber M.F.V.L. PD.11.006 Wei Y. TL.08.005 Weitzel W. TL.12.001 Weng K.P. PD.04.007 Woo J.Y. PD.11.001, PD.11.002, PD.15.005 Wu C.H. TL.11.003

S107

Wu M.H. TL.15.004 Wu T.R.G. PD.01.007, PD.10.001, PD.15.006, PD.16.002 Wu Z. TL.13.012 X Xiao C.H. PA.01.002 Xiao M.S. PA.09.002, TL.09.003 Xiaojuan J.I. TL.13.002 Xin L. PD.03.002 Xing C.Y. TL.04.006 Xu R.F. TL.08.007 Xue D. TL.10.016 Xue E.-S. PA.13.001, PA.13.002 Xue E.S. PD.15.001, PD.15.002 Y Yada N. PD.01.017 Yamachira V.S. PA.15.006, PD.01.004, PD.05.003 Yamashita T. PA.03.003, PA.03.004 Yand D.M. PD.12.005 Yang D.M. PD.01.008, PD.11.009, PD.12.004, PD.12.006, PD.15.010 Yang I. PD.11.001, PD.11.002, PD.15.005 Yang L. TL.03.001 Yang R. TL.13.002 Yang S.-H. TL.09.008 Yang W. TL.08.006 Yang Y. TL.04.006, TL.08.007 Yi Q. TL.17.003 Yi T. TL.17.003 Yonezaki R.C. PD.11.010 Yoo W.Y. PA.08.003, TL.08.009 Yoon J.H. PD.01.014 Yoshida M. PA.01.004 You K. TL.13.007 You S.S. PA.09.002 Youli C. PD.03.002 Yu B.L. PD.09.014 Yu E.S. TL.01.005 Yu G. TL.17.003 Yu J.S. PD.01.001, TL.08.001, TL.08.005 Yu S. PD.03.002 Yu X.L. TL.08.004, TL.08.001, TL.08.005 Yuan L.J. TL.04.006, TL.03.013, TL.10.016 Yun C. PD.03.002 Yung-Lung K. TL.09.008 Z Zamith M.M. TL.10.013 Zanini M. PD.17.003 Zardo K.M. PD.17.024 Zatiti S.C.A. PD.11.008 Zavariz J.D. PA.05.001, PD.08.010 Zerwes N. PA.10.001 Zhang J. TL.08.007, TL.09.003 Zhang M.H. PD.08.002 Zhang X. TL.08.001

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Zhang Y. PD.15.002 Zhansen E. PA.11.001 Zhen Y.E. PD.01.002 Zheng W. TL.03.008 Zhongtao B.A.O. PD.01.002 Zhou H.Y. TL.08.007 Zhou J. TL.13.010, TL.03.008 Zhou N. TL.10.016 Zhou Q. PA.04.007

Volume 39, Number 5S, 2013

Zhou W. PD.04.001, PD.04.002 Zhu Q.L. PA.09.002, TL.09.003 Zinzindohoue F. TL.08.008 Ziosi A. PD.11.024 Zoumpoulis P. PD.13.009 Zoumpoulis S. PD.13.012 Zubarev A. TL.13.009, TL.12.002, TL.13.015 Zubarev A.V. TL.06.001, TL.07.001, TL.12.002, TL.13.015 Zulim R.M.I. PA.17.008

