Snowstorm appearance of synovial fluid on musculoskeletal ultrasound Cheng-Hsun Lu, Ko-Jen Li Journal of Medical Ultrasound 2019 27(3):119-120

Thickness of the plantar fascia in asymptomatic subjects Lova Hasina Rajaonarison Ny Ony Narindra, Nicolas Fanantenana Herinirina, Holitiana Rakotonirina, Gabrielle Emmylou Andrianah, Hasina Dina Ranoharison, Rado Randriamboavonjy, Ahmad Ahmad Journal of Medical Ultrasound 2019 27(3):121-123 Objectives: The objectives of this study are to determine the average and extreme values of the thickness of plantar fascia (PF) and to evaluate its correlations with anthropometric parameters and walking activity. Materials and Methods: Analytic study of 226 feet. On these feet, the thickness of the PF was measured on ultrasound; and its correlation with the age, height, weight, body mass index (BMI), gender, and daily walking of the participants were studied. Results: Thickness of the PF was symmetrical; the extreme values were 1.8 mm and 4.3 mm with an average of 3 mm ± 0.5. There was positive correlation of PF thickness with age, height, weight, BMI, and daily walking (P < 0.05). The variation of the PF thickness with gender was not significant (P > 0.05). Conclusion: Thickness of PF has a close correlates with age, height, weight, BMI, and walking activity.

Diagnostic use of ultrasonography in carpal tunnel syndrome and its correlation with the Chinese version of boston carpal tunnel questionnaire Xue Deng, Lai-Heung Phoebe Chau, Suk-Yee Chiu, Kwok-Pui Leung, Yong Hu, Wing-Yuk Ip Journal of Medical Ultrasound 2019 27(3):124-129 Introduction: There were yet no correlation studies performed between ultrasound and the Chinese version of Boston Carpal Tunnel Questionnaire (C-BCTQ). Besides, controversies still remain regarding the correlation between ultrasound and different language versions of BCTQ. Purpose of the Study: To examine whether ultrasound can (i) reflect symptom severity and/or functional status, (ii) differentiate primary/secondary symptom, and (iii) correlate with subscale items in C-BCTQ. Methods: Forty-two Chinese female individuals (aged 58.84 ± 9.02 years) with 73 hands were enrolled in the study. Factor analysis was used to identify the hidden factors of C-BCTQ. Correlations were examined between hidden factors, relevant subscale items of C-BCTQ, and ultrasound. Results: Three factors were identified as Factor One (functional status, 36.534%), Two (sensory symptoms, 15.057%) and Three (pain, 11.867%), with 63.458% of total variance explained in C-BCTQ. All the ultrasound parameters were positively correlated with Factor One (r = 0.29-0.411, P < 0.05), while no correlations were found with Factor Two and Three. Meanwhile, correlation between wrist cross-sectional area and functional status scale (FSS) was also found (W-CSA, r = 0.266, P = 0.023), whereas no correlation was found with symptom severity scale (SSS), subscales of primary symptom (Paresthesia) and secondary symptom (pain) related items in C-BCTQ. Conclusion: Morphological information via ultrasound can reflect the impact on functionality that carpal tunnel syndrome (CTS) exerted. However, it can be used neither to describe symptom severity nor differentiate primary/secondary symptom of CTS.

Cutoff values of acoustic radiation force impulse two-location measurements in different etiologies of liver fibrosis Tse-Hwa Hsu, Po-Hsiang Tsui, Wan-Ting Yu, Shiu-Feng Huang, Jennifer Tai, Yung-Liang Wan, Dar-In Tai Journal of Medical Ultrasound 2019 27(3):130-134 Background: Acoustic radiation force impulse (ARFI) imaging is a popular modality to measure liver fibrosis. ARFI selects optimal locations for measurement under imaging guiding. However, there are concerns on study locations and observers bias. To decrease the variations, ARFI at two locations was measured with standardized protocol. This study attempted to establish its cutoff values according to Metavir fibrosis score in different etiologies. Methods: A consecutive series of patients who received liver histology study were prospectively enrolled. All cases had hemogram, liver biochemistry, viral markers, and ARFI two-location measurements within 4 weeks of histology study. A standardized protocol was performed by single technologist. We excluded patients with alanine aminotransferase >5x upper limit normal. Results: Five hundred and ten patients that included 153 seronegative for both HBsAg and anti-HCV Non-B non-C (NBNC), 33 autoimmune liver diseases (AILD), 261 chronic hepatitis B (CHB), and 63 chronic hepatitis C (CHC) were enrolled. About 83% of NBNC patients had fat cell >5%. For diagnosis of liver cirrhosis, the area under receiver operating characteristic curve of NBNC, AILD, CHB, and CHC groups was 0.937, 0.929, 0.784, and 0.937; the cutoff values for mean ARFI were 1.788, 2.095, 1.455, and 1.710 m/s, respectively. The sensitivity and specificity are both over 0.818 for patients with nonalcoholic fatty liver diseases, CHC, and AILD, but the corresponding data are only 0.727–0.756 in CHB. The Fibrosis-4 Score is as good as ARFI on fibrosis assessment in NBNC. Conclusion: The performance of ARFI two-location measurement is excellent in NBNC, AILD, and CHC, but is only satisfactory in CHB.

