Abstract Book

Transcription

Abstract Book

Abstract Book
Day 1 (Friday, 20 May)
Categorical Course
Breast
valuating the Symptomatic
E
Patient
08:00 - 09:30
Pediatric
08:00 - 09:30
GBR 103
Chairpersons:
Eun Suk Cha Ewha Womans University Mokdong Hospital, Korea
Bo Kyoung Seo Korea University Ansan Hospital, Korea
CC 1 BR-1 08:00 - 08:20
US Evaluation for Breast Pain
21
Su Hyun Lee
Department of Radiology, Seoul National University
Hospital, Korea
CC 1 BR-2 08:20 - 08:40
US Evaluation for Palpable Lump in the Breast
22
Eun Young Chae
Department of Radiology, Asan Medical Center, Korea
CC 1 BR-3
08:40 - 09:00
US Evaluation for Nipple Discharge
23
Jung Hyun Yoon
Department of Radiology, Severance Hospital, Korea
CC 1 BR-4
09:00 - 09:20
Ultrasound Evaluation for Axillary Lesion
24
Ji Soo Choi
Department of Radiology, Samsung Medical Center, Korea
S of Male Genitourinary
Genitourinary U
08:00 - 09:20
Tract
First Step in Pediatric Brain and
Spine US
Room 201
Chairpersons:
Byung Chul Kang E
wha Womans University Mokdong Hospital,
Korea
Hak Jong Lee Seoul National University Bundang Hospital, Korea
CC 2 GU-1
08:00 - 08:25
Ultrasound Image of Kidney, Adrenal Gland, and 26
Bladder
Hyuck Jae Choi
Department of Radiology, Kangwon National University
Hospital, Korea
CC 2 GU-2
08:25 - 08:50
US of Scrotum
28
Sung Il Jung
Department of Radiology, Konkuk University Medical
Center, Korea
CC 2 GU-3
08:50 - 09:15
US of Prostate
38
Deuk Jae Sung
Department of Radiology, Korea University Anam Hospital,
Korea
Room 203
Chairpersons:
Young Seok Lee Dankook University Hospital, Korea
So-Young Yoo Samsung Medical Center, Korea
CC 3 PED-1
08:00 - 08:30
Pediatric Brain US: Technique and Normal Anatomy 41
Yun Jung Lim
Department of Radiology, Inje University Haeundae Paik
Hospital, Korea
CC 3 PED-2
08:30 - 09:00
Pediatric Brain US: Common Pathology
46
Yun-Woo Chang
Department of Radiology, Soonchunhyang University Seoul
Hospital, Korea
CC 3 PED-3
09:00 - 09:30
Pediatric Spinal Canal US
54
Bo-Kyung Je
Department of Radiology, Korea University Ansan Hospital,
Korea
Physics
Physics in Emerging Ultrasound
Imaging Technologies
08:30 - 09:30
Chairperson: Yong-Tae Kim KRISS, Korea
GBR 101
CC 4 PHY-1
08:30 - 08:50
Principles in Ultrasound Elastography Imaging
56
Tai-Kyong Song
Department of Electronic Engineering, Sogang University,
Korea
CC 4 PHY-2
08:50 - 09:10
Principles in Photoacoustic Imaging
57
Junghwan Oh
Department of Biomedical Engineering, Pukyong National
University, Korea
CC 4 PHY-3
09:10 - 09:30
Principles in Ultrafast Ultrasound Imaging
58
Yangmo Yoo
Department of Electronic Engineering and Biomedical
Engineering, Sogang University, Korea
Cardiovascular
10:30 - 12:00
Doppler USG: From Basic to
Cutting Edge
Room 203
Chairpersons:
Jongmin Lee Kyungpook National University & Hospital, Korea
Ki Seok Choo Pusan National University Yangsan Hospital, Korea
CC 5 CV-1 10:30 - 10:50
Carotid Doppler USG: Practical Application
Yeo Koon Kim
Bundang Hospital, Korea
59
1
CC 5 CV-2
10:50 - 11:20
Contrast-Enhanced Ultrasound in Imaging Carotid 61
Arterial Diseases
Dirk-Andre Clevert
Department of Radiology, University of MunichGrosshadern Campus, Germany
CC 5 CV-3
11:20 - 11:40
Lower Extremity Artery: Evaluation with USG
62
Ho Jong Chun
Department of Radiology, The Catholic University of Korea,
Seoul St. Mary's Hospital, Korea
CC 5 CV-4
11:40 - 12:00
Lower Extremity Vein: Evaluation with USG
63
Ki Seok Choo
Department of Radiology, Pusan National University
Yangsan Hospital, Korea
09:20 - 10:10
enile Doppler US: Can It
P
Stand in Future?
Room 201
Chairpersons:
Jongchul Kim Chungnam National University Hospital, Korea
Seong Kuk Yoon Dong-A University Hospital, Korea
MS GU-1
09:20 - 09:40
Penile Doppler US: Revisited
Dae Chul Jung
MS GU-2
09:40 - 10:00
New Clinical Application of Penile Doppler US
Joo Yong Lee
Department of Urology, Severance Hospital, Korea
65
70
Screening Breast US
09:30 - 10:10
GBR 103
Chairperson:
Woo Kyung Moon Seoul National University Hospital, Korea
HI 1 BR-1
09:30 - 10:00
Mammographic Breast Density and Screening 73
Ultrasound
Jiyon Lee
Department of Radiology, New York University School of
Medicine, USA
KMUL: Intensification of Technical Competitive Strength in
Korean Diagnostic and Therapeutic
10:05 - 11:30
Chairperson:
송태경, 서강대학교
HI 2 KMUL-1
HI 2 KMUL-3
10:25 - 10:35
HI 2 KMUL-4
10:35 - 10:45
HI 2 KMUL-5
10:45 - 11:00
HI 2 KMUL-6
11:00 - 11:15
HI 2 KMUL-7
11:15 - 11:30
의료기기 R&D 지원 방향 - 미래창조과학부
허성오
한국연구재단
의료기기 지원 방향 - 보건복지부
박순만
한국보건산업진흥원
미래초음파 혁신기술 - 진단기술
박진용
알피니언메디칼시스템
미래초음파 혁신기술 - 모바일헬스케어 기술
류정원
힐세리온
Special Focus Session
Hot Issues
Breast
10:15 - 10:25
의료기기 R&D 지원 방향 - 산업통상자원부
허 영
한국산업기술평가원
미래초음파 혁신기술 - 치료기술
장진우
세브란스병원
Multidisciplinary Session
Genitourinary
HI 2 KMUL-2
KOR
GBR 101
Breast
Breast US BI-RADS
10:30 - 12:00
Chairpersons:
Hak Hee Kim Asan Medical Center, Korea
Boo-Kyung Han Samsung Medical Center, Korea
SFS 1 BR-1
10:30 - 10:55
Update in Breast US BI-RADS
91
Bong Joo Kang
SFS 1 BR-2
10:55 - 11:25
Clinical Applications of Breast Ultrasound BI-RADS 94
Jiyon Lee
Department of Radiology, New York University School of
Medicine, USA
SFS 1 BR-3
11:25 - 11:50
Medical Audit of Screening Breast US
101
Min Jung Kim
KSUM General Assembly
12:10 - 13:20
KMUL General Assembly
12:10 - 13:20
10:05 - 10:15
초음파영상연구의 새로운 방향: 임상적 측면
최병인
초음파의료기기연구회
2
GBR 103
The 47th Annual Congress of Korean Society of Ultrasound in Medicine
KOR
GBR 103
KOR
GBR 101
Luncheon Symposium
Toshiba
R
ecent Advancement in Radiologic
Technology
12:10 - 13:20
GBR 102
Chairperson:
Byung Ihn Choi Chung-Ang University Hospital, Korea
LS 1 Toshiba-1
12:10 - 12:40
Superb Micro-vascular Imaging and Contrast-
103
enhanced US: Assessment of Breast Tumor Vascularity
Bo Kyoung Seo
Department of Radiology, Korea University Ansan Hospital,
Korea
LS 1 Toshiba-2
12:40 - 13:10
Shear Wave Elastography with a Propagation Map 104
in Chronic Hepatitis: Comparison with Transient
Elastography and Interobserver Agreement
Eun Sun Lee
Department of Radiology, Chung-Ang University Hospital,
Korea
Genitourinary
Upcoming Issues of Renal US
13:20 - 14:50
Room 201
Chairpersons:
Min Hoan Moon SNU Boramae Medical Center, Korea
Young Taik Oh Yonsei Severance Hospital, Korea
SFS 2 GU-1 13:20 - 13:40
Overview of Elastography in Renal Disease
105
Liang Wang
Department of Ultrasound, Peking Union Medical College
Hospital, China
SFS 2 GU-2 13:40 - 14:00
ARFI Quantification in Chronic Renal Disease
109
Liang Wang
Department of Ultrasound, Peking Union Medical College
Hospital, China
SFS 2 GU-3
14:00 - 14:20
US of Renal Artery Stenosis: Revisited
113
Byung Kwan Park
SFS 2 GU-4
14:20 - 14:40
Contrast Enhanced Ultrasound of Renal Disease 114
Jung Jae Park
Pediatric
SFS 3 PED-2
13:50 - 14:20
Emergency US in Gastrointestinal Tract
Jae-Yeon Hwang
SFS 3 PED-3
14:20 - 14:50
Emergency US in Pediatric Musculoskeletal System
Jung-Eun Cheon
Hospital, Korea
136
139
The Korean Society for Therapeutic Ultrasound
Therapeutic Ultrasound
13:20 - 14:50
GBR 102
Chairpersons:
Min Joo Choi School of Medicine, Jeju National University, Korea
Jae Young Lee Seoul National University Hospital, Korea
KSTU-1 13:20 - 13:50
Physics in Therapeutic Ultrasound
142
Yongrae Roh
Department of Medical Engineering, Kyungpook National
University Hospital, Korea
KSTU-2
13:50 - 14:10
Brain Applications Using Therapeutic Ultrasound 143
Jin Woo Chang
Department of Neurosurgery, Yonsei University Severance
Hospital, Korea
KSTU-3
14:10 - 14:30
Body Applications Using Therapeutic Ultrasound 144
Young Sun Kim
KSTU-4
14:30 - 14:50
Emerging Technologies in Therapeutic Ultrasound 145
Eun Joo Park
Department of Biomedical Research Institute, Seoul
National University Hospital, Korea
Jisan Lecture
15:20 - 16:30
GBR 103
Chairperson:
Kil-Ho Cho Yeungnam University Medical Center, Korea
JS-1
15:25 - 16:10
Hip, Groin and Beyond
Marnix van Holsbeeck
Department of Radiology, Henry Ford Hospital, USA
146
Pediatric Emergency US
13:20 - 14:50
Room 203
Chairpersons:
Young Seok Lee Dankook University Hospital, Korea
Jung-Eun Cheon Seoul National University Hospital, Korea
SFS 3 PED-1 13:20 - 13:50
Emergency US in Urogenital Field
Masahiro Kitami
Department of Radiology, Tohoku University, Japan
115
3
Interactive Case Review
16:30 - 17:50
GBR 103
Chairpersons:
Joon Il Choi The Catholic University of Korea, Seoul St. Mary's
Hospital, Korea
Jung-Ah Choi H
allym University Dongtan Sacred Heart Hospital,
Korea
Panelists Abdomen
Mi-Hye Yu
Konkuk University Medical Center, Korea
Breast
Jung Min Chang
Seoul National University Hospital, Korea
Genitourinary
Sung Yoon Park
Severance Hospital, Korea
Musculoskeletal
Eun Hae Park
Chonbuk National University Hospital, Korea
H&N / Thyroid
Hyun Kyung Lim
Soonchunhyang University Seoul Hospital, Korea
Pediatric
Ah Young Jung
Asan Medical Center, Korea
Series Course
Breast
volving Issues in Breast Ultrasound
E
Imaging and Intervention
13:20 - 14:20
GBR 103
Chairpersons:
Sun Mi Kim Seoul National University Bundang Hospital, Korea
Seung Ja Kim Sheikh Khalifa Specialty Hospital, UAE
SC 1 BR-1 13:20 - 13:30
Evolving Technologies in Breast Ultrasound
147
Young Mi Park
Department of Radiology, Inje University Busan Paik
Hospital, Korea
SC 1 BR-2
13:30 - 13:40
Comparison and Combination of Two Ultrasound 238
Techniques of Automated Breast Volume Scanner and
Hand Held Ultrasound: With and Without Knowledge of
MRI
Yoonsoo Kim, Bong Joo Kang, Sung Hun Kim
SC 1 BR-3
13:40 - 13:50
How and When to Use a Computer-Aided 238
Diagnosis System in Breast Ultrasound?
Yoonsoo Kim, Bong Joo Kang, Ji Eun Baek,
Hyun Sil Lee, Sung Hun Kim
SC 1 BR-4
13:50 - 14:00
Clinical Application of S-DetectTM to Breast 239
Masses on US: A Study Evaluating the Diagnostic
Performances and Agreement with a Dedicated Breast
Radiologist
Kiwook Kim, Jung Hyun Yoon
4
SC 1 BR-5
14:00 - 14:10
Ultrasound-Guided Preoperative SAVI SCOUT 239
Reflector Placement for Intraoperative Guidance for
Nonpalpable Breast Lesions: Preliminary Data of
Prospective Multi-Institutional Clinical Evaluation
Jiyon Lee, Hilde Toth, Freya Schnabel,
Jennifer Chun Kim, Kathleen Allen,
Peter Blumencraz, Steven Shivers, Charles Cox
Department of Radiology, NYU School of Medicine, USA
SC 1 BR-6
14:10 - 14:20
Combined Use of Ultrasonography and Virtual 240
Touch Tissue Imaging Quantification to Differentiate
Benign and Malignant Breast Lesions Small than 10
mm
Zeng Zeng
Department of Radiology, Shanghai Tenth People's
Hospital of Tongji University, China
Young Investigator Award
14:20 - 14:50
GBR 103
Chairperson:
Se Hyung Kim Seoul National University Hospital, Korea
YIA-114:20-14:30
Assessment of Respiratory Motion Effect on 240
Focal Liver Lesions Using Image Fusion of
Computed Tomography and Ultrasonography
Hyun Jeong Park1, Min Woo Lee2, Tae Wook Kang2,
Jiwon Ryu3, Jaeil Kim3, Won-Chul Bang3,
Young-Taek Oh1, Jung-Woo Chang1, Byung Ihn Choi1
1
Korea
2
3
Department of Medical Engineering, Samsung Electronics
Co., Ltd., Korea
YIA-2
14:30 - 14:40
Shear-Wave Elastography in Diagnosis of Breast 241
Non-Mass Lesions: Influencing Factors for FalseNegative and False-Positive Results
So Yoon Park, Ji Soo Choi, Boo-Kyung Han,
Eun Young Ko, Eun Sook Ko
YIA-3
14:40 - 14:50
Long Term Follow-Up of Breast Cancer Survivors 241
Detected by Screening Program in Korean Women
Aged 40-49 Years in Comparison that Detected by
Symptom
So Yeon Won1, Seung Ii Kim2, Hyung Seok Park2,
Eun-Kyung Kim1, Hee Jung Moon1,
Jung Hyun Yoon1, Min Jung Kim1
1
2
Department of Surgery, Severance Hospital, Korea
Scientific Sessions
Cardiovascular
9:30 - 10:10
Room 203
Chairperson:
Sang Il Choi Seoul National University Bundang Hospital, Korea
SS 1 CV-1
09:30 - 09:40
Ultrasound Fusion Imaging with Real-Time 231
Navigation for EVAR Surveillance
Jin Hyun Joh
Department of Surgery, Kyung Hee University Hospital at
Gangdong, Korea
SS 1 CV-2
09:40 - 09:50
Value of Contrast Enhanced Ultrasound in Long 231
Term Surveillance for Endoleaks after Aortic
Endovascular Aneurysm Repair: An Interesting Case
Illustration
Wey Chyi Teoh, Andrew Tan
Department of Radiology, Changi General Hospital,
Singapore
SS 1 CV-3
09:50 - 10:00
Noninvasive Measurement of Regional Pulse 232
Wave Velocity in Human Ascending Aorta with
Ultrasound Imaging
Chengwu Huang1, Dong Guo2, Feng Lan3,
Hongjia Zhang2, Jianwen Luo1
1
Department of Biomedical Engineering, Tsinghua
University, China
2
Department of Cardiac Surgery, Capital Medical University,
Beijing Anzhen Hospital, China
3
Department of Beijing Institute of Heart, Lung and Blood
Vessel Diseases, China
SS 1 CV-4
10:00 - 10:10
A Comparison of Popliteal Arteries Between 232
Fractured and Sound Legs by Ultrasound in Patients
with Femur Fracture
Kwang Jae Lee, Yong-Soon Yoon, Eun-Sil Kim,
Jung-Hoo Lee
Department of Rehabilitation Medicine, Presbyterian
Medical Center, Seonam University College of Medicine,
Korea
Genitourinary
11:40 - 12:00
Room 201
Chairperson:
Sung Eun Rha T
he Catholic University of Korea, Seoul St. Mary's
Hospital, Korea
Pediatric
10:30 - 11:40
SS 2 PED-3
10:50 - 11:00
Reproducibility of the Supersonic Shear-Wave 234
Elastography for Evaluation of the Liver Stiffness in
Children
Hee Mang Yoon, Jeong Rye Kim, Ah Young Jung,
Jin Seong Lee, Young Ah Cho
SS 2 PED-4
11:00 - 11:10
UltraFast Doppler Ultrasonography for Arterial 234
Evaluation in Children: Comparison with Conventional
Doppler Ultrasonography
Yu Jin Kim, Young Hun Choi, Jung-Eun Cheon,
Woo Sun Kim, In-One Kim, Ji-Eun Park, Youngjin Ryu
Hospital, Korea
SS 2 PED-5
11:10 - 11:20
Ultrasonographic Malignancy Risk Stratification 235
of Thyroid Nodules in Children: Comparison between
K-TIRADS and KSThR Guidelines
Young Jin Ryu, Ji Eun Park, Yu Jin Kim, Jung-Eun Cheon,
Young Hun Choi, Woo Sun Kim, In-One Kim
Hospital, Korea
SS 2 PED-6
11:20 - 11:30
Effect of Body Mass Index in the Diagnosis of 236
Nutcracker Syndrome in Children
Mi-Jung Lee1, Mu Sook Lee2, Myung-Joon Kim1,
Hyun Joo Shin1, Haesung Yoon1
1
2
Department of Radiology, Jeju National University
Hospital, Korea
SS 2 PED-7
11:30 - 11:40
Ultrasonographic Findings of Inguinal Hernia 236
Containing Ovary or Omental Fat in Girls
Su-Mi Shin
Boramae Medical Center, Korea
Room 201
Chairpersons:
Choon-Sik Yoon Gangnam Severance Hospital, Korea
Hye-Kyung Yoon Kangwon National University Hospital, Korea
SS 2 PED-1
10:30 - 10:40
Ultrasonographic Detection of Cerebellar 233
Hemorrhage in Preterm Infants: Comparison with MR
Findings
Ji Eun Park, Young Jin Ryu, Yu Jin Kim,
Young Hun Choi, Jung-Eun Cheon, Woo Sun Kim,
In-One Kim
Hospital, Korea
SS 2 PED-2
10:40 - 10:50
Correlation of Postnatal US and MR Findings of 233
Isolated Ventriculomegaly
Jeong Rye Kim, Ah Young Jung, Jin Seong Lee,
Young Ah Cho, Hee Mang Yoon
SS 2 GU-1
11:40 - 11:50
A Comparison of Ultrasound Guided 237
Transperineal and Transrectal Prostate Biopsy
for Detection of Prostate Cancer: A Prospective
Randomized Controlled Trial
Le-Hang Guo, Hui-Xiong Xu, Hui-Jun Fu
Hospital, China
SS 2 GU-2
11:50 - 12:00
The Use of VTIQ as New Tissue Strain Analytics 237
Measurement in Testicular Lesions
Dirk-Andre Clevert
Department of University of Munich-Grosshadern Campus,
Radiology, Germany
5
Physics
13:20 - 14:50
Chairperson:
Yangmo Yoo Sogang University, Korea
GBR 101
SS 3 PHY-1
13:20 - 13:30
Sonophoresis with Specialized Cavitation Seed
242
Gilsu Song, Jinho Kim, Ohrum Cha, Jongbum Seo
Department of Biomedical Engineering, Yonsei University,
Korea
SS 3 PHY-2
13:30 - 13:40
A Novel Method for Vessel Cross-Sectional Shear 243
Wave Imaging (VCS-SWI): A Feasibility Study
Qiong He, Guoyang Li, Yanping Cao, Jianwen Luo
University, China
SS 3 PHY-3
13:40 - 13:50
A New Arterial Wall Motion Tracking Method 243
using An Adaptive Reference Frame Selection in
Ultrafast Imaging System
Hyunah Seo, Jinbum Kang, Yangmo Yoo
Department of Electronic Engineering, Sogang Univ., Korea
SS 3 PHY-4
13:50 - 14:00
Freehand 3D Elastography with 1D Linear Array 244
Based on Electromagnetic Tracking
Fu-Feng Lee, Qiong He, Jianwen Luo
Department of Medical Engineering, Tsinghua University,
China
6
SS 3 PHY-5
14:00 - 14:10
A New High Pulse-Repetition Frequency Ultrafast 244
Sliding Compound Doppler Imaging Method for Fast
Flow Characterization
Jinbum Kang, Yangmo Yoo
Department of Electronic Engineering, Sogang University,
Korea
SS 3 PHY-6
14:10 - 14:20
Compressed Sensing for High Frame Rate and 245
High Image Quality Ultrasound Imaging
Jing Liu, Qiong He, Jianwen Luo
Department of Medical Engineering, Tsinghua University,
China
SS 3 PHY-7
14:20 - 14:30
Improvement of Primary Healthcare System Using 245
Wireless Mobile Ultrasound Device: A Pilot Study
(Example of KOICA-CTS Program in Vietnam)
Dong-Hoon Jung1, Dae-Hyun Hwang1,
Seon-Jeong Min1, Jeong-Won Ryu2
1
Department of Radiology, Hallym University Sacred Heart
Hospital, Korea
2
Department of Healcerion Inc., Korea
Day 2 (Saturday, 21 May)
Categorical Course
Thyroid
pdate of US Imaging: Thyroid
U
Malignancy
08:00 - 09:30
GBR 101
Chairpersons:
Joon Hyung Lee Dong-A University Hospital, Korea
Hyun Sook Hong S
oonchunhyang University Bucheon Hospital,
Korea
CC 6 THY-1 08:00 - 08:30
US Imaging of Papillary Thyroid Cancer and Its 150
Variants
Jung Hee Shin
CC 6 THY-2 08:30 - 09:00
US Imaging of Follicular and Medullary Thyroid 153
Cancers
Jeeyoung Kim
Yeouido St. Mary's Hospital, Korea
CC 6 THY-3 09:00 - 09:30
Anaplastic Thyroid Carcinoma and Primary 155
Thyroid Lymphoma: Clinical and Imaging Features
Yoon Jung Choi
Department of Radiology, Kangbuk Samsung Medical
Center, Korea
Musculoskeletal
08:00 - 09:30
L
ower Extremity US Anatomy
and Basic Approach
GBR 102
Chairpersons:
Doo Hoe Ha Bundang CHA Hospital, Korea
Young Hwan Lee D
aegu Catholic University Medical Center,
Korea
CC 7 MSK-1 08:00 - 08:15
Hip157
Min A Yoon
Department of Radiology, Korea University Guro Hospital,
Korea
CC 7 MSK-2 08:15 - 08:30
Ultrasound Anatomy of Knee Joint
160
Seok Hahn
Hospital, Korea
CC 7 MSK-3 08:30 - 08:45
Ankle163
Yoonah Song
Department of Radiology, Hanyang University Medical
Center, Korea
CC 7 MSK-4 08:45 - 09:00
Foot165
Jina Park
CC 7 MSK-5 09:00 - 09:15
Lower Extremity US Anatomy and Basic 166
Approach: Artery
Ji Young Hwang
Department of Radiology, Ewha Womans University
Mokdong Hospital, Korea
CC 7 MSK-6 09:15 - 09:30
Lower Extremity US Anatomy and Basic 172
Approach: Vein
Kyung-Sik Ahn
Korea
Abdomen
Problem Solving with USG
08:00 - 09:20
GBR 103
Chairpersons:
Yong Yeon Jeong C
honnam National University Hwasun Hospital,
Korea
Jong Young Oh Dong-A University Hospital, Korea
CC 8 ABD-1 08:00 - 08:30
Upper Abdominal Pain
174
Na Yeon Han
Korea
CC 8 ABD-2 08:30 - 08:55
Lower Abdominal Pain
177
Hyun Jeong Park
Korea
CC 8 ABD-3 08:55 - 09:20
Abnormal Laboratory Findings
185
Honsoul Kim
Hot Issues
Thyroid
Non-Invasive Treatment of Thyroid
Lesion
09:30 - 10:10
GBR 101
Chairpersons:
Dong Gyu Na H
uman Medical Imaging & Intervention Center,
Korea
Jin Yong Sung Daerim Saint Mary's Hospital, Korea
HI 3 THY-1 09:30 - 10:10
Local Ablation of Benign Thyroid Nodules - 190
Alternatives to Surgery and Radioiodine Therapy
Frank Gruenwald
Department of Nuclear Medicine, Hospital of The University
of Frankfurt, Germany
7
Musculoskeletal
Luncheon Symposium
Advanced in MSK US
09:30 - 10:10
GBR 102
Chairpersons:
Kil-Ho Cho Yeungnam University Medical Center, Korea
Sung Moon Lee Keimyung University, Korea
HI 4 MSK-1 09:30 - 10:10
Idiosyncrasies in Nerve Imaging
12:10 - 13:10
Chairperson:
Won Jae Lee Samsung Medical Center, Korea
194
Debate Session
HCC Screening
09:20 - 10:10
Bracco
GBR 103
Chairpersons:
Dal Mo Yang Kyung Hee University Hospital at Gangdong, Korea
Chang Hee Lee Korea University Guro Hospital, Korea
DS ABD-1 09:20 - 09:45
HCC Screening, Ultrasound is Enough
186
Jae Young Lee
Department of Radiology, Seoul National University,
College of Medicine, Korea
DS ABD-2
09:45 - 10:10
US is Not Enough
189
Joon-Il Choi
GBR 101
LS 2 Bracco - 1
12:10 - 12:40
Clinical Application of CEUS in the Liver
207
Woo Kyoung Jeong
LS 2 Bracco - 2
12:40 - 13:10
Contrast-enhanced US: Application in the GI Tract 208
Se Hyung Kim
Hospital, Korea
Samsung Medison
12:10 - 12:50
GBR 103
Chairperson:
Joon Koo Han Seoul National University Hospital, Korea
LS 3 Samsung Medison - 1 12:10 - 12:30
S-Fusion for US Guided Interventional 209
Procedures: Is it an Academic Toy or a Valuable
Practical Tool for Radiologists?
