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Interventional procedures in superficial lesions: the value of 2D with additional coronal reformatted 4D ultrasonography guidance.

Chang CY, Wang HK, Chiou HJ, Chou YH, Chen TH, Chiou SY - Korean J Radiol (2006 Jan-Mar)

Bottom Line: No major procedure-related complications occurred.The procedural times were similar to those procedural times with using two-dimensional US.Combining the two dimensional and 4D US techniques aids the physician when performing US-guided interventional procedures for the superficial lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan. cmychang@vghtpe.gov.tw

ABSTRACT

Objective: We wanted to assess the usefulness of four-dimensional (4D) ultrasonography (US), i.e., real-time three-dimensional US, as an adjunct for performing various US-guided interventional procedures in superficial lesions.

Materials and methods: Thirty-three patients were referred for US-guided interventional procedures for superficial lesions, including core biopsy in 19, fine-needle aspiration in eight, therapeutic drug injection in four and needle puncture in two. The procedures were performed under 4D US guidance. We reviewed the pathologic/cytologic results of the core biopsies or needle aspirations, and also the outcomes of drug injection or needle puncture.

Results: For all the patients who underwent 4D US-guided core biopsy, the specimens were adequate for making the pathological diagnosis, and specimens were successfully obtained for those patients who underwent 4D US-guided aspiration. The patients treated with 4D US-guided therapeutic drug injection or needle puncture had a good response. No major procedure-related complications occurred. The procedural times were similar to those procedural times with using two-dimensional US.

Conclusion: Combining the two dimensional and 4D US techniques aids the physician when performing US-guided interventional procedures for the superficial lesions.

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Related in: MedlinePlus

A 21-year-old man suffering with osteogenic sarcoma in the left distal femur received neoadjuvant chemotherapy and surgical resection of the tumor. An enlarged, left inguinal lymph node was palpated.A. Color Doppler US showed the enlarged node with a prominent cortex of increased vascularity. The proposed optimal site for the needle aspiration was in the cortical portion of the node (arrowheads).B. Four-dimensional US-guided fine-needle aspiration was performed. Axial 2D image (left) showed that the needle (arrowheads) had penetrated into the cortex of the node. Real-time volume-rendered imaging in the coronal reformatted plane (right) showed the needle tip (arrow) in the central cortical portion of the node. By combining information from both images, we confirmed that the needle tip was in the central cortical portion of the node in all three orthogonal planes.
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Figure 2: A 21-year-old man suffering with osteogenic sarcoma in the left distal femur received neoadjuvant chemotherapy and surgical resection of the tumor. An enlarged, left inguinal lymph node was palpated.A. Color Doppler US showed the enlarged node with a prominent cortex of increased vascularity. The proposed optimal site for the needle aspiration was in the cortical portion of the node (arrowheads).B. Four-dimensional US-guided fine-needle aspiration was performed. Axial 2D image (left) showed that the needle (arrowheads) had penetrated into the cortex of the node. Real-time volume-rendered imaging in the coronal reformatted plane (right) showed the needle tip (arrow) in the central cortical portion of the node. By combining information from both images, we confirmed that the needle tip was in the central cortical portion of the node in all three orthogonal planes.

Mentions: Eight patients received 4D US-guided needle aspiration of their superficial lesions (Figs. 2, 3). All the procedures were performed successfully. Three of the patients had a clinical presentation of a gout attack. Monosodium urate crystals were identified in the aspirated specimens upon microscopic examination, which confirmed the clinical suspicion of gout. One patient with nasopharyngeal carcinoma presented with an enlarged lymph node (1.9 cm) in the right periauricular region, and this patient was diagnosed as having metastatic nasopharyngeal carcinoma after 4D US-guided aspiration. Two patients with enlarged lymph nodes in the neck (0.8 cm) or the inguinal region (2.9 cm) underwent 4D US-guided needle aspiration, and this showed no evidence of malignancy. These two patients had no evidence of progressive change in their nodal status at the 1-year clinical follow-up. One patient with a hypoechoic nodule in the right thyroid (1.8 cm in size), underwent 4D US-guide aspiration and there was no evidence of malignancy. One patient suffered from a small subdeltoid ganglion (0.5 cm). After aspiration of about 0.5 cc of jelly-like material, the patient's symptoms were dramatically relieved. There is no recurrence at six months follow up.