Role of orbital ultrasound in the assessment of clinically detected papilledema Khaleel Ibraheem Mohson, Noor Auday Journal of Medical Ultrasound 2019 27(3):135-140 Background: Increased intracranial pressure (ICP) is frequently seen, and it is considered a serious problem that needs a careful assessment and management, especially by easy and least invasive modalities. Objective: The objective of the study is to assess the optic nerve sheath diameter (ONSD) using transorbital ultrasound (US) as a marker and indicator for diagnosing raised intracranial pressure. Patients and Methods: It is a prospective study that was carried out in Neurology and/or Ophthalmology Clinics, Baghdad Teaching Hospital in the Medical City Complex during the period from June 2016 to May 2017; in this study, 40 patients seeking medical help for other causes were considered to be a control group and the other 40 patients who were complaining of raised ICP symptoms and suggested of having optic disc swelling by ophthalmoscopy examination. All the patients and the control group were examined by transorbital US to measure the ONSD, and then, only the patients with symptoms of raised intracranial underwent a lumbar puncture (LP). Results: Pearson's correlation test was used, demonstrating a very significant correlation between the ultrasonographic ONSD and the measurements of LP (R > 0.9) and (P < 0.001). Transorbital US yielded high sensitivity (91.6%) with modest specificity (75%) and high accuracy (90.0%) of ONSD was considered the normal the cutoff value of (5 mm) obtained from the control group. The US also showed the crescent sign and the optic disc bulging with lower sensitivity than the ONSD (61.1% and 41.6%, respectively) but with very high specificity (100%) for both. Conclusion: ONSD by transorbital ultrasonography is highly accurate, easily performed, and noninvasive procedure for the detection of raised ICP. Routine daily monitoring of ONSD could be of help in intensive care units when invasive ICP monitoring is not available or contraindicated; it also has a good role in early recognition of intracranial hypertension.

Is thyroid imaging reporting and data system useful as an adult ultrasonographic malignancy risk stratification method in pediatric thyroid nodules? Yasemin Durum Polat, Veli Süha Öztürk, Nimet Ersoz, Ahmet Anık, Can Zafer Karaman Journal of Medical Ultrasound 2019 27(3):141-145 Background: Data on thyroid imaging reporting and data system (TI-RADS) generally belong to studies performed in adults. Therefore, we aimed to evaluate the performance and utility of TI-RADS in the pediatric group. Materials and Methods: From January 2015 to 2018, 108 nodules were evaluated in 1028 thyroid ultrasound examinations. Images were retrospectively evaluated by two radiologists with 3 and 7 years of pediatric radiology experience, according to TI-RADS classification. Morphological findings of the detected nodules and their histopathological results were recorded. Histopathological findings and at least 12 months of follow-up imaging were taken as reference. Results: Seventy-one patients were female (67%). The mean age was 11.4 ± 4.7, and the mean nodule size was 7.4 ± 8.3 mm. According to the histopathological assessment and at least 12 months' follow-up with clinical and sonographic stability 100 (95.2%) of the nodules were benign and 5 (4.8%) were malignant. Two nodules, nondiagnostic cytology and 1 nodule were found to be suspicious for malignancy. All malignant nodules were in the TI-RADS 5 category. The majority of benign nodules (79%) were found in low TI-RADS categories. About 80% of the malignant nodules were very hypoechoic and taller than wide in shape, also all malignant nodules had microcalcifications (P = 0.000). The sensitivity of TI-RADS was 100%, specificity was 78.8%, positive predictive value (PPV) was 19.2%, and negative predictive value (NPV) was 100%. Conclusion: According to our study, TI-RADS system can be used to evaluate thyroid nodules in pediatric patients similar to adults.