ULTRASOUND IN MEDICINE AND BIOLOGY The Official Journal of the World Federation for Ultrasound in Medicine and Biology INSTRUCTIONS FOR CONTRIBUTORS AIMS & SCOPE Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. The journal publishes original contributions on significant advances in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and the interactions between ultrasound and biological materials, including bioeffects. Extended reviews of subjects of contemporary interest in the field are also published, in addition to occasional editorial articles, clinical and technical notes, letters to the editor and a calendar of forthcoming meetings. It is the aim of the journal fully to meet the information and publication requirements of the clinicians, scientists, engineers and other professionals who constitute the biomedical ultrasonic community. , Original Contributions: Peer-reviewed, high-quality research investigations dealing with ultrasound and its applications in biomedicine. , Review Articles: Reviews of major areas or sub-areas in ultrasound in medicine and biology. These articles may be of any length and are peerreviewed. , Technical and Clinical Notes: Brief studies [approximately 4 printed pages (12 double spaced submitted pages) or less]. However, submissions based solely on the description of a single case, i.e. case reports, will not be considered for publication. , Editorials: On an occasional basis. , Book Reviews: Reviews and abstracts of the current literature in the appropriate fields will be published. Book Reviews should be submitted electronically through the Elsevier Editorial website (http://elsevier. com/umb). Authors and publishers should forward newly published works to the Associate Editor for Book Reviews: Dr. Robert J. Eckersley, King’s College London, Imaging Sciences Div. of the Rayne Institute, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, London, UK SE1 7EH. , Letters to the Editor: Comments on articles published in the Journal and on other matters of interest to biomedical ultrasound researchers. They should be short (normally not more than 400 words), doublespaced, and include references where appropriate. Where a published article is involved, the original author(s) will be invited to submit a response. , Calendar: Provides notices of forthcoming meetings, courses, and other events relevant to biomedical ultrasound researchers. All such items will normally be listed (at no charge) in each issue. Please submit the date, conference/course title, and contact name to the Editorial office at least 6 months in advance. , Official Communications of the WFUMB: For example, approved changes in the Constitution. , WFUMB Newsletter (ECHOES): News concerning societies affiliated with the WFUMB (e.g., the names and addresses of newly elected officers as well as narrative reports of scientific meetings) should be sent directly to the Newsletter Editor, David Evans, PhD, DSc at [email protected] This material should not be sent to the Editor-inChief of UMB.

CONTACT INFORMATION Please contact the Editorial Office through any of the following means: Managing Editor: Rose M. Randolph, University of Cincinnati Cardiovascular Center, Room 3988, 231 Albert Sabin Way, Cincinnati, Ohio, USA 45267-0586. Email: [email protected]; Phone: +1 513-5582508; Fax: +1 513-558-6102. Editor-in-Chief: Christy K. Holland, Ph.D., Ultrasound in Medicine and Biology Editorial Office, University of Cincinnati Cardiovascular Center, Room 3988, 231 Albert Sabin Way, Cincinnati, Ohio, USA 45267-0586. Email: [email protected]; Phone: +1 513-558-5675; Fax: +1 513-5586102. http://www.ultrasound.uc.edu

MANUSCRIPT SUBMISSION Manuscripts are accepted for consideration with the understanding that they have not been published elsewhere, except in abstract form, and are not concurrently under review elsewhere. If a contribution has more than one author, its submission is taken to imply that the first author has the permission of the other authors for their

names to appear. In cases of multiple authorship, the Editor may ask for a statement of the contribution made by each author to the work and usually will do so when there are more than five authors. ‘‘Guest’’ authorship is not permitted. Manuscripts will be reviewed by appropriate members of the Editorial Board and other referees with expertise in the area of presentation. Acceptance will depend on originality, relevance, and scientific content of the material. When the manuscript deals with methodology describing the effects of ultrasound upon physical or biological systems, an exact description of the components used, their characteristics and their set-up must be provided so that other researchers will be able to duplicate the observations and measurements made. When the manuscript deals with a novel method, technique or system, the principles upon which it is based must be described in detail for its principles of operation to be understood clearly by experts in the field. If the system incorporates engineering or signal processing procedures that are not conventional or commercially available, these procedures must be described in detail. Block diagrams usually describe the sequence of conventional procedures used in the system. The improved performance of such novel systems over existing systems must be described and illustrated as well as limitations and errors to which the system described is subject. Responsibility for protection of proprietary information will rest with the authors. When the manuscript deals with clinical studies in which commercial diagnostic ultrasound systems are used, these should be identified with brand name and the manufacturer’s address. The console and transducers should be specified, as well as relevant control settings.