Jeong Min Lee
Hospital, Korea
LS 3 Samsung Medison - 2 12:30 - 12:50
A.I.(Artificial Intelligence) is Coming: S-Detect for 210
Thyroid
Jung Hwan Baek
Quantitative US Biomarkers
10:30 - 12:00
GBR 103
Chairpersons:
Young Hoon Kim S
eoul National University Bundang Hospital,
Korea
SFS 4 ABD-1 10:30 - 11:00
Doppler USG
196
Kyoung Doo Song
SFS 4 ABD-2 11:00 - 11:30
Application of CEUS Perfusion Techniques
203
Paul Sidhu
Department of Radiology, King's College Hospital, London,
United Kingdom
SFS 4 ABD-3 11:30 - 12:00
US Elastography
204
So Yeon Kim
8
Lower Extremity US In-depth Discussion
13:20 - 14:50
GBR 102
Chairpersons:
Myung Jin Shin Asan Medical Center, Korea
Jaehyuck Yi Kyungpook National University Hospital, Korea
SFS 5 MSK-1
13:20 - 13:35
Ultrasound-guided Intervention of the Hip Joint
211
Byeong Seong Kang
Department of Radiology, Ulsan University Hospital, Korea
SFS 5 MSK-2
13:35 - 13:50
Knee213
So Young Park
Department of Radiology, Kyung Hee University Hospital at
Gangdong, Korea
SFS 5 MSK-3
13:50 - 14:10
Ankle214
Sun Joo Lee
Hospital, Korea
SFS 5 MSK-4
14:10 - 14:30
Ultrasound of the Foot
220
Wan Tae Kim
Department of Radiology, VHS Medical Center, Korea
SFS 5 MSK-5
14:30 - 14:50
Vascular Doppler
224
Ji Young Oh
Department of Radiology, National Medical Center, Korea
Misinterpretation by US
15:20 - 16:50
GBR 103
Chairpersons:
Kyung Sook Shin Chungnam National University Hospital, Korea
Shin Ho Kook Kangbuk Samsung Medical Center, Korea
SFS 6 Multiorgan-1
15:20 - 15:50
US Misinterpretation: Abdomen
225
Hee Sun Park
Center, Korea
SFS 6 Multiorgan-2
15:50 - 16:20
US Misinterpretation: Breast
226
Eun-Kyung Kim
SFS 6 Multiorgan-3
16:20 - 16:50
Misinterpretations in Thyroid and Neck 227
Ultrasonography
Inseon Ryoo
Korea
Series Course
Thyroid
New Approach in Thyroid Imaging
13:20 - 14:50
Chairpersons:
Jin Young Kwak Severance Hospital, Korea
Jeong Hyun Lee Asan Medical Center, Korea
GBR 101
SC 2 THY-1
13:20 - 13:40
Keypoints of 2015 ATA Guideline: What We 229
Should Know
Ji-Hoon Kim
Hospital, Korea
SC 2 THY-2
13:40 - 13:50
US Elastography Using Carotid Artery Pulsation: 254
Efficacy and Reproducibility Analysis in Differential
Diagnosis of Thyroid Nodules
Yoon Joo Cho, Eun Ju Ha, Miran Han
Department of Radiology, Ajou University Hospital, Korea
SC 2 THY-3
13:50 - 14:00
Shear Wave Velocity: A New Quantitative Index to 254
Estimate the Status of Thyroid in Diffuse Thyroid
Disease
Linyao Du, Qiao Ji, Xiu-Juan Hou, Xiao-Lei Wang
Department of Radiology, In-Patient Ultrasound
Department, The Second Affiliated Hospital of Harbin
Medical University, China
SC 2 THY-4
14:00 - 14:10
Computer-Aided Diagnosis System for 255
Diagnosing and Characterization of Thyroid Nodules
on Ultrasound: Initial Clinical Assessment
Young Jun Choi, Jung Hwan Baek, Hye Sun Park,
Jeong Hyun Lee
SC 2 THY-5
14:10 - 14:20
Role of Combined Fine-Needle Aspiration and 255
Core Needle Biopsy Diagnosis in Thyroid Nodules
Diagnosed as Atypia / Follicular Lesion of
Undetermined Significance
Dong Gyu Na1, Ji-Hoon Kim2
1
Department of Radiology, Human Medical Imaging and
Intervention Center, Korea
2
Hospital, Korea
SC 2 THY-6
14:20 - 14:30
Fine-Needle Aspiration versus Core-Needle 256
Biopsy for Diagnosis of Thyroid Malignancy and
Neoplasm: A Matched Cohort Study
Soo-Yeon Kim1, Eun-Kyung Kim2, Hee Jung Moon2,
Jung Hyun Yoon2, Jin Young Kwak2
1
Hospital, Korea
2
SC 2 THY-7
14:30 - 14:40
A Modified Thyroid Imaging Reporting and Data 257
System (mTI-RADS) for Thyroid Nodules in Coexisting
Hashimotos Thyroiditis
Hang Zhou1, Hui-Xiong Xu2, Wen-Wen Yue2,
Lin-Yao Du1, Jun-Mei Xu2, Bo-Ji Liu2, Xiao-Long Li2,
Dan Wang2
1
2
Department of Radiology, Department of Medical
Ultrasound, Shanghai Tenth Peoples Hospital, Ultrasound
Research and Education Institute, Tongji University School
of Medicine, China
SC 2 THY-8
14:40 - 14:50
Suspicious Thyroid Nodules with Benign Results 257
on Core Needle Biopsy: Malignancy Rate and
Management Strategy
Saerom Chung, Hye Sun Park, Jung Hwan Baek,
Jeong Hyun Lee, Young Jun Choi
Hands-on Session
Thyroid Hands-on: Advanced Anatomy
15:20 - 16:10 / 16:20 - 17:10
Moderator:
Jung Hwan Baek Asan Medical Center, Korea
HS-1
GBR 101
15:20 - 16:10 / 16:20 - 17:10
Thyroid and Perithyroid Anatomy
230
Jung Hwan Baek
9
Scientific Sessions
Head & Neck
10:30 - 11:00
GBR 101
Chairpersons:
So Lyung Jung T
Hospital, Korea
Young Hen Lee Korea University Ansan Hospital, Korea
SS 4 HN-1
10:30 - 10:40
Ultrasonography of Major Salivary Glands in the 246
Sjogren Syndrome
Jeong Kyu Kim1, Jung-Yoon Choe2, Hoon Kyu Oh3
1
Department of Otorhinolaryngology, Daegu Catholic
University Medical Center, Korea
2
Department of Internal Medicine, Daegu Catholic
3
Department of Pathology, Daegu Catholic University
Medical Center, Korea
SS 4 HN-2
10:40 - 10:50
Association of Xerostomia and Ultrasonographic 247
Features of the Major Salivary Glands after Radioactive
Iodine Ablation for Papillary Thyroid Carcinoma
Sang Soo Roh, Dong Wook Kim
Hospital, Korea
SS 4 HN-3
10:50 - 11:00
US-Guided Fine Needle Aspiration versus 247
US-Guided Core Needle Biopsy for Distant Metastases
in Cervical Lymph Nodes from Other than Head / Neck
Region: A Propensity Score Matching Study
Kyeong Hwa Ryu, Jeong Hyun Lee, Jung Hwan Baek,
Young Jun Choi, Mi Sun Chung, Kye Jin Park
Thyroid
11:00- 12:00
GBR 101
Chairpersons:
So Lyung Jung T
Hospital, Korea
Young Hen Lee Korea University Ansan Hospital, Korea
SS 4 THY-2
11:10 - 11:20
Interobserver Variability of Descriptive 248
Parameters for the Ultrasonographic Assessment of
Thyroid Nodules According to the Korean Thyroid
Imaging Reporting and Data System
Jung Min Bae, Soo Yeon Hahn, Jung Hee Shin,
Eun Young Ko, So Yoon Park, Seung Hee Choi
SS 4 THY-3
11:20 - 11:30
Diagnostic Performances and Interobserver 249
Agreement According to Observer Experience:
A Comparison Study Using Three Guidelines for
Management of Thyroid Nodules
Jieun Koh1, Soo-Yeon Kim2, Hye Sun Lee3,
Eun-Kyung Kim1, Jin Young Kwak1, Hee Jung Moon1,
Jung Hyun Yoon1
1
2
Hospital, Korea
3
Department of Biostastistics Collaboration Unit, Severance
Hospital, Korea
SS 4 THY-4
11:30 - 11:40
The Thyroid Imaging Reporting and Data System 249
(TIRADS) on US, but not the BRAFV600E Mutation, is
Associated with Lateral Lymph Node Metastasis in PTC
Young Jean Park, Eun-Kyung Kim, Hee Jung Moon,
Jung Hyun Yoon, Jin Young Kwak
SS 4 THY-5
11:40 - 11:50
Simultaneous Fine-Needle Aspiration and Core 250
Needle Biopsy for First-Line Diagnostic Method in
Thyroid Nodules
Dong Gyu Na
SS 4 THY-6
11:50 - 12:00
Core Needle Biopsy as a First-Line Biopsy 251
Method for Initially Detected Thyroid Nodule: A
Comparative Study Using Propensity Score Matching
Hyun Kyung Lim1, So Lyung Jung2, Jung Hee Shin3,
Soo Yeon Hahn3
1
Department of Radiology, Soonchunhyang University
Seoul Hospital, Korea
2
Department of Radiology, The Catholic University of
Korea, Seoul St. Mary's Hospital, Korea
3
Department of Radiology, Samsung Medical Center,
Korea
SS 4 THY-1
11:00 - 11:10
A Multicenter, Prospective Validation Study for 248
the Korean Thyroid Imaging Reporting and Data
System in Patients with Thyroid Nodules (K-TIRADS)
Eun Ju Ha1, Won-Jin Moon2, Dong Gyu Na3,
Yeong Hen Lee4, Nami Choi2, Jae Kyun Kim5
1
2
Center, Korea
3
4
Department of Radiology, Korea University Ansan
Hospital, Korea
5
Korea
10
Musculoskeletal
10:30 - 11:20
Chairpersons:
Sang-Hoon Lee Asan Medical Center, Korea
Young Cheol Yoon Samsung Medical Center, Korea
Abdomen
GBR 102
SS 5 MSK-1
10:30 - 10:40
Correlation between Imaging Methods and 251
Clinical Impairment in Patients with Frozen Shoulder
Jae Hwal Rim, Gi Young Park
Department of Rehabilitation Medicine, Daegu Catholic
SS 5 MSK-2
10:40 - 10:50
Severity Correlation between Cross Sectional 252
Area and Electrodiagnostic Parameters in Carpal
Tunnel Syndrome
Kwang Jae Lee, Yong-Soon Yoon, Seung-Gyu Lim
Medical Center, Seonam University College of Medicine,
Korea
SS 5 MSK-3
10:50 - 11:00
Role of Ultrasound in the Evaluation of Thenar 252
Muscles Length
Sabrilhakim Sidek1, Mohd Shukry Mohd Khalid1,
Rozaidi Roslan2, Shahrul Naim Sidek2
1
Department of Radiology, Medical Imaging Unit, Faculty of
Medicine, Universiti Teknologi MARA, Selangor, Malaysia
2
Department of Mechatronics Engineering Dept., Kulliyyah
of Engineering, International Islamic University Malaysia,
Kuala Lumpur, Malaysia
SS 5 MSK-4
11:00 - 11:10
The Usefulness of SMI Technology on Ultrasound 253
for Evaluation of Patients with Rheumatoid Arthritis
Guen Young Lee, Su Jin Kim, Jong Bum Lee,
Sung Bin Park, Byung Ihn Choi, Jee Young Jung
Korea
SS 5 MSK-5
11:10 - 11:20
Automatic Fiber Segmentation Method Based on 253
FCM Clustering
Qihao Zhang, Qiong He, Jianwen Luo
University, China
Case Based Reviews (MSK)
11:20-12:00
GBR 102
Chairpersons:
Min Hee Lee Asan Medical Center, Korea
Ji-Seon Park Kyung Hee University School of Medicine, Korea
CR MSK-1
11:20 - 11:30
Hye Jin Yoo
Seoul National University Hospital, Korea
CR MSK-2 11:30 - 11:40
Sang Yoon Kim
Dankook University Hospital, Korea
CR MSK-3
11:40 - 11:50
Sung Gyu Moon
Kunkook University Hospital, Korea
CR MSK-4 11:50 - 12:00
You Seon Song
Pusan University Hospital, Korea
13:20 - 14:50
GBR 103
Chairpersons:
Yong Moon Shin Asan Medical Center, Korea
Mi-Suk Park Yonsei University College of Medicine, Korea
SS 6 ABD-1
13:20 - 13:30
Dynamic Contrast-Enhanced Ultrasound of 258
Gastric Cancer: Correlation with Perfusion CT
Parameters - Preliminary Results
Ijin Joo, Se Hyung Kim, Jae Young Lee,
Joon Koo Han
Hospital, Korea
SS 6 ABD-2
13:30 - 13:40
Visibility of Hepatic Focal Lesion: Agreement 258
between Kupffer Phase Images of Sonazoid-Enhanced
Ultrasound and Hepatobiliary Phase Images of
Gadoxetic Acid-enhanced MRI
Woo-Young Yang, Hee Sun Park, Young Jun Kim,
Mi Hye Yu, Sung Il Jung, Hae Jeong Jeon
Center, Korea
SS 6 ABD-3
13:40 - 13:50
Pulsed High-Intensity Focused Ultrasound (HIFU) 259
Treatment in The Pancreas: Preclinical Evaluation for
the Safety and Feasibility in Swine Model
Won Chang, Jae Young Lee, Joon Koo Han,
Jae Seok Bae, Yeon Jin Cho, Jae Hwan Lee
Hospital, Korea
SS 6 ABD-4
13:50 - 14:00
A Questionnaire Study Assessing Quality of 259
Physicians who Perform Ultrasound Examination for
National HCC Surveillance in Korea
Moon Hyung Choi1, Seung Eun Jung1, Yeol Kim2
1
2
Department of Family Medicine, National Cancer Center,
Korea
SS 6 ABD-5
14:00 - 14:10
Ultrasonographic Appearance of Early 260
Cholangiocarcinoma
Surachate Siripongsakun, Sirachat Vidhyarkorn
Department of Radiology, Chulabhorn Hospital, Thailand
SS 6 ABD-6
14:10 - 14:20
Prevalence and Clinical Significance of 260
Tumefactive Gallbladder Sludge
Tae Wook Kang1, Mimi Kim1, Seong Hyun Kim1,
Dong Hyun Sinn2, Young Kon Kim1, Seung Soo Kim1
1
2
Department of Internal Medicine-G-I / Hepatology,
Samsung Medical Center, Korea
SS 6 ABD-7
14:20 - 14:30
Safety of Percutaneous Biopsy for Hepatic 261
Angiosarcoma: Results of a Multicenter
Korean Survey
Jeong Ah Hwang, Tae Wook Kang, Min Woo Lee
11
SS 6 ABD-8
14:30 - 14:40
Evaluation of Hepatic Steatosis Using Acoustic 261
Structure Quantification of Ultrasound in Rat Model:
Comparison with Pathology and MR Spectroscopy
Dong Ho Lee, Jae Young Lee
Hospital, Korea
12
SS 6 ABD-9
14:40 - 14:50
Enhanced Chemotherapy Combined with Focused Ultrasound for Pancreatic Cancer:
In Vivo Animal Study
Eun-Joo Park1, Yun Deok Ahn2, Yuri Cheon2,
Jae Young Lee1
1
Hospital, Korea
2
262
SE 010
Scientific Exhibition
Abdomen
SE 001
SE 002
SE 003
SE 004
SE 005
SE 006
SE 007
SE 008
SE 009
Ethanol Lavage of Large Hepatic Cysts by EUS
263
Guidance and a Percutaneous Approach
Sun-Ho Lee, Dong-Wan Seo, Dongwook Oh,
Tae Jun Song, Do Hyun Park, Sang Soo Lee,
Sung Koo Lee, Myung-Hwan Kim
Department of Internal Medicine-G-I/Hepatology, Asan
SE 011
Shear Wave Elastography with a Propagation Map 263
in Chronic Hepatitis
Eun Sun Lee, Jong Beum Lee, Hwi Ryong Park,
Jeongin Yoo, Ji In Choi, Hyun Jung Park,
Sung Bin Park, Byung Ihn Choi
Korea
SE 012
Lymphoma of Abdomen+
Thuy Tran Thi Bich
Department of Radiology, Ultrasound, Vietnam
264
SE 013
Common Template Format Protocols for FAST
264
Mohamed Roshan Arakkal
Department of Radiology, AL Qassimi Hospital Ministry of
Health, United Arab Emirates
The Result of a Study of Ultrasound Findings on 264
Cholelithiasis Associated with Cholangitis
Undral Shinekhuu1, Badamsed Tserendorj2
1
Department of Radiology, Mongolian National University of
Health Sciences, Mongolia
2
Department of Radiology, Institute of Medical Sciences,
Mongolia
Research in Ultrasound Symptoms of Fatty Liver 265
and Hepatic Steatosis
Delgermaa Batsuuri, Badamsed Tserendorj
Medical Sciences, Mongolia
Role of Ultrasonography in Evaluation of 265
Obstructive Jaundice
Prakash Sharma, Subita Lalchan, Prabhat Kumar Tiwari
Department of Radiology, Manipal Teaching Hospital,
Nepal
Clinical Applications for Ultrasound Fusion Imaging of the Liver
Jia Ren Perry Liew, Yan Rong Yong, Charlyn Chee,
Yan Ne Ong, Wey Chyi Teoh
Singapore
SE 014
SE 015
SE 016
266
SE 017
Setting Ultrasound Diagnostic Criteria for 266
Pancreatic Cancer
Buyandelger Bayansan, Badamsed Tserendorj
Department of Radiology, Mongolian Radiological Society,
Mongolia
SE 018
Ultrasound Guided Procedures: PCD, PTBC, 267
Central Line and Chemoport; 584 Patients
Virasack Rajpho1, Darehyun Hwang2
1
Department of Intervention, Faculty of Basic Medical
Science, University of Health Science, University of Lao
PDR, Lao People's Democratic Republic
2
Department of Intervention, Dongtan Sacred Heart
Hospital, Korea
Ultrasound Fusion Imaging with MRI: Technical 267
Advances and Clinical Applications
Moon Hyung Choi, Joon-Il Choi, Michael Yong Park,
Soon Nam Oh, Sung Eun Rha, Seung Eun Jung,
Jae Young Byun
Application of Wireless Mobile Hand-Held 267
Ultrasound System in Point-of Care Ultrasonography
and Its Education
Dong-Hoon Jung1, Dae-Hyun Hwang1, Jeong-Won Ryu2
1
Department of Radiology, Dongtan Sacred Heart Hospital,
Korea
2
A Randomized Controlled Trial of Comparison on 268
Ultrasonography Evaluation of Pancreas According to
Patient Position: Supine versus Sitting
Seung-Hwa Lee, Dong-Hwan Kim, Eun-Seong Seo
Department of Center for Health Promotion, SeoHae
Hospital, Korea
Is the Spleen Stiffness Value Acquired Using 268
Acoustic Radiation Force Impulse (ARFI) Technology
Predictive of the Presence of Esophageal Varices in
Patients with Cirrhosis of Various Etiologies?
Heejin Kwon, Sangyun Lee, Jinhan Cho,
Jongyeong Oh
Department of Radiology, Dong-A University Hospital,
Korea
Prospective Comparison of Liver Stiffness 269
Measurements of Virtual Touch Quantification (VTQ)
Elastography and Elastography Point Quantification
(ElastPQ) for the Evaluation of Hepatic Fibrosis
Hyunsuk Yoo, Jeong Min Lee, Jeong Hee Yoon,
Dong Ho Lee, Won Chang
Hospital, Korea
Does CT Have Any Added Value after Sonographic 269
Diagnosis of Acute Right Side Colonic Diverticulitis?
Ju Hwa Min, Hyun Cheol Kim, Sang Won Kim,
Dal Mo Yang
Department of Radiology, Kyung Hee University Hospital at
Gangdong, Korea
Imaging Findings of Abdominal Wall Masses: 270
Differential Diagnosis on US
Youe Ree Kim, Young Hwan Lee, Soo Yeon Jeong,
Kwon Ha Yoon
Department of Radiology, Wonkwang University School of
Medicine & Hospital, Korea
Ultrasonography Features of Benign Hepatic Lesions
Seonga Wi, Daejung Kim
Department of Radiology, Bundang CHA, Korea
270
13
SE 019
SE 020
Results of the Research on Chest Ultrasound 271
Findings for the Diagnosis of Pneumonia
Zolboo Baatarjav1, Tumur-Ochir Tsedv-Ochir2,
Tseren Dorj Badamsed3
1
Department of Radiology, MNUMS, Mongolia
2
Department of Pulmonary, State Third Central Hospital,
Mongolia
3
Department of Radiology, State Third Central Hospital,
Mongolia
Spontaneous Intra-Abdominal Hematoma Presenting as Mass in Ultrasonography
Seonga Wi, Dae Kim
271
SE 028
SE 029
Breast
SE 021
SE 023
SE 024
SE 025
SE 026
SE 027
14
Granulomatous Mastitis: Difficult to Diagnose-
272
Difficult to Treat. Applying Triple Test for Better
Outcome
Asif Momin, Shenaz Momin
Department of Radiology, Chief of Imaging, Prince Aly
Khan Hospital, India
Combined Use of Ultrasound (US) Elastography 272
and Doppler US at MR Directed (Second-Look) US
Examination: Influence on Diagnostic Performance of
Radiologists for Distinguishing Benign from Malignant
Breast Masses
Hye Shin Ahn1, Mijung Jang2, Sun Mi Kim2,
Bo La Yun2, Mirinae Seo3
1
Korea
2
3
Department of Radiology, Kyung Hee University Medical
Center, Korea
Tuberculous Lymphadenitis in the Left Axilla 273
Misdiagnosed as Metastasis: A Case Report and
Review of Literature
Hui Li
Department of Radiology, Shandong Medical Imaging
Research Institute Affiliated To Shandong University, China
US-Guided Core Biopsy in BI-RADS 3 & 4 Breast 273
Lesions: Four-Year Outcome Analysis in a Single
Institution
Seung Hee Choi, Boo-Kyung Han, Eun Young Ko,
Eun Sook Ko, Ji Soo Choi
Effect of Calcifications on Shear Wave 274
Elastography in Benign Breast Lesions
Seung Hee Choi, Eun Young Ko, Boo-Kyung Han,
US-Guided 14G Core Biopsy for Breast: Results of 7 Years-Experience and Long Term Follow-Up
Inha Jung, Eunkyung Kim
SE 031
SE 032
SE 033
SE 034
Ultrasound-Guided Photoacoustic Imaging for 275
the Selective Detection of EGFR-Expressing Breast
Cancer and Lymph Node Metastases
Meihua Zhang1, Hoe Suk Kim1, Tiefeng Jin2, Ann Yi3,
Woo Kyung Moon1
1
Hospital, Korea
2
Department of Science and Radiology, College of
Medicine, Seoul National University, Korea
3
Hospital HealthCare System Gangnam Center, Korea
Predictive Value of Tumor Vascularity Measured 275
with Doppler Sonography in Neoadjuvant
Chemotherapy of Breast Cancer
Alisher Kakhkharov1, Jamoliddin Kahhorov2,
Fatima Kakhkharova3
1
Department of Oncology and Radiology/Breast Cancer
Unit, Tashkent Medical Academy/Tashkent City Oncology
Center, Uzbekistan
2
Department of Therapeutic Radiology and Oncology,
Tashkent Medical Academy/National Scientific Oncology
Center, Uzbekistan
3
Department of Radiology, National Scientific Oncology
Center, Uzbekistan
Quantitative Assessment of Tumor Vascularity 276
of the Breast Masses Using Superb Micro-Vascular
Imaging (SMI) and Contrast-Enhanced Ultrasound
Ah Young Park1, Bo Kyoung Seo1, Kyu Ran Cho2,
Ok Hee Woo3
1
Hospital, Korea
2
Korea
3
Korea
Analysis of Background Parenchymal 276
Echogenicity in Breast Ultrasound: Correlation with
Mammographic Breast Density and Background
Parenchymal Enhancement in Breast MR
Kyunghee Ko, Hae Kyoung Jung, Youdong Kim
Diagnostic Performance of Shear-Wave 277
Sonoelastography and B-Mode Ultrasound to
Differentiate Benign and Malignant Breast Lesions:
The Emphasis on the Cutoff Value of Quantitative and
Qualitative Parameters
Eun Jee Song, Yu-Mee Sohn, Mirinae Seo
Center, Korea
Comparison of Strain and Shear-Wave 277
Elastography of the Breast Masses for Differentiation
of Benign and Malignancy
Mirinae Seo, Hye Shin Ahn, Sung Hee Park,
Byung Ihn Choi, Jong Beum Lee
Korea
274
SE 035
SE 036
SE 037
SE 038
SE 040
SE 042
SE 043
Three-Dimensional (3D) Shear Wave Elastography: 278
The Strength and Usefulness in Differentiating Benign
and Malignant Breast Masses
Gayoung Choi1, Ok Hee Woo1, Hye Seon Shin1,
Kyu Ran Cho2, Bo Kyoung Seo3
1
Korea
2
Korea
3
Hospital, Korea
3D Shear-Wave Elastography for Differentiating 278
Benign from Malignant Breast Masses in Comparison
with 2D SWE
Hyeyoung Choi, Yu-Mee Sohn, Mirinae Seo
Center, Korea
Foreign Bodies of the Breast: In Vivo and In Vitro 279
Radiologic-Clinical Correlation
Ji Min Kim1, Shin Young Kim1, Deuk Young Lee2,
Jong Eun Lee3
1
Cheonan Hospital, Korea
2
Department of Surgery, Yonsei Angelot Women's Clinic,
Korea
3
Department of Surgery, Soonchunhyang University
Efficiency of US Elastography and Color Doppler 279
US in Distinguishing Fibroadenoma from TripleNegative Breast Cancer
Soo Hyun Yeo1, Woo Kyung Moon2, Ga Ram Kim3
1
Department of Radiology, Keimyung University Dongsan
2
Hospital, Korea
3
Department of Radiology, Inha University Hospital, Korea
It's Time to Pay Attention to Special Breast Cancer 280
Hyunjeong Kim1, Shinyoung Kim1, Sangmi Lee2,
Deukyoung Lee3, Jongeun Lee4
1
2
Department of Nuclear Medicine, Soonchunhyang
University Cheonan Hospital, Korea
3
Department of Surgery, Yeonsei Angelot, Korea
4
SE 044
SE 045
SE 046
SE 047
SE 048
Malignant Lesions in Premammary Zone of the 281
Breast: The Great Mimickers of Benign Lesions
Jin Hwa Lee1, Bo Ra Kim1, Su Jin Kim2, Miri Lee3,
Se Heon Cho3
1
Korea
2
Department of Pathology, Dong-A University Hospital,
Korea
3
Department of Surgery, Dong-A University Hospital, Korea
Mammographic and Ultrasonographic Findings 281
of Thread-Embedding Procedure for Breast
Augmentation: Case report
So Yoon Park, Boo-Kyung Han, Eun Young Ko,
Breast Cancer in a Cowden Syndrome Patient: 282
Imaging and Clinical Findings
Ikjung Hwang1, Young Mi Park1, Sun Jeong Moon1,
Suk Jung Kim2, Hyun Kyung Jung2, Sun Joo Lee1,
Hye Jung Choo1, Dong Wook Kim1,
Hae Woong Jeong1, Sang Suk Han1
1
Hospital, Korea
2
Hospital, Korea
Imaging Findings of Adenoid Cystic Carcinoma 282
of the Breast: A Case Report
Gayoung Lee1, Young Mi Park1, Suk Jung Kim2,
Hyun Kyung Jung2, Sun Joo Lee1, Hye Jung Choo1,
Dong Wook Kim1, Hae Woong Jeong1,
Sang Suk Han1
1
Hospital, Korea
2
Hospital, Korea
A Rare Case of Hidradenocarcinoma Arising in 283
the Male Breast: Sonographic Findings and a Brief
Review
Hyun Ji Lee1, Okhee Woo1, Hye Seon Shin1,
1
Korea
2
Korea
3
Hospital, Korea
Breast Tubular Carcinoma
280
Nomuundari Ganbat, Tuvshinjargal Dashjamts
Department of Radiology, Ulaanbaatar Songdo Hospital,
Mongolia
Primary Breast Fibrosarcoma Mimicking Invasive 281
Ductal Carcinoma in a Patient with Interstitial Injection
Mammoplasty: Focusing on the Sonographic and MR
Findings
Soo Young Chae1, Ok Hee Woo1, Hye Seon Shin1,
1
Korea
2
Korea
3
Hospital, Korea
15
Cardiovascular
SE 049
SE 050
SE 051
SE 052
SE 053
SE 054
Ultrasound Guided Procedures in Angiography 283
Room: Arteriovenous Procedure, PCD, PTBD, PTGBD
and Chemoport; 837 Patients
Virasack Rajpho, Daehyun Hwang
Sicence, University of Healthscience, Lao PDR, Lao
People's Democratic Republic
Genitourinary
SE 055
SE 056
Ultrasound Comparison of Carotid Intima-Media 284
Thickness Between Type 2 Diabetic and Normoglicemic
Population
Erdembileg Tsevegmid1, Otgon Ginj2,
Uurtuya Shuumarjav3
1
Department of Radiology, School of Medicine, MNUMS,
Gurvan Gal Teaching Hospital of MNUMS, Mongolia
2
Department of Radiology, National Center for Maternal
and Child Health of Mongolia, Mongolia
3
Department of Physiology, Mongolian National University
of Medical Sciences, Mongolia
A Comparative Study for the Measurement of the 284
Systolic and Diastolic Ankle-Brachial Pressure Index
in Diabetic Patients with Calcified and Non-Calcified
Tibial Arteries
Akram Asbeutah1, Abdullah Almajran2, Sami Asfar3
1
Department of Radiology, Kuwait University, Kuwait
2
Department of Community Medicine & Statistical Sciences,
Kuwait University, Kuwait
3
Department of Surgery, Kuwait University, Kuwait
Regional Pulse Wave Velocity Imaging: 285
A Quantitative Method to Evaluate the Focal Vascular
Sclerosis
Shuai Huang1, Zhenzhou Li2, Chaochao Zhu1,
Xiang Wu1, Qingfeng Gao1, Zi Tao1, Minhua Lu1
1
Department of Medical Engineering, Guangdong Key
Laboratory for Biomedical Measurements and Ultrasound
Imaging, School of Biomedical Engineering, Shenzhen
University Shenzhen, China
2
Department of Radiology, Department of Ultrasound, The
Second Peoples Hospital of Shenzhen, China
Orthogonal Golay Pairs-Coded Diverging Wave 285
Compounding for High-Quality and High-Frame-Rate
Ultrasound Imaging
Feifei Zhao, Jianwen Luo
University, China
Anatomical Variations of the Internal Jugular Vein 286
on Ultrasound and CT for Performing Vascular
Cannulation
Byung Wook Park, Hyangkyoung Kim
Department of Surgery, Chung-Ang University Hospital,
Korea
SE 057
SE 058
SE 059
SE 060
SE 061
SE 062
16
The Study of the Ultrasound Findings of Renal 286
Hematoma Caused by Trauma
Oyundari Idersaikhan1, Badamsed Tserendorj2
1
2
Mongolia
The Result of the Study of Ultrasound 287
Assessment of Normal Renal Parameters in Mongolian
Ethnic
Oyuntogos Batdelger1, Badamsed Tserendorj2,
Oyundari Idersaikhan1, Undral Shinekhuu1,
Bolormaa Damdinsuren3, Uranzaya Ganbold4
1
2
Department of Radiology, The Third Central Hospital of
Mongolia, Mongolia
3
Department of Radiology, Occupational Health Center,
Mongolia
4
Department of Radiology, The First Central Hospital of
Mongolia, Mongolia
Comparative Study of Sonographic Prostate 287
Volume and Intravesical Prostatatic Protrusion in the
Patients with Lower Urinary Tract Symptoms
Sumiran Shrestha, Sudeep Thapa
Department of Radiology, Padma Nursing Home, Nepal
Comparison of Prostate Volume and Blood PSA 288
Level in Mongolian Non-Diabetic Screening Patients
and Type II Diabetic Patients at Their Initial Diagnosis
Darkhijav Yanjiv1, Tugsjargal Purevsukh2,
Battsengel Darkhantsetseg1, Gombosuren Orkhon1,
Bayanzul Nergui1, Ganbat Nomuundari1,
Tuvshinjargal Dashjamts2
1
Department of Radiology, Ulaanbaatar Songdo Hospital,
Mongolia
2
US of Bladder Masses
288
Dong Won Kim, Seong Kuk Yoon
Korea
Can Differentiation of Cystitis Glandularis from 289
Bladder Cancer be Possible on Ultrasonography?
Jongchul Kim
Department of Radiology, Chungnam National University
Hospital, Korea
US Evaluation of Uterine Cervical Lesions
289
Sung Bin Park1, Byoung Hee Han2, Young Ho Lee2
1
Korea
2
Department of Radiology, Cheil General Hospital, Korea
Tuberculosis of Male Genitourinary Tract
Yongsoo Kim, Young Seo Cho, Sanghyuk Yim
Department of Radiology, Hanyang University Guri
Hospital, Korea
289
SE 063
SE 065
SE 067
Prenatal Diagnosis of Aberrant Right Subclavian 290
Artery in the Korean Population
Mijin Song, Byoung Hee Han, Young Hwa Kim,
Myung Sook Lee, Hyeun Cha Cho, Young Ho Lee
Department of Radiology, Cheil General Hospital, Korea
Value of Renal RFA with Contrast Enhanced 290
Ultrasound (CEUS) as a Problem Solving Tool for a
RCC in a Single Kidney and Another Case of Chronic
Renal Disease
Shenaz Momin, Asif Momin
Department of Radiology, Chief of Imaging Prince Aly Khan
Hospital, India
A Rare Case of Genital Filariasis in a Patient 291
Presenting as a Vaginal Wall Cystic Lesion:
a Case Report
Prasanna Ghimire1, Pragya Gauautam Ghimire2,
Ayushma Adhikari3
1
Department of Radiology, Nepalgunj Medical College and
Teaching Hospital, Kohalpur, Banke, Nepal
2
Department of Pathology, Nepalgunj Medical College and
Teaching Hospital, Kohalpur, Banke, Nepal
3
Department of Obstetrics and Gynecology, Nepalgunj
Medical College and Teaching Hospital, Kohalpur, Banke,
Nepal
Head & Neck
SE 068
Feasibility of Ultrasound in Assessment of Vocal 291
Cord Structure and Movement
Heung Cheol Kim, Sook Namgung, Myungsun Hong,
Koeun Yang
Department of Radiology, Chuncheon Sacred Heart
Hospital, Korea
Musculoskeletal
SE 069
SE 070
SE 071
SE 072
SE 073
SE 074
SE 075
SE 076
US Guided Core Needle Biopsy for 292
Musculoskeletal Lesions, Diagnostic Accuracy and
Safty
Noh Hyuck Park, Sun Jung Kim, Ji Yeon Park
Department of Radiology, MyongJi Hospital, Korea
Atrophy of Foot Muscles in Mongolian Patients 292
with Diabetes Mellitus Can Be Detected with
Ultrasonography
Bolortuya Galsandorj1 , Oyundari Idersaikhan2,
Munkhsaikhan Purevkhuu2, Sainbileg Sonomtseren3,
Munkhbaatar Dagvasmberel3
1
Department of Radiology, State First Central Hospital,
Mongolia
2
3
Department of Internal Medicine - Endocrine, MNUMS,
Mongolia
SE 077
Ultrasound Shear Wave Imaging: Quantitative 293
Monitoring of the Progress of Amyotrophic Lateral
Sclerosis?
Chaochao Zhu1, Zhenzhou Li2, Shuai Huang1,
Qingfeng Gao1, Xiang Wu1, Zi Tao1, Minhua Lu1
1
Department of Medical Engineering, Guangdong Key
Laboratory for Biomedical Measurements and Ultrasound
Imaging, School of Biomedical Engineering, Shenzhen
University Shenzhen, China
2
Department of Radiology, Department of Ultrasound,
The Second Peoples Hospital of Shenzhen, China
Sonographic Appearance of Palpable Superficial 293
Masses
Norharifah Zainal, Angela Anthony, Kho Ying Ying,
Sanamandra Sarat Kumar
Department of Radiology, Singapore General Hospital,
Singapore
Evaluation of a Mathematical Model for a Personalized MR-HIFU Treatment for Bone Pain
Sin Yuin Yeo1, Huub Ten Eikelder1, Daniela Modena1,
Aaldert Elevelt2, Katia Donato2, Dragan Bosnacki1,
Edmond Van Dijk2, Holger Gruell1
1
Department of Biomedical Engineering, Eindhoven
University of Technology, Netherlands
2
Department of Oncology Solutions/In-body Sensing/
Embedded Systems, Philips Research Eindhoven,
Netherlands
294
Strain Elastography Features of Epidermoid 294
Tumors in Superficial Soft Tissue: Differences from
Other Benign Soft Tissue Tumors and Malignant
Tumors
Hee Jin Park
Department of Radiology, Kangbuk Samsung Medical
Center, Korea
Us Finding of the Superficial Lesions: Difficult to 295
be Categorized
Dalsu Park
Department of Radiology, s-seoul Hospital, Korea
Ultrasonographic Findings of Superficial Soft 295
Tissue Masses in Epidermis and Dermis of the
Extremities
Dasom Kim1, Sun Joo Lee1, Hye Jung Choo1,
Young Mi Park1, Kil-Ho Cho2, Sung Moon Lee3
1
Hospital, Korea
2
Department of Radiology, Yeungnam University Medical
Center, Korea
3
Ulnar Nerve beyond Guyon Canal with an 296
Emphasize on US
Dong Gun Kim1, Sun Joo Lee1, Hye Jung Choo1,
Young Mi Park1, Kil-Ho Cho2, Sung Moon Lee3,
Young Hwan Lee4
1
Hospital, Korea
2
Department of Radiology, Yeungnam University Medical
Center, Korea
3
4
Department of Radiology, Daegu Catholic University
17
SE 078
SE 079
SE 080
SE 081
Sonoelastographic Evaluation of Plantar 296
Fasciitis after Collagen Injection Therapy
Minchul Kim, Yun Sun Choi, Myung-Won You
Department of Radiology, Eulji Hospital, Eulji University,
Korea
Soft Tissue Tumors: Musculoskeletal US
Joonbum Koo
Department of Radiology, Dongguk University Ilsan
Hospital, Korea
297
A Pictorial Review of the Cystic Lesions Around the Knee
Joonbum Koo
Hospital, Korea
297
Subungual Glomangioma of the Toe: Role of 297
Ultrasound Doppler for Diagnosis
Sabrilhakim Sidek, Mohd Shukry Mohd Khalid,
Mohd Farhan Hamdan, Mohammad Hanafiah,
Bushra Johari
Department of Radiology, Medical Imaging Unit, Faculty of
Medicine, Universiti Teknologi MARA, Selangor, Malaysia
Pediatric
SE 082
SE 083
SE 084
SE 085
18
Cranial Ultrasound in Neonates
298
Feasibility and Clinical Usefulness of ARFI 298
Imaging of Sternocleidomastoid Muscle in Infants with
Congenital Muscular Torticollis
Dong Rak Kwon, Gi-Young Park, Dae-Gil Kwon
Department of Rehabilitation Medicine, Daegu Catholic
Shear Wave Elastography of Testis with 299
Varicocele: Preliminary Results
Haesung Yoon1, Mi-Jung Lee1, Hyun Joo Shin1,
Myung-Joon Kim1, Yong Seung Lee2
1
2
Prenatal Diagnosis of an Umbilical Vein 299
Aneurysm: Case Reports
Erdembileg Tsevegmid1, Buyanjargal Enkhbold2,
Baatartsogt Tumur3, Zolzaya Jalbuu3,
Munkhsaikhan Buyan3
1
Department of Radiology, School of Medicine, MNUMS
"Gurvan Gal" Teaching Hospital of MNUMS, Mongolia
2
Department of Radiology, "Gurvan Gal" Teaching Hospital,
Mongolia
3
Department of Obstetrics and Gynecology, "Gurvan Gal"
Teaching Hospital, Mongolia
SE 086
SE 087
SE 088
SE 089
SE 090
SE 091
SE 092
Prenatal Ultrasound Detection of Congenital 300
Fetal Anomalies: 5 Year Results
Baatartsogt Tumur3, Munkhsaikhan Buyan3,
Mendbayar Damdinsuren3, Zolzaya Jalbuu3,
Javzandulam Badrakh3, Lkhagvasuren Purevdorj3
1
Department of Radiology, School of Medicine, MNUMS,
"Gurvan Gal" Teaching Hospital of MNUMS, Mongolia
2
Department of Radiology, "Gurvan Gal" Teaching Hospital
of MNUMS, Mongolia
3
Department of Obstetrics and Gynecology, "Gurvan Gal"
Teaching Hospital of MNUMS, Mongolia
Measuring Renal Pelvis AP diameter in Pediatric 300
Renal Pathologies
Critical Ultrasonographic Findings: Neonatal 300
Abdomen
Hee Jeong Kim, Young Seok Lee
Department of Radiology, Dankook University Hospital,
Korea
Superb Micro-Vascular Imaging in Pediatric Focal 301
Nodular Hyperplasia
Sookmin Hwang, So-Young Yoo, Woo Kyoung Jeong,
Tae Yeon Jeon, Ji Hye Kim
Sonographic Approach to Vomiting Baby
Jihyun Bae, Jae-Yeon Hwang
301
Developmental Venous Anomaly in Neonatal Ultrasound
Wee Kyoung Kim
302
Congenital Perineal Lipoblastoma with Accessory 302
Scrotum
Wee Kyoung Kim
Physics
SE 093
SE 094
Performance Demonstration of Novel Backing 302
Structure for Intravascular Ultrasound Transducer
Seon Mi Ji, Jin Ho Sung, Chan Yuk Park,
Jong Seob Jeong
Department of Medical Biotechnology, Donggguk
University, Korea
Temperature-Responsive Tissue Mimicking 303
Phantom for High Intensity Focused Ultrasound
Therapy
Donghee Ma1, Yong Tae Kim2, Se Hwa Kim1
1
Department of Nano-Bio Measurement, KRISS (Korea
Research Institute of Standards and Science), Korea
2
Department of Medical Metrology, KRISS, Korea
Thyroid
SE 095
SE 096
SE 097
SE 098
SE 099
SE 100
SE 101
Cytology-Ultrasonography (CU) Risk Stratification 303
System Based on FNA Cytology and Korean-Thyroid
Imaging Reporting and Data System (K-TIRADS)
Dong Gyu Na1, Jung Hwan Baek2, Jin Yong Sung3,
Ji-Hoon Kim4
1
2
3
Department of Radiology, Daerim St. Marys Hospital,
Korea
4
Hospital, Korea
First-Line Use of Core Needle Biopsy for 304
High-Yield Preliminary Diagnosis of Thyroid Nodules
Young Joong Kim1, Hye Yeon Han2,
Jong Myeong Yi2, Jung Hwan Baek4,
Shin Young Park3, Jae Young Seo1
1
Department of Radiology, Konyang University Hospital,
Korea
2
Department of Radiology, Daejeon Sun Hospital, Korea
3
Department of Pathology, Konyang University Hospital,
Korea
4
Nodular (N) and Non-Nodular (Non-N) 304
Configuration of Subacute Granulomatous Thyroiditis
(SAT): Characteristics and Interval Change (IC) Using
Follow-Up (FU) Ultrasonography (US)
Yoo Jin Lee, Dong Wook Kim
Hospital, Korea
Ultrasonography Features of Thyroidal Fatty 305
Lesions in the Thyroid Gland: A Preliminary Study
Jung Won Park, Dong Wook Kim
Hospital, Korea
Ultrasound-Guided Fine Needle Aspiration Biopsy 305
Versus Core Needle Biopsy: Comparison of PostBiopsy Hematoma Rates and Risk Factors
In Hye Chae1, Eun-Kyung Kim2, Hee Jung Moon2,
1
2
SE 102
SE 103
SE 104
SE 105
SE 106
SE 107
SE 108
SE 109
Differentiation of Parathyroid Carcinoma from 306
Parathyroid Adenoma by Preoperative Ultrasonography
Meeyoung Nam, Jung Hee Shin, Soo Yeon Hahn
Prediction of Lymph Node Metastasis in Papillary 306
Thyroid Carcinoma Patients by Vascular Index on
Power Doppler US, Microvessel Density, and Vascular
Endothelial Growth Factor
Ji Hye Lee, Hyun Joo Shin, Jung Hyun Yoon,
Eun-Kyung Kim, Hee Jung Moon, Jin Young Kwak
SE 110
SE 111
Histogram and Gray Level Co-Occurrence Matrix 307
on Gray-Scale Ultrasound Images for Diagnosing
Lymphocytic Thyroiditis
Young Gyung Shin1, Jung Hyun Yoon2,
Eun-Kyung Kim2, Hee Jung Moon2, Jin Young Kwak2
1
Department of Radiology, Kosin University Gospel
Hospital, Korea
2
Metastatic Renal Cell Carcinoma in Thyroid 307
Gland: Ultrasonographic Features and Role of Image
Guided Biopsy in its Diagnosis
Ok Kyu Song1, Ja Seung Koo2, Jin Young Kwak1,
Hee Jung Moon1, Jung Hyun Yoon1, Eun Kyung Kim1
1
2
Department of Pathology, Severance Hospital, Korea
Application of Breast US-CAD System to Thyroid 308
Nodule
Jung Min Bae, Eun Young Ko, Soo Yeon Hahn,
Jung Hee Shin
Pyriform Sinus Fistula Mimicking Thyroid Nodule 308
Soo Chin Kim, Ji-hoon Kim
Hospital, Korea
Diagnostic Performance of Gray-Scale US, 309
Elastography, and Doppler US in Thyroid Nodules: a
Prospective Study
Soo Yeon Hahn, Jung Hee Shin, Eun Young Ko
The Result of the Case Study of Ultrasound 309
Imaging of Retrosternal Goiter
Munkhsaikhan Purevkhuu1, Badamsed Tserendorj2
1
Department of Radiology, Health Sciences University of
Mongolia, Mongolia
2
Mongolia
Analysis of Thyroid US Patterns of Some Thyroid 310
Diseases
Bolorchimeg Ganbold1, Badamsed Tserendorj2
1
2
Mongolia
Clinical Application of SMI for Differential 310
Diagnosis of Thyrotoxicosis
Masayuki Shigeta, Naoko Hidaka, Mizuho Minakata,
Harumi Daikoku, Masafumi Kitaoka
Department of Endocrinology and Metabolism, Showa
General Hospital, Japan
Efficacy and Safety of Minimally Invasive 311
Treatment in Patients with Benign Parathyroid Lesions
Eun Ju Ha
Innovative Technique in Image-Guided Ablation 311
of Benign Thyroid Nodules: Combined Ethanol and
Radiofrequency Ablation
Hye Sun Park, Jung Hwan Baek, Sae Rom Chung,
Young Jun Choi, Jeong Hyun Lee
19
SE 112
SE 113
20
Distinguishing Benign from Malignant Thyroid 312
Nodules at Thyroid Ultrasound (US): Utility of Superb
Microvascular Imaging (SMI) and US ElastographyInfluence on Diagnostic Performance
Hye Shin Ahn1, Mirinae Seo1, Sung Hee Park1,
Jong Beum Lee1, Byung Ihn Choi1
1
Korea
2
Center, Korea
Thyroid Core Needle Biopsy: Patients' Pain and Satisfaction Compared to Fine Needle Aspiration
Jaesun Ji1, Yeo Koon Kim1, Sang Il Choi1,
Ji Hoon Kim2, Yoon Ho Song1, Joo Hyun Kim1,
Eun Hee Seo1, Gwan Hong Min1
1
2
Hospital, Korea
SE 114
SE 115
312
SE 116
Ultrasonography-Guided Ethanol Ablation of 313
Benign Thyroid Nodules: A Single Institution
Experience
Mi Ri Kwon, Jung Hee Shin, Soo Yeon Hahn,
Jae Wook Ryu
Papillary Thyroid Carcinoma Arising within a Follicular Adenoma: A Case Report
Yeun Jeong Kim, Hyun Sook Hong, Sun Hye Jeong,
Eun Hye Lee, Jeong Ja Kwak
Bucheon Hospital, Korea
313
US-Guided Core Needle Biopsy Did Not Reduce 314
Diagnostic Lobectomy for Thyroid Nodules Diagnosed
as Atypia of Undetermined Significance / Follicular
Lesion of Undetermined Significance (AUS/FLUS)
Jung Hyun Yoon
Categorical Course
CC 1 BR-1 Evaluating the Symptomatic Patient
08:00 - 08:20
US Evaluation for Breast Pain
Su Hyun Lee
Department of Radiology, Seoul National University Hospital, Korea
I. Types of Pain
- Cyclic pain
- Noncyclic pain
- Extramammary (nonbreast) pain
II. Cyclic Pain
-20-30’s, premenopausal women / postmenopausal women with HRT
- Normal monthly changes in hormones
-Usually most severe before a menstrual period,
both breasts
-Heaviness or soreness that radiates to the armpit
and arm
III. Noncyclic pain
- 30-40’s, transient, focal (one fingerbreadth)
-Sharp, burning pain that occurs in one area of a
breast
-Cause: fibrocystic change, fibroadenoma, mastitis,
ductectasia, Mondor’s disease (sclerosing
periphlebitis), cyst, gynecomastia
IV. Evaluation
- History, physical exam
- Imaging:
≥ 40 years old --> Mammography, Ultrasound
< 40 years old --> Ultrasound, MLO-view
V. Management
- Specific treatment for detected causes
- No-detected abnormality on imaging
Assurance --> if persists (> 6 months): danazol,
bromocriptine, gamma-linolenic acid (GLA)
21
Categorical Course
May 20, Friday (GBR 103)
Chairpersons:Eun Suk Cha Ewha Womans University Mokdong Hospital, Korea
GBR 103
KSUM Open 2016
CC 1 BR-2 Evaluating the Symptomatic Patient
08:20 - 08:40
GBR 103
US Evaluation for Palpable Lump in the Breast
Eun Young Chae
Palpable lumps in the breast are common. Most
palpable lumps are discovered by the patient, and
most are benign. However, the most common
symptoms of breast cancer are also palpable lumps.
Thus, careful evaluation and prompt diagnosis are
necessary to rule out malignancy. A thorough clinical
history, clinical breast examination, and imaging
evaluation are needed for a definitive diagnosis.
Clinical history is helpful in assessing the
relative importance of the clinical finding. Those
in postmenopausal women have a higher chance of
malignancy. Clinical breast examination is usually
performed in conjunction with US and can be limited
22
to the area of concern. Because malignant palpable
lumps often produce nonspecific clinical findings
that cannot be distinguished from benign lesions,
imaging evaluation is indicated in almost all cases to
characterize the lesion.
Initial imaging modality can be selected depending
on the patient’s age. For women age 40 and older,
a diagnostic mammogram can be performed using
a radiopaque marker. For younger women under
40, US is typically used for the initial evaluation.
The role of breast US for evaluating patients with
palpable lumps including the US technique and
various clinical scenarios will be presented.
Categorical Course
CC 1 BR-3
Evaluating the Symptomatic Patient
08:40 - 09:00
US Evaluation for Nipple Discharge
Jung Hyun Yoon
Approximately 2-5% of women come to clinics
complaining of nipple discharge, a symptom causing
considerable anxiety and concern to patients and
clinicians, since it may be a presenting symptom for
breast cancer (1). In spite of the anxiety it causes,
the majority of patients with nipple discharge prove
to have breast diseases of benign etiology; 5-12%
of women with nipple discharge are diagnosed
with breast cancer. The primary goal in the
evaluation and management of patients with nipple
discharge is distinguishing between physiological
and pathological causes, and most importantly
diagnosing breast cancer if present (1).
The most adequate imaging modality for
patients with nipple discharge is controversial (2).
Mammography is indicated in all patients with
nipple discharge for evaluation of occult breast
cancers. However, mammography has low sensitivity
(10-58%) and positive predictive values (PPV, 16-
18%) reported in patients with nipple discharge.
Galactography has relatively high sensitivity (~100%)
in detecting lesions involving ductal structures,
but is an invasive imaging method that cannot be
used when symptoms occur intermittently, not to
mention radiation exposure during examinations.
Breast ultrasonography (US) is a non-invasive
imaging method that can be performed to evaluate
morphologic features of breast masses and its
relationship to the surrounding ductal structures (2).
By performing US in patients with nipple discharge,
we may identify the cause of nipple discharge,
perform biopsy for pathological confirmation,
and the extent of ductal structures involved prior
to surgery (3). In this session, we will discuss the
imaging features of common breast pathology that
causes nipple discharge in women, and the role
of US in both imaging and deciding upon further
management for these women.
23
Categorical Course
GBR 103
KSUM Open 2016
CC 1 BR-4
Evaluating the Symptomatic Patient
09:00 - 09:20
GBR 103
Ultrasound Evaluation for Axillary Lesion
Ji Soo Choi
Radiologists have increasingly imaged the axilla
in females presenting with axillary symptoms. The
purpose of this lecture is to discuss the ultrasound
(U S) s canning t e chniqu e and p e rcu t ane ou s
interventions, and present the US findings of a
variety of diseases involving the axilla.
1. Basic anatomy
A. The axilla is composed of the axillary artery
and vein, brachial plexus, lymph nodes,
fat, accessory breast tissue, skin and
subcutaneous glands
B. The anatomic boundaries are as follows
i. Superior: the clavicle, scapula and first rib
ii.Posterior: subscapularis, teres major and
latissimus dorsi muscles
iii. Anterior: pectoralis major and minor muscles
iv. Medial: serratus anterior and first four ribs
v. Lateral: coracobrachialis and short head of
the biceps muscle
C. Axillary lymph node-bearing area is divided
into three regions
i. Level I: Lymph nodes lateral and inferior to
the pectoralis minor muscle
ii. Level II: Lymph nodes beneath the pectoralis
minor muscle
iii. Level III: Lymph nodes deep and medial to
the medial border of the pectoralis minor
muscle
24
2. Axillary US
A. Scanning technique
i. Scanning is typically targeted over the area
of concern; however, if there is a suspicious
finding, it is important to cover the entire
axillary region to evaluate for any associated
findings.
ii. A xillary ultrasound should be performed
using a high frequency (7.5-17-MHz) lineararray transducer. A lower frequency (57.5-MHz) setting may be needed for larger
patients or for patients with a large axillary
fat pad.
iii. T he patient should lie in a supine oblique
position, with her hand above her head with
the arm abducted and externally rotated
(“bathing beauty” position).
iv. A ll findings should be documented in
orthogonal planes with and without calipers
and a lesion’s largest dimension should also
be recorded.
B. US-guided intervention
i. If the initial imaging evaluation of the axilla
reveals a suspicious finding, percutaneous
procedures, such as ultrasound-guided fineneedle aspiration or ultrasound-guided core
needle biopsy, may be performed.
3. US findings of axillary diseases
A. Skin lesion
i. Epidermal inclusion cyst: cystic mass may be
seen as solid, circumscribed, and complex.
Categorical Course
C. Lymph nodes
i. Benign: smaller than 2 cm in size, lobulated
shape, smooth margin, uniformly thin (3 mm
or less) cortex
ii. M alignant: cortical thickening, absence of
the fatty hilum, non-hilar cortical blood flow,
round shape
D. Post-operative findings: skin and trabecular thickening, postoperative collections/
lymphoceles, fat necrosis and recurrence
E. Neoplasm
i. L ipoma: well-defined homogeneous fatty
mass, echogenicity is somewhat variable
ii. H emangioma: lobulated superficial well-
circumscribed solid masses that are
predominantly hypoechoic and may contain
areas of calcifications
iii. Schwannoma: well-defined oval homogeneously hypoechoic mass with or without
posterior enhancement. Collagen deposit areas
appear as a coarse echotexture or as focally
increased echogenic areas. confirmation of a
neurovascular bundle adjacent to the mass
References
1. A Practical Approach to Imaging the Axilla: Insights
Imaging (2015) 6:217-229
2.Sonography of Axillary Masses: What should be
considered other than the lymph nodes?: J Ultrasound Med 2009;28:923-939
3.Axillary Staging of Breast Cancer: What the
Radiologist Should Know: RadioGraphics 2013;33:
1589-1612
25
Categorical Course
B. Congenital developmental anomalyaccessory breast tissue
i. Fibroadenoma, pseudoangiomatous stromal
hyperplasia, breast cancer
KSUM Open 2016
CC 2 GU-1
US of Male Genitourinary Tract
08:00 - 08:25
Chairpersons:Byung Chul Kang Ewha Womans University Mokdong Hospital, Korea
Room 201
Ultrasound Image of Kidney, Adrenal Gland, and Bladder
Hyuck Jae Choi
Department of Radiology, Kangwon National University Hospital, Korea
1. Ultrasound image of kidney, adrenal gland,
and bladder
(1) Anatomy
1) Size: The length of kidney is 9.0-13.0 cm (mean,
11.7 cm) and 2.6-3.6 times of L2 vertebral
height. Right kidney is smaller than left kidney
by 0.5. In case of ureter duplex system, the size
of kidney increases by 10%. There are variation
of kidney size and in case of decreased kidney
volume the longer diameter of kidney size can
be normal due to replacement lipomatosis
and maintenance of renal sinus. Some authors
evaluate renal function with thickening of renal
parenchyma, in this case thickness of renal
parenchyma more than 1 cm considered normal.
Adrenal gland is small organ which consists
with cortex and medulla. It is located in
anterosuperior aspect each kidney and located in
perirenal space with ipsilateral kidney. Adrenal
gland has three layer; 1. zona glomerularis, 2.
zona fasciculata, 3. zona reticularis. Each layer
produces aldosterone, cortisol, and androgen.
Normal thickness of adrenal gland is 3-6 mm.
Bladder consists with well distensible muscle.
Its capacity is 400-500 mL. Bladder consists
with mucosa, submucosa, lamina propria, and
muscle.
2) Echogenicity: Echo of normal kidney is same or
lower compared with that of the liver.
3) Doppler parameter: In normal kidney, resistive
index is lower than 0.7, acceleration index is
more than 300 cm/sec, acceleration time is less
than 70 msec.
26
(2) Imaging methods
1)General methods: Usually kidney is hindered
with ribs, small bowel, and colon, so care should
be taken for appropriate examination. Liver
and the spleen are sometimes useful sonic
windows for right and left kidney evaluation. In
decubitus position, the air containing bowel is
displaced further from the kidney and kidney
is well visualized (especially left kidney). When
kidney is hindered with rib cage, intercostal
scanning and change the position to sitting
position help kidney scanning. In adult, 3~5
MHz (curved linear) transducer is usually used.
The radiologist should evaluate renal sinus,
renal pelvis, renal artery, renal vein, renal
cortex and medulla. In sagittal scan, both renal
hilum should be included and color Doppler
and resistive index should be obtained in plane
including renal sinus. When scanning adrenal
gland, adrenal gland is usually hindered with
ribs, transverse colon in posterior approach, and
is hindered with transverse process in anterior
approach. Right adrenal gland is well visualized
in intercostal approach (sometimes axial scan in
anterior and posterior approach). Liver is useful
sonic window for right adrenal gland scanning.
In scanning left adrenal gland oblique coronal
scanning in posterior or lateral approach is
useful. Spleen or kidney can be used as a sonic
window.
In scanning the bladder, sagittal scan from
bladder dome to neck is needed. For evaluation
of bladder wall thickening or bladder mass,
bladder filling is mandatory. Patients position
during bladder scanning is supine position.
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Doppler image, patients should keep the breath.
For adequate acquisition of Doppler exam,
radiologist should pay attention to abstain from
raising aliasing artifact.
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May 20, Friday (Room 201)
2)Doppler sonography: With color Doppler or
power Doppler, radiologist can detect vessel.
With spectral Doppler radiologists can acquire
information about the blood flow such as
resistive index. During acquiring spectral
KSUM Open 2016
CC 2 GU-2
08:25 - 08:50
US of Scrotum
Sung Il Jung
Department of Radiology, Konkuk University Medical Center, Korea
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Room 201
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CC 2 GU-3
08:50 - 09:15
Room 201
US of Prostate
Deuk Jae Sung
Department of Radiology, Korea University Anam Hospital, Korea
1. Introduction
Ultrasound examination of the prostate and
surrounding structures is used in the diagnosis
of prostate cancer, benign prostatic enlargement,
prostatitis, prostatic abscesses, congenital anomalies,
and male infertility and for the treatment of prostatic
cancer, abscesses, and benign prostatic enlargement.
Ultrasound-guided biopsy of the prostate is reserved
for evaluating those patients who have abnormal
digital rectal examinations or an abnormal serum
prostatespecific antigen (PSA) level, and those
in whom tissue diagnosis is needed for further
management. Ultrasound findings may be used to
guide targeted or systematic biopsy of the prostate,
which is performed to supplement the standard
systematic biopsy protocol in order to improve the
positive cancer yield of prostate biopsy. However,
current ultrasound techniques using gray scale, color
Doppler, and power Doppler imaging, elastography,
and contrast-enhanced ultrasound are not sufficient
to confirm or exclude the presence of prostate
cancer, and they should not be used to preclude the
performance of prostate biopsy. These parameters
are intended to assist practitioners performing an
ultrasound examination of the prostate. At this
point in time, transrectal ultrasound (TRUS)-guided
biopsy remains the standard as it is inexpensive,
widely available and the procedure is relatively easy
to learn. The widespread introduction of PSA to
detect prostate cancer and the detection of smaller
and earlier cancers in the prostate gland has created
many more cancers that are not visible on TRUS and
this has resulted in an evolution in the development
of biopsy strategies in men with suspected prostate
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cancer.
2. Zonal Anatomy of the Prostate
The concept of zonal anatomy of the prostate gland
was first propose by McNeal and is central to our
present day understanding of prostate cancer and its
distribution. The original two-zone concept has now
developed into four separate anatomical regions;
peripheral zone (PZ), central zone (CZ), transition
zone (TZ) and anterior fibromuscular stroma.
3. TRUS Appearance of the Prostate and
Surrounding Structures
A. Prostate
The transrectal approach to ultrasound of the
prostate is the method of choice, as image quality
is superior to transabdominal or transperineal
examinations. In patients for whom the transrectal
approach is not possible, a transperineal ultrasound
examination may be used to direct a biopsy
procedure. The prostate should be imaged in its
entirety in at least 2 orthogonal planes, sagittal
and axial or longitudinal and coronal, from the
apex to the base of the gland. The PZ/CZ area has a
fine stippled appearance on TRUS, which is based
on the reflection of propagated ultrasound waves
by the interfaces between stroma and fluid-filled
acinar lumina. The homogeneous pattern in the
normal PZ is different from the TZ, which is more
heterogeneous with variable sized glandular areas
and is accentuated by BPH. Muscular, stromal
and fibrous tissue free of normal glands have few
interfaces and appear hypoechoic. The hypoechoic
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B. Seminal Vesicles and Periprostatic Space
The seminal vesicles should be evaluated for size,
shape, position, symmetry, and echogenicity from
their insertion into the prostate via the ejaculatory
ducts to their cranial and lateral extents. Particular
attention should be given to the normal tapering of
the seminal vesicle as it joins the prostate. In patients
being evaluated for infertility, the vasa deferentia
must be evaluated. The presence and size of seminal
vesicle, ejaculatory, Müllerian, or utricle cysts or
evidence of seminal vesicle or ejaculatory duct
obstruction should be noted. The structure of the
capsule of the prostate is indicated by the interface
between the prostate gland and the surrounding
fat. The periprostatic fat and neurovascular bundle
should be evaluated for symmetry and echogenicity.
4. TRUS-Guided Biopsy
Before performing a biopsy, it is imperative that the
indication for performing the procedure is confirmed
as appropriate. Typically, the need for prostate
biopsies is determined on the basis of the serum PSA
levels and/or a suspicious digital rectal examination.
This information needs to be interpreted in the
context of the patient’s wider clinical history and
condition. In particular a biopsy should only be
performed where it is likely to influence management
of the patient’s prostate related condition.
TRUS biopsy is usually performed with the
patient in the left lateral position. A digital rectal
examination should always be performed. This
allows the examiner to assess the overall size of the
prostate gland and any areas of induration that help
determine areas of suspicion. Both longitudinal
and transverse images are obtained with minimal
discomfort to the patient. Probes must be adequately
lubricated before introduction into the rectum. The
ultrasound probe is introduced and a satisfactory
image obtained. 10 or 12 core biopsy strategy is
employed to sample tissue form the prostate gland
at the base, mid-gland and apex. This is based on
the original sextant biopsy protocol with added
lateral cores. The initial biopsy is taken midway
between the mid-point of the prostate gland and the
lateral margin. The probe is then rotated laterally
and a subsequent biopsy is taken at the same level
but more laterally placed to sample tissue from the
anterior horn of the PZ. It is important to place the
biopsy needle correctly at the prostate capsule in
order to sample the outer-most part of the PZ. The
biopsy needle travels a few millimetres forward of
its position on TRUS and a frequent error is the
insertion of the biopsy needle into the PZ prostatic
tissue which results in the biopsy needle passing
further into then gland and not sampling the area
close to the capsule which is frequently the site of
the PZ cancers. It is important to ensure the biopsy
sampling is spatially distributed correctly at the
base, mid-gland and apex. Care must be taken not
to re-biopsy the same area particularly in smaller
prostates as this can give misleading information
about the extent of the cancer within the gland. After
the procedure, it is important to re-iterate to the
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appearance of cancer in the prostate gland is due
to the destruction of normal glandular tissue by the
cancer cells. Familiarity with normal structures in
the prostate gland with a hypoechoic appearance
improves diagnostic accuracy. These include the
urethra and periurethral tissues, the ejaculatory duct
complex, the seminal vesicles and the ampulla of the
vasa at the base of the prostate and the entry point of
the neuro-vascular bundles at the base and apex on
each side of the prostate gland. Other benign entities
that appear hypoechoic on TRUS are BPH nodules,
cysts and areas of prostatitis.
An estimated volume is determined from
measurements in 3 orthogonal planes (volume =
length × height × width × 0.52). The volume of
the prostate may be correlated with the PSA level.
Alternatively, prostate volume can be calculated
using prostate planimetry, which allows greater
accuracy by accommodating individual variations in
prostate shape. The gland should be evaluated for a
focal mass, echogenicity, symmetry, and continuity
of margins. Color and power Doppler sonography
may be helpful in detecting areas of increased
vascularity that can be used to select potential sites
for biopsy. The course of the prostatic urethra should
be documented, when possible, and asymmetry
between left and right periurethral tissues as well as
any effect on the base of the bladder should be noted.
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patient the potential complications of the procedure
and particularly what signs to look for in terms of
infection, retention or persistent bleeding. They
should be advised to rest, take their prophylactic
antibiotics, drink good amounts of fluid and not
drive immediately after the procedure. Patients
with an indwelling catheter, diabetes mellitus,
immunosuppression, etc. should be particularly
vigilant for the signs of infection.
5. TRUS in Other Diseases except
Prostate Cancer
Utricle cysts are confined to the prostate and are
strictly midline. These cysts are usually smaller (no
more than 15 mm in long axis), do not communicate
with the urethra, and are commonly associated
with other congenital anomalies, such as intersex
disorders, cryptorchidism, and hypospadias.
Müllerian duct cyst result from failure of complete
regression of the Müllerian duct in utero. These cysts
can be much larger, may extend above the prostate
gland, and are prone to hemorrhage. On TRUS, they
appear as spherical hypoechoic foci in the prostate
with posterior acoustic enhancement. In the absence
of an extraprostatic component, the appearances of
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Müllerian and utricular cysts are indistinguishable
on TRUS. Paramedian cysts (e.g., ejaculatory duct
cysts) are located laterally, close to the midline, and
posterior to the prostatic urethra. Ejaculatory duct
cysts are rare and are caused by either congenital or
acquired obstruction of the ejaculatory duct.
Congenital seminal vesicle cysts are rare. These
cysts are frequently associated with an ectopic ureter
draining into the seminal vesicle from a dysplastic
kidney or unilateral renal agenesis, explained by a
common embryologic mesonephric origin.
TRUS is often performed for the patients with
infertility or hematospermia. Ejaculatory duct
obstruction can occur because of a large Müllerian
duct cyst, trauma or inflammation. TRUS findings
in suspected ejaculatory duct obstruction include
midline cysts, dilated seminal vesicles or ejaculatory
ducts, and hyperechoic regions suggestive of
calcifications. Hematospermia, the presence of blood
in seminal fluid, is usually caused by nonspecific
inflammation of the prostate and seminal vesicles.
Several studies of hematospermia carried out
using TRUS have revealed that the commonest
cause of hematospermia is prostate calculi. Other
causes include cysts, chronic prostatitis, prostatic
hypertrophy and malignant lesions.
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CC 3 PED-1
First Step in Pediatric Brain and Spine US
Chairpersons:Young Seok Lee Dankook University Hospital, Korea
Room 203
Pediatric Brain US: Technique and Normal Anatomy
Yun Jung Lim
Department of Radiology, Inje University Haeundae Paik Hospital, Korea
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08:00 - 08:30
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CC 3 PED-2
08:30 - 09:00
Pediatric Brain US: Common Pathology
Yun-Woo Chang
Department of Radiology, Soonchunhyang University Seoul Hospital, Korea
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Room 203
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CC 3 PED-3
09:00 - 09:30
Room 203
Pediatric Spinal Canal US
Bo-Kyung Je
Department of Radiology, Korea University Ansan Hospital, Korea
The advances in ultrasonography (US) have
improved the diagnostic value of pediatric
spinal canal ultrasonography. When performed
in newborns and infants whose spinal arches
are incompletely ossified and predominantly
cartilaginous, the US bean can transmit through
the spinal canal. Therefore, US can visualize most
of structures in spinal canal and characterize nearly
all spinal anomalies. In this lecture, we will remind
the technique of the spinal canal US and discuss the
indications and normal versus abnormal findings of
spinal canal US.
Technique
The patients is examined in the prone position
with a small pillow under the abdomen to create a
kyphotic curvature of the vertebrae. Sometimes the
examination can be performed in decubitus position.
Using a linear high frequency (e.g., 5-12 MHz)
transducer, images are obtained in both transverse
and longitudinal planes. In the infants older than
4 months with partially ossified posterior elements
of the vertebrae, the midline scan over the spinous
process is limited, then the paramedian scan allows
sufficient examination. Movement of the spinal cord
and cauda equine can be evaluated using real time
US such as M-mode or video clips. Color Doppler US
can be added to characterize soft tissue masses on
the back or in the spinal canal.
Indications
• Skin-covered soft tissue mass of the back
• Midline cutaneous malformations of the back:
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High risk: complicated or atypical sacral
dimple, skin stigmata, hemangiomas, cutis
aplasia, hairy patches, skin tags, asymmetric
gluteal crease
◆Low risk: simple midline dimples
• Extremity and foot deformities
• Anorectal malformations
• Genitourinary malformations
• Birth-related spinal cord injury
•Intracranial hemorrhage: to detect subarachnoid
lumbar blood collections
•P ost lumbar puncture: to demonstrate the
suspected complications after lumbar puncture
c.f.) Indications of MRI rather than US:
myelomeningocele, obvious CSF drainage from a
dimple
◆
Normal anatomic landmarks
•Count of vertebral level
◆Count up from the tip of coccyx
◆Caudal end of dural sac (S 1-2)
◆Angulation of curvature of spine (L5/S1)
◆Renal hilum (L 1-2)
•Spinal cord
◆H y p o e c h o i c t u b u l a r s t r u c t u r e w i t h a n
echogenic central canal (central echo complex)
◆Surrounded by the anechoic CSF of the
subarachnoid space
•Conus medullaris
◆ Caudal end of spinal cord
◆At the level of L2-3 in neonates / L1-2 in 3
month-infants
•Filum terminale
◆Cordlike echogenic structure, extending
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Normal variants
•Transient dilatation of central canal: disappears
during the postnatal first weeks
•Ventriculus terminalis
◆ Cystic dilatation in conus medullaris
◆Due to incomplete fetal regression of the
embryonic terminal ventricle
•Filar cyst
◆N o r m a l a r a c h n o i d r e f l e c t i o n o r c y s t i c
embryonic remnant
◆Typical imaging findings: midline location,
within filum, just below conus, fusiform shape,
well defined simple cyst)
Without no clinical significance
◆ Without need for additional imaging
•Prominent filum terminale: more echogenic filum
than nerve roots, but normal thickness
•Pseudomass by nerve root clumping: asymmetric
clumping of nerve roots in the decubitus position
•Pseudosinus tract: fibrous tissue extending from
a skin dimple to the coccyx
◆
Spinal disorders
•Spinal lipoma
◆Lipomyelocele / lipomyelomeningocele: due to
premature disjunction of superficial ectoderm
from neuroectoderm
◆ Fibrolipoma of filum terminale
◆ Intradural lipoma
•Dorsal dermal sinus: due to incomplete separation
of superficial ectoderm from neuroectoderm,
resulting in focal segmental adhesion
•T i g h t f i l u m t e r m i n a l e s y n d r o m e : d u e t o
incomplete involution of distal spinal cord,
resulting in an abnormally thickened filum
terminale
•D iastematomyelia: sagittal cleft in the spinal
cord, resulting in two asymmetric hemicords
•T erminal myelocystocele: due to disturbance
of CSF circulation with resulting dilatation of
ventriculus terminalis and disruption of dorsal
mesenchyme
•Caudal regression syndrome: blunt-ending distal
spinal cord, agenesis of sacrococcygeal spine
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caudally to insert on the C1 body
Surrounded by the echogenic nerve roots of
cauda equine
◆Less than 2 mm in thickness, measured at the
level of L5/S1
c.f.) 1.1 mm on J Ultrasound Med 2015;34:19431949
•C raniocervical junction with a sub-occipital
sagittal scan: pons, medulla oblongata, echogenic
clivus, anechoic cisterna magna, hyperechoic
cerebellar vermis and tonsils, hypoechoic spinal
cord
•Features to note on spinal US
◆ Level of the conus medullaris
◆ Pulsatility of the cord and nerve roots
◆Position of the cord in a dorsal/ventral
orientation
◆ Thickness of Filum terminale
◆Presence of an intrathecal mass, lipoma or
dermal sinus tract
◆
KSUM Open 2016
CC 4 PHY-1
08:30 - 08:50
Physics in Emerging Ultrasound Imaging Technologies
GBR 101
Principles in Ultrasound Elastography Imaging
Tai-Kyong Song
Department of Electronic Engineering, Sogang University, Korea
Elasticity imaging for medical diagnosis aims to
provide a quantitative visualization of mechanical
properties of human tissues using the relation
between the wave propagation velocity and the tissue
viscoelastic properties. These properties are known
to carry information about the tissue composition,
micro-structure, physiology and pathology;
pathological phenomena such as weakening of
vessel walls, plaque formation, cirrhosis of the
liver, legion formation during HIFU treatment,
and tumorigenesis are related to changes in tissue
elasticity. For this reason, elasticity imaging has
been a hot research topic to industry, academia and
medicinal profession since early 90’s; two major
elasticity imaging technologies are based on magnetic
resonance imaging and ultrasound. Numerous
ultrasound elasticity imaging methods have been
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developed, which all involve both the excitation to
cause localized displacement of soft tissue and a
monitoring of the deformation response induced by
the excitation. These methods are generally classified
based on the techniques to induce stress in the tissue
and types of elastic modulus to be measured. Among
the three types of modulus, shear modulus offers
better means for the quantification of mechanical
properties of different tissues. In this lecture, we
will focus on acoustic radiation force (ARF) methods
with an advantage in creating shear waves in a region
of interest at a wide range of depths and various
techniques for measuring shear wave velocity or
shear stress. In particular, recent developments of
shear wave elasticity imaging (SWEI) techniques are
discussed along with commercial implementations
for selected methods.
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CC 4 PHY-2
GBR 101
Principles in Photoacoustic Imaging
Junghwan Oh
Department of Biomedical Engineering, Pukyong National University, Korea
Photoacoustic imaging is an emerging technique
based on the photoacoustic effects that results
from the formation of acoustic waves due to light
absorption in sample. Nanosecond laser pulses are
typically employed to irradiate biological tissues.
Through the conversion of the absorbed light energy
into heat, the acoustic waves can be generated within
the irradiated volume following the transient thermoelastic expansion of the tissues. Using an ultrasound
transducer, these acoustic waves can be detected and
collected to reconstruct a photoacoustic image of the
spatial distribution of light absorbers from the tissue
compositions. Therefore, PAI effectively combines
the contrast of optical imaging techniques with the
depth of penetration and resolution of ultrasound
imaging.
Photoacoustic acoustic system can be classified
into two modes: transmission mode and reflection
mode, according to the direction of the transducer
versus the excitation light. In transmission-mode
PAT, the laser-induced PA signal is opposite the
ultrasound detection, whereas the imaging target is
at the middle. As a result, transmission-mode PAT is
limited its application to cell samples or thin parts of
small animal).
In contrast, reflection-mode PAT configure the
excitation light and the transducer at the same side
of the imaging target. Therefore, reflection-mode
PAT allows deep imaging inside biological tissue that
holds a promise for diagnostic imaging and guided
for cancer treatment.
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08:50 - 09:10
KSUM Open 2016
CC 4 PHY-3
09:10 - 09:30
GBR 101
Principles in Ultrafast Ultrasound Imaging
Yangmo Yoo
Department of Electronic Engineering and Biomedical Engineering, Sogang University, Korea
Ultrafast imaging based on plane-wave transmit
and coherent receive beamforming is an emerging
imaging technique in medical ultrasound imaging.
It has been used for improving frame rates in
ultrasound B-mode imaging without sacrificing image
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quality. In addition, it can provide full quantifiable
flow analysis over a large region of interest with
high spatio-temporal resolution. In this lecture,
the physics in ultrafast ultrasound imaging will be
reviewed and its new applications will be discussed.
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CC 5 CV-1 Doppler USG: From Basic to Cutting Edge
10:30 - 10:50
Carotid Doppler USG: Practical Application
Yeo Koon Kim
Department of Radiology, Seoul National University Bundang Hospital, Korea
During the last 10 years, two large multicenter
trials, the North American Symptomatic Carotid
Endarterectomy Trial (NASCET) and the
Asymptomatic Carotid Artery Stenosis trial (ACAS)
have reported a reduction in the risk of stroke for
patients with internal carotid artery (ICA) stenosis
who underwent carotid endarterectomy compared
with medical management. Dissemination of
the results of the trials resulted in an estimated
74% increase between 1994 and 1996 in patients
undergoing carotid endarterectomy. In these trials,
stenosis was assessed before surgery by angiography,
calculated by the NASCET method, and in North
America this has become the gold standard for
patient selection for endarterectomy.
Duplex ultrasonography (DUS) is the primary
noninvasive screening procedure for evaluation of
ICA stenosis and is widely used in clinical practice
to select patients for angiography. The importance
of the measurement properties of DUS in predicting
angiographic stenosis has been recognized by the
large number of recent studies that have examined
different DUS criteria against the gold standard of
angiography.
By DUS, atherosclerotic plaque can be defined as a
measured protrusion of the intima-media thickness
(IMT) of >1.5 mm into the lumen or by a subjective
estimate. Recent studies have suggested that the
presence of plaque, defined subjectively or as a
local thickening of >1.5 mm, might be predictive of
cardiovascular outcomes.
The extent, location, and characteristics of
atherosclerotic plaque in the common carotid
artery (CCA) and internal carotid artery (ICA)
should be documented with gray-scale imaging. The
vessels should be imaged as completely as possible,
with caudal angulation of the transducer in the
supraclavicular region and cephalic angulation at the
level of the mandible. Color Doppler imaging should
be performed to detect areas of abnormal blood
flow that require Doppler spectral analysis. Pulsed
wave (PW) Doppler spectral analysis should be
performed, and the velocity of blood flow in the midCCA and proximal ICA as well as proximal to, at, and
immediately distal to the diseased areas should be
measured. Evaluation of the external carotid artery
(ECA) should be performed, as it is a source of bruit
and differences in the Doppler appearance of the
ECA and ICA improve observer confidence that the
bifurcation vessels have been correctly identified.
Color and PW Doppler imaging of both vertebral
arteries should also be performed to rule out the
presence of a subclavian steal. The topography of
the plaque, velocity information, and interpretation
of the results by the radiologist can be conveniently
recorded in a standardized format.
The Society of Radiologists in Ultrasound
convened a multidisciplinary panel of experts in
the field of vascular ultrasonography (US) to come
to a consensus regarding Doppler US for assistance
in the diagnosis of carotid artery stenosis. The
panel’s consensus statement is believed to represent
a reasonable position on the basis of analysis of
available literature and panelists’ experience. Key
elements of the statement include the following:
(a) All internal carotid artery (ICA) examinations
should be performed with gray-scale, color Doppler,
and spectral Doppler US. (b) The degree of stenosis
determined at gray-scale and Doppler US should
be stratified into the categories of normal (no
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Chairpersons:Jongmin Lee Kyungpook National University & Hospital, Korea
Room 203
KSUM Open 2016
stenosis), 50% stenosis, 50%-69% stenosis, 70%
stenosis to near occlusion, near occlusion, and
total occlusion. (c) ICA peak systolic velocity (PSV)
and presence of plaque on gray-scale and/or color
Doppler images are primarily used in diagnosis and
grading of ICA stenosis; two additional parameters,
ICA-to-common carotid artery PSV ratio and ICA
enddiastolic velocity may also be used when clinical
or technical factors raise concern that ICA PSV may
not be representative of the extent of disease. (d)
ICA should be diagnosed as (i) normal when ICA
PSV is less than 125 cm/sec and no plaque or intimal
thickening is visible; (ii) 50% stenosis when ICA
PSV is less than 125 cm/sec and plaque or intimal
thickening is visible; (iii) 50%-69% stenosis when
ICA PSV is 125-230 cm/sec and plaque is visible;
(iv) 70% stenosis to near occlusion when ICA PSV
is greater than 230 cm/sec and visible plaque
and lumen narrowing are seen; (v) near occlusion
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when there is a markedly narrowed lumen at color
Doppler US; and (vi) total occlusion when there is no
detectable patent lumen at gray-scale US and no flow
at spectral, power, and color Doppler US. (e) The
final report should discuss velocity measurements
and gray-scale and color Doppler findings. Study
limitations should be noted when they exist. The
conclusion should state an estimated degree of ICA
stenosis as reflected in the above categories. The
panel also considered various technical aspects of
carotid US and methods for quality assessment and
identified several important unanswered questions
meriting future research.
References
1. RadioGraphics 2005; 25:1561-1575
2.Radiology 2003; 229:340-346
3.Ann Intern Med. 2014;161:336-346
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CC 5 CV-2
Doppler USG: From Basic to Cutting Edge
Room 203
Contrast-Enhanced Ultrasound in Imaging Carotid Arterial Diseases
Dirk-Andre Clevert
Department of Radiology, University of Munich-Grosshadern Campus, Germany
The standard of care for the initial diagnosis of
carotid artery bifurcation diseases is carotid duplex
ultrasound. Carotid abnormalities or difficult
examinations may represent a diagnostic challenge
in patients with clinical symptoms as well as in the
follow-up after carotid endarterectomy, carotid
artery stenting or other interventions. A promising
new method in the diagnosis and follow-up of
pathologic carotid diseases is contrast-enhanced
ultrasound (CEUS). In comparison with magnetic
resonance imaging or computed tomography, the
contrast agents used for CEUS remain within the
vascular space and hence can be used to study
vascular disease and could provide additional
information on carotid arterial diseases.
This course describes the current carotid duplex
ultrasound examination and compares the pathologic
findings with CEUS.
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10:50 - 11:20
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CC 5 CV-3
11:20 - 11:40
Room 203
Lower Extremity Artery: Evaluation with USG
Ho Jong Chun
Department of Radiology, The Catholic University of Korea, Seoul St. Mary's Hospital, Korea
Ultrasound has been generally established in
evaluation of the arterial diseases of the lower
extremities. Duplex ultrasound refers to a
combination of B-mode imaging with flow velocity
imaging by color and pulsed Doppler ultrasound.
B-mode ultrasound provides a direct tomographic
view of anatomical structures, allowing a clear
evaluation of arterial lumen and atheromatous
plaques, while Doppler ultrasound provides
hemodynamic information about blood flow velocity
within the arterial lumen.
The lower extremity artery normally demonstrates
a three-phase or triphasic flow pattern. Initially, a
high velocity peak results from systole during the
cardiac cycle, then an inverse flow occurs in the
early diastole which is followed by a progressive flow
velocity in the late diastole. This triphasic waveform
is characteristic of arteries supplying the skeletal
muscle with high peripheral resistance. In occlusive
arterial diseases, the flow velocity usually increases
at the point where the lumen is narrowed. As the
disease progresses, the triphasic flow diminishes to
a biphasic flow. If the disease progresses further, the
flow loses its pulsatile nature to a monophasic signal
with increased diastolic flow.
Stenoses are usually quantified by the peak systolic
velocity (PSV) and the PSV ratio (PSVR) of prestenotic or post-stenotic flow to in-stenosis flow.
Velocity spectrum characteristics of a >50% stenosis
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includes an elevated PSV >200 cm/s, systolic
spectral broadening indicating highly disturbed flow
with simultaneous forward and retrograde velocity
spectra during systole. The PSVR across a stenosis
>2 indicates >50% stenosis and a PSVR >4 correlates
with >70% stenosis.
In many vascular laboratories, duplex scanning
has become the primary step in noninvasive
vascular diagnosis after clinical evaluation
and ABI measurement. In a study of duplex
ultrasound prospectively compared to conventional
arteriography (Moneta GL et al. J Vasc Surg.
1992;15:275-284), the sensitivity of duplex
ultrasound ranged from 89% for significant iliac
artery stenosis to 67% for popliteal artery stenosis.
Stenosis was successfully distinguished from
occlusion in 98% of cases. Specificity in that study
was at least 97% for supra-popliteal lesions and 93%
for infra-popliteal lesions.
However, duplex ultrasound can be timeconsuming and highly operator dependent. Given
these limitations, other imaging modalities, such
as magnetic resonance or computed tomographic
angiography should be pursued if clinical symptoms
indicate peripheral artery disease, but when duplex
ultrasound fails to detect significant lesions. For
postoperative surveillance after peripheral vascular
interventions, however, duplex ultrasound remains
as the most important non-invasive imaging tool.
Categorical Course
CC 5 CV-4
Room 203
Lower Extremity Vein: Evaluation with USG
Ki Seok Choo
Department of Radiology, Pusan National University Yangsan Hospital, Korea
1. Anatomy of lower extremity vein
1) Deep vein
Under muscle and deep fascia axial vein and
intramuscular vein
Axial vein: common iliac vein- external iliac
vein (internal iliac vein)-common femoral veinsuperficial femoral vein (deep femoral vein)-popliteal
vein- calf vein
Calf vein: pair
2) Superficial vein
Epifascia vein: above superficial fascia
Saphenous vein: between superficial fascia and
deep fascia (saphenous space)
Course of greater saphenous (medial malleolus to
groin along the medial side of thigh)
A. A single GSV can be found within the entire
length of the saphenous compartment. There
may or may not be a large tributary joining the
GSV.
B. When true duplication is present, there are two
GSVs in the saphenous compartment ?
C. The middle portion of the GSV is barely visible
(or not visible at all (hypoplastic or absent) for a
variable length in approximately 30% of the cases,
with a subcutaneous tributary bypassing the missing
section
Course of small saphenous vein (post. calf)
A. T h e S S V j o i n s t h e p o p l i t e a l v e i n a t t h e
saphenopopliteal junction.
B. T he SSV continues superiorly as the thigh
extension or the vein of Giacomini, and it
connects with the popliteal vein through an
anastomotic vein.
C. There may be no connection to deep veins in
the popliteal fossa, and the SSV may continue
proximally as the thigh extension or the vein of
Giacomini
3) Perforating vein
Connection between superficial vein and deep vein
(about 100 perforating vein)
4) Communicating vein
Connection between superficial vein and superficial
vein
2. DVT diagnosis by US
1) Patient position
A. Femoral v., ATV: supine
B. Popliteal v., PTV, peroneal v., soleus v
B. : Hip abduction, slightly knee flexion
B .: Prone position with ankle on contralateral ankle
2) 2D gray scale
B. : Transverse scan
B. : Check compressibility
B. : Non-compressible portion of v.
B. : Color & spectral Doppler to check the presence
of flow
3) US diagnostic criteria of DVT
A. Direct signs
B. : Intramural thrombus
B. : Incompressibility
B. : N onocclusive thrombosed vein: partially
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Categorical Course
11:40 - 12:00
KSUM Open 2016
3. Varicose vein diagnosis by US
1) Patient position
A. Erect or semierect position
B. : Weight bearing - contralateral side of lower leg
B. Site for evaluation
B. : Sapheno-femoral junction
B. - check for presence of DVT
B. - transverse scan
B. - longitudinal scan: color & spectral Doppler to
evaluate the reflux
B. - valsalva maneuver to induce reflux
B. - reflux time > 1 sec: abnormal
Trace GSV on transverse scan -> Reflux to
branch / Relation with varicose vein / Reflux
to perforators (Huterian’s, Dodd’s, Boyd’s,
Cockett’s perforators)
: Sapheno-popliteal junction
- anatomical variance
- m/c: SSV to popliteal vein at popliteal fossa
- augmentation of calf or using BP cuff
- not use valsalva maneuver
Trace SSV -> Relation with varicose vein/
Reflux to perforators
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4. Venous insufficiency diagnosis by US
1) Reflux time
B. > 1 sec: femoral, popliteal vein
B. > 0.5 sec: GSV, SSV, calf deep vein
B. > 0.35 sec: perforators
2) Perforator diameter
B. > 4 mm: most of them with reflux
B. 2 -3 mm: can have reflux -> check reflux on
Doppler
3) Superficial vein diameter
B. > 5 mm: most of them with reflux
References
1. Duplex ultrasound evaluation of patients with chronic
venous disease of the lower extremities. Khilnani NM.
Am J Roentgenol. 2014;202(3):633-42
2.Coleridge-Smith P, Labropoulos N, Partsch H,
Myer K, Nicolaides A, Cavezzi A. Duplex ultrasound
investigation of the veins in chronic venous disease
of the lower limbs: UIP consensus document. Part
1. Basic principles. Eur J Vasc Endovasc Surg 2006;
31:83-92
3.Min RJ, Khilnani NM, Golia P. Duplex ultrasound
evaluation of lower extremity venous insufficiency. J
Vasc Interv Radiol 2003; 14:1233-1241
4.Coleridge-Smith P, Labropoulos N, Partsch H, et
al. Duplex ultrasound investigation of the veins
in chronic venous disease of the lower limbs: UIP
consensus document. Part 2. Anatomy. Eur J Vasc
Endovasc Surg 2006; 31:83-92
5.Levent Oğuzkurt Ultrasonographic anatomy of the
lower extremity superficial veins Diagn Interv Radiol
2012; 18:423-430
Categorical Course
collapse
B. : Increase in vein diameter
B. : No flow on color and spectral Doppler
B. Indirect signs
B. : Loss of phasicity: proximal thrombosis
B. : Loss of augmentation: distal thrombosis
MS GU-1
Chairpersons:Jongchul Kim Chungnam National University Hospital, Korea
Room 201
Penile Doppler US: Revisited
Dae Chul Jung
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09:20 - 09:40
Penile Doppler US: Can It Stand in Future?
KSUM Open 2016
Comparison between pre- & post-injection
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MS GU-2
Penile Doppler US: Can It Stand in Future?
09:40 - 10:00
Chairpersons:Jongchul Kim Chungnam National University Hospital, Korea
Room 201
New Clinical Application of Penile Doppler US
Joo Yong Lee
Erectile dysfunction (ED) is defined as insufficient
erection or inability to maintain erection for
satisfactory sexual intercourse. ED is caused by
a combination of factors such as physiologic,
neurologic, hormonal, arterial, and cavernosal
impairments. ED affects about 150 million men
worldwide, and the number of subjects who suffer
from ED is expected to double by 2025 as the result
of improved life expectancy and the age-related
nature of ED.
Doppler ultrasonography of the penis following
pharmacostimulation or cavernous injection and
stimulation represents second-line evaluation of
penile blood flow. However, it is the most reliable
and least invasive diagnostic modality for assessing
ED. The test adds an imaging dimension and a
quantification component to the evaluation of blood
flow in the penis distinct from first-line evaluation,
which relies on the assessor’s judgment alone. Penile
Doppler ultrasonography with assessment of the
cavernosal artery flow dynamics as an investigation
for ED was established in 1985 by Lue, et al. Since
then, its role has further evolved most noticeably
since the more recent introduction of the oral PDE5
inhibitors such as sildenafil and tadalafil.
Recently, new application of penile Doppler
ultrasonography has been introduced. Cardiovascular
disease is a major cause of morbidity and mortality in
the developed countries. Traditional risk factors such
as obesity, physical inactivity, and diet are used to
screen for cardiovascular disease. However, these risk
factors miss a significant population who are at risk
for future cardiac events. ED has many associated
conditions in common with cardiovascular disease
and has been shown to be an independent risk factor
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for cardiovascular. Measurements made on penile
Doppler ultrasonography, such as cavernosal artery
peak systolic velocity (PSV), cavernosal artery intimamedial thickness, and the finding of cavernosal
artery calcification, are indicators of generalized
vascular disease. Thus, elements of penile Doppler
ultrasonography can identify men at higher risk
for cardiovascular disease. Also, endothelial cell
dysfunction is associated with cardiovascular disease
and vasculogenic ED. Measured via peripheral
artery tonometry (PAT), endothelial dysfunction
in the penis is an independent predictor of future
cardiovascular events. Kovac et al. assessed
whether measurement of endothelial dysfunction
differentiates men with vasculogenic ED identified
by duplex ultrasound from those without. A total of
142 men were retrospectively assessed using patient
history, penile Doppler ultrasonography and PAT.
ED was self-reported and identified on history. In
results, the measurement of endothelial function
with EndoPAT differentiates men with vasculogenic
ED from those without.
Peyronie’s disease (PD) is a benign, localized
connective tissue disorder of unknown etiology
that causes fibrous thickening of the penile tunica
albuginea. It was first described in 1743 by Francois
Gigot de la Peyronie, the personal physician of
King Louis XVI of France. The prevalence of PD
has been reported to be around 3.2%. Power
Doppler can identify hyperperfusion around the
plaques in the earlier, active inflammatory phase.
A significant proportion of patients with PD have
erectile dysfunction with reports suggesting a
range of 4%-80%. Lastly, it is helpful to document
the pre-operative baseline velocities, in case there
References
1.Althof SE, Eid JF, Talley DR, et al. Through the eyes
of women: the partners' perspective on tadalafil.
Urology. 2006;68:631-635.
2.Auerbach SM, Gittelman M, Mazzu A, et al.
Simultaneous administration of vardenafil and
tamsulosin does not induce clinically significant
hypotension in patients with benign prostatic
hyperplasia. Urology. 2004;64:998-1003; discussion
1003-1004.
3.Bechara A, Romano S, Casabe A, et al. Comparative
efficacy assessment of tamsulosin vs. tamsulosin plus
tadalafil in the treatment of LUTS/BPH. Pilot study. J
Sex Med. 2008;5:2170-2178.
4.Boyle P, Robertson C, Mazzetta C, et al. The
association between lower urinary tract symptoms
and erectile dysfunction in four centres: the UrEpik
study. BJU Int. 2003;92:719-725.
5.Braun M, Wassmer G, Klotz T, et al. Epidemiology
of erectile dysfunction: results of the 'Cologne Male
Survey'. Int J Impot Res. 2000;12:305-311.
6.Brock GB, McMahon CG, Chen KK, et al. Efficacy
and safety of tadalafil for the treatment of erectile
dysfunction: results of integrated analyses. J Urol.
2002;168:1332-1336.
7.Cappelleri JC, Siegel RL, Osterloh IH, et al.
Relationship between patient self-assessment of
erectile function and the erectile function domain of
the international index of erectile function. Urology.
2000;56:477-481.
8.Carson CC. Combination of phosphodiesterase-5
inhibitors and alpha-blockers in patients with benign
prostatic hyperplasia: treatments of lower urinary
tract symptoms, erectile dysfunction, or both? BJU
Int. 2006;97 Suppl 2:39-43; discussion 44-35.
9.Carson CC, Rajfer J, Eardley I, et al. The efficacy and
safety of tadalafil: an update. BJU Int. 2004;93:12761281.
10.Choi KH, Soh BH, Oh CY, et al. The Analysis of
Clinical Efficacy of Phosphodiesterase 5 Inhibitors for
Erectile Dysfunction using SS-Penogram. Korean J
Androl. 2009;27:194-200.
11. Donatucci CF, Brock GB, Goldfischer ER, et al.
Tadalafil administered once daily for lower urinary
tract symptoms secondary to benign prostatic
hyperplasia: a 1-year, open-label extension study.
BJU Int. 2011;107:1110-1116.
12.Eardley I, Cartledge J. Tadalafil (Cialis) for men with
erectile dysfunction. Int J Clin Pract. 2002;56:300304.
13.Fisher WA, Rosen RC, Eardley I, et al. Sexual
experience of female partners of men with erectile
dysfunction: the female experience of men's attitudes
to life events and sexuality (FEMALES) study. J Sex
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is worsening of erectile function after surgical
correction of the deformity.
Color Doppler sonography reveals the absence
of cavernosal blood flow with a high resistance,
low velocity trace from the cavernosal artery. The
sinusoids will be engorged and of low or mixed
echogenicity, depending on the completeness of
sinusoidal thrombosis. The sinusoids will also not
be compressible on probe pressure, and flow in
the dorsal vein flow will be poor or unrecordable.
High-flow (non-ischemic) priapism was first
reported by Burt et al. in 1960. They described
the case of a man who developed priapism after
traumatic coitus. It is typically a delayed sequela of
perineal or genital trauma with the development of
arteriocavernous fistulas. Cavernous blood is arterial
and well oxygenated. Doppler ultrasound allows a
non-invasive accurate investigation for high-flow
priapism with sensitivity approaching 100% for
diagnosing arteriosinusoidal fistula. The diagnostic
distinction between high- and low- flow priapism
is essential as the treatment differs, with low flow
requiring prompt aspiration with surgical shunting
often being necessary in resistant cases.
Penile fracture is a rare condition that results from
blunt trauma causing rupture of the tunica albuginea
of the corpus cavernosum. It occurs most commonly
during sexual intercourse. Doppler ultrasound is a
useful tool, both in the acute setting and in long-term
follow-up to detect those patients with developing
erectile dysfunction.
In summary, penile Doppler ultrasonography plays
an important role in the investigation of patients
with erectile dysfunction, particularly when there has
been a disappointing response to pharmacological
agents. This technique is technically demanding and
requires a thorough understanding of the relevant
anatomy and physiology of the erection mechanism.
With this knowledge abnormalities involving the
underlying soft tissue (e.g., Peyronie’s plaques) or
hemodynamics can be diagnosed.
KSUM Open 2016
Med. 2005;2:675-684.
14.Giannitsas K, Mitropoulos D, Konstantinopoulos A,
et al. Phosphodiesterase-5 inhibitors in the treatment
of lower urinary tract symptoms and benign
prostatic hyperplasia. Expert Opin Pharmacother.
2008;9:1687-1693.
15.Goldstein I, Lue TF, Padma-Nathan H, et al. Oral
sildenafil in the treatment of erectile dysfunction.
Sildenafil Study Group [see comments][published
erratum appears in N Engl J Med 1998; 339: 59]. N
Engl J Med. 1998;338:1397-1404.
16.Kaplan SA, Gonzalez RR, Te AE. Combination of
alfuzosin and sildenafil is superior to monotherapy
in treating lower urinary tract symptoms and erectile
dysfunction. Eur Urol. 2007;51:1717-1723.
17.Khan MA, Thompson CS, Dashwood MR, et al.
Endothelin-1 and nitric oxide in the pathogenesis of
urinary tract disorders secondary to bladder outlet
obstruction. Curr Vasc Pharmacol. 2003;1:27-31.
18.Kim BH, Yi S, Kim J, et al. Influence of alcohol on
the hemodynamic effects and pharmacokinetic
properties of mirodenafil: a single-dose, randomizedsequence, open-label, crossover study in healthy male
volunteers in Korea. Clin Ther. 2009;31:1234-1243.
19.Kim HW, Park WJ, Choi YS, et al. The Correlation
between Erectile Dysfunction and the Severity
of Coronary Artery Involvement in Patients with
72
Coronary Artery Disease. Korean J Urol. 2007;48:94102.
20.Kim JJ, Moon DG. Past, Present and Future of PDE5
Inhibitor. Korean J Androl. 2008;26:49-60.
21.Kloner RA, Jackson G, Emmick JT, et al. Interaction
between the phosphodiesterase 5 inhibitor, tadalafil
and 2 alpha-blockers, doxazosin and tamsulosin in
healthy normotensive men. J Urol. 2004;172:19351940.
22.Kovanecz I, Rambhatla A, Ferrini MG, et al. Chronic
daily tadalafil prevents the corporal fibrosis and venoocclusive dysfunction that occurs after cavernosal
nerve resection. BJU Int. 2008;101:203-210.
23.Kuan J, Brock G. Selective phosphodiesterase type 5
inhibition using tadalafil for the treatment of erectile
dysfunction. eid. 2002;11:1605-1613.
24.Liguori G, Trombetta C, De Giorgi G, et al. Efficacy
and safety of combined oral therapy with tadalafil and
alfuzosin: an integrated approach to the management
of patients with lower urinary tract symptoms and
erectile dysfunction. Preliminary report. J Sex Med.
2009;6:544-552.
25.Marumo K, Nakashima J, Murai M. Age-related
prevalence of erectile dysfunction in Japan:
assessment by the International Index of Erectile
Function. Int J Urol. 2001;8:53-59.
Hot Issues
HI 1 BR-1
Screening Breast US
09:30 - 10:00
Mammographic Breast Density and Screening Ultrasound
Jiyon Lee
Department of Radiology, New York University School of Medicine, United States
In this talk, I will define, illustrate, and discuss
mammographic breast density, measurement
techniques, BI-RADS, and why we care about
breast density. This includes breast density-related
limitations of mammography and origin of belief that
it is an independent risk factor for BC.
The USA breast density legislation and current
data regarding screening US will also be covered,
along with great case examples of US in use.
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SFS 1 BR-1
Breast US BI-RADS
10:30 - 10:55
GBR 103
Chairpersons:Hak Hee Kim Asan Medical Center, Korea
Update in Breast US BI-RADS
Bong Joo Kang
The ACR BI-RADS-Ultrasound divided into
four sections
SECTION I: General Considerations
SECTION II: Breast Imaging Lexicon
SECTION III: Reporting System
SECTION IV: Guidance
SECTION I: General Considerations
A. Breast Anatomy
B. Image Quality
C. Labeling and Measurement
D. Documentation
SECTION II: Breast Imaging Lexicon
A. Tissue Composition
B. Mass
C. Calcifications
D. Associated Features
E. Special Cases
SECTION III: Reporting System
A. US Report Organization
1. Indication for examination
2. Statement of scope and technique of breast
US exam
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KSUM Open 2016
3. S uccinct description of the overall breast
composition(screening only)
4. Clear description of any important findings
5. C omparison to previous exam, including
correlation with physical, MMG, MRI
6. Composite reports
7. Assessment
8.Management
felt to explain the patient’s symptoms (if any).
-If irregular masses in intraductal extension, its
shape, margins, orientation, posterior features,
and echo pattern should be described.
-If no abnormality is identified under US, consider
a ductogram (galactogram), which may show
peripheral abnormalities more effectively than
US.
B. BI-RADS Assessment Categories and Management Recommendations
4. A 52-year-old woman with a family history of
unilateral breast cancer (mother diagnosed at the age
of 67) presents with a large, painful breast mass. Her
mammograms show no abnormalities other than a
4 cm circumscribed mass, characterized at US as a
simple cyst. For relief of her symptoms, she requests
aspiration. What assessment and management
recommendations should be provided in the breast
imaging report?
-Benign (category 2) assessment, audit negative
-The requested cyst aspiration is for therapeutic
rather than diagnostic purposes.
SECTION IV: Guidance
1. Which type of breast imaging examination
should I recommend for my patients?
-When in doubt, refer to the ACR Appropriateness
Criteria® (http://www.acr.org/Quality-Safety/
Appropriateness-Criteria/Diagnostic/BreastImaging). The ACR Appropriateness Criteria®
provides recommendations for both screening
and diagnostic breast imaging procedures.
2. A woman in her 20s consulted a gynecologist,
who discovered a palpable breast mass; the woman
thinks that the mass has been palpable for a long
time, but the gynecologist insists on imaging, which
shows probable fibroadenoma. What should the
assessment be? Is biopsy always necessary?
-The correct assessment: probably benign
(category 3), recommend surveillance imaging,
unless the woman prefers biopsy or even excision
if the mass is cyclically painful.
-If the woman declines surveillance imaging and
a biopsy is done for this category 3 lesion, the
probably benign assessment should not change.
3. A woman undergoes breast US examination to
evaluate spontaneous bloody nipple discharge, and
I see a mass within a duct. How do I describe this
using the BI-RADS® lexicon?
-Most of these masses require biopsy.
-R equired statement: the length of the duct
segment that contains the mass or debris, size
and intraductal location of such masses, presence
of vascularity, clock-face position, distance from
the nipple, and whether or not these masses are
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5. When a woman is recalled from screening
for an asymmetry, and spot-compression or spot
compression magnification views show no persistent
abnormality, is it necessary to perform US?
-It is neither necessary nor appropriate to perform
US
-80% of asymmetries: summation artifacts.
-W ith spot-compression or spot-compression
magnification views depicting a focal asymmetry
(non-mass lesion visible on two different
mammographic projections) as the only imaging
finding, then it would indeed be appropriate
to perform US targeted at the mammographic
lesion.
-S uch cases would be assessed as probably
benign (category 3) unless prior mammograms
demonstrated at least 2-3 years of stability
resulting in a benign (category 2) assessment.
6. In reporting the findings of a US examination,
how many sonographic descriptors of a mass
should be used to support its assessment? Is it
acceptable to simply report that the mass has benign
characteristics?
-There is no specific number of descriptors that
7. How should lesion location be reported on
follow-up sonograms of a mass?
A 42-year-old woman was found to have a
circumscribed mass at baseline mammography.
At diagnostic mammography and US, the mass
was assessed as probably benign and its location
at US was recorded as right breast, 10 o’clock,
5 cm posterior to the nipple. She returned for a
6-month follow-up US, and the sonographer told
the interpreting physician that the mass was located
at 11:00 in the right breast 6 cm posterior to the
nipple but that she had labeled her images of the
mass exactly as they had been annotated on the
previous US examination. The technologist asked the
physician if what she had done was correct.
-The report could state: “The right breast mass
seen previously at 10:00 position, 5 cm posterior
to the nipple is the same mass seen on today’s
exam in the right breast at 11:00 position, 6 cm
posterior to the nipple, the minor difference
being due to variability in patient positioning.”
8. US revealed a large axillary mass in a patient
with known metastatic melanoma. Previously, this
mass had been biopsied and shown to represent
an axillary lymph node with metastatic melanoma.
Except for the axillary mass, US examination
revealed no abnormalities in the breast. What is the
appropriate assessment for this examination?
-The appropriate assessment is benign (category
2).
-A n a s s e s s m e n t o f k n o w n b i o p s y - p r o v e n
malignancy (category 6) would not be
appropriate, as this assessment is used for known
breast cancers (defined in the BI-RADS® Atlas as
being either invasive breast carcinoma or ductal
carcinoma in situ). Note that other malignancies
(lymphoma, leukemia, sarcoma, metastasis, etc.),
even when present in the breast or axilla, are not
considered to be breast cancer.
9. Should assessment category 0 be applied to
breast US examinations?
-In general, assessment category 0 should not be
assigned to diagnostic breast US examinations.
-Assessment category 0 indeed is appropriate for
screening breast US examinations.
10. For bilateral screening US performed either by
the technologist or the physician with no abnormality
identified, what images should I record?
-I n addition to demographics (patient’s name,
unique identifier, date of birth or age, facility
name, and location), record one image in one
plane (ordinarily radial) for each quadrant, and
one image of the retroareolar region just behind
the nipple.
-T he axilla could be scanned as well, but this
was not required in the ACRIN 6666 protocol,
nor was there a requirement to record a
representative negative image. - - The standard
set of five images per breast was recorded.
11. Should I avoid using breast US for male patients
with clinical findings because gynecomastia may be
misinterpreted as malignancy?
-N o, US is indicated for evaluation of most
palpable abnormalities, regardless of the patient’s
gender.
-Men with palpable masses located far from the
nipple would be referred for US on completion of
mammography. Gynecomastia itself is frequently
palpable and tender, with mammography most
commonly being definitive in confirming the
diagnosis.
Reference
1.Radiology. ACo. breast imaging reporting and data
system, breast imaging atlas, 5th edition: Reston, VA:
American College of Radiology; 2013.
93
must be used
-B enign: circumscribed margin, oval shape,
parallel orientation.
-Suspicious: indistinct margin, irregular shape, or
not parallel orientation
-R eports should be clear and concise, and too
many adjectives may detract from the message,
but the referring clinician or the next radiologist
who views the sonograms may appreciate
knowing the criteria used to justify a benign
assessment.
KSUM Open 2016
SFS 1 BR-2
Breast US BI-RADS
10:55 - 11:25
GBR 103
Clinical Applications of Breast Ultrasound BI-RADS
Jiyon Lee
Department of Radiology, New York University School of Medicine, United States
ACR BI-RADS history and overarching aims
Quick refs: tables of changes, helpful checklists to
summarize current lexicon
(Mammography reporting and lexicon-not covered
here)
Ultrasound reporting and lexicon-yes covered here
(Sections: FAQs and Guidance-not covered here)
Final reporting: uncoupling of assessment
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categories and management recs validates flexible
language we have been using in reports
Case examples to illustrate
E.g. descriptors
E.g. composite mammo/US report with one overall
BI-RADS
( Follow up and outcomes monitoring (FUOM)
section--not covered here)
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SFS 1 BR-3
Breast US BI-RADS
11:25 - 11:50
GBR 103
Medical Audit of Screening Breast US
Min Jung Kim
Screening mammography program has been
established in America, and reported to reduce
breast cancer deaths among women age 40 years
and older in several randomized clinical trials (1),
although there are some debates on the degree
of contribution of screening on improvement of
survival in breast cancer patients (2). In Korea, since
1999, the National Cancer Screening Program (NCSP)
has recommended biannual screening mammograms
(3). However, the outcome of breast cancer screening
has been not good; the cancer detection rate was 0.6
per 1,000 screenings with a sensitivity of 34.8%, a
positive predictive value of 0.6%, and an interval
cancer rate of 1.3 per 1,000 negative screenings (4,
5). Therefore, to improve the performance of breast
cancer screening, quality control of mammography
equipment, technologists, and radiologists was
needed. The Korean Institute for Accreditation of
Medical Imaging was established for the quality
control of special medical imaging equipment. All
the mammography in all facilities that wanted to join
the breast cancer screening program in NCSP, must
be accredited and certificated by the Korean Institute
for Accreditation of Medical Imaging since 2004.
Meanwhile, for the quality control of interpretation
by radiologist who joined NCSP, the mammography
boot camp was developed by Korean Society of
Radiology (KSR) and Korean Society of Breast
Imaging (KSBI) since 2012. This process was also
found in the history of screening program in U.S.A
(6-8) and could be a representative example for the
necessity of medical audit in breast cancer screening.
In this talk, the goal of screening breast imaging
(6), the necessity of medical audit, desirable goals
for surrogate measures of screening outcomes (9),
the potential way to improve the outcome of medical
audit (10).
References
1.Humphrey LL, Helfand M, Chan BKS, Woolf SH.
Breast Cancer Screening: A Summary of the Evidence
for the U.S. Preventive Services Task Force. Annals of
Internal Medicine 2002;137:347-360
2.Harding C, Pompei F, Burmistrov D, Welch HG,
Abebe R, Wilson R. Breast Cancer Screening,
Incidence, and Mortality Across US Counties. JAMA
Intern Med 2015;175:1483-1489
3.Suh M, Choi KS, Lee YY, Jun JK. Trends in Cancer
Screening Rates among Korean Men and Women:
Results from the Korean National Cancer Screening
Survey, 2004-2012. Cancer Res Treat 2013;45:86-94
4.Kang MH, Park EC, Choi KS, Suh M, Jun JK, Cho E.
The National Cancer Screening Program for breast
cancer in the Republic of Korea: is it cost-effective?
Asian Pac J Cancer Prev 2013;14:2059-2065
5.Kim Y, Jun JK, Choi KS, Lee HY, Park EC. Overview
of the National Cancer screening programme and the
cancer screening status in Korea. Asian Pac J Cancer
Prev 2011;12:725-730
6.Farria DM, Monsees B. Screening mammography
practice essentials. Radiol Clin North Am
2004;42:831-843, vi
7.Feig SA. Adverse effects of screening mammography.
Radiol Clin North Am 2004;42:807-819, v
8.United States General Accounting Office Mammography
Quality Standards Act: x-ray quality improved, access
unaffected, but impact on health outcomes unknown.
GAO/T-HEHS-98- 164:1- 10. Washington, DC: US
General Accounting Office, 1998
9.Feig SA. Auditing and benchmarks in screening and
diagnostic mammography. Radiol Clin North Am
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2007;45:791-800, vi
10.Kim SY, Kim MJ, Moon HJ, Yoon JH, Kim EK
Training Effect on Screening Breast Ultrasound
for Women at Average Risk of Breast Cancer:
Improvement in the Positive Test Rate and Biopsy
Rate over 3 Years RSNA. Chicago, IL, 2015
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11.Moon HJ, Jung I, Park SJ, Kim MJ, Youk JH, Kim
EK. Comparison of Cancer Yields and Diagnostic
Performance of Screening Mammography vs.
Supplemental Screening Ultrasound in 4394 Women
with Average Risk for Breast Cancer. Ultraschall Med
2015;36:255-263
Luncheon Symposium
LS 1 Toshiba-1
12:10 - 12:40
Toshiba Recent Advancement in Radiologic Technology
Luncheon Symposium
Chairperson: Byung Ihn Choi Chung-Ang University Hospital, Korea
GBR 102
Superb Micro-Vascular Imaging and Contrast-Enhanced US:
Assessment of Breast Tumor Vascularity
Bo Kyoung Seo
Department of Radiology, Korea University Ansan Hospital, Korea
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LS 1 Toshiba-2
12:40 - 13:10
Toshiba Recent Advancement in Radiologic Technology
Chairperson: Byung Ihn Choi Chung-Ang University Hospital, Korea
GBR 102
Shear Wave Elastography with a Propagation Map in Chronic
Hepatitis: Comparison with Transient Elastography and
Interobserver Agreement
Eun Sun Lee
Department of Radiology, Chung-Ang University Hospital, Korea
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SFS 2 GU-1 Upcoming Issues of Renal US
Chairpersons:Min Hoan Moon SNU Boramae Medical Center, Korea
Room 201
Overview of Elastography in Renal Disease
Liang Wang
Department of Ultrasound, Peking Union Medical College Hospital, China
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13:20 - 13:40
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SFS 2 GU-2 Upcoming Issues of Renal US
Room 201
ARFI Quantification in Chronic Renal Disease
Liang Wang
Department of Ultrasound, Peking Union Medical College Hospital, China
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SFS 2 GU-3
Room 201
US of Renal Artery Stenosis: Revisited
Byung Kwan Park
Renal artery stenosis (RAS) is the narrowing of
one or both of the renal arteries, most often caused
by atherosclerosis or fibromuscular dysplasia. This
narrowing of the renal artery can decrease blood flow
to the kidney, resulting in renovascular hypertension
or reduced renal function.
The screening examination for RAS is renal
Doppler ultrasonography (US). Pulsus tardus and
parvus is considered a typical US finding. However, it
is often detected in the late stage of RAS in which the
size of a kidney becomes small. The use of contrastenhanced CT increases a risk for contrast-induced
nephrotoxicity. The use of contrast-enhanced MRI
increases a risk for nephrogenic systemic fibrosis in
patients with poor renal function.
I have experienced many cases with RAS which
is diagnosed with color Doppler US, spectral
Doppler US, and contrast-enhanced US. These US
examinations are performed to assess arterial orifice,
which is most often involved with RAS. US contrast
material does not influence renal function.
The purpose of my presentation is to show how to
perform US for evaluating the orifice of renal artery
and describe various US features of RAS.
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14:00 - 14:20
KSUM Open 2016
SFS 2 GU-4
14:20 - 14:40
Room 201
Contrast Enhanced Ultrasound of Renal Disease
Jung Jae Park
Contrast enhanced ultrasonography (CEUS)
utilizes the microbubbles as echo-contrast media
and the contrast agent is free of nephrotoxicity.
After injecting contrast agent, normal kidney
enhances rapidly and it is not excreted into the
urinary tract. Therefore, CEUS has advantages in
evaluating variable renal diseases especially for
the patients with decreased renal function. The
European Federation of Societies for Ultrasound in
Medicine and Biology (EFSUMB) provided clinical
guidelines and recommendations, and the non-
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hepatic applications were updated in 2011. CEUS
can be indicated for Evaluation of renal ischemia/
infarction, characterization of focal lesions, and renal
infections. CEUS has several advantages compared
to conventional US technique such as color Doppler
US. Additionally, recent studies have suggested
promising perspectives of CEUS as a novel imaging
biomarker by evaluating perfusion of diseased or
transplanted kidney quantitatively. CEUS can be
used as a therapeutic modality by US triggered drug
delivery.
SFS 3 PED-1 Pediatric Emergency US
Chairpersons: Young Seok Lee Dankook University Hospital, Korea
Room 203
Emergency US in Urogenital Field
Masahiro Kitami
Department of Radiology, Tohoku University, Japan
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13:20 - 13:50
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SFS 3 PED-2
13:50 - 14:20
Room 203
Emergency US in Gastrointestinal Tract
Jae-Yeon Hwang
Department of Radiology, Pusan National University Yangsan Hospital, Korea
1. Background
•Proper selection of transducers: convex transducer for broad scanning → high resolution linear
transducer for detailed examination
•G raded compression technique, Harmonic
imaging increase identification of bowel wall
layers
•Five alternating bowel wall layers
Superficial mucosa - echogenic inner layer
Muscularis mucosa - hypoechoic
Submucosa - echogenic thicker layer
Muscularis propria - hypoechoic
Serosa - echogenic outermost layer
2. Symptomatic approach
•Vomiting: volvulus, intussusception, enterocolitis,
HSP, pyloric stenosis
•Pain: intussusception, appendicitis, enterocolitis,
mesenteric adenitis, small bowel obstruction,
omental infarction
•H ematochezia: intussusception, enterocolitis,
Meckel’s diverticulum
• Diarrhea: enterocolitis, Crohn’s disease
• Fever: appendicitis (perforated), enterocolitis,
3. Malrotation and Midgut volvulus
•UGI study is most accurate modality: located the
position of the duodeno-jejunal junction → In US,
retroperitoneal position of the duodenal third
portion between the SMA and aorta
• US examination
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• Malrotation: reversal of SMA/SMV relationship
• Volvulus:
- whirlpool sign (+) → SMV wrapping around
the SMA in a clockwise direction
- distended stomach and duodenum ending in
the beaklike configuration
4. Hypertrophic Pyloric Stenosis
•2-8 weeks baby (peak 3-5 weeks), may be older
age in prematurity
• US examination
•U se convex probe to explore pyloric canal
→ change probe with high resolution linear
transducer
•P osition in right lateral decubitus or supine
position
•Posteriorly directed pyloric channel when the
stomach is distended with gastric contents
• Measurements
- T ransverse view → pyloric circular muscle
thickness ≥ 3 mm
- Longitudinal view → pyloric channel length
≥ 14-17 mm (※ π = 3.14)
•Fixed thickening and obstruction of the pyloric
channel while US examination
- DDx: pylorospasm → borderline thickening (<
3 mm), intermittent spasm
- DDx: normal transient elongation of pyloric
channel
5. Intussusception
• Typical age: 5-36 months (peak 5 to 9 months)
•O utside typical age → pathologic lead point
6. Acute appendicitis
• US
•D iameter (outside - outside) > 6 mm, Noncompressible
•F l u i d - f i l l e d l u m e n , t a r g e t a p p e a r a n c e ,
appendicolith, increased periappendiceal
echogenicity, pericecal or periappendiceal
fluid, enlarged mesenteric LNs, loss of mural
integrity,
•S uppurative: increased and heterogeneous
wall echogenicity, hypervascularity of
periappendiceal tissue
• Gangrenous change: advanced dilatation, low
of echogenic submucosal layer, absence of
vascularity
• Perforation (20-30% of children)
-Non-visualization of appendix, decompressed
appendix, phlegmon, intraperitoneal fluid,
focal bowel wall thickening, loculated or
collections of fluid, abscess
• US techniques
-Gradual compression technique
-Explorer site of maximal tenderness with high
resolution linear probe
-Find ascending colon and proceed down to
the cecum
-Identify terminal ileum (or IC valve): lack of
blind loop with peristaltic movement
-Appendix is located 1-2 cm below the TI or (IC
valve)
-N o r m a l a p p e n d i x : d i a m e t e r ≤ 6 m m ,
thickness ≤ 2 mm
-U se convex probe for retrocecal position,
explorer RUQ
-Lower cecum (in pelvis) --> empty urinary
bladder, use of convex probe
-Left lateral decubitus position --> displace
appendix and cecum medially
•A ppendicitis in young children (less than 4
years)
-C linically unsuspected appendicitis is
common: Vague abdominal pain, diarrhea,
fever
-Frequent perforation (nearly 100% at 1-yearold, 80% at 3 years old, 50% at 5 years old)
-Same criteria with older children (> 6 mm in
MOD)
7. Mesenteric adenitis
• E n l a r g e d m e s e n t e r i c L N s w i t h N O R M A L
appendix, Self-limiting disease
•E i t h e r p r i m a r y i n f l a m m a t i o n o f L N o r
secondary inflammation (viral infection, Crohn
disease etc.)
• US
•L N > 5 mm (in short axis) are frequent in
normal children (peak age 10 years)
•Cluster of three or more LNs ≥ 10 mm (in short
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(duplication cyst, Meckel diverticulum, HSP,
polyp, lymphoma…)
• US
•Spinal cord
• Linear high resolution transducer,
•F requently seen at the RUQ (subhepatic
region), several centimeters
•Transverse view: doughnut, target, bulls eye,
multiple concentric ring sign
•L ongitudinal view: pseudokidney, sandwich,
hay fork signs
•( from outer layer) Thin hypoechoic intussuscipiens - echogenic mucosal surface of
intussuscipiens - thicker hypoechoic returning
limb of intussusceptum - thin echogenic serosal
surfaces of everting and entering limb - echogenic
mesentery, vessels, lymph nodes - central
hypoechoic entering limb of intussusceptum
• Predictors of irreducibility
• Thickened outer wall > 10 mm
• Reduced vascular flow on color Doppler study
•Trapped peritoneal fluid within the intussusceptum
• At least 2 LNs, one of which is greater than 11 mm
• Pathologic lead point
•Intramural or subserosal gas → risk of bowel
necrosis and perforation
• Small bowel intussusception
•U sually transient, resolve on delayed US
examination
• Smaller than ileocecal intussusception
•Persistent, symptomatic SB intu. may require
surgical intervention
KSUM Open 2016
axis), normal appendix
8. Henoch-Schönlein purpura
• GI involvement of systemic vasculitis
•B owel wall hemorrhage (hematoma) can be a
lead point of intussusception (up to 50%)
•Abdominal pain may precede the onset of skin
lesions, mimic appendicitis
•US
•C ircumferential bowel wall thickening with/
without focal intramural hematoma (mucosal
or submucosa)
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•Hyperemia of the bowel wall (echogenic bowel
wall thickening)
•Frequent in duodenum and small bowel
•Intussusception
9. Omental infarction
•Common right sided abdominal pain (rare nausea
and vomiting)
•Ovoid echogenic mass between the abdominal
wall and colon, peripheral hyperemia
SFS 3 PED-3
Room 203
Emergency US in Pediatric Musculoskeletal System
Jung-Eun Cheon
Ultrasound (US) is a first-line modality for a
wide range of pediatric musculoskeletal imaging
indications. Readily accessible in both emergency and
outpatient settings, US allows radiologists to perform
a dynamic assessment of the musculoskeletal
system without using ionizing radiation or sedation.
The purpose of this review is to understand the
common indications for emergency US in pediatric
musculoskeletal system and to describe the spectrum
of pathologic findings seen on US examination.
Infectious and Inflammatory Disorders
Transient synovitis
Transient synovitis or toxic synovitis of the hip is
a self-limited inflammatory condition of the joint
space precipitated by a prior viral infection such as
upper respiratory infection or allergy. Most children
with transient synovitis may present with a limp
but without fever or abnormalities on laboratory
examinations. US demonstrates joint effusion in the
anterior recess of the hip joint. Normally the anterior
and posterior parts of the joint capsule are attached
closely to each other. A linear echo located centrally
marks the interface between the two layers. With
joint effusion the anterior joint capsule assumes
a convex shape and underlying fluid within the
anterior recess can be visualized.
US evaluation of the femoral epiphysis is
mandatory to look for irregularities of the cartilage
and ossification center in case of Legg-Calve-Perthes
disease or a physeal step in slipped upper femoral
epiphysis. If one of these entities is suspected on
US, further evaluation by radiography and MRI will
establish the extent of the disease in detail. The most
important differential diagnosis is septic arthritis due
to the devastating consequences to the hip joint in
case of delayed diagnosis. However, US is unable to
accurately differentiate between transient synovitis
and a septic hip, and it may provide a false-negative
result in early stages of the disease. The currently
accepted mode of practice is US- guided aspiration of
fluid to exclude the possibility of septic arthritis.
Septic arthritis
Acute septic arthritis is a medical emergency
as early diagnosis and treatment is mandatory to
prevent joint destruction, growth disturbances and
early degenerative disease. In children over the
age of 2 years it is mostly caused by hematogenous
seeding, less frequently by contiguous spread from
adjacent osteomyelitis. The hip joint is most common
involved site; knee, shoulder and elbow are other
common preferred sites. The presenting symptoms
are fever, pain, inability of weight bearing, elevated
erythrocyte sedimentation rate (ESR) and C-reactive
protein (CRP). US is highly sensitive to detect joint
effusion, but neither amount and echogenicity of the
effusion nor adjacent hyperemia on color Doppler
US imaging allow distinguishing infectious from
non-infectious arthritis. Because of the relationship
between septic arthritis and adjacent osteomyelitis,
adjacent osseous structures should be examined.
Careful US evaluation may show areas of cortical
destruction, periosteal new bone formation and
subperiosteal fluid collections that may correspond
to an osteomyelitis.
Osteomyelitis
Osteomyelitis is an infection of bone marrow and
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14:20 - 14:50
KSUM Open 2016
bone usually caused by bacteria. Infection occurs
through three possible routes: hematogenous, which
is by far the most common way in children, by
contiguity, and by direct implantation. In children
more than 80% of cases of osteomyelitis occur
due to hematogenous seeding after a transient
episode of bacteremia. Due to the architecture of the
supplying vessels, the primary site of the Infectious
process is the metaphyseal region of the long bones.
Further spread varies according to age and depends
on the vascular anatomy of the metaphysealepiphyseal region. Typical signs and symptoms of
acute osteomyelitis include fever, local pain and
tenderness. However initial signs may be vague
and misleading especially in infants, who may only
present with pseudoparalysis.
Radiographs should always be the first study
obtained in patients with suspected osteomyelitis.
However, bone changes are not detectable until
after 7-10 days. US may demonstrate features of
acute osteomyelitis within 2 days. The earliest sign
is juxtacortical soft tissue swelling followed by
periosteal elevation with a thin layer of fluid. As
periosteal attachment is loose in young children,
subperiosteal abscess formation rapidly occurs and is
seen as hypoechoic lenticular-shaped fluid collection
along the cortex. In the appropriate clinical setting,
this finding confirms acute osteomyelitis. After USguided puncture to obtain material for cultivation
of the causative organism antibiotic therapy can
be started immediately. Cortical erosions can be
seen later in the course of the disease and US is
also useful in detecting fistula formation in chronic
osteomyelitis. In children under the age of 2 years,
blood vessels cross the physis thus propagating
spread of infection into the epiphysis and into the
joint space. In patients with suspected osteomyelitis
and negative or inconclusive results on US urgent
MRI is mandatory.
Soft-Tissue Infection
Cellulitis is defined as an infection of skin and
subcutaneous tissue. US appearance initially
resembles edema of subcutaneous fat, showing
swelling, increased echogenicity and blurring
of tissue planes. Further progression leads to
hypoechoic strands between hyperechoic fatty
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lobules. Increased vascularity on color Doppler US
suggests an inflammatory process. Accumulation of
pus and abscess formation can readily be detected
by US and US-guided puncture can be performed for
diagnostic and therapeutic purposes.
Juvenile Idiopathic Arthritis
Juvenile idiopathic arthritis encompasses a
heterogeneous group of inflammatory arthritides.
The hallmark of this disease is synovitis, which can
be readily detected on US examination. Color or
power Doppler imaging may be especially helpful
in revealing the synovial hyperemia that signifies
active synovitis. US also plays an important role in
identifying enthesitis and tenosynovitis, allowing
clinicians to identify inflammatory changes occurring
outside the joint space. Finally, US can be used
to perform targeted intraarticular corticosteroid
injections for patients with identified disease.
Trauma-related Lesions
Intramuscular hematoma
Intramuscular hematomas may occur after injuries
that mechanically disrupt muscle fibers. In healthy
individuals, this usually results from a significant
musculoskeletal trauma, although in patients with
hemophilia, more minor traumas may precipitate
intramuscular hematomas that require medical
treatment.
Myositis ossificans
Posttraumatic myositis ossificans may occur after
a single episode of trauma or after repetitive small
traumas occurring in a discrete area. However,
because up to 40% of patients may not recall a
specific inciting trauma, myositis ossificans is not
always initially considered as a possible cause of
a palpable soft-tissue mass in patients. Typically,
myositis ossificans appears as an ovoid hypoechoic
mass that does not infiltrate adjacent structures.
In its early stages, myositis ossificans may display
mild vascularity and ill-defined margins on US
images, whereas mature myositis ossificans should
appear avascular with an echogenic shadowing rim
compatible with calcification
Tendon laceration
Lacerated tendons typically appear as a hypoechoic
area with disruption of fibrillary tendon structures
and possible surrounding soft-tissue edema. If
complete, separation of the tendon at the site
of injury is easily identified. Soft-tissue echoes
compatible with gas may be identified in cases
of penetrating injury, which can be confirmed by
radiography. Careful attention should be paid to the
position of the US probe, because beam angling can
create anisotropy artifact and can falsely suggest
tendon disruption.
Fractures
US can be used to evaluate for a radiologically
occult fracture in the setting of acute or subacute
trauma. Fractures of phalanges, metacarpal and
metatarsals often show only subtle changes on
radiographs, whereas on US an interruption of the
cortical continuity or a buckle can easily be seen.
US can be particularly useful in the infants as a lack
of ossification can hinder an accurate radiographic
evaluation.
References
1. H ryhorczuk AL, Restrepo R, Lee EY. Pediatric
Musculoskeletal Ultrasound: Practical Imaging
Approach. AJR Am J Roentgenol 2016 Mar 21:W1W11. [Epub ahead of print] PubMed PMID:
26998556.
2.Maurer K. Musculoskeletal ultrasound in childhood.
Eur J Radiol 2014;83(9):1529-37.
3.Callahan MJ. Musculoskeletal ultrasonography of
the lower extremities in infants and children. Pediatr
Radiol 2013;43 Suppl 1:S8-22.
4.Thapa M, Vo JN, Shiels WE 2nd. Ultrasound-guided
musculoskeletal procedures in children. Pediatr
Radiol 2013;43 Suppl 1:S55-60.
5.Robben SG. Ultrasonography of musculoskeletal
infections in children. Eur Radiol 2004 ;14 Suppl
4:L65-77.
6.Chauvin NA, Ho-Fung V, Jaramillo D, Edgar JC,
Weiss PF. Ultrasound of the joints and enthuses in
healthy children. Pediatr Radiol 2015; 45:1344-1354
7.Monsalve J, Kan JH, Schallert EK, Bisset GS,
Zhang W, Rosenfeld SB. Septic arthritis in children:
frequency of coexisting unsuspected osteomyelitis and
implications on imaging work-up and management.
AJR 2015; 204:1289-1295.
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Foreign body
Foreign bodies usually appear hyperechoic in
relation to the surrounding soft tissues. Material
such as wood or plastic tends to produce shadowing,
whereas metallic objects produce reverberation or a
“comet-tail” artifact. Color Doppler can be utilized to
ensure that there are no vascular structures adjacent
to the foreign body.
KSUM Open 2016
KSTU-1 Therapeutic Ultrasound
13:20 - 13:50
Chairpersons:Min Joo Choi School of Medicine, Jeju National University, Korea
GBR 102
Physics in Therapeutic Ultrasound
Yongrae Roh
Department of Medical Engineering, Kyungpook National University Hospital, Korea
Just as sunlight can be brought to a focus using a
magnifying glass on a piece of paper, ultrasonic beams
can be focused resulting in energy concentration
that is high enough to induce biological changes in
human bodies, which is called high intensity focused
ultrasound (HIFU). The HIFU is gaining rapid clinical
acceptance as a treatment modality enabling noninvasive tissue heating and ablation for numerous
applications.
The mechanisms by which HIFU induces such
biological effects in tissues can broadly be divided
into two classes: thermal and mechanical. Thermal
effects are those arising from the temperature rise
that results from the absorption of ultrasound energy
as it passes through tissues. Mechanical effects
are those arising either from the formation and
activity of micron-sized bubbles in the field (acoustic
cavitation) or from the flow of fluids induced by the
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ultrasound pressure wave (acoustic streaming).
HIFU beams are generated from sources placed
either outside a body (for treatment of tumors of
the liver, kidney, breast, uterus, pancreas and bone)
or in the rectum (for treatment of the prostate),
and are designed to enable rapid heating of a target
tissue volume while leaving tissues in the ultrasound
propagation path relatively unaffected. Given the
wide-ranging applicability of HIFU, numerous
extra-corporeal, transrectal and interstitial devices
have been designed to optimize application-specific
treatment delivery.
In this lecture, the physical principle and
overview of clinical usage of HIFU treatment is
introduced first. Then, the principle of operation of
representative HIFU devices is described in light of
their mechanisms governing HIFU propagation and
HIFU-induced heating.
13:50 - 14:10
GBR 102
Brain Applications Using Therapeutic Ultrasound
Jin Woo Chang
Department of Neurosurgery, Yonsei University Severance Hospital, Korea
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KSTU-2
KSUM Open 2016
KSTU-3
14:10 - 14:30
GBR 102
Body Applications Using Therapeutic Ultrasound
Young Sun Kim
High-intensity focused ultrasound (HIFU) therapy
induces temperature elevation of the target tissue
by focusing ultrasound waves with high energy
into a small spot. Temperature can be elevated to
the degree where the target tissue is immediately
necrotized (i.e., ablation therapy), or where the target
tissue gets susceptible to chemo-radiation therapy
or the low temperature-sensitive liposome vehicle
releases its drug contents (i.e., mild hyperthermia).
Because ultrasound waves are propagated through
the body, HIFU therapy can be performed in a
completely non-invasive way, which provides a great
clinical benefit.
In clinical applications, HIFU therapy is guided
and monitored by either ultrasonography (US) or
magnetic resonance (MR) imaging. As compared to
US-guidance, MR-guided HIFU therapy has merits
in terms of a capability of MR thermometry and the
better image quality which are likely to contribute
to more efficient and safer treatment. However,
MRI is inferior to US in terms of cost effectiveness.
Determination of guiding modality between US and
MR should be made based on clinical weighting of its
advantages and disadvantages in the specific organ
targeted.
Clinical applications of HIFU therapy have the
longest history in the treatment of uterine fibroids
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and the prostate cancer, and its indications are being
widened. MR-guidance is already actively used for
treating the diseases of the uterus, the bone, the
prostate gland, the breast and the brain, or is under
investigation for being used for the diseases of the
liver, the kidney and the pancreas.
Clinically-available MR-guided HIFU systems are
adopting either point-by-point sonication technique
or volumetric sonication technique. Whereas
volumetric ablation technique is known to be able to
treat more volume within a given time owing to its
mechanism of action, the risk of causing near field
thermal injury (such as skin burn) is also increased.
Stable monitoring of the temperature at the target
tissue is an essential part of mild hyperthermia
therapy, therefore MR-guided HIFU seems to be the
only solution for this purpose. Volumetric ablation
technique is more favorable for inducing localized
mild hyperthermia than point-by-point technique.
In this presentation, guiding and monitoring
techniques of HIFU therapy which are necessary for
clinicians to understand this therapeutic modality
will be introduced, and the current status of clinical
applications of MR-HIFU ablation therapy in
various body parts will be overviewed. In addition, a
potential clinical use of localized mild hyperthermia
by MR-HIFU will also be discussed.
14:30 - 14:50
GBR 102
Emerging Technologies in Therapeutic Ultrasound
Eun Joo Park
Department of Biomedical Research Institute, Seoul National University Hospital, Korea
Ultrasound, due to its ability of localizing the
focus where acoustic energy is accumulated
without affecting the pathway, have been actively
investigated as a potential alternative for not only
for cancer treatment but also for CNS disease care.
Therapeutic ultrasound in cancer treatment is mainly
based on the thermal effects as thermal ablation or
hyperthermia. However, mechanical destruction
of targeted area can also be used in solid tumor
removal. This lecture covers emerging technologies
of therapeutic ultrasound that are currently studied:
thermal ablation, histotripsy, Sonoporation, drug
delivery, etc.
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KSTU-4
KSUM Open 2016
JS-1
Jisan Lecture
15:25 - 16:10
Chairperson: Kil-Ho Cho Yeungnam University Medical Center, Korea
GBR 103
Hip, Groin and Beyond
Detecting possible sources of pain in the hip, groin,
and lower abdominal wall area can be challenging
since physical examinations can be non-specific
and symptoms can occur simultaneously or present
similarly. Some of the underlying musculoskeletal
pathologies include musculotendinous injuries,
pubic symphysis instability, hip labral tears, nerve
entrapment and non-palpable or atypical hernias.
An initial ultrasound study for poorly localized
regional pain should follow a scanning protocol that
covers the entire area for a complete examination.
Shorter, tailored studies are appropriate for clinically
unambiguous areas. If the US study reveals more
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than one possible source of symptoms, such as
discovering a small hernia and a hip labral tear,
additional tests, including injections of the hip
joint, may be needed to distinguish among them.
Techniques for MSK US focusing on groin/inguinal
anatomy have been described (Robinson 2006,
Jamadar 2006, Jamadar 2007, Stavros 2010, Yoong
2013, Jacobson 2015). This presentation presents
a regional three-part approach for a MSK US study
developed in a step-by step checklist format that
relies less on detailed anatomic knowledge and is
appropriate for those with beginner and intermediate
skills.
Series Course
SC 1 BR-1 13:20 - 13:30
Evolving Issues in Breast Ultrasound Imaging and Intervention
Evolving Technologies in Breast Ultrasound
Young Mi Park
Department of Radiology, Inje University Busan Paik Hospital, Korea
The incidence and prevalence of breast cancer
have been continuously increasing in recent years. In
order to improve the prognosis and life expectancy,
early diagnosis of breast cancer is critical. Although
conventional breast ultrasonography (US) is
commonly used in detecting breast diseases, this
technique has the unavoidable limitation of low
specificity. In addition, breast US has provided little
practical benefit in cancer detection because of the
poor conspicuity of some cancers, the significant
operator time and experience necessary for a highquality screening, and the lack of standardization
due to variability in operator skill and experience.
Thus, other sonographic methods that adequately
address these limitations are needed.
1. Ultrasound Elastography
In recent years, there has been increasing
interest in assessing tissue elastic properties by
sonography. By adding information about stiffness
to the ultrasound findings, elastography has the
potential to decrease the false positive findings and
to improve the specificity of US. There are two main
methods of assessing the stiffness (elasticity) of a
breast mass. The first is strain elasticity imaging,
also called static elastography. Strain elastography,
the first commercialized elastography technique,
uses unquantifiable freehand compression, which
requires continuous transducer compression or
external mechanical compression. This technique
is operator dependent and only gives a qualitative
estimation of tissue stiffness. The second type
is acoustic stress elasticity imaging or dynamic
elastography, including supersonic shear imaging
and acoustic radiation force impulse (ARFI) imaging.
ARFI imaging is a new elastography technique
that reduces operator dependency and improves
reproducibility because of the addition of automated
tissue compression, and has high specificity and
sensitivity. This technique requires no external
compression and uses focused high-intensity, shortduration acoustic pulses from a US transducer to
generate localized tissue displacements producing
shear waves in the region of interest (ROI), providing
quantitative assessment of tissue stiffness based on
tracking of the shear wave propagation caused by the
pushing pulse. ARFI imaging allows three types of
diagnosis: virtual touch tissue imaging (VTI), virtual
touch tissue quantification (VTQ), and virtual touch
tissue imaging quantification (VTIQ). Thus, it offers
a combination of qualitative and quantitative clinical
diagnostic tools. VTIQ is a color overlay of the
ultrasound image, with different colors representing
the speed of the shear waves (in meters per second).
The stiffer (nonelastic) the tissue through which
the wave passes, the greater the shear velocity is.
The wave propagation speed is an intrinsic and
reproducible property of tissue, and ARFI tissue
quantification generates objective and reproducible
data.
The VTIQ shear wave technique uses multiple push
pulses across the transducer face at multiple depths
and provides an elastogram of tissue stiffness based
on shear wave speed. Multiple ROIs can be placed
on the elastogram, which detects pulse sequences
that can measure localized shear wave velocity
(SWV) from 0.5 to 10 m/s in multiple locations. In
addition to detecting SWV, VTIQ can also display
shear wave quality. Qualitative maps of shear waves
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Chairpersons:Sun Mi Kim Seoul National University Bundang Hospital, Korea
Seung Ja Kim Sheikh Khalifa Specialty Hospital, UAE
GBR 103
KSUM Open 2016
that display green coloring for SWV values were
considered reliable. This is useful in interpreting
whether the shear wave is of sufficient magnitude
with an adequate signal-to-noise ratio to accurately
estimate SWV in the SWV display. Because shear
waves cannot propagate in vicious fluid, no signal
can be measured e.g. in cysts.
Although some overlap is observed between the
SWV values of benign and malignant lesions, the
mean, minimum, and maximum SWV values of
malignant lesions were significantly higher than
those of benign lesions. Many studies have shown
that qualitative findings and quantitative parameters
from shear wave elastography are useful to
differentiate benign from malignant breast masses.
Adding US elastography to B-mode US may help to
improve the differentiation of benign and malignant
lesion.
2. Automated Breast Volume Scanner (ABVS)
and Computer-aided Diagnosis (CAD) System
Hand-held ultrasound (HHUS) has limitations such
as operator dependency and inability to image and
store three-dimensional (3-D) volumes of the breast.
To overcome these problems, ABVS was developed.
This modality makes it possible to visualize large
sections of the breast from the skin surface to the
chest wall at once and store entire breast volumes
on a picture archiving and communication system.
Moreover, multiplanar reconstructions are possible
in coronal and sagittal planes. As the amount
of acquired image data increases, however, the
time needed by a radiologist to read these images
increases consequently. For the detection of
breast lesions, ABVS has several advantages over
conventional US. 1) ABVS provides automated and
standardized scanning. 2) Reconstructed images
can be saved and transmitted for later analysis,
thereby facilitating remote consultation. 3) ABVS
is less operator dependent, thereby improving
standardization and reproducibility. 4) Overlooking
a lesion is less probable with ABVS, compared to
the small field of view provided by conventional US,
ABVS offers a wider field of view covering the entire
breast volume. 5) Unlike other imaging modalities,
lesions that are not detected during breast US are
148
not typically documented; however, ABVS has the
potential to provide complete documentation.
ABVS has several limitations. First, ABVS often
has difficulty in clearly visualizing tissue behind the
nipple on account of the nipple’s acoustic shadow.
Second, in instances where the patient is lean and
the breast texture is hard or when the patient is
unable to fully elevate her arms, ABVS images
may not completely cover the full breast volume.
Third, the most common artifact on ABVS images is
corrugation, which is typically caused by respiratory
motion and can be minimized by slowing the
respiratory rate. Fourth, some masses slide during
the ABVS scan and may result in partial deletion
of the tumor image. Fifth, the ABVS probe is too
large to examine the axillary region. Sixth, flow
information cannot be imaged by ABVS. Finally,
US scanning along the line of the mammary duct is
considered to be indispensable because most breast
carcinomas originate in the epithelial duct tissue
and spread along the ducts. As ABVS has several
advantages and limitations with respect to HHUS,
ABVS may serve as an effective adjunct screening
tool to mammography and conventional sonography.
Many benign lesions that are undetected on
mammograms are detected in the US images. It is
often difficult for clinicians to decide correctly on
either biopsy or follow-up for US-detected lesions.
Therefore, assistance by a computer-aided diagnosis
(CAD) system would be useful to differentiate
between benign lesions and breast cancers more
efficiently and accurately. Image processing
techniques have been applied to improve detection
rate and increase specificity. A crucial task for a CAD
system is discovering efficient computerized features
to distinguish benign and malignant tumors. Some
studies have shown that using CAD can improve the
radiologist performance of distinguishing malignant
from benign breast lesions in 3-D US images.
References
1. Teke M, Goya C, Teke F, et al. Combination of Virtual
Touch Tissue Imaging and Virtual Touch Tissue
Quantification for differential diagnosis of breast
lesions. J Ultrasound Med 2015; 34:1201-1208
2.Liu H, Zhao L, Xu G, et al. Diagnostic value of virtual
Series Course
held ultrasound. Eur J Radiol 2015;84: 1232-1235
4.Liu H, Tan T, Zelst J, Mann R, Karssemeijer N, Platel
B. Incorporating texture features in a computer-aided
breast lesion diagnosis system for automated three
dimensional breast ultrasound. J Medical Imaging
2014;1(2) : 024501
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touch tissue imaging quantification for benign and
malignant breast lesions with different sizes. Int J
Clin Exp Med 2015;8:13118-13126
3.Ana YY, Kim SH, Kang BJ. The image quality and
lesion characterization of breast using automated
whole-breast ultrasound: A comparison with hand
KSUM Open 2016
CC 6 THY-1 Update of US Imaging: Thyroid Malignancy
08:00 - 08:30
Chairpersons:Joon Hyung Lee Dong-A University Hospital, Korea
Hyun Sook Hong Soonchunhyang University Bucheon Hospital, Korea
GBR 101
US Imaging of Papillary Thyroid Cancer and Its Variants
Jung Hee Shin
Papillary thyroid carcinoma (PTC) is the most
common type of thyroid malignancy and constitutes
approximately 80- 90% of primary thyroid
carcinomas which arise from follicular cells. The
diagnostic features of PTC include characteristic
nuclear cytology. Recent studies have suggested
that different histopathological variants of PTC
can also have a different clinical course and patient
prognosis. The role of US has expanded to enable
the characterization of PTC variants based on their
US features. I will discuss various US findings of
PTC variants, cytopathological features, biological
behavior, clinical sequences and molecular profiles.
Despite some overlap in US findings between
benign and malignant nodules, accepted US
malignant features such as microcalcifications,
speculated/microlobulated margins, nonparallel
orientation, and marked hypoechogenicity have
been reported to be helpful in identifying malignant
thyroid nodules, especially in papillary thyroid
carcinomas.
The variants with more unfavorable outcomes are
the tall cell, columnar cell, and hobnail variants.
Other variants of papillary carcinoma, such as the
solid variant and diffuse sclerosing variant, may be
associated with a less favorable outcome, although
the data remain conflicting. Identifying patients with
higher risk of recurrence and death is essential. Some
histopathologic variants of thyroid carcinomas are
important to recognize because of their association
with familial tumor syndromes or misdiagnosis by a
benign-looking appearance.
150
Follicular Variant (FVPTC)
• FVPTC is the second most common variant of
PTC, following conventional PTC.
• Histopathological examination of FVPTC reveals
a neoplasm with nuclear features of PTC and
a predominantly follicular growth pattern,
characterized by follicles lined by PTC cells that
consist of more than 70-80% of the tumor.
• FVPTCs show benign looking tumor more
frequently compared with conventional PTCs.
FVPTC shows dichotomous ultrasonographic
features; PTC-like (infiltrative, malignantlooking) tumor and follicular neoplasm-like
(encapsulated, benign) tumor.
• Only 5-20% of FVPTC exhibit BRAF mutations.
• The prognostic factors and survival rates
of conventional PTC and FVPTC are not
significantly different.
• Thyroid tumors currently diagnosed as
noninvasive encapsulated FVPTC have a very low
risk of adverse outcome and was recently revised
as “noninvasive follicular thyroid neoplasm with
papillary-like nuclear features” (NIFTP). NIFTP
likely represents the “benign” counterpart or
precursor of the invasive EFVPTC.
Tall Cell Variant (TCVPTC)
• TCVPTC is composed of a majority of tall cells
(≥50% of all tumor cells) with eosinophilic
cytoplasm and nuclear features characteristic of
PTC.
• Almost all cases were associated with
intranodular microcalcification, extrathyroidal
extension, and lymph node metastasis, which are
characteristic features of thyroid malignancies.
Categorical Course
Columnar Cell Variant (CCVPTC)
• CCVPTC is characterized by predominance
of columnar cells with pronounced nuclear
stratification.
• These tumors have a higher risk of distant
metastases and tumor-related mortality, the
latter seen mostly in patients with an advanced
disease stage at presentation.
• Two cases of CCVPTC appeared hypoechoic
nodules with or without calcifications, which has,
at minimum more than one typical malignant US
feature.
• The BRAFV600E mutation is found in one-third
of these tumors.
Hobnail variant
• The hobnail variant is recently described and
characterized by the predominance of cells with
a hobnail appearance with apically placed nuclei
and bulging of the apical cell surface.
• These tumors harbored a PTC-associated genetic
abnormality, either a BRAFV600E mutation
(80%) or a RET /PTC1 rearrangement (20%).
• No report regarding US features of this variant is
noted.
• This variant of papillary carcinoma appears to
be associated with frequent distant metastases
(typically to lung) and increased risk of tumorrelated death.
Solid Variant
• Histologically, the diagnosis may be made when
solid nests of cells with cytological features of
PTC represent more than 50% of the tumor mass.
• The solid variant tumors appear to be more
frequently associated with distant metastases
that are present in about 15% of cases, and with
a slightly higher mortality rate, However, among
children and adolescents with post-Chernobyl
papillary carcinomas, which frequently were of
the solid variant, the mortality was very low (<1%)
during the first 10 years of follow-up.
• Importantly, the solid variant of papillary
carcinoma should be distinguished from poorly
differentiated thyroid carcinoma, with which it
shares the insular, solid, and trabecular growth
patterns.
• This variant shows usual malignant features of
PTC on US.
Diffuse Sclerosing Variant (DSVPTC)
• DSVPTC is an uncommon variant of PTC
constituting 0.7-5.3% of PTCs.
• Ultrasonographic features of DSVPTC are
characterized by an ill-defined heterogeneous
solid mass with scattered microcalcifications with
a snowstorm appearance, and it is almost always
combined with multiple metastatic lymph nodes
at the lateral neck.
• Histopathologically, the scattered microcalcifications and heterogeneous hypoechogenicity
correlate to psammoma bodies, extensive
fibrosis, and lymphocytic infiltration.
• This unusual variant of PTC frequently lacks
BRAF mutations.
• This variant is frequently seen in young patients
and has a higher incidence of cervical lymph
node involvement and pulmonary metastasis,
resulting in a less favorable prognosis.
• Nevertheless, the overall mortality appears
to be low, with a disease-specific survival of
approximately 93% at 10 years of follow-up. The
diffuse sclerosing variant tends to be found in
younger patients in whom response to treatment
is high.
Cribriform-Morular Variant (CMVPTC)
• CMVPTC is frequently seen in patients with
familial adenomatous polyposis (FAP) due to a
germline mutation in the adenomatous polyposis
coli (APC) gene.
• It is characterized by a prominent cribriform
architecture and formation of whorls or morules
composed of spindle cells.
• It commonly affects young adults with a female
predominance.
• Sporadic CMVPTC is often solitary, whereas
CMVPTC with FAP is more frequently multicentric.
• About 30% of CMVPTCs are diagnosed 4 to 12
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Categorical Course
May 21, Saturday (GBR 101)
• TCVPTC has the highest prevalence of activating
point mutations of BRAF (up to 77%) as
compared with conventional PTCs.
• TCVPTC is associated with a poor prognosis.
KSUM Open 2016
years prior to the development of polyposis.
This diagnosis should raise the possibility of the
familial disease and prompt consideration for
colonic examination and genetic counseling.
• An oval circumscribed heterogeneous hypoechoic
solid nodule without a hypoechoic halo or
calcification was the most common US feature of
CMVPTC.
• No BRAF mutation was found in any cases
reported.
• It is generally associated with a good prognosis
and a relatively indolent clinical course.
Warthin-Like Variant (WVPTC)
• They named this variant “Warthin-like tumor”
as its histological features resemble those of
Warthin tumors of the salivary glands.
• It is characterized by papillary architecture and
oncocytic cells frequently arising in a background
of lymphocytic thyroiditis.
• WVPTC can be misdiagnosed as a probably
benign nodule or focal thyroiditis with US.
All cases are associated with heterogeneous
parenchyma in the background.
• WVPTC shows a more favorable prognosis with
a lower incidence of nodal metastasis, which
can be explained by the presence of lymphatic
tissue within the tumor restraining neoplastic
progression and diffusion.
152
References
1.Kim GR, Shin JH, Hahn SY, Ko EY, Oh YL.
Ultrasonographic features and clinical characteristics
of Warthin-like variant of papillary thyroid
carcinoma.
2.Haugen BR, Alexander EK, Bible KC, et al. 2015
American Thyroid Association Management
Guidelines for Adult Patients with Thyroid Nodules
and Differentiated Thyroid Cancer: The American
Thyroid Association Guidelines Task Force on
Thyroid Nodules and Differentiated Thyroid Cancer.
Thyroid. 2016 Jan;26(1):1-133.
3.Rhee SJ, Hahn SY, Ko ES, Ryu JW, Ko EY, Shin JH.
Follicular variant of papillary thyroid carcinoma:
distinct biologic behavior based on ultrasonographic
features. Thyroid. 2014 Apr;24(4):683-8.
4.Nikiforov YE, Seethala RR, Tallini G, et al.
Nomenclature Revision for Encapsulated Follicular
Variant of Papillary Thyroid Carcinoma: A Paradigm
Shift to Reduce Overtreatment of Indolent Tumors.
JAMA Oncol. 2016 Apr 14. [Epub ahead of print]
5.Lee JH, Shin JH, Lee HW, Oh YL, Hahn SY, Ko
EY. Sonographic and cytopathologic correlation of
papillary thyroid carcinoma variants. J Ultrasound
Med. 2015 Jan;34(1):1-15.
6.Lee YS, Kim Y, Jeon S, Bae JS, Jung SL, Jung CK.
Cytologic, clinicopathologic, and molecular features of
papillary thyroid carcinoma with prominent hobnail
features: 10 case reports and systematic literature
review. Int J Clin Exp Pathol. 2015 Jul 1;8(7):7988-97.
Categorical Course
GBR 101
US Imaging of Follicular and Medullary Thyroid Cancers
Jeeyoung Kim
Department of Radiology, The Catholic University of Korea, Yeouido St. Mary's Hospital, Korea
Thyroid nodules are common; nearby 40% to 50%
of the population by ultrasound (US). The majority of
thyroid nodules represent benign hyperplastic nodules or
adenomas. Approximately 5% of nodules are malignant.
The histopathologic classification of these malignant
tumors includes papillary thyroid cancer (75 - 80%),
follicular carcinoma (15-18%), anaplastic carcinoma (310%), medullary carcinoma (4-5%), lymphoma (5%) and
metastasis (1-3).
1. Follicular Neoplasm
Follicular neoplasms of the thyroid are usually
diagnosed following fine-needle aspiration (FNA) biopsy
of thyroid nodules. As determined by FNA cytology,
approximately 20% of thyroid nodules are diagnosed as
follicular neoplasms. Follicular neoplasm is a cytologic
term used to encompass both the benign proliferation
of thyroid follicular cells in adenoma and the malignant
proliferation in carcinoma. An FNA diagnosis of a
follicular neoplasm represents a heterogeneous group of
lesions including benign follicular hyperplasia, follicular
adenomas (FA), follicular carcinomas (FC), and the
follicular variant of papillary thyroid carcinoma. Hürthle
cell neoplasms are also often included in this group. FA
and FC have similar cytologic features. Because FNA
biopsy cannot differentiate FA from FC, lobectomy or
total thyroidectomy is recommended when the FNAB
result of a thyroid nodule suggests a follicular neoplasm.
Unlike adenomas, carcinomas have vascular or capsular
invasion. In general, when a biopsy of a thyroid nodule
reveals a follicular neoplasm, approximately 80-90%
of such lesions will be adenomas and 10-20% will be
carcinomas (2, 4).
Several retrospective studies have described the
US features of follicular neoplasms. Previous reports
on the US features of follicular neoplasms showed
variable results. FAs and FCs share many US features.
Nevertheless common US features of FA have been
described as predominantly cystic or mixed cystic
pattern, isoechoic echogenicity, and a homogeneous
echo texture. While a predominantly solid pattern,
an incomplete or unevenly thick halo, hypoechoic
echogenicity, a heterogeneous echo texture, and presence
of calcifications have been suggested as common US
features of FC. Tumor size (larger than 4 cm) has been
described as a risk factor for malignancy, but there is
no significant difference in tumor size between FAs and
FCs in recent reports. However, FC was more common
than FA in follicular neoplasms larger than 4 cm.
Hypoechoic echogenicity was more frequently seen in
FCs compared with FAs. Peripheral rim calcifications are
generally considered as a sign of benignancy or adenoma,
but several studies have reported than peripheral
calcifications could also be seen in malignant thyroid
tumors, such as FCs and PTCs. They have suggested that
thyroid nodules that show interruption, thickening of
peripheral calcification and internal hypoechogenicity
should be considered suspicious lesions and it may be a
sign of FC.
A predominantly solid pattern, a heterogeneous
echo texture, and the presence of calcifications were
independent predictors of FC and combinations of 2 or
more of these US features may achieve higher specificity
and PPV in diagnosing FC (5-8).
2. Medullary Carcinoma
Medullary thyroid carcinoma (MTC) arises from
parafollicular or C cells that produce calcitonin (CT),
and accounts for 5-10% of all thyroid cancers. MTC is
hereditary in about 25% of cases. It has a more aggressive
behavior than the well-differentiated thyroid carcinoma,
and 10-year mortality rates for patients with MTCs
vary from 13.5% to 38%. Therefore, early and precise
preoperative diagnosis is important (9). Measurement
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Categorical Course
08:30 - 09:00
KSUM Open 2016
of serum CT is helpful in diagnosis of MTC. But, not
all MTCs secrete CT. MTC can be diagnosed by fine
needle aspiration (FNA) cytology of the tumor based on
typical cytologic features and the presence of amyloid
in the background. However, the sensitivity of FNA
for diagnosing MTC has been reported to be only 63%.
Additional immunostaining for calcitonin or calcitonin
measurement of the washout fluid improves the
diagnostic sensitivity of FNA (10).
US characteristics of thyroid malignancies have
been established for a papillary thyroid cancer (PTC),
which account for more than 70% of all malignant
nodules. There are a few reports that have evaluated
the US findings of MTC. The predominate US features
of the MTCs are a solid internal content, ovoid to
round shape, hypoechogenicity, microcalcifications or
macrocalcifications. MTCs were classified as malignant
nodules for 72%- 81% of cases by US criteria (11- 13).
The US findings of MTC were not significantly different
from papillary thyroid cancer (PTC), except for a high
prevalence of round to oval shape and circumscribed
margin [12, 14]. Micro- or macrocalcifications was the
most common malignant features of MTC. MicroMTCs
(≤1cm) had spiculated margins more frequently than
macroMTCs and macroMTCs (>1 cm) had smooth
margins more frequently than microMTCs (13).
MTCs were larger, more frequently showed a cystic
change, and more commonly homogeneous echo texture
of a solid portion, compared with PTCs.
References
1.Brander, A., et al., Thyroid gland: US screening in a
random adult population. Radiology, 1991. 181(3): p.
683-7.
2.Hedinger, C., E. Dillwyn Williams, and L.H. Sobin,
The WHO histological classification of thyroid
tumors: A commentary on the second edition. Cancer,
1989. 63(5): p. 908-911.
3.Desser, T.S. and A. Kamaya, Ultrasound of thyroid
154
nodules. Neuroimaging Clin N Am, 2008. 18(3): p.
463-78, vii.
4.Carling, T. and R. Udelsman, Follicular neoplasms
of the thyroid: what to recommend. Thyroid, 2005.
15(6): p. 583-7.
5.Int J Endocrinol.
6.Seo, H.S., et al., Thyroid follicular neoplasms: can
sonography distinguish between adenomas and
carcinomas? J Clin Ultrasound, 2009. 37(9): p. 493500.
7.Sillery, J.C., et al., Thyroid Follicular Carcinoma:
Sonographic Features of 50 Cases. American Journal
of Roentgenology, 2010. 194(1): p. 44-54.
8.Zhang, J.Z. and B. Hu, Sonographic features of
thyroid follicular carcinoma in comparison with
thyroid follicular adenoma. J Ultrasound Med, 2014.
33(2): p. 221-7.
9.Leboulleux, S., et al., Medullary thyroid carcinoma.
Clin Endocrinol (Oxf), 2004. 61(3): p. 299-310.
10.Bugalho, M.J., J.R. Santos, and L. Sobrinho,
Preoperative diagnosis of medullary thyroid
carcinoma: fine needle aspiration cytology as
compared with serum calcitonin measurement. J
Surg Oncol, 2005. 91(1): p. 56-60.
11.Lee, S., et al., Medullary thyroid carcinoma:
comparison with papillary thyroid carcinoma and
application of current sonographic criteria. AJR Am J
Roentgenol, 2010. 194(4): p. 1090-4.
12.Kim, S.H., et al., Ultrasonographic findings of
medullary thyroid carcinoma: a comparison with
papillary thyroid carcinoma. Korean J Radiol, 2009.
10(2): p. 101-5.
13.Choi, N., et al., Ultrasonographic findings of
medullary thyroid cancer: differences according to
tumor size and correlation with fine needle aspiration
results. Acta Radiol, 2011. 52(3): p. 312-6.
14.Lee, S., et al., Medullary Thyroid Carcinoma:
Comparison With Papillary Thyroid Carcinoma
and Application of Current Sonographic Criteria.
American Journal of Roentgenology, 2010. 194(4): p.
1090-1094.
Categorical Course
GBR 101
Anaplastic Thyroid Carcinoma and Primary Thyroid Lymphoma:
Clinical and Imaging Features
Yoon Jung Choi
Department of Radiology, Kangbuk Samsung Medical Center, Korea
Anaplastic thyroid carcinoma and Primary
B-cell lymphoma of the thyroid: Clinical features
and Various Ultrasonographic Characteristics.
Anaplastic thyroid carcinoma (ATC) is a highly
aggressive, lethal cancer with short median survival
from diagnosis with 1year survival less than 10% (1).
According to SEER 2009 data, annual age-adjusted
incidence is 2 per million per year, representing less
than 2% of all thyroid cancers (2). There is a slight
female to male predominance of 1.5 to 1. Symptoms
are variable depending on the involved area but most
commonly encountered symptoms are compressive
symptoms with a rapidly enlarging neck mass. Hard
fixation to surrounding structures presenting dysphagia,
hoarseness, dyspnea, neck pain, sore throat, and cough
can be diagnostic clue with rapid enlargement of neck (3).
Average tumor size is 6 cm at presentation, ranging from
3 to 20 cm (1). Cervical lymphadenopathy is present in
as many as 40% of patients and a high proportion (43%70%) of patients present with distant metastases. The
most common site of metastases in a 50-year review by
McIver et al. was the lung (42%) followed by bone (32%)
and brain (9%) (1).
The work-up for ATC begins with a high clinical
suspicion, followed by fine needle aspiration (FNA) of
the lesion; pathological diagnosis is most commonly
made on FNA (4) but many times a diagnosis of
“anaplastic cancer” is not correct if only based on FNA.
Usually core needle biopsy or open surgical sample
should be employed. Ancillary test such as a lymphoma
protocol, serum calcitonin, and CEA may be helpful in
differentiating ATC from TL, medullary thyroid cancer,
or other poorly differentiated forms of thyroid cancer
[4]. If the diagnosis still remains in question open
biopsy before beginning definitive treatment should be
considered with efforts to remove the mass as much as
possible and securing airway and determining the extent
of disease is very important .
Imaging modalities, ATC should include a computer
tomography (CT) scan of the neck, chest, and
mediastinum in order to assess the local extent of disease
and invasion into surrounding structures to complete
a metastatic work-up. About 33% have disease outside
the neck at presentation and additional 33% develop
other than neck in the first 6-12 months so initial staging
should include brain, neck, chest, abdomen, and pelvis.
Magnetic resonance imaging (MRI) may be a helpful
adjunct in determining bony and vascular involvement
of the tumor (5). There is no role for a thyroid scan in the
work-up of ATC as these tumors do not have the ability
to concentrate iodine. Ultrasonography (US) features
usually large infiltrative thyroid masses with extensive
invasion to adjacent structures including trachea,
esophagus, and common carotid artery, displaying
irregular shaped, heterogeneous hypoechoic mass (6).
US have a limited window to evaluate the whole extent
when tumor gets larger but the primary use is in the
core biopsy and in the first encountered diagnosis. US
examination should be also focused on the extension
of airway, involved vessels and involved surrounding
structures because stage Iva has better prognosis and US
examinations differentiates from T4a to T4b which is a
tumor grown outside the thyroid.
It is important to differentiate TL and medullary
thyroid cancer from ATC as these pathologies, carry a
better prognosis and have a different treatment strategy
(4). Surgical resections, external beam irradiation, and
chemotherapy have not resulted in improvements in
overall survival but the team efforts should be tried to
alleviate the patient sufferings.
Primary B-cell lymphoma (PTL) is a rare thyroid
tumor, representing approximately 1%- 5% of thyroid
malignancies and less than 2% of extra nodal lymphomas
(7). The incidence of PTL is similar to ATC at 2 per
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KSUM Open 2016
million per year. Diffuse large B-cell lymphoma, and the
mucosa-associated lymphoid tissue (MALT) lymphoma
are histological subtypes and are often present at later age
and women are more commonly affected (2). The most
common presentation is a rapidly enlarging neck mass
in 70% of patients, 30% of patients have compression
signs most patients are euthyroid at initial presentation
but 10% will present with hypothyroidism and some
associated with hoarseness or dysphagia and sometimes
is combined with pain (8, 9). Presently, up to 88% of
TLs can be diagnosed by FNA but published reports
show that core needle biopsy can lower unnecessary
surgical procedures with high diagnostic yield. Sufficient
specimen can be obtained through core biopsy abled flow
cytometry and CD marker examinations (10). Diffuse
large cell lymphomas are associated with CD markers CD
5, CD 10, CD 23, CD 43, CD 30, and the BCL-2 oncogene
whereas MALT lymphomas are associated with CD5,
CD 10, and CD 23 (9). Ultrasonography (US) findings
of thyroid lymphoma were reported to be extremely
hypoechoic masses when involved diffuse bilaterally,
and homogeneous low echoic mass in solitary nodules.
US features of thyroid lymphoma have been reported
as homogeneous low echogenicity in cases with solitary
nodules and extremely hypoechoic masses intermingled
with echogenic structures in diffusely involved lymphoma
with underlying thyroiditis (11, 12). It is also important
to distinguish MALT lymphomas from Hashimoto’s
thyroiditis but US finding alone is hard to differentiate
the Hashimoto’s thyroiditis from lymphoma because
many US features overlap. In US, over half the patients
are seen with discrete thyroid nodules, and 20% have
adenopathy (12).
US guided core biopsy (US-CNB) is not used as a
routine diagnostic tool for thyroid nodules but for
cytology indeterminate case, it can be considered as an
alternative biopsy method because the role of surgery
is limited in thyroid lymphoma (13). US show various
different morphological features of primary thyroid
lymphoma, US-CNB is helpful in diagnosing thyroid
lymphoma (13-15).
References
1.McIver, B., et al., Anaplastic thyroid carcinoma: a 50year experience at a single institution. Surgery, 2001.
130(6): p. 1028-34.
156
2.Aschebrook-Kilfoy, B., et al., Thyroid cancer incidence
patterns in the United States by histologic type, 19922006. Thyroid, 2011. 21(2): p. 125-34.
3.Banks, C.A., et al., Thyroid disease and compressive
symptoms. Laryngoscope, 2012. 122(1): p. 13-6.
4.Green, L.D., L. Mack, and J.L. Pasieka, Anaplastic
thyroid cancer and primary thyroid lymphoma: a
review of these rare thyroid malignancies. J Surg
Oncol, 2006. 94(8): p. 725-36.
5.Pasieka, J.L., Anaplastic thyroid cancer. Curr Opin
Oncol, 2003. 15(1): p. 78-83.
6.Kim, E.H. and J.Y. Kim, Aggressive primary thyroid
lymphoma: imaging features of two elderly patients.
2014. 33(4): p. 298-302.
7.Ansell, S.M., C.S. Grant, and T.M. Habermann,
Primary thyroid lymphoma. Semin Oncol, 1999.
26(3): p. 316-23.
8.Derringer, G.A., et al., Malignant lymphoma of the
thyroid gland: a clinicopathologic study of 108 cases.
Am J Surg Pathol, 2000. 24(5): p. 623-39.
9.Tsang, R.W., et al., Non-Hodgkin's lymphoma of
the thyroid gland: prognostic factors and treatment
outcome. The Princess Margaret Hospital Lymphoma
Group. Int J Radiat Oncol Biol Phys, 1993. 27(3): p.
599-604.
10.Cha, C., et al., Primary thyroid lymphoma: can the
diagnosis be made solely by fine-needle aspiration?
Ann Surg Oncol, 2002. 9(3): p. 298-302.
11.Takashima, S., et al., Primary thyroid lymphoma:
comparison of CT and US assessment. Radiology,
1989. 171(2): p. 439-43.
12.Ota, H., et al., Usefulness of ultrasonography for
diagnosis of malignant lymphoma of the thyroid.
Thyroid, 2006. 16(10): p. 983-7.
13.Kwak, J.Y., et al., Primary thyroid lymphoma: role of
ultrasound-guided needle biopsy. J Ultrasound Med,
2007. 26(12): p. 1761-5.
14.Ha, E.J., et al., Core needle biopsy could reduce
diagnostic surgery in patients with anaplastic thyroid
cancer or thyroid lymphoma. Eur Radiol, 2016. 26(4):
p. 1031-6.
15.Hahn, S.Y., et al., Ultrasonography-guided core
needle biopsy for the thyroid nodule: does the
procedure hold any benefit for the diagnosis when
fine-needle aspiration cytology analysis shows
inconclusive results? Br J Radiol, 2013. 86(1025): p.
20130007.
Categorical Course
CC 7 MSK-1 Lower Extremity US Anatomy and Basic Approach
Chairpersons:Doo Hoe Ha Bundang CHA Hospital, Korea
Young Hwan Lee Daegu Catholic University Medical Center, Korea
GBR 102
Hip
Min A Yoon
Department of Radiology, Korea University Guro Hospital, Korea
Ultrasound of hip
• Advantages
• Wide availability, relatively low cost
• Can be used in metal implant
• Portability, rapidity of examination
• Disadvantage
• Limited to joint and soft tissue pathology
• Operator dependent
Role of ultrasound in hip pain
• Assessment of intra- and extra-articular fluid
collection in native and prosthetic hip
• bursa, synovial pathology
• Guiding aspiration and biopsy
• Assessment of muscle and tendon pathology
• Dynamic evaluation
• Snapping, locking or clicking hip
[Anterior hip]
Anterior joint recess
• Supine position
• Transducer in oblique longitudinal and transverse
plane over the femoral neck
• Between deep fascia of the iliopsoas and the femoral
neck
• Joint capsule: two distinct capsular layer, thicker
anterior (iliofemoral lig.)
• Collapsed synovial recess (effusion (-) )
• Iliofemoral ligament + anterior/posterior joint
capsule + synovial membrane
Joint effusions in adult hips
• US finding
• Asymmetric distension of the recess, compared to
the opposite side
• Increased thickness of the anterior joint capsule
• Variable echogenicity, depending on fluid nature
• Pitfalls
•Hypoechoic synovium: distension of the anterior
recess without effusion
• Anisotropy: collapsed synovial recess vs. effusion
Iliopsoas muscle
• Lateral to femoral neurovascular bundle
• Tendon: posterior aspect of the muscle belly, in front
of the labrum
Sartorius and tensor fascia lata
• Sartorius: medial side of ASIS
• Runs medially, over rectus femoris
• Tensor fascia lata: lateral side of ASIS
• More echogenic (fatty tissue among the fascicles)
Lateral femoral cutaneous nerve
• Just medial to ASIS
• Small tubular structure passing through a tunnel by a
split in the lateral end of the inguinal ligament
• Innervation of skin on lateral part of the thigh
• Meralgia paresthetica
• Anterolateral thigh pain, burning, numbness,
itching
• Compression or injury of LFCN
Rectus femoris
• Two heads of rectus femoris at its origin
• Direct tendon (straight head)
• AIIS
• Superficial (anterior) aponeurosis
• Posterior shadowing at union of direct and indirect
t. (changes in orientation)
• Indirect tendon (reflected head, primary head)
• Superior acetabular ridge
• Central aponeurosis, within substance of muscle
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08:00 - 08:15
KSUM Open 2016
Anterior muscle injury
• Related to eccentric muscle contraction
• Common in sports (adolescents and athletes)
• Adolescent
• Apophyseal avulsion
• Evaluation of bony insertions of muscles
• Tensor fascia lata, rectus femoris tendinopathy
• Overuse tendinopathy (forceful extension of hip)
• Tenderness over AIIS-AIIS
• US
• Thickened, heterogeneous echogenicity
• Tenderness on pressure with probe
• Rectus femoris tendon tear
• Sportsmen with tendinopathy
• Forceful contraction against resistance
• Proximal tears < central aponeurosis or distal MT
junction
• US: a focal gap in the tendon + hematoma,
retraction
Snapping hip
• Causes of snapping hip
• Intraarticular causes
• Abnormality of the joint itself
• Intraarticular bodies, SOC, labral tear…
• Extraarticular causes
• Internal
• Snapping of the iliopsoas tendon
• External
• Snapping iliotibial band
Snapping iliopsoas tendon
• Lateral shifting of iliopsoas tendon over the bone
surface of iliopectineal eminence, when hip flexion,
abduction and ER
→ comes back in extension, adduction and IR
→ tendon impingement on the iliopectineal eminence
→ moves abruptly in medial direction, causing the
snap
• US
• Dynamic study
• Oblique transverse scan, oriented along short axis
of tendon over iliopectineal eminence
• Patient position: frog leg → normal anatomic
position
• Abrupt sudden lateral-to-medial motion
Iliopsoas bursitis
• Largest para-articular synovial bursa of the hip region
• Communication with the joint cavity
158
• Most of individuals with hip pathology
• Reservoir in cases of abundant joint effusion
• ↓ IA pressure and damage to structures
• Located between medial femoral vessels and lateral
iliopsoas muscles
[Lateral hip]
Technique
• Oblique lateral or true lateral
• Adequate adjustment of the focal zone
• Avoid anisotropic effect: tilting of probe parallel to
long axis of tendons
Greater trochanter
• Four facets
• Anterior, lateral, posterior and superoposterior
• Gluteus medius: superoposterior and lateral facets
• Gluteus minimus: anterior facet
Lateral hip pain
• Greater trochanteric pain syndrome”
• Tendinopathy or bursitis around the trochanteric
region
• Middle aged elderly women, pain of lateral, posterior
aspect of GT, pain on pressure (when sleeping on the
affected side)
• Microtrauma leading to gluteus tendons and
associated trochanteric bursitis
• US
• Tendinopathy of gluteus medius and minimus
• Swelling, heterogeneous echotexture
• Most commonly anterior portion of the gluteus
medius
• Disadvantage
• In obese patient
• Anisotropy (as focal tendinopathy or partial tear)
Snapping iliotibial band
• External snapping
• Impingement of the posterior border of the fascia lata
or anterior portion of the gluteus maximus over the
osseous prominence of the greater trochanter
• US
• Thick, hypoechoic fascia lata
• Dynamic: abrupt, sudden displacement of fascia
lata, when adduction, extension → flexion or IR →
ER
Morel-Lavallee lesion
• Post-traumatic seroma along trochanteric region
Categorical Course
• Acute injury
• Forceful extension of the leg against resistance
• Commonly biceps femoris, semitendinosus >
semimembranosus
• US: difficult in hypertrophied thighs
• MR can be helpful in surgical candidates
[Posterior hip]
[Medial hip]
Hamstring injury
• Tendinopathy : swollen, hypoechoic, calcification
Adductor injuries
• Common sporting injuries following overuse, acute
trauma
• Hyperabduction of hip and hyperextension of the
abdominal wall, with forced external rotation of the
leg
• Most commonly superficial adductor longus or
gracilis
• US: irregular, hypoechoic, ill-defined adductor origin,
hematoma
Ischial tuberosity
• Semimembranosus tendon: most cranial, lateral
• Large coronal aponeurosis, medial to tendon
• distally muscle arising from medial end of
aponeurosis
• Conjoined tendon of semitendinosus and biceps
femoris
• Superficial and lateral position
• Semitendinosus muscle belly
• Arising more cranial position, compared with
biceps
• Sciatic nerve
• Lateral to the conjoined tendon
Ischiogluteal bursitis
• Irritation to bursa, prolonged sitting, severe weight
loss
• Reduction of subcutaneous fat in the buttock,
repetitive minor trauma on bursa
→ inflammation and fluid distension
Techniques
• Position: thigh abduction, external rotation, knee
flexion
• Three muscles
• Adductor longus, adductor brevis, adductor magnus
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and proximal thigh, between deep layer of the
subcutaneous tissue and fascia
• Shear strain, causing a hemorrhage of rich vascular
plexus, piercing the fascia lata
→ extravasation of bloods along the perifascial plane
→ dissecting the fat lobules of the subcutaneous
tissue
• Chronic stage, a reactive pseudocapsule
• US
• Well-defined hypo-anechoic collection, located
just superficial to the linear echogenic deep
fascia, fluid-fluid level, hyperechoic mural
nodule
KSUM Open 2016
CC 7 MSK-2 08:15 - 08:30
Lower Extremity US Anatomy and Basic Approach
Ultrasound Anatomy of Knee Joint
Seok Hahn
Department of Radiology, Inje University Haeundae Paik Hospital, Korea
160
GBR 102
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GBR 102
Ankle
Yoonah Song
Department of Radiology, Hanyang University Medical Center, Korea
1) Anterior Ankle
• Position: ① Knee flexed 45°, the plantar surface of the
foot lines flat on the table
② Supine position with the foot free
• Contents: Extensor tendons (tibialis anterior,
extensor hallucis longus, extensor digitorum longus),
tibialis anterior artery, deep peroneal nerve
◼ Tibialis anterior insertion onto the 1st cuneiform
◼ Tibialis anterior twice the diameter of the extensor
hallucis longus tendon
• Anterior recess of the ankle joint
◼ Mid longitudinal plane over the dorsum of the
ankle to examine the anterior recess of the
tibiotalar joint
2) Lateral Ankle
• Contents: Peroneus longus and peroneus brevis,
lateral ligamentous complex (anterior talofibular
ligament, posterior talofibular ligament,
calcaneofibular ligament), syndesmosis (anterior
tibiofibular ligament, posterior tibiofibular ligament,
interosseous membrane)
◼ Peroneal tendons: behind lateral malleolus, shortaxis view
◆ Intermittent subluxation of peroneal tendons
• Scanning at rest and during dorsiflexion and
eversion of the foot against resistance, at the
level of the lateral malleolus
• Peroneus longus inserts at the plantar aspect of
the middle cuneiform and 1st metatarsal bone
• Peroneus brevis inserts at the base of the 5th
metatarsal bone
◼ Anterior talofibular ligament: inversion (forefoot
slightly internally)
◆ Transducer parallel to the examination bed
placing its posterior edge over the distal lateral
malleolus
Put the end of your probe on the fibula tip and
rotate towards the horizontal
◆ Sonographic anterior drawer test
◼ Calcaneofibular ligament: oblique coronal plane,
dorsiflexion
◆ Superior edge over the tip of the lateral malleolus
and inferior margin slightly posterior to it,
towards the heel, deep to peroneal tendons
◼ Anterior tibiofibular ligament
◆ Keep the posterior edge of the transducer on
the lateral malleolus, rotate its anterior edge
upwards
◆
3) Medial Ankle
• Position: “frog-leg” or seated with the plantar surface
of the foot rolled internally, behind the medial
malleolus, short-axis view
• Contents: Tibialis posterior, flexor digitorum,
flexor halluces longus, deltoid ligament (deep and
superficial), tarsal tunnel (posterior tibial vessels and
the tibial nerve; divided medial and lateral plantar
nerves)
◼ Tibialis posterior tendon
◆ Broad delta-like insertion to the navicular
◼ Flexor hallucis longus: commonly a small amount
of fluid accumulates
◼ Deltoid ligament: dorsiflexion with coronal scans
◆ Superior edge of the transducer is kept over the
tip of the medial malleolus
◆ Inferior edge is rotated slightly
• Posterior (tibiotalar), parallel or slightly
anterior (tibiocalcanear), neutral position
(tibionavicular)
4) Posterior Ankle
• Prone position, foot hanging out of the examination
table
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08:30 - 08:45
KSUM Open 2016
• Contents: Achilles tendon, plantaris tendon,
retrocalcaneal bursa
• From myotendinous junction to its calcaneal
insertion (short and long axis view)
References
1.Bianchi S, Martinoli C, Gaignot C, De Gautard R,
Meyer JM. Ultrasound of the ankle: anatomy of the
tendons, bursae, and ligaments. Semin Musculoskelet
164
Radiol 2005; 9:243-259
2.Fessell DP, Vanderschueren GM, Jacobson JA, et al.
US of the ankle: technique, anatomy, and diagnosis of
pathologic conditions. Radiographics 1998; 18:325340
3.Martinoli C. Musculoskeletal ultrasound: technical
guidelines. Insights Imaging 2010; 1:99-141
4. Peetrons P, Creteur V, Bacq C. Sonography of ankle
ligaments. J Clin Ultrasound 2004; 32:491-499
Categorical Course
GBR 102
Foot
Jina Park
Department of Radiology, Seoul National University Boramae Medical Center, Korea
Ultrasonography (US) is a useful tool for imaging,
which can be used for the assessment of possible
causes of foot pain. In patients with foot pain, US
provides information not only about soft tissue
pathologies including muscular/tendinous/
ligamentous injuries, plantar fascia abnormalities,
plantar plate injury, intermetatarsal bursitis and
Morton's neuromas, but also about bone and joint
abnormalities, such as fracture and synovitis.
The standard US examination of the foot performed
via dorsal and plantar approaches. In dorsal
approach, the patient should be placed in supine
position with the knee flexed at approximately 90°
and the foot on the examination table. The superficial
tendons (tibialis anterior, extensor hallucis longus
and extensor digitorum longus), intrinsic foot
muscles/tendons and dorsal aspects of joints can
be identified. In plantar approach, the patient can
be placed in supine or prone position and both legs
on the bed or placed on a pillow. The plantar fascia,
plantar plates, muscles/tendons, hallucal sesamoids
and plantar aspects of joints can be identified. The
intermetatarsal spaces can be visualized with both
dorsal and plantar approaches.
Sonography provides a rapid, cheap, noninvasive,
and dynamic method for examination of the structures
of the foot. It can demonstrates abnormalities before
they become evident at other imaging modalities. A
clear understanding of normal sonographic anatomy
is required to achieve correct diagnosis.
165
Categorical Course
08:45 - 09:00
KSUM Open 2016
CC 7 MSK-5 09:00 - 09:15
Lower Extremity US Anatomy and Basic Approach
GBR 102
Lower Extremity US Anatomy and Basic Approach: Artery
Ji Young Hwang
Department of Radiology, Ewha Womans University Mokdong Hospital, Korea
166
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167
KSUM Open 2016
168
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169
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170
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171
KSUM Open 2016
09:15 - 09:30
GBR 102
Lower Extremity US Anatomy and Basic Approach: Vein
Kyung-Sik Ahn
Venous system of lower extremity
1. Deep veins
2. Superficial veins
3. Perforating veins
1. Deep veins
① Common femoral vein (CFV)
② Femoral vein (FV)
③ Deep femoral vein (DFV)
④ Popliteal vein (Pop V)
⑤ Anterior tibial vein (ATV)
⑥ Posterior tibial vein (PTV)
⑦ Peroneal vein (Pero V)
2. Superficial veins
① Great saphenous vein (GSV)
- Anterior accessory GSV (AAGSV)
- Posterior accessory GSV (PAGSV)
- Anterior thigh circumflex vein (ATCV)
- Posterior thigh circumflex vein (PTCV)
② Small saphenous vein (SSV)
- Cranial (thigh) extension of SSV
- Giacomini vein
3. Perforating veins
posterolateral
②Knee perforators
- Medial / suprapatellar / infrapatellar /
popliteal fossa PV
③ Leg perforators
- Medial leg PV: paratibial PV / posterotibial
PV (Cockett)
- Anterior leg PV
- Lateral leg PV
- Posterior leg PV: medial GCM / lateral GCM
/ intergemellar / para-Achillean PV
④ Ankle perforators
- Medial / anterior / lateral PV
Ultrasound Approach
1. Patient positioning
- Deep vein: hip external rotation & knee
flexion position
- Superficial vein: erect, non-weight-bearing
position for examination of reflux
2. Probe selection
- 5 MHz or greater (trade-off btw resolution
and beam penetration)
3. Probe positioning
4. Technique: compression technique for
thromboembolic disease / reflux assessment
for venous insufficiency
References
① Thigh perforators
- Medial thigh PV: PV of the femoral canal
(Hunterian), inguinal PV
- Anterior thigh PV
- Lateral thigh PV
- Posterior thigh PV: posteromedial / sciatic /
172
1.AIUM Practice Guideline for the Performance of
Peripheral Venous Ultrasound Examinations. J
Ultrasound Med. 2015;34(8):1-9.
2.Oguzkurt L. Ultrasonographic anatomy of the lower
extremity superficial veins. Diagn Interv Radiol.
Categorical Course
22.
5.Caggiati A, Bergan JJ, Gloviczki P, Eklof B, Allegra
C, Partsch H. Nomenclature of the veins of the
lower limb: extensions, refinements, and clinical
application. J Vasc Surg. 2005;41(4):719-24.
6.Meissner MH. Lower extremity venous anatomy.
Semin Intervent Radiol. 2005;22(3):147-56.
7. K h i l n a n i N M , M i n R J . I m a g i n g o f v e n o u s
insufficiency. Semin Intervent Radiol. 2005;22(3):17884.
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2012;18(4):423-30.
3.Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati
A, Myers K, et al. Duplex ultrasound investigation
of the veins in chronic venous disease of the lower
limbs--UIP consensus document. Part II. Anatomy.
Eur J Vasc Endovasc Surg. 2006;31(3):288-99.
4.Caggiati A, Bergan JJ, Gloviczki P, Jantet G, WendellSmith CP, Partsch H. Nomenclature of the veins of
the lower limbs: an international interdisciplinary
consensus statement. J Vasc Surg. 2002;36(2):416-
KSUM Open 2016
CC 8 ABD-1 Problem Solving with USG
08:00 - 08:30
Chairpersons:Yong Yeon Jeong Chonnam National University Hwasun Hospital, Korea
GBR 103
Upper Abdominal Pain
Na Yeon Han
I. Upper Abdominal Pain Syndromes
Upper abdominal pain syndromes typically have
characteristic locations: right upper quadrant pain
(table 1), epigastric pain (table 2), or left upper
quadrant pain (table 3). Biliary and hepatic etiologies
cause right upper quadrant pain syndromes.
Pancreatic and gastric etiologies often cause
epigastric pain and left upper quadrant pain is often
related to the spleen. Ultrasonography plays an
important role in evaluation of patients with right
upper quadrant pain because ultrasonography is both
sensitive and specific in demonstrating gallstones,
biliary dilatation, and features that suggest acute
inflammatory disease. Furthermore, it is an accurate,
safe, relatively inexpensive, and readily accessible
imaging modality for investigating these patients.
However, ultrasonography has limited role in
evaluation of patients with epigastric or left upper
quadrant pain.
Causes of abdominal pain in adults
Table 1. right upper quadrant pain
Clinical features
Comments
Biliary colic
Intense, dull discomfort located in the RUQ or
epigastrium. Associated with nausea, vomiting,
and diaphoresis. Generally lasts at least 30
minutes, plateauing within 1 hour. Benign
abdominal examination.
Patients are generally wellappearing.
Acute cholecystitis
Prolonged (>4 to 6 hours) RUQ or epigastric pain,
fever. Patients will have abdominal guarding and
Murphy's sign.
Acute cholangitis
Fever, jaundice, RUQ pain.
May have atypical presentation in
older adults or immunosuppressed patients.
Sphincter of Oddi
dysfunction
RUQ pain similar to other biliary pain.
Biliary type pain without other
apparent causes.
RUQ pain with fatigue, malaise, nausea, vomiting,
and anorexia. Patients may also have jaundice,
dark urine, and light-colored stools.
Variety of etiologies include
hepatitis A, alcohol, and druginduced.
Biliary
Hepatic
Acute hepatitis
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RUQ pain with a pleuritic component, pain is
sometimes referred to the right shoulder.
Aminotransferases are usually
normal or only slightly elevated.
Liver abscess
Fever and abdominal pain are the most common
symptoms.
Risk factors include diabetes,
underlying hepatobiliary or
pancreatic disease, or liver
transplant.
Budd-Chiari
syndrome
Symptoms include fever, abdominal pain, abdominal
distention (from ascites), lower extremity edema,
jaundice, gastrointestinal bleeding, and/or hepatic
encephalopathy.
Variety of causes.
Portal vein
thrombosis
Symptoms include abdominal pain, dyspepsia, or
gastrointestinal bleeding.
Clinical manifestations depend on
extent of obstruction and speed
of development. Most commonly
associated with cirrhosis.
Table 2. epigastric pain
Clinical features
Comments
Acute myocardial
infarction
May be associated with shortness of breath and
exertional symptoms.
Consider particularly in patients
with risk factors for coronary
artery disease.
Acute pancreatitis
Acute-onset, persistent upper abdominal pain
radiating to the back.
Chronic
pancreatitis
Epigastric pain radiating to the back.
Associated with pancreatic insufficiency.
Peptic ulcer
disease
Epigastric pain or discomfort is the most
prominent symptom.
Occasionally, discomfort localizes
to one side.
Gastroesophageal
reflux disease
Associated with heartburn, regurgitation, and
dysphagia.
Gastritis/
gastropathy
Abdominal discomfort/pain, heartburn, nausea,
vomiting, and hematemesis.
Variety of etiologies including
alcohol and nonsteroid antiinflammatory drugs (NSAIDs).
Functional
dyspepsia
The presence of one or more of the following:
postprandial fullness, early satiation, epigastric
pain, or burning.
Patients have no evidence of
structural disease.
Gastroparesis
Nausea, vomiting, abdominal pain, early satiety,
postprandial fullness, and bloating.
Most causes are idiopathic,
diabetic, or postsurgical.
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Perihepatitis
(Fitz-Hugh-Curtis
syndrome)
KSUM Open 2016
Table 3. left upper quadrant pain
Clinical features
Comments
Splenomegaly
Pain or discomfort in LUQ, left shoulder pain,
and/or early satiety.
Multiple etiologies.
Splenic infarct
Severe LUQ pain.
Atypical presentations common.
Associated with a variety of
underlying conditions (eg,
hypercoagulable state, atrial
fibrillation, and splenomegaly).
Splenic abscess
Associated with fever and LUQ tenderness.
Uncommon. May also be associated
with splenic infarction.
Splenic rupture
May complain of LUQ, left chest wall, or left
shoulder pain that is worse with inspiration.
Most often associated with
trauma.
II. Ultrasonography for Acute Pain in the Right
Upper Quadrant
US is superior to computed tomography as the
initial imaging investigation for assessment of biliary
disease causing acute right upper quadrant pain.
① Acute Cholecystitis
✓ The presence of cholecystolithiasis in
combination with maximal tenderness over
the sonographically localized gallbladder
(sonographic Murphy sign): The most
sensitive US finding in acute cholecystitis
✓ The presence of a tensely distended
gallbladder is also very helpful.
✓ Obstructing stone in the gallbladder neck or
cystic duct
✓ Gallbladder wall thickening (>3 mm) and
pericholecystic fluid: neither sensitive nor
specific for acute cholecystitis
✓ Hypervascularity on Doppler US:
supplementary role
✓ Acalculous cholecystitis : 5%-10% of all cases
of acute cholecystitis
② Complications of Acute Cholecystitis
Additional imaging may be required and CT is
an excellent second choice.
A. Gangrenous Cholecystitis
B. Emphysematous Cholecystitis
176
C. Gallbladder Perforation
D. Cholecystoenteric Fistula
③ Choledocholithiasis
Sonography is not the study of choice for
evaluation of choledocholithiasis because of its
limited sensitivity; however, it is highly specific if a
stone is identified. If choledocholithiasis is suspected
but cannot be confirmed by sonography, magnetic
resonance cholangiopancreatography is highly
sensitive and specific.
④ Liver Abscess
The sonographic appearances are varied (from
anechoic to highly echogenic)
✓ gas may be noted
✓ may have a more solid appearance
✓ US is also a readily available, portable, safe, and
cost-effective means for guiding percutaneous
drainage
References
1.F r o m t h e R S N A r e f r e s h e r c o u r s e s : i m a g i n g
evaluation for acute pain in the right upper quadrant.
Radiographics. 2004 Jul-Aug;24(4):1117-35.
2 Emergent right upper quadrant sonography. J
Ultrasound Med. 2009 Apr;28(4):479-96.
3http://www.uptodate.com/contents/causes-ofabdominal-pain-in-adults
Categorical Course
GBR 103
Lower Abdominal Pain
Hyun Jeong Park
Department of Radiology, Chung-Ang University Hospital, Korea
177
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08:30 - 08:55
KSUM Open 2016
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GBR 103
Abnormal Laboratory Findings
Honsoul Kim
This lecture will focus on performing abdominal
ultrasonography for patients who present with
abnormal laboratory findings that reflect dysfunction
of the hepatic and pancreatobiliary system.
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08:55 - 09:20
KSUM Open 2016
DS ABD-1 HCC Screening
09:20 - 09:45
Chairpersons:Dal Mo Yang Kyung Hee University Hospital at Gangdong, Korea
GBR 103
HCC Screening, Ultrasound is Enough
Jae Young Lee
Department of Radiology, Seoul National University, College of Medicine, Korea
The decision whether to adopt a surveillance policy
towards HCC should be relay on the prevalence of
the disease in the population and on the resources of
a particular country (1).
Implementation of any screening program in the
daily practice of each country also requires that such
program do not consume resources out of proportion
of the importance of the disease (prevalence,
socioeconomic impact, etc) in the country (1). A
surveillance program that requires a too large
number of resources would not be desirable.
In my lecture, the value of ultrasound as a
screening tool will be reviewed with introduction of
HCC surveillance. The introduction is as follows.
mortality rates are not appropriate surrogate
endpoints (3).
B. Deciding what level of risk of HCC is high
enough to trigger surveillance, what
screening tests to apply and how frequently
(surveillance interval), and how abnormal
results should be dealt with (diagnosis and/
or recall) are important.
C. According to a randomized controlled trial
of surveillance versus no surveillance that
has shown a survival benefit to a strategy
of 6-monthly surveillance with AFP and
US, HCC related mortality was reduced by
37% in the surveillance arm (4). Lots of
studies suggested that screening increases
the proportion of diagnosed HCCs that are
resectable and improves survival (1, 5-8).
1. Why is early detection of HCC important?
A. Despite continuous improvement in the
management of hepatocellular carcinoma
(HCC), its prognosis remains poor, with
an overall 1-year survival rate of 47% (2).
This is partly related to a diagnosis of HCC
established at an advanced stage for more
than 2/3 of patients, for which time therapy
is less effective. Therefore, accurate tools for
early diagnosis of HCC are essential. Curative
resection or ablation in patients with earlystage HCC shows much better median
survival reaching 50-70% at 5 years.
3. Who is the At-Risk population?
A. Efficacy of surveillance is highly dependent
on the incidence of HCC. Lin et al found that
surveillance with AFP and ultrasound was
cost-effective regardless of HCC incidence
(9).
Table 1 describes the groups of patients in which
these limits are exceeded. The subgroups of hepatitis
B carriers in which the incidence of HCC exceeds
0.2%/years are given in Table 1.
2. What is the objective of HCC surveillance?
A. The objective of HCC surveillance must
be to decrease mortality from the disease
or provide at a minimum a meaningful
improvement in survival duration. Other
endpoints such as stage migration and 5 year
4. Advantages of Ultrasound in HCC
surveillance program
A. Ultrasound has a sensitivity of between
65% and 80% and a specific greater than
90% when used as a screening test. The
performance, even though it is not ideal, is
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superior to any of the serological test. The
major drawback of ultrasound for HCC
surveillance is operator dependency (9).
5. Room for improvement
A. In order that a surveillance program is
successful, the test has to be reproducible and
the test characteristics homogeneous within
the area in which it is applied. Unfortunately,
US is not much reproducible. It depends on
the experiences of radiologists or primary
physicians; scanning device; or scanning
condition. That is the weak point of US for
surveillance tool.
References
1.Bolondi L, Sofia S, Siringo S, et al. Surveillance
programme of cirrhotic patients for early diagnosis
and treatment of hepatocellular carcinoma: a cost
effectiveness analysis. Gut. 2001;48(2):251-9.
2.Pote N, Cauchy F, Albuquerque M, et al. Performance
of PIVKA-II for early hepatocellular carcinoma
diagnosis and prediction of microvascular invasion. J
Hepatol. 2015;62(4):848-54.
3.Bruix J, Sherman M. Management of hepatocellular
carcinoma. Hepatology. 2005;42(5):1208-36.
4.Zhang BH, Yang BH, Tang ZY. Randomized controlled
trial of screening for hepatocellular carcinoma. J
Cancer Res Clin Oncol. 2004;130(7):417-22.
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5.Trevisani F, De Notariis S, Rapaccini G, et al.
Semiannual and annual surveillance of cirrhotic
patients for hepatocellular carcinoma: effects on
cancer stage and patient survival (Italian experience).
Am J Gastroenterol. 2002;97(3):734-44.
6.Yuen MF, Cheng CC, Lauder IJ, Lam SK, Ooi CG,
Lai CL. Early detection of hepatocellular carcinoma
increases the chance of treatment: Hong Kong
experience. Hepatology. 2000;31(2):330-5.
7.Wong LL, Limm WM, Severino R, Wong LM.
Improved survival with screening for hepatocellular
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carcinoma. Liver Transpl. 2000;6(3):320-5.
8.M c M a h o n B J , B u l k o w L , H a r p s t e r A , e t a l .
Screening for hepatocellular carcinoma in Alaska
natives infected with chronic hepatitis B: a 16-year
population-based study. Hepatology. 2000;32(4 Pt
1):842-6.
9.Lin OS, Keeffe EB, Sanders GD, Owens DK. Costeffectiveness of screening for hepatocellular
carcinoma in patients with cirrhosis due to
chronic hepatitis C. Aliment Pharmacol Ther.
2004;19(11):1159-72.
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DS ABD-2
HCC Screening
Chairpersons:Dal Mo Yang Kyung Hee University Hospital at Gangdong, Korea
GBR 103
US is Not Enough
Joon-Il Choi
Early detection of hepatocellular carcinoma (HCC)
is thought to reduce the mortality because curative
treatment options can be applied to patients with
early stage. Most of guidelines for the management
of hepatocellular carcinoma (HCC) recommend
the ultrasonography (US) as a surveillance tool
for patients with risk factors of hepatocellular
carcinoma. Biannual US and alpha feto-protein
(αFP) surveillance was proved to reduce cancerrelated mortality for patients with risk factors in
China. However, US has some shortcomings; 1)
Quality of US is operator dependent, 2) detecting
minute hepatic tumors in macronodular cirrhotic
background or infiltrative tumor is very difficult,
3) US has some blind spots for liver scanning and
sonic window is limited in patients with cirrhosis
or obesity. Known sensitivity of US surveillance for
HCC is between 65-80% and recent meta-analysis
revealed that the sensitivity for early stage HCC was
65%. Therefore, some alternative options for HCC
surveillance are under investigation, especially for
patients with very high risk. In Japanese consensusbased clinical practice guidelines (2010), dynamic
CT or dynamic MRI/EOB-MRI is recommended
every 6-12 months as an alternative of US + αFP
every 3-4 months for patients with super-high-risk
(liver cirrhosis with HBV or HCV). A few clinical
trials are undergoing to investigate the possibility of
other imaging modalities (contrast enhanced US, low
radiation dose dynamic CT, gadoxetic acid enhanced
MRI and noncontrast MRI). In Korea, medical cost
for CT or MRI is not too high when compared to
that of US (twice or three times of fee for US) and
therefore, CT or MRI can be cost-effective for HCC
surveillance. I hope we can find more sensitive
ways for the surveillance of HCC with reasonable
cost in the future to overcome the limitations of US
surveillance.
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Debate Session
09:45 - 10:10
KSUM Open 2016
HI 3 THY-1 Non-Invasive Treatment of Thyroid Lesion
09:30 - 10:10
Chairpersons:Dong Gyu Na Human Medical Imaging & Intervention Center, Korea
Jin Yong Sung Daerim Saint Mary's Hospital, Korea
GBR 101
Local Ablation of Benign Thyroid Nodules - Alternatives to Surgery
and Radioiodine Therapy
Frank Gruenwald
Department of Nuclear Medicine, Hospital of The University of Frankfurt, Germany
Dominated by thyroid surgery and - in case of
Plummer’s disease - radioiodine therapy, treatment
of thyroid nodules is also depending on regional
specific aspects. For hyperfunctional nodules,
radioiodine treatment is the therapy of choice
in most cases, due to the relatively low risks. In
malignant nodules or suspected malignancy, surgery
is preferred in most countries.
In addition to these treatment options, there are
several clinical situations, in which local ablative
procedures are the therapy of choice considering
pros and cons:
treatment)
Patients who generally fear therapeutic amounts of
radioactive substances
Patients who cannot be suppressed by thyroid
hormones, e.g. due to cardiologic diseases
Patients who are not willing to (or cannot) stay at
the hospital for several days
Children, particularly if parents (or patients) fear
radioactivity
Patients with Graves’ disease and high risk of
deterioration of endocrine ophthalmopathy, especially
if there are contraindications against corticoid
medication
1 Cold or scintigraphic indifferent thyroid
nodules which are symptomatic or are
expected to become symptomatic in the
near future or cause cosmetic problems
Patients who are not operable due to high risks
concerning anaesthesiaPatients who fear general
anaesthesia.
Patients who do not agree to lose at least one half
of the thyroid gland, since hemithyroidectomy or
total thyroidectomy are the surgical procedures of
choice in nodular goiter.
Patients with increased local risk for surgery (e.g.,
patients who had been operated on before or are
suffering from laryngeal nerve paresis because of
other reasons).
Patients with increased bleeding risks, e.g.,
under anticoagulation; however, this fact has to be
considered also when planning local ablation.
3 Thyroid cancer, mainly for inoperable cases
Several methods of local ablation to treat
thyroid diseases are available:
Local ethanol injection (PEIT) with a history
of about 30 years, frequently used especially in
Denmark, Korea, Japan and Germany
Radiofrequency ablation (RFA), which was
introduced to clinical practice about 15 years ago and
has been developed and refined particularly in Korea
Percutaneous LASER ablation (LASER), frequently
used in Italy, introduced about 15 years ago
Microwave ablation (MWA), which has been
initially used in China about 5 years ago
High-intensity focused ultrasound (HiFu), which
was used in France and Bulgaria for the first time
about 5 years ago and is now applied in several other
countries, e.g. Germany
2 Hot nodules or Graves’ disease or goiter
with scintigraphically indifferent nodules
Patients after iodine excess (e.g., amiodarone
High-intensity Focused ultrasound (HiFu)
HiFu has been used for about 20 years to treat
several diseases, particularly benign and malignant
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Microwave ablation (MWA)
Microwave ablation is based on the local
application of microwaves with a frequency of 900
to 2,450 MHz. This method has been used for many
years for the treatment of several liver and lung
diseases. Microwaves excite water molecules in the
tissue to oscillation, inducing temperature increase
in the neighborhood of the antenna. Above 45 °C we
expect initial protein denaturation and irreversible
destructions of cell membranes and interruption
of cell regeneration. Above 60 °C, irreversible
coagulation necrosis in the thyroid tissue occurs. As
it is true also for other methods of thermal ablation,
problems can occur by heterogeneous tissue texture
(e.g., calcification, blood, fibrosis) and therefore
heterogeneous tissue reaction to the treatment. In
addition, heat sink effects have to be considered in
the vicinity of blood vessels with diameters > 3 mm.
The extent of the necrotic zone is operated by the
power (W) of the MWA system and the application
time. By measuring the temperature in the center of
the nodule (by the microwave antenna), it is possible
to evaluate therapeutic effects immediately.
A combination of local ablation (e.g., MWA) with
radioiodine therapy can be useful in cases of cold
and hot nodules, in Graves’ disease with goiter or in
multinodular goiter with very high thyroid volumes
(which cannot be treated with radioiodine alone).
Radiofrequency ablation (RFA)
In the past, radiofrequency ablation had been
used for the treatment of various diseases of several
organs, especially malignant liver tumors. RFA in
thyroid diseases was initially used in Korea, USA and
Japan.
Monopolar as well as bipolar electrodes are used
for RFA, both methods having advantages and
disadvantages. For monopolar RFA, a second electric
pole is necessary, placed at the thigh, causing a
current through the torso. The treatment electrode
itself has a very small “active area” (about 10 mm
and less), therefore, a precisely defined ablation zone
is possible, particularly useful in the moving shot
technique, in which the electrode is moved more
or less continuously during the ablation procedure.
In contrast, in bipolar techniques, both electrodes
(separated by a small insulator) are placed into the
nodule. The active zone is larger (10 to 40 mm). One
main advantage is that no current is affecting the rest
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Hot Issues
tumors, e.g. of the prostate gland. It can be
controlled by diagnostic ultrasound or magnetic
resonance imaging. The focused ultrasound field is
generated by a piezoelectric transducer with center
frequency of 1 to 7 MHz, aimed at the target region
in the tissue. Acoustic energy is transformed to heat,
causing heating in the target up to 60°C within a
few seconds and subsequently protein denaturation.
The lesions have typically an elliptical shape and
a volume of 50 to 300 mm3. Between the “shots”,
adequate time intervals for recovery are necessary to
prevent tissue boiling and forming of bubbles which
could change the volume and shape of the targeted
tissue and also distort the field. This issue causes the
drawback, that the procedure is time consuming.
Whereas there are limitations in moving organs and
in regions, where air-filled structures (e.g., bowel)
or bone affects successful treatment, it can be used
nearly without these drawbacks at the neck. Before
the treatment, target volume and organs at risks,
including safety margins, have to be defined. The
probe has a maximal penetration depth of 1.5 cm
and an exchangeable cooling kit. The system selects
safety margins:
0.5 cm from the skin
0.3 cm from the trachea
0.2 cm from the carotid artery
One day after the intervention, functional imaging
is repeated with 99mTc-pertechnetate for hot and
indifferent and with 99mTc-Hexakis-(2-methoxy2-methylpropylisonitrile) (MIBI) for cold nodules
to assess treatment success. As the total uptake
of 99mTc-MIBI or 99mTc-pertechnetate in a specific
area of the thyroid depends on many factors of
current individual metabolism, nodular uptake
is only evaluated as the background is adjusted
and in relation to total thyroidal uptake. 99mTcMIBI -uptake is reduced by about 35%, and 99mTcpertechnetate uptake is reduced by about 30%,
respectively. Volume reduction is about 50% after 3
months. Moving-beam echotherapy (BEAMOTION)
can reduce treatment duration by about 60 to 80%.
Therefore, it will be possible to treat also nodules
with volumes over 4 ml.
KSUM Open 2016
of the body.
The RFA electrode is placed in the nodule under
ultrasound control. The application of high-frequent
alternating electric current (in the range of about 200
to 1000 kHz) causes agitation of ions in the tissue
and subsequently frictional heat in the region closely
adjacent (only few mm) to the electrode. Remote
areas are heated slowly by thermal conduction from
the region adjacent of the electrode. Like for other
methods of thermic ablation, the therapeutic effect of
RFA depends on the temperature and the duration of
the heating.
Several techniques are used, e.g. the moving-shot
and the multi-shot techniques (see above). Initially,
the electrode tip is positioned in the deepest portion
of the nodule and is moved backward within the
nodule after starting the administration of RF power.
The procedure can be visualized sonographically. If
no hyperechoic zone appears at the electrode tip, RF
power is increased to a maximum of 110 W. Severe
side effects occur very rarely.
The moving-shot technique is successful in nodules
up to 4 cm in diameter. In larger nodules more than
one session might be needed.
Light Amplified Stimulated Emission of
Radiation (LASER) therapy
LASER therapy uses collimated monochromatic
coherent light energy to destroy tissue by energy
absorption. For the flat-tip method, a 300 µmdiameter plane-cut optic fiber is inserted through
the sheath of a 21 G Chiba needle. 4 mm of the bare
fiber is in direct contact with the thyroid tissue to be
treated. Lidocaine (subcapsular injection) is used
for local anesthesia. One to 4 needles are placed
around the nodule. Correct placement is controlled
by multiplanar ultrasound imaging. Initially, energy
levels of 1,200 to 1,800 J (per fiber) with an output
power of 2 to 4 W are used. Therapy success is
documented by the appearance of highly echogenic
patterns, needles are moved/pulled back by 1 cm
increments and further treatments (administration
of LASER energy) are applied. By this technique,
nodules up to 60 ml can be treated.
Percutaneous ethanol injection (PEIT)
Local instillation of ethanol was used about 30
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years ago to treat benign thyroid nodules. Besides
volume reduction of indifferent and cold nodules
and the therapy of focal autonomy (in patients
who could not be treated with radioiodine, due to
various reasons), the method was (and is) used
for sclerotherapy of recurrent cysts and also for
the treatment of local recurrence and lymph node
metastases in thyroid cancer.
Under ultrasound control, 96% ethanol is injected
via a G20- G22 needle into the nodule. Local
anaesthesia is recommended because the procedure
can be very painful. Acute side effect is an instantly
occurring pain, spreading to the ear/jaw on the
affected side, probably due to tissue infiltration and
increase of local tissue pressure.
Within the last decade, this technique of local
ablation of thyroid nodules lost importance due to
the high risks of side effects, the logistic challenges
and the upcoming new methods of thermoablation.
Conclusion
There are several methods of local ablation as
alternatives to surgery or radioiodine therapy. All
of these methods have strengths and weaknesses.
Severe side effects are rare (< 1 % of all cases) and
mostly transient. The reported success rates in the
literature differ, mainly due to different inclusion
criteria. Several parameters are supposed to
influence therapeutic effects in all of these studies:
Initial volume
Structure (mixed/cystic/solid)
Echogenicity
Function (hot/cold/indifferent)
Localization (e.g. superficial/deep)
Intensity of the treatment, e.g. power, temperature,
time
Experience of the treating physician with the
specific method
Follow-up time
Overall, a volume reduction of about 50% to
70% can be expected, slightly more in cystic than
in solid nodules. Longest and most experiences
exist concerning ethanol treatment and RFA.
MWA should be preferred in nodules with high
volumes (e.g. > 50 ml), HiFu can be preferred in
small nodules in patients, who refuse to have any
scar after the treatment. In all other cases, RFA can
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should be kept in mind, that radioiodine treatment
is the treatment of choice in hot nodules, due to very
low risks of side effect of this highly targeted therapy.
Before planning local ablation of cold nodules,
malignancy should be excluded using fine needle
biopsy, MIBI scintigraphy and serum calcitonin
measurement besides sonographic evaluation.
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Hot Issues
be recommended as the first technique of choice.
Internally cooled systems can reduce the risk of side
effects and should be used routinely. If the speed of
HiFu techniques can be improved, a wider spectrum
of treatable nodules can be expected in the future
for this method. Besides all these considerations, it
KSUM Open 2016
HI 4 MSK-1 Advanced in MSK US
09:30 - 10:10
Chairpersons:Kil-Ho Cho Yeungnam University Medical Center, Korea
Sung Moon Lee Keimyung University, Korea
GBR 102
Idiosyncrasies in Nerve Imaging
Nerve ultrasound is growing rapidly as a new field
within musculoskeletal ultrasound. Carpal tunnel
ultrasound and ultrasound of the ulnar nerve have
been investigated from the very beginning but now
is the time that smaller and smaller nerve branches
are being traced. Simultaneously, nerve detail as
observed by ultrasound is dramatically improving.
Nerves now show with improved spatial resolution at
a near histologic detail. At times of rapid change in
this modality of imaging it is appropriate to pause to
discuss some of the peculiarities that one encounters
while investigating nerves.
This lecture is built on the following observations
- Nerves may hurt in places where they are not
injured
- Nerves swell in areas where they are not impinged
- Nerves can get hit twice
- Nerves dance
- Nerves have an affinity for fluid
The following reference list will provide some
insights into the principles that will be discussed in
detail and will be illustrated with plenty of image
material.
References
• Dejerine J, Dejerine A, Mouzon J. Les lésions de
gros troncs nerveux des membres par projectiles de
guerre. Presse Med. 1915; 40:321-8.
• Dilley A, Summerhayes C, Lynn B. An in vivo
investigation of ulnar nerve sliding during upper limb
movements. Clin Biomech. 2007;22:774-9.
• Ditmars DM, van Holsbeeck M, Fateh A. Clinical
194
correlation of ultrasound ndings of the median nerve
in carpal tunnel syndrome. (Abstract) Presented at
the Michigan Academy of Plastic Surgeons Meeting,
Mackinac Island. July 28, 2010.
• Donato G, Galasso O, Valentino P, et al. Pathological
finings in subsynovial connective tissue in idiopathic
carpal tunnel syndrome. Clin Neuropathol.
2009;28:129-35.
• H o u g h A D , M o o r e A P , J o n e s M P . R e d u c e d
longitudinal excursion of the median nerve in
carpal tunnel syndrome. Arch Phys Med Rehabil.
2007;88:569-76.
• Martinoli C, Bianchi S, Gandolfo N, et al. US of nerve
entrapments in osteo brous tunnels of the upper and
lower limbs. Radiographics. 2000;20:S199-213.
• Nakamichi K, Tachibana S. Restricted motion of the
median nerve in carpal tunnel syndrome. J Hand
Surg Br. 1995;20: 460-64.
• Rossey-Marec D, Simonet J, Beccari R, et al.
Ultrasonographic appearance of idiopathic radial
nerve constriction proximal to the elbow. J
Ultrasound Med. 2004;23:1003-7.
• Spinner RJ, Hèbert-Blouin MN, Amrami KK. A
complex cyst characterized into its individual
components: A shared pathogenesis from the superior
tibio bular joint. J Surg Orthop Adv. 2010;19:143-8.
• Spinner RJ, Scheithauer BW, Amrami KK, et al. e
unifying articular (synovial) origin of intraneural
ganglia: Evolution- Revelation-Revolution.
Neurosurgery. 2009;65:A115-24.
• Stewart JD. Peripheral nerve fascicles: anatomy and
clinical relevance. Muscle Nerve. 2003;28:525-41.
• Stewart JD. The variable clinical manifestations of
ulnar neuropathies at the elbow. J Neurol Neurosurg
Psychiatry. 1987;50(3):252-8.
• van Doesburg MH, Yoshii Y, Villarraga HR, et al.
Median nerve deformation and displacement in the
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Ultrasound assessment of the displacement and
deformation of the median nerve in the human carpal
tunnel with active finger motion. J Bone Joint Surg
Am. 2009;91:2922-30.
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carpal tunnel during index finger and thumb motion.
J Orthop Res. 2010;28(10):1387-90.
• Yoshii Y, Villarraga HR, Henderson J, et al.
KSUM Open 2016
SFS 4 ABD-1 Quantitative US Biomarkers
10:30 - 11:00
Chairpersons:Young Hoon Kim Seoul National University Bundang Hospital, Korea
Doppler USG
Kyoung Doo Song
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GBR 103
Application of CEUS Perfusion Techniques
Paul Sidhu
Department of Radiology, King's College Hospital, London, United Kingdom
Ultrasound contrast agents in conjunction with
contrast specific imaging modes are increasingly
accepted in clinical use for diagnostic imaging.
Contrast-enhanced ultrasound (CEUS) has improved
the detection and characterization of abnormalities
in comparison to conventional ultrasound in many
organs including the liver, kidney, pancreas and
testis. Dynamic Contrast Enhanced Ultrasound
(DCE-US) overcomes subjective evaluation of
the enhancement between normal and abnormal
parenchyma, or between a focal lesion and the
surrounding tissue and may afford potential for
a better understanding of the pathophysiology of
angiogenesis of benign and malignant lesions. DCEUS for quantification of tumour perfusion should
be similar irrespective of ultrasound equipment,
data acquisition and analysis software. The
parameters encountered in DCE-US quantification
will be presented, with emphasis on quantification
of DCE-US to evaluate data objectively to enable
comparison of imaging techniques, to evaluate new
UCA applications, to quantify tissue and tumour
enhancement in order to characterize focal lesions, to
evaluate therapeutic response, and to limit variability
in clinical diagnosis.
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11:00 - 11:30
KSUM Open 2016
11:30 - 12:00
GBR 103
US Elastography
So Yeon Kim
Accurate estimation of fibrosis stage is helpful for
the evaluation of treatment and prognosis of the
disease. Noninvasive detection and quantification
of hepatic fibrosis is becoming more and more
important clinically. The ideal test for staging of
hepatic fibrosis should be noninvasive, simple,
readily available, less expensive, reproducible, and
accurate. Although liver biopsy is the current gold
standard for the assessment of hepatic fibrosis, the
problems of liver biopsy are high rates of sampling
errors, invasiveness, difficulty to repeat, and
observer variability. In contrast, US elastography
have many advantages to become an ideal test for the
quantification of hepatic fibrosis.
US Elastography techniques have evolved
significantly over the past two decades. US
elastography is not only an active area of research
but also has now been implemented on clinical
practice. According to its rapid development and
adaptation from engineering and many vendors,
variable terminology and parameters have been used,
which can be very confusing. Recently, the European
Federation of Societies for Ultrasound in Medicine
and Biology (EFSUMB) (1, 2), the World Federation
for Ultrasound in Medicine and Biology and Biology
(WFUMB) (3, 4), and the Society of Radiologists
in Ultrasound (5) has proposed guidelines and
recommendations for US elastography. Since 2012,
the Quantitative Imaging Biomarkers Alliance
(QIBA) of the Radiological Society of North America
also started the Ultrasound Shear Wave Speed (SWS)
Biomarker committee (http://qibawiki.rsna.org/
index.php/Ultrasound_SWS_Biomarker_Ctte) as
a form of continuing efforts to improve the value
and practicality of the quantitative values obtained
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from US elastography. In addition, European
experts suggested an extension of The Standards for
Reporting of Diagnostic Accuracy Studies (STARD)
for reporting diagnostic accuracy studies on liver
fibrosis tests, The Liver FibroSTARD standards (6).
In this review, the terms defined by the WFUMB are
mainly used in order to facilitate the uniformity in
description.
US elastography technique can be categorized
into the stain imaging and the shear wave imaging.
The strain imaging can be obtained by strain
elastography by quasi-static methods and acoustic
radiation force impulse (ARFI) excitation. As the
strain imaging generally does not provide the
absolute values of liver stiffness, it will not be
discussed in this review. The shear wave imaging
can use a controlled vibrating external vibration
(Fibroscan, Echogen) as also known as transient
elastography or one-dimensional elastography or
ARFI in order to generate shear waves. The methods
of shear wave speed measurement and imaging using
ARFI excitation include point shear wave speed
measurement in a region of interest (Virtual Touch
Quantification, Simens; ElastPQ, Philips; SmartShearwave elastography, Samsung) and shear wave
speed imaging (ShearWave Elastography, Aixplorer
SuperSonic Imagine) as also known as twodimensional shear wave elastography.
For shear wave speed-based methods, the physical
quantity is speed itself, and/or Young’s modulus
converted from shear wave speed on assumptions of
constant density, homogeneity, isotropy, and static
deformation using the by the equation for Young’s
2
elastic modulus (kPa) (E=3ρν , where ν is the shear
wave velocity (m/sec) and ρ is the density of tissue,
by the viscosity. Thus, shear wave speed becomes a
function of frequency, and the higher frequency is,
the faster the speed. This could lead to differences in
shear wave speed measured with different imaging
system. 1D transient elastography uses a lower
excitation frequency of 50 Hz, whereas point shearwave elastography and shear-wave elastography
typically use higher frequencies (9). The choice of
frequency used in those studies was partly dictated
by technical constraints, such as transducer
configuration and depth of tissue studied, because
a higher frequency would result in wave amplitude
dissipation and signal-to-noise ratio decrease.
There are patient-specific issues that need to
be addressed. Cutoff values for fibrosis stage can
vary according to its etiology. The presence of
inflammation, cholestasis, right heart failure or
hepatic venous congestion can also affect the liver
stiffness values.
Because of the lack of standardization in
terminology, shear-wave frequency, reported
parameters, and other technical factors comparing
different elastographic techniques can be
challenging. We should also consider patient-related
factors when we interpreted the liver stiffness values.
References
1.Cosgrove D, Piscaglia F, Bamber J, Bojunga J,
Correas JM, Gilja OH, et al. EFSUMB guidelines and
recommendations on the clinical use of ultrasound
elastography. Part 2: Clinical applications. Ultraschall
Med 2013;34:238-253
2.Bamber J, Cosgrove D, Dietrich CF, Fromageau J,
Bojunga J, Calliada F, et al. EFSUMB guidelines and
recommendations on the clinical use of ultrasound
elastography. Part 1: Basic principles and technology.
Ultraschall Med 2013;34:169-184
3.Shiina T, Nightingale KR, Palmeri ML, Hall TJ,
Bamber JC, Barr RG, et al. WFUMB guidelines and
recommendations for clinical use of ultrasound
elastography: Part 1: basic principles and terminology.
Ultrasound Med Biol 2015;41:1126-1147
4.Ferraioli G, Filice C, Castera L, Choi BI, Sporea
I, Wilson SR, et al. WFUMB guidelines and
recommendations for clinical use of ultrasound
elastography: Part 3: liver. Ultrasound Med Biol
2015;41:1161-1179
205
assumed to be constant).
For transient elastography, successful
measurements are validated using the following
criteria: 1) number of valid shots ≥ 10; 2) ratio of
valid shots to the total number of shots ≥60%;
and 3) interquartile range (IQR, reflecting the
variability of measurements) less than 30% of the
median liver stiffness measurement (LSM) value
(IQR/LSM ≤30%). However, for the other US
elastography techniques, the minimum number
of measurements and the reliability measurement
have not been defined well. According to the
WFUMB recommendations, the median value of
5-10 measurements is considered with point shear
wave speed measurement and the mean value of four
measurements with shearwave speed imaging.
Patients should fast for 4-6 hours before US
elastography as food intake can increase liver
stiffness value. Increasing transducer compression
could increase the shear wave speed, and thus, right
lobe measurements by the intercostal approach,
unaffected by the effect of probe compression against
the liver parenchyma, are preferred. Elastography
measurements are acquired during breath-holding
to minimize liver motion. Deep inspiration has been
shown to increase stiffness measurements compared
with resting expiratory position. Hence, breathhold at expiration is preferable to obtain consistent
liver position between acquisitions and to avoid
overestimation of liver stiffness. To have a clear
sonic window is important in a sense that adequate
shear wave generated by ARFI push pulse is needed
for accurate measurement. The attenuation is higher
with a stiffer liver, which leads to more variable
measurements in cirrhotic patients.
Depth of measurement can be a confounding
factor to assess liver stiffness (7). Correlation
between liver stiffness and fibrosis stage is higher
for measurements made at 1-3 cm below the liver
capsule than for superficial measurements performed
between 0 and 1 cm below the liver capsule (8).
In addition, there can be artifact at the area just
beneath the liver capsule. According to the Society
of Radiologists in Ultrasound, the ARFI pulse has a
sweet spot at 4-5-cm depth with most equipment.
Contrary to the basic assumption in calculating the
liver stiffness, the liver display velocity dispersion
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5.Barr RG, Ferraioli G, Palmeri ML, Goodman
ZD, Garcia-Tsao G, Rubin J, et al. Elastography
Assessment of Liver Fibrosis: Society of Radiologists
in Ultrasound Consensus Conference Statement.
Radiology 2015;276:845-861
6.Boursier J, de Ledinghen V, Poynard T, Guechot
J, Carrat F, Leroy V, et al. An extension of STARD
statements for reporting diagnostic accuracy studies
on liver fibrosis tests: the Liver-FibroSTARD
standards. J Hepatol 2015;62:807-815
7.Shin HJ, Kim MJ, Kim HY, Roh YH, Lee MJ.
Comparison of shear wave velocities on ultrasound
elastography between different machines,
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transducers, and acquisition depths: a phantom
study. Eur Radiol 2016
8.Sporea I, Sirli RL, Deleanu A, Popescu A, Focsa
M, Danila M, et al. Acoustic radiation force
impulse elastography as compared to transient
elastography and liver biopsy in patients with chronic
hepatopathies. Ultraschall Med 2011;32 Suppl 1:S4652
9.Tang A, Cloutier G, Szeverenyi NM, Sirlin CB.
Ultrasound Elastography and MR Elastography
for Assessing Liver Fibrosis: Part 2, Diagnostic
Performance, Confounders, and Future Directions.
AJR Am J Roentgenol 2015;205:33-40
Luncheon Symposium
LS 2 Bracco - 1
Chairperson: Won Jae Lee Samsung Medical Center, Korea
GBR 101
Clinical Application of CEUS in the Liver
Woo Kyoung Jeong
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12:10 - 12:40
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LS 2 Bracco - 2
12:40 - 13:10
Chairperson: Won Jae Lee Samsung Medical Center, Korea
Contrast-enhanced US: Application in the GI Tract
Se Hyung Kim
208
GBR 101
Luncheon Symposium
LS 3 Samsung Medison - 1
Chairperson: Joon Koo Han Seoul National University Hospital, Korea
GBR 103
S-Fusion for US Guided Interventional Procedures: Is it an Academic
Toy or a Valuable Practical Tool for Radiologists?
Jeong Min Lee
209
Luncheon Symposium
12:10 - 12:30
KSUM Open 2016
LS 3 Samsung Medison - 2
12:30 - 12:50
Chairperson: Joon Koo Han Seoul National University Hospital, Korea
GBR 103
A.I.(Artificial Intelligence) is Coming: S-Detect for Thyroid
Jung Hwan Baek
210
SFS 5 MSK-1
Chairpersons:Myung Jin Shin Asan Medical Center, Korea
GBR 102
Ultrasound-guided Intervention of the Hip Joint
Byeong Seong Kang
Department of Radiology, Ulsan University Hospital, Korea
1. General considerations
1) Transducer selection
With modern equipment, a high-frequency linear
probe can be used to image the hip joint, typically
with frequencies around 9~15 MHz depending on
patient body habitus. Occasionally, a lower-frequency
probe may be required if the patient is obese.
2) Pre-procedure diagnostic assessment
A detailed pre-procedural US examination,
including color Doppler, is mandatory to identify and
characterize the target and determine its relation to
adjacent neurovascular structures before planning
the needle trajectory. Initially, it is a good practice
to mark the site for transducer placement and the
expected site for needle entry with a marking pen. A
written informed consent explaining the procedure,
its risks, and response is mandatory prior to any
procedure.
3) Sterility
Providing an aseptic environment is of paramount
importance in minimizing the introduction of
infection, particularly when injecting into the joint
itself. This essentially involves using sterile gloves
and probe covers; cleaning of the skin with an
antiseptic skin preparation, such as chlorhexidine
solution; and ensuring the needle tip passes through
the cleaned area of skin, avoiding any areas of broken
skin or overlying infected areas.
4) Needle selection
A 22-gauge needle is usually used for injections
around the hip. A larger bore needle, such as a 16 or
18 gauge may be needed for aspiration, particularly if
the fluid is infected.
5) Technical tips
Intervention of the hip joint are usually performed
with a free-hand technique, which allows direct,
dynamic visualization of the needle and its tip
throughout the procedure. The needle is best
visualized when its long axis is parallel and in line
with the long axis of the transducer face and in
this plane, it is seen as a linear echogenic structure
with reverberation artifact distally. In cases where
the needle may be difficult to identify, holding the
needle steady while moving the transducer helps in
identifying the needle. Alternatively, the needle may
be repositioned to run along the longitudinal axis of
the transducer.
2. Ultrasound-guided aspiration of the hip
joint
The most common reason for aspiration in the hip
is for the diagnosis of infection. However, reliance
on the ultrasound appearance of the effusion is
not sufficient to distinguish between infection and
a simple effusion. Pus can appear anechoic, and a
complex appearance to the effusion does not reliably
indicate sepsis.
The presence of a joint effusion is confirmed
by an increased volume of fluid in the anterior
recess. This is usually measured in the oblique
sagittal plane along the line of the femoral neck
and should be compared with a measurement from
the contralateral side. The normal distance from
femoral neck to the capsule has been described as
between 4 and 10 mm. It can sometimes be difficult
to differentiate thickened synovium from joint
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Luncheon Symposium
13:20 - 13:35
KSUM Open 2016
effusion because both have similar appearances on
ultrasound. If this is the case, asking the patient to
move the hip is helpful because this will disperse
an effusion around the joint, whereas synovial
thickening would remain constant in appearance.
Aspiration of joint effusion is not always necessary
and should be confined to patients in whom there is
a high clinical suspicion of sepsis. For aspiration of
the hip joint, the patient should be positioned supine
and the transducer placed in the longitudinal oblique
plane along the axis of the femoral neck to examine
the anterior recess and confirm the presence of
effusion. Aspiration can be performed either in the
axial or sagittal plane.
3. Ultrasound-guided injection of the hip joint
Injection of the hip joint is undertaken for a
variety of reasons. Inflammatory arthritis may be
treated with direct injection of cortisone into the hip.
Similarly, symptomatic relief of osteoarthritis may
also be achieved. Frequently, it is unclear whether
a patient’s symptoms are due to hip pathology, for
instance if the patient has both hip osteoarthritis and
degenerative change in the spine. In this situation, a
diagnostic injection of long-acting anesthetic into the
hip can help make the distinction.
A combination of local anesthetic and steroids is
used to maximize symptom relief. Corticosteroids
can be injected with the goals of short-term and
medium-term pain relief, reduction of inflammation,
and improved mobility. Steroid injections usually
take 48-72 hour to be effective and, hence, are
combined with local anesthetics for a rapid onset of
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action. An important point is that steroid injections
do not provide long-term pain relief and usually do
not alter the course of underlying disease, hence
should be used in conjunction with rehabilitative
exercises. Contraindications include infection,
known allergy or hypersensitivity to injectate, or
known coagulopathies.
4. Complications of ultrasound-guided
intervention of the hip joint
1) Infection at the puncture site and of the hip joint
itself
2) Bleeding into the joint
3) Injury to the femoral nerve
4) Allergy to the local anesthetics
- Systemic symptoms: headache, dizziness,
circumoral numbness, tachycardia
- Local symptoms: paresthesia or prolonged
anesthesia
References
1.Rowbotham EL, Grainger AJ. Ultrasound-guided
intervention around the hip joint. AJR Am J
Roentgenol 2011;197:W122-7
2.Thapa M, Vo JN, Shiels WE 2nd. Ultrasound-guided
musculoskeletal procedures in children. Pediatr
Radiol 2013;43 Suppl 1:S55-60
3.Nestorova R, Vlad V, Petranova T, Porta F, Radunovic
G, Micu MC, et al. Ultrasonography of the hip. Med
Ultrason 2012;14:217-24
4.Daftary AR, Karnik AS. Perspectives in ultrasoundguided musculoskeletal interventions. Indian J Radiol
Imaging 2015;25:246-60
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SFS 5 MSK-2
GBR 102
Knee
So Young Park
Department of Radiology, Kyung Hee University Hospital at Gangdong, Korea
The most accurate imaging modality for the
evaluation of the knee is magnetic resonance (MR)
imaging and ultrasonography (US) is limited in the
evaluation of cartilage, menisci, anterior cruciate
ligament, posterior cruciate ligament, and bone
marrow of the knee. However, US can allow us to
evaluate joint space, tendons, ligaments, muscles,
synovial cysts, and bursitis in the knee. US is also
useful in performing dynamic test, and as guidance
tool of aspiration or injection.
I’ll show various US cases of the knee - synovitis,
infectious arthritis or paraarticular abscesses,
prepatellar bursitis, patellar tendinopathy or tear in
anterior knee, osteoarthritis with meniscal extrusion,
medial collateral ligament tear, and ganglion cyst
in medial knee, lateral collateral ligament injury
and schwannoma in lateral knee, and Baker’s cyst
(ruptured or nonruptured), deep vein thrombosis,
tennis leg, other synovial cysts, muscle hematoma,
and necrotizing fasciitis in posterior knee and calf.
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13:35 - 13:50
KSUM Open 2016
SFS 5 MSK-3
13:50 - 14:10
Ankle
Sun Joo Lee
Department of Radiology, Inje University Busan Paik Hospital, Korea
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GBR 102
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55/F
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KSUM Open 2016
SFS 5 MSK-4
14:10 - 14:30
GBR 102
Ultrasound of the Foot
Wan Tae Kim
Department of Radiology, VHS Medical Center, Korea
Ultrasound is an efficient and widely available
modality for evaluation of the foot. Tendon and soft
tissue pathology can be diagnosed by ultrasound.
Rapid comparison with the asymptomatic ankle
and direct correlation of sonographic findings
with the patient’s symptoms are advantages of
ultrasound. A focused foot ultrasound study can
usually be performed more efficiently than with
MRI. Knowledge of the location of the pain and the
acuity of the injury usually narrows the differential
diagnosis.
Anatomy
The foot plays an essential role in standing and
locomotion. It supports the body weight in standing
and absorbs shock in running and jumping. The foot
is characterized by a complex anatomy: it is formed
by 28 bones, 30 joints, and more than 100 muscles,
tendons, and ligaments.
From the viewpoint of anatomy and kinetics, the
foot is divided into three distinct sections: hindfoot,
midfoot, and forefoot. The hindfoot is separate from
the midfoot by the midtarsal (or Chopart) joint,
includes the talus and calcaneus. The midfoot is
separate from the forefoot by the tarsometatarsal
(Lisfranc) joint, includes the navicular, cuboid, and
three cuneiform bones and the forefoot includes the
metatarsals and phalanges. The muscles attached to
the tibia and fibular end in tendons proximal to or at
the level of the ankle joint. These tendons insert into
the foot.
The joints of the lesser toes are the metarsophalangeal and the proximal and distal interphalangeal joints. These are synovial-lined joints that
allow flexion-extension movements of the toes. In
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metatarsophalangeal joint, thick fibrocartilaginous
plantar plates insert into the base of the proximal
phalanx and extend posteriorly to cover the cartilage
of the plantar aspect of the metatarsal heads. The
plantar plate serve as the weight-bearing plat-form
of the metatarsal heads and are the main stabilizers
of the metatarsophalangeal joints by resisting
dorsiflexion. The plantar plates are connected on
each side with the collateral ligaments.
Scanning technique
Foot ultrasound requires a high-frequency (712 MHz) linear array transducer. A hockey-stick
probe can be used as well. The dynamic capabilities
of ultrasound allow examination in multiple planes
including stress views.
Dorsal foot
The standard US examination of the foot begins
with its dorsal aspect, keeping the patient supine/
seated position with the knee flexed at approximately
45-90°. The sole of the foot lies on the examination
bed while the ankle is in slight plantar flexion.
Transverse US imaging planes are the best suited to
identify the superficial long tendons as they course
over the dorsum of the foot. The extensor and flexor
tendons show the typical linear fibrillar structure
on longitudinal scanning and a finely punctuate
echo pattern on transverse scanning. The flexor and
extensor tendons with their synovial sheaths can
evaluated along their full length.
Plantar foot
The standard US examination of the plantar aspect
of the foot is performed the patient prone and the
Categorical Course
Interdigital web space
The web spaces of the foot can be evaluated from
the plantar of dorsal foot. The patient is examined
supine/seated position, with the heel resting on
or hanging over the examination table. As each
interspace is examined sonographically from
the dorsal approach, the examiner applies finger
pressure to each plantar interspace. If ultrasound is
used to evaluate from the plantar approach, finger
pressure is applied to each dorsal interspace.
These are homogeneously hyperechoic areas due
to the presence of normal fatty tissue. In the normal
foot, bursae are not usually seen.
Metatarsophalangeal and interphalangeal
joints
The metatarsophalangeal joints are imaged as a
triangular echogenic space delimited by the metarsal
head, the phalangeal base and the capsule. No
effusion is present when the capsule is stretched
linearly over the two articular surfaces and the only
anechoic area in the joint is the cartilage line.
Pathology of foot
Plantar fasciitis
The plantar fascia has a fundamental role in foot
biomechanics, including supporting the medial
longitudinal arch and dissipating the forces and
stresses of the foot during gait or other loading
conditions. More recently, the plantar fascia
has been postulated to play an important role in
proprioception and peripheral motor coordination.
The etiology of plantar fasciitis is primarily due to
mechanical overload, although the pathogenesis is
poorly understood and likely multifactorial in nature.
Plantar fasciitis classically involves the proximal
third of the central cord of the plantar aponeurosis.
Patients with proximal plantar fasciitis usually
describes a dull aching pain the plantar hindfoot
area, often directly over the medial calcaneal
tubercle.
The characteristic sonographic findings of proximal
plantar fasciitis, including hypoechoic thickening of
the plantar fascia, loss of fibrillar echotexture, and
loss of fascial edge sharpness. Other sonographic
findings of proximal plantar fasciitis include cortical
irregularity of the calcaneus, often with an associated
enthesophyte, and perifascial edema in acute cases.
It is generally accepted that a plantar aponeurosis
thickness of >4 mm is consistent with plantar
fasciitis.
Plantar fibromatosis (Ledderhose disease)
Plantar fibromatosis is a benign fibroblastic
proliferative disorder characterized by focal nodular
enlargement most commonly within the central
cord of the plantar fascia. Most lesions are solitary
and unilateral; however, approximately one-third of
lesions are bilateral.
Clinically, patients will most often presents with a
painless fibrous nodule easily palpated on physical
examination. Occasionally, the nodule may become
painful from direct pressure against the arch of the
shoe.
The sonographic appearance of a plantar fibromatosis
includes a hypoechoic fusiform nodular thickening
within the central cord of the plantar fascia.
Typically, the nodule is located more superficial
within the aponeurosis having a predilection for the
medial versus the central lesion (40%) of the cord.
Continuity of the nodule with the plantar fascia
distinguishes it from other soft tissue tumors. Color
Doppler imaging shows vascularity in cases of an
inflammatory fibroma or atypical cases.
Morton’s neuroma
Morton’s neuroma is a benign perineural fibrosis
of an intermetatarsal plantar nerve. It most common
affects the second and third metatarsal spaces. It
is more common in middle aged females. The chief
complaints are a burning and tingling sensation
down the interspace of the involved toes. This is
made worse by walking in high-heeled shoes with
a narrow toe box and is relieved by rest and by
removing the shoe.
Morton’s neuroma is rounded hypoechoic nodular
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foot hanging freely over the examination table or
resting on the toes. For longitudinal evaluation,
the transducer is oriented with the long axis of
the plantar fascia. The normal plantar fascia has a
fibrillar echotexture and its thickness is <4mm if
measured perpendicularly to the long axis of the
calcaneus.
KSUM Open 2016
lesion. The mass is usually oriented parallel to the
long axis of the metatarsals, deep to the interosseous
muscle and distal to the intermetatarsal ligament.
Abnormal web space soft tissue nodular lesion
measuring equal to or greater than 3mmm in
diameter (which replaced, displaced or obscured the
neurovascular bundle) was diagnostic of a Morton’s
neuroma. The sonographic Mulder sign would be
helpful to detect the Morton’s neuroma.
Masses
Most soft tissue masses of the foot are benign nonneoplastic conditions, including ganglionic cysts,
bursitis, foreign body granuloma, and giant cell
tumor of the tendon sheath.
The foot is the third most common location of
ganglionic cyst following the wrist and hand. The
ultrasonographic appearance of ganglionic cysts is
variable, ranging from round to oval and lobulated
masses.
In the forefoot, giant cell tumor of the tendon
sheath shows a predilection for a location among
the toes. It represents by far the most common
solid benign soft tissue mass. Ultrasonography
demonstrates giant cell tumor as a painless solid
hypoechoic nodule with a hypervascular pattern
located adjacent to or enveloping a tendon.
Foreign body
The differential diagnosis of a plantar heel
pain includes a foreign body since they are most
commonly found within the subcutaneous fat of the
plantar aspect of the foot. A history of traumatic
puncture is not always reported. Ultrasonography
can assist the diagnosis, size, and position of foreign
body in relation to adjacent anatomic structures,
which is especially important for detecting
radiolucent structures. Foreign bodies often appear
as linear hyperechoic band-like structures, and may
be surrounded by granulomatous tissue that has a
hypoechoic halo appearance. Surrounding hyperemia
on color Doppler is frequent; especially, in more
acute cases. Depending on the size of the foreign
body, glass and metal may produce a posterior
reverberation artifact while wood, thorns, and plastic
usually demonstrate posterior acoustic shadowing. A
systematic approach to scanning is recommended to
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assist with locating foreign bodies that may be small
and hidden in deeper structures. Ultrasonography
can also guide percutaneous removal.
References
1.Chiou-Tan F, Furr-Stimming E, John J, Harrell JS,
Zhang H, Taber KH. Procedure-oriented sectional
anatomy of the foot. J Comput Assist Tomogr. 2015
Jan-Feb;39(1):140-2.
2.Hoffman D, Bianchi S. Sonographic evaluation of
plantar hindfoot and midfoot pain. J Ultrasound
Med. 2013 Jul;32(7):1271-84.
3.Hoffman DF, Grothe HL, Bianchi S. Sonographic
evaluation of hindfoot disorders. J Ultrasound. 2014
Apr 8;17(2):141-50.
4.Lee SY, Park HJ, Kwag HJ, Hong HP, Park HW, Lee
YR, Yoon KJ, Lee YT. Ultrasound elastography in the
early diagnosis of plantar fasciitis. Clin Imaging. 2014
Sep-Oct;38(5):715-8.
5.Beeson P. Plantar fasciopathy: revisiting the risk
factors. Foot Ankle Surg. 2014 Sep;20(3):160-5.
6.Tahririan MA, Motififard M, Tahmasebi MN,
Siavashi B. Plantar fasciitis. J Res Med Sci. 2012
Aug;17(8):799-804.
7.Bignotti B, Signori A, Sormani MP, Molfetta L,
Martinoli C, Tagliafico A. Ultrasound versus magnetic
resonance imaging for Morton neuroma: systematic
review and meta-analysis. Eur Radiol. 2015
Aug;25(8):2254-62.
8.Espinosa N, Schmitt JW, Saupe N, Maquieira GJ,
Bode B, Vienne P, Zanetti M. Morton neuroma:
MR imaging after resection--postoperative MR
and histologic findings in asymptomatic and
symptomatic intermetatarsal spaces. Radiology. 2010
Jun;255(3):850-6.
9.Lee MJ, Kim S, Huh YM, Song HT, Lee SA, Lee
JW, Suh JS. Morton neuroma: evaluated with
ultrasonography and MR imaging. Korean J Radiol.
2007 Mar-Apr;8(2):148-55.
10.De Maeseneer M, Madani H, Lenchik L, Kalume
Brigido M, Shahabpour M, Marcelis S, de Mey J,
Scafoglieri A. Normal Anatomy and Compression
Areas of Nerves of the Foot and Ankle: US and MR
Imaging with Anatomic Correlation. Radiographics.
2015 Sep-Oct;35(5):1469-82.
11.Donovan A, Rosenberg ZS, Bencardino JT, Velez ZR,
Blonder DB, Ciavarra GA, Adler RS. Plantar tendons
of the foot: MR imaging and US. Radiographics. 2013
Nov-Dec;33(7):2065-85.
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Review and Meta-analysis. Acad Emerg Med. 2015
Jul;22(7):777-87.
14.B i a n c h i S , M a r t i n o l i C . U l t r a s o u n d o f t h e
musculoskeletal system, Berlin Heidelberg: Springer,
2007:835-917
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12.Park HJ, Lee SM, Lee SY, Son ES, Chung EC, Rho
MH, Lee SJ. Ultrasound-Guided Percutaneous
Removal of Wooden Foreign Bodies in the Extremities
with Hydro-Dissection Technique. Korean J Radiol.
2015 Nov-Dec;16(6):1326-31.
13.Davis J, Czerniski B, Au A, Adhikari S, Farrell I,
Fields JM. Diagnostic Accuracy of Ultrasonography in
Retained Soft Tissue Foreign Bodies: A Systematic
KSUM Open 2016
SFS 5 MSK-5
14:30 - 14:50
GBR 102
Vascular Doppler
Ji Young Oh
Department of Radiology, National Medical Center, Korea
As ultrasound equipment has developed over the
past decades, Doppler ultrasonography become
familiar to radiologist as well as other physicians. It
is an easily available and non-invasive assessment
of vascular structures in lower extremities and is
frequently used for evaluation of arterial stenosis,
venous incompetence and venous thrombosis
in clinical fields. Although resolution of CT
angiography and MR angiography continues to
improve, providing detailed artery anatomy and
3-D vessel reconstruction, theses cannot overcome
the advantage of duplex US, it's noninvasiveness,
portability and no risk for the contrast usage. The
most important advantage of duplex US is the
hemodynamic information afforded to assess limb
perfusion before and after intervention. Doppler
US is an effective approach for survey of arterial
disease, detecting lesions, and helping to triage
224
patients to therapeutic options such as angioplasty,
atherectomy, stent placement or surgery.
It can be applied to evaluate the nature of
perivascular masses, differentiating hematoma from
pseudoaneurysm, arteriovenous fistula and soft tissue
mass mimicking vascular structure, such as various
vascular malformations. As followed increment
of transvascular catheterization, the incidence of
iatrogenic arteriovenous fistula or pseudoaneurysm
gradually elevates and the fast diagnosis and
management are implied. In the clinical fields and
intervention units, real time US guided interventions
are frequently performed, Doppler US makes great
contributions to the accurate intervention and the
decrease of procedure related complications.
The presentation will provide an review of clinical
applications of Doppler US for the diagnosis and
treatment of lower limb vascular pathologies.
Categorical Course
SFS 6 Multiorgan-1
GBR 103
Chairpersons:Kyung Sook Shin Chungnam National University Hospital, Korea
US Misinterpretation: Abdomen
Hee Sun Park
Department of Radiology, Konkuk University Medical Center, Korea
Ultrasound is frequently the first imaging modality
for evaluation of patients presenting with abdominal
pain, abnormal biochemical test, or suspected
mass. Patients may proceed to further imaging such
as computed tomography or magnetic resonance
imaging, based on the ultrasound findings. Vice
versa, complementary ultrasound imaging is
sometimes necessary for the indeterminate findings
on cross-sectional imaging. More than any other
diagnostic imaging techniques, ultrasound quality
is particularly operator-dependent and subjective
to interpretive error. Also, ultrasound artifacts are
commonly encountered in clinical practice and may
provide a source of confusion for the interpreting
physician. While some artifacts may be avoidable
which arise secondary to improper scanning
techniques, other ones are generated owing to the
physical limitations of the modality. Familiarity of
normal ultrasound findings as well as ultrasound
artifacts would be helpful for accurate interpretation
and decision making for abdominal diseases.
References
1.Kamaya A, Wong-You-Cheong J. Diagnostic
Ultrasound: Abdomen and Pelvis. Amirsys, Elsevier,
2015.
2.Feldman MK, Katyal S, Blackwood MS. US artifacts.
Radiographics. 2009;29(4):1179-89.
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15:20 - 15:50
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SFS 6 Multiorgan-2
15:50 - 16:20
GBR 103
US Misinterpretation: Breast
Eun-Kyung Kim
Ultrasonography is a valuable tool in breast
imaging and commonly used in symptomatic as well
as asymptomatic patients. There are various factors
related to the misinterpretation of the breast lesion
226
such as detection error, misinterpretation or miscorrelation with other images. In this talk, various
misinterpreted cases on breast US will be reviewed.
Categorical Course
SFS 6 Multiorgan-3
GBR 103
Misinterpretations in Thyroid and Neck Ultrasonography
Inseon Ryoo
Department of Radiology, Korea University Guro Hospital, Korea
1. Overview of thyroid and neck ultrasonography (USG) in work up for thyroid nodule
and postoperative follow up.
A. Thyroid nodules are found in up to twothirds of general population, 9-15% among
them are malignant nodules.
B. Thyroid cancer: The most common cancer in
Korea, rapidly increased in the last decade.
C. USG: the most sensitive diagnostic imaging
modality for detection of thyroid nodules or
postop recurrence or metastatic nodes
2. Mimickers of thyroid nodule on thyroid
USG
A. Thyroidal lesions
i. Thyroid abscess : anechoic or hypoechoic
mass with variable internal echogenicity,
peripheral vascularity without significant
internal vascular flow
ii. Focal thyroiditis: hypoechoic nodular
lesion with ill-defined margin with
heterogeneous parenchymal echogenic
back ground
iii. Lymphoma: marked hypoechoic,
homogeneous, and pseudocystic lesion
with well- defined margin, coastline like
growth
B. Non-thyroidal lesions
i. Pharyngoesophageal diverticulum:
irregular boundary of posterior wall at
posterior portion of thyroid gland with
hypoechoic rim, heterogeneous internal
echogenicity, connection to esophagus,
and chronological changes
ii. Parathyroid nodules: typical location
of parathyroid gland, homogeneous
hypoechoic oval shaped, separated from
the thyroid gland by thyroid capsules
iii. Branchial cleft cyst (4th): anechoic or
predominant hypoechoic cystic mass with
heterogeneous internal echogenicity,
sometimes with comet tail artifacts,
chronological changes
iv. Sympathetic ganglion: posterior to
upper thyroid gland, homogeneous low
echoic spindle or oval shaped lesion with
continuous linear structures in cranial and
caudal directions
3. Mimickers of postoperative tumor
recurrence or neck node metastasis on
neck USG
A. Postoperative changes in thyroidectomy beds
i. Postoperative granuloma: hypoechoic
lesion with internal echogenic single/
double or curvilinear lines, avascular or
minimal peripheral vascularity
ii. Postoperative neuroma: long narrow solid
pattern without vascularity
iii. Remnant thyroid tissue: homogeneous
isoechoic mass at postoperative beds with
usually triangular shape lesion based on
trachea
B. Non-thyroidal lesions
i. Pharyngoesophageal diverticulum:
heterogeneous internal echogenicity with
internal strong echogenic foci, irregular
posterior acoustic shadow, hypoechoic
rim, chronological changes
ii. Sympathetic ganglion: upper thyroid level,
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16:20 - 16:50
KSUM Open 2016
homogeneous low echoic oval/spindle
shape lesion with continuous linear
structures in cranial and caudal directions
iii. Calcified lymph node: macrocalcifications
rather than microcalcifications
iv. Hypertrophied transverse process of
228
cervical vertebra: dense calcified mass
with marked hypoechoic component at
level III lateral neck
v. Thoracic duct terminal: between left
subclavian vein and internal jugular vein
with slow internal flow