Contrast-enhanced ultrasonography for the diagnosis of frozen shoulder Kamal Mezian, Ke-Vin Chang Journal of Medical Ultrasound 2019 27(3):146-147 Introduction: Adhesive capsulitis (AC), also known as frozen shoulder, is challenging for diagnosis, particularly in early stages. A promising tool is contrast-enhanced ultrasonography (CEUS), which has been successfully applied on musculoskeletal ultrasonography. Methods and Results: Two antecedent studies reported the application of CEUS on AC patients although different methods were used. The first research team administered the contrast media intravenously to facilitate detection of microcirculation through observing different distributions of time–intensity curves between the affected and unaffected shoulders.The second study has introduced a pioneering approach, injecting the contrast media mixed with saline directly into the glenohumeral joint. The authors designated this novel method as “US arthrography”. According to our best knowledge, this is the first study reporting the application of intraarticular CEUS in humans. Conclusion: Both presented studies reported CEUS to be capable of differentiating shoulders with AC from normal controls.

Nonoperative choice of anterior cruciate ligament partial tear: Ultrasound-guided platelet-rich plasma injection Chi-Kai You, Chen-Liang Chou, Wei-Ting Wu, Yu-Chun Hsu Journal of Medical Ultrasound 2019 27(3):148-150 Anterior cruciate ligament (ACL) injury is one of the common musculoskeletal injuries. The most serious condition shall be managed by surgery, while the partial tear prefers conservative treatment, rehabilitation, exercise training, or platelet-rich plasma (PRP) injection. We describe the case of a 25-year-old female started to have right knee pain for a long time and the ACL partial tear was diagnosed through the magnetic resonance imaging (MRI). After three times of PRP injection through ultrasound guidance, the pain, instability, and enhancements of ACL tear in the postintervention MRI were decreased. This case confirms the effect of PRP combined with conservative treatment under the accuracy procedure and may provide another choice for the treatment of the ACL tear.

Congenital duodenal stenosis: Prenatal evaluation by three-dimensional ultrasound HDlive silhouette mode, magnetic resonance imaging, and postnatal outcomes Pedro Teixeira Castro, Ana Paula Pinho Matos, Heron Werner, Edward Araujo Júnior Journal of Medical Ultrasound 2019 27(3):151-153 The “double bubble” sign is a common sign of congenital duodenal obstruction (CDO), which has been detected during prenatal diagnosis for over 40 years. CDO is strongly associated with chromosomal and structural abnormalities and encompasses a wide spectrum of diagnoses. Here, we describe a case of duodenal stenosis, a rare cause of duodenal obstruction, which was suspected using conventional two-dimensional ultrasound and three-dimensional reconstruction with the HDlive silhouette mode at the 28th prenatal week. The suspicion was further supported by magnetic resonance imaging performed at the 32nd prenatal week and confirmed by postnatal surgery.

Application of sonography in the diagnosis and follow-up of trapped temporal horn of lateral ventricle: Two case reports Jia-Yun Huang, Nan-Chang Chiu, Muh-Lii Liang, Hui-Ju Chen, Yi-Jie Lin, Che-Sheng Ho Journal of Medical Ultrasound 2019 27(3):154-157 Trapped temporal horn of lateral ventricle (TTHLV) is a rare condition of isolated focal hydrocephalus. We report two cases with different presentations, etiologies, and surgical managements. The first case involved an extremely preterm male baby with a history of ventriculitis and intraventricular hemorrhage; he received external ventricle drainage twice due to obstructive hydrocephalus. TTHLV was detected by sonography. He received a ventriculoperitoneal shunt involving two catheters to bypass the adhesion site. There was no ventricular dilatation during 2 years of follow-up. The second case involved a term baby with an enlarged head; brain sonography revealed left focal hydrocephalus with TTHLV and mild midline shift. Neuroendoscopic cystoventriculostomy with fenestration from the left trigone to the frontal horn was performed and serial follow-up brain sonography for 3 months showed decreased ventricle size. The suitable surgical techniques for the management of TTHLV should be adjusted according to the patients' condition to obtain more favorable outcomes. Brain sonography can be a useful tool for the diagnosis and for following up the surgical outcomes in infants with TTHLV.