ETHICS Manuscripts describing animal or human experiments must make it clear that these experiments were conducted in a generally acceptable ethical and humane fashion. Manuscripts reporting the results of animal experimentation must state their compliance with research protocols approved by their local Institutional Care and Animal Use Committee (IACUC). Manuscripts reporting the results of human experimentation must include a statement that the experimental protocol was approved by a local institutional review board (IRB) and that informed consent for the study was obtained from all human subjects per the WORLD Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects, 2008 (http://www. wma.net/en/30publications/10policies/b3/). Authors must also disclose all forms of financial support, both monetary and equipment, received by any author in performing and describing the work which is the subject of the submitted manuscript.

ONLINE SUBMISSION PROCESS All manuscripts (text and artwork) must be submitted electronically through the Ultrasound in Medicine and Biology online submission and review website (http://ees.elsevier.com/umb). New manuscript submission items should include the following and be uploaded in the order shown below: (1) A cover letter (stating that the manuscript, or specified parts of it, have not been and will not be submitted elsewhere for publication and listing three or more potential reviewers for their manuscript, with their email addresses). (2) The manuscript (Title page, Abstract with keywords, Main text (with all tables listed at end), Acknowledgements, References List, and Figure Legends). Each page should be double-spaced with indented paragraphs and numbered separately, with the exception of the title page. (3) Figures (uploaded as a separate file and numbered). Complete instructions for electronic artwork submission can be found at http:// www.elsevier.com/wps/find/authors.authors/authorartworkinstructions. All files should be labeled with appropriate and descriptive file names (e.g., SmithText.doc, Fig1.eps). Revised manuscript submissions should also be accompanied by a unique file (separate from the cover letter) that provides a detailed response to all reviewers’ comments. This ‘‘Detailed Response to Reviewers’’ letter should list each reviewer comment followed by the authors’ response. Each response should include the modified text excerpt with the page/line numbers where it can be found in the revised manuscript. The preferred order of files for revisions is: Cover Letter, Detailed Response to Reviewers, Revised Manuscript file and Figure(s). Revised submission files should all be source files, not .pdfs. A complete checklist can be found at http://ees.elsevier.com/umb/img/Checklist.pdf.

ULTRASOUND IN MEDICINE AND BIOLOGY MANUSCRIPT PREPARATION A checklist of common manuscript formatting errors can be found here (http://ees.elsevier.com/umb/img/Checklist.pdf). Original Contributions, Reviews, and Technical and Clinical Notes should be organized in the following format (without section numbers): Introduction, Materials and Methods, Results, Discussion, Conclusions, Acknowledgements, References, Appendices (if needed) and Tables. In some cases, the Results, Discussion, and Conclusions sections may more appropriately be combined than separated (at the author’s discretion). Every effort should be made to avoid jargon, to write out in full all acronyms the first time they are mentioned, and to present the contents of the study as clearly and as concisely as possible. Title Page (Page 1): This first page should include the manuscript title, the authors’ names and institutional affiliations, and the corresponding author’s name and contact information (postal address, telephone number, fax number, e-mail address). Abstract and Keywords (Page 2): The abstract should be written as one paragraph (without section headings) and should have no more than 150 words. The abstract should state the purpose of the study, basic procedures, most important findings, and principal conclusions with an emphasis on the new aspects of the study. Following the abstract, list up to 10 keywords or phrases for indexing. For LaTeX submissions, the abstract page may be combined with the title page. Nomenclature and Abbreviations in all manuscripts should conform to the International System of Units and all authors are encouraged to obtain a guide to the SI entitled Units, Symbols and Abbreviations from http://physics.nist.gov/cuu/Units/. Figures should not be embedded in the text but uploaded as separate files. All figures should be high resolution. TIFF, EPS, and PDF figures must conform to the following minimum resolution specifications: grayscale and color images: 300 dpi; combination grayscale and color images: 500e900 dpi. Line art (bitmap) figures must be 900e1200 dpi. References. Text references: References should be cited in the text stating, within parentheses, the first author’s surname and the year of publication, e.g. (Smith 1965). However, if the name is used as part of the sentence, only the year of publication should be given in the parentheses. Example: ‘‘. . . the study by Smith (1965) showed significant results.’’ If a reference has two authors, the citation should include the surnames of both authors. Example: (Smith and Jones 1965) or Smith and Jones (1965). If a reference has more than two authors, the citation should include only the surname of the first author and the abbreviation et al. Example: (Smith et al. 1965) or Smith et al. (1965). Multiple citations should be separated by semicolons and listed in alphabetical order. Example: (Brown 1965; Gray 1986; Jones 1988; Smith 1978). If the author(s) and the year are identical for more than one reference, a lowercase letter should be inserted after the year. Example: (Smith and Jones 1965a, 1965b) or Smith and Jones (1965a, 1965b). ‘‘Personal communications’’ may not be used as references, although references to written, not oral, communications may be inserted (in parentheses) in the text. Information from manuscripts submitted but not yet accepted should be cited in the text as ‘‘unpublished observations’’ (in parentheses). Uniform resource locators (URLs) may not be used for references. Reference list: The reference list should begin on a separate page at the end of the manuscript, and should be typed double-spaced like the text, with the second and third lines indented. This list is alphabetized by the first authors’ surname, not numbered. All references should be cited in the text, and should be verified by the author(s) against the original