Interventional procedures in superficial lesions: the value of 2D with additional coronal reformatted 4D ultrasonography guidance.

Chang CY, Wang HK, Chiou HJ, Chou YH, Chen TH, Chiou SY - Korean J Radiol (2006 Jan-Mar)

A 21-year-old man suffering with osteogenic sarcoma in the left distal femur received neoadjuvant chemotherapy and surgical resection of the tumor. An enlarged, left inguinal lymph node was palpated.A. Color Doppler US showed the enlarged node with a prominent cortex of increased vascularity. The proposed optimal site for the needle aspiration was in the cortical portion of the node (arrowheads).B. Four-dimensional US-guided fine-needle aspiration was performed. Axial 2D image (left) showed that the needle (arrowheads) had penetrated into the cortex of the node. Real-time volume-rendered imaging in the coronal reformatted plane (right) showed the needle tip (arrow) in the central cortical portion of the node. By combining information from both images, we confirmed that the needle tip was in the central cortical portion of the node in all three orthogonal planes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667574&req=5

Figure 2: A 21-year-old man suffering with osteogenic sarcoma in the left distal femur received neoadjuvant chemotherapy and surgical resection of the tumor. An enlarged, left inguinal lymph node was palpated.A. Color Doppler US showed the enlarged node with a prominent cortex of increased vascularity. The proposed optimal site for the needle aspiration was in the cortical portion of the node (arrowheads).B. Four-dimensional US-guided fine-needle aspiration was performed. Axial 2D image (left) showed that the needle (arrowheads) had penetrated into the cortex of the node. Real-time volume-rendered imaging in the coronal reformatted plane (right) showed the needle tip (arrow) in the central cortical portion of the node. By combining information from both images, we confirmed that the needle tip was in the central cortical portion of the node in all three orthogonal planes.
Mentions: Eight patients received 4D US-guided needle aspiration of their superficial lesions (Figs. 2, 3). All the procedures were performed successfully. Three of the patients had a clinical presentation of a gout attack. Monosodium urate crystals were identified in the aspirated specimens upon microscopic examination, which confirmed the clinical suspicion of gout. One patient with nasopharyngeal carcinoma presented with an enlarged lymph node (1.9 cm) in the right periauricular region, and this patient was diagnosed as having metastatic nasopharyngeal carcinoma after 4D US-guided aspiration. Two patients with enlarged lymph nodes in the neck (0.8 cm) or the inguinal region (2.9 cm) underwent 4D US-guided needle aspiration, and this showed no evidence of malignancy. These two patients had no evidence of progressive change in their nodal status at the 1-year clinical follow-up. One patient with a hypoechoic nodule in the right thyroid (1.8 cm in size), underwent 4D US-guide aspiration and there was no evidence of malignancy. One patient suffered from a small subdeltoid ganglion (0.5 cm). After aspiration of about 0.5 cc of jelly-like material, the patient's symptoms were dramatically relieved. There is no recurrence at six months follow up.

Bottom Line: No major procedure-related complications occurred.The procedural times were similar to those procedural times with using two-dimensional US.Combining the two dimensional and 4D US techniques aids the physician when performing US-guided interventional procedures for the superficial lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan. cmychang@vghtpe.gov.tw

ABSTRACT

Objective: We wanted to assess the usefulness of four-dimensional (4D) ultrasonography (US), i.e., real-time three-dimensional US, as an adjunct for performing various US-guided interventional procedures in superficial lesions.

Materials and methods: Thirty-three patients were referred for US-guided interventional procedures for superficial lesions, including core biopsy in 19, fine-needle aspiration in eight, therapeutic drug injection in four and needle puncture in two. The procedures were performed under 4D US guidance. We reviewed the pathologic/cytologic results of the core biopsies or needle aspirations, and also the outcomes of drug injection or needle puncture.

Results: For all the patients who underwent 4D US-guided core biopsy, the specimens were adequate for making the pathological diagnosis, and specimens were successfully obtained for those patients who underwent 4D US-guided aspiration. The patients treated with 4D US-guided therapeutic drug injection or needle puncture had a good response. No major procedure-related complications occurred. The procedural times were similar to those procedural times with using two-dimensional US.

Conclusion: Combining the two dimensional and 4D US techniques aids the physician when performing US-guided interventional procedures for the superficial lesions.

Show MeSH
Related in: MedlinePlus