documents. For each reference, all authors must be listed. Citations to the same first author(s) should be listed with the oldest date first. To facilitate proper organization of references and citations, UMB style templates for EndnoteÒ, RefworksÒ, and Reference ManagerÒ are available for download (http://ees.elsevier.com/umb/img/references. html). The full title of articles, chapters and books, and the beginning and ending page numbers should be given. Book references should include the location and name of the publisher. Papers that are accepted but not yet published can be included among the references by designating the journal and adding ‘‘in press’’ (in parentheses). The titles of journals should be abbreviated according to the style used in the List of Journals Indexed in Index Medicus, published annually as a separate publication by the US National Library of Medicine and as a list in the January issue of Index Medicus. Examples of correct forms of references are given below: Journal: Fleming AD, McDicken WN, Sutherland GR, Hoskins PR. Assessment of colour Doppler tissue imaging using test-phantoms. Ultrasound Med Biol 1994;20:937e41. Book: Williams AR. Ultrasound: Biological effects and potential hazards. New York: Academic Press, 1983. Edited book Haney MJ, O’Brien WD. Temperature dependency of ultrasonic propagation properties in biological materials. In: Greenleaf JF, ed. Tissue characterization with ultrasound. Boca Raton, FL: CRC Press, 1986. pp. 15e55. Footnotes. Footnotes, as distinct from literature references, should be avoided. Where they are essential, the following symbol order should be used: *, y, z, x, k. Tables. Tables should be numbered with Arabic numerals (1,2,3,etc.). Authors are asked to keep each table to a reasonable size; very large tables, packed with data, simply confuse the reader. Each table and every column should be provided with an explanatory heading, with units of measure clearly indicated. The same data should not be reproduced in both table and figure format. Footnotes to a table should be indicated by symbols in the following order: *, y, z, x, k. LaTeX Instructions. Template files and instructions for submitting manuscripts using LaTeX (optional) can be found here (http://umbjournal.org/content/ latex).

REVIEW & PRODUCTION PROCESS All manuscripts are peer reviewed. All material accepted for publication is subject to copyediting. Authors will receive PDF page proofs of their article before publication, and should answer all queries and carefully check all editorial changes. Any corrections to proofs must be restricted to printer’s errors; other than these, any substantial changes at this stage should be discussed with the Editor and, if accepted, will be charged to the author. Authors will receive a free electronic offprint. Additional print copies may be purchased using the offprint order form that is sent with the e-page proofs. There is a voluntary page charge, which however, is not a condition of publication.

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ULTRASOUND IN MEDICINE AND BIOLOGY Official Proceedings of the 14th Congress of the World Federation for Ultrasound in Medicine and Biology 16th Cong...

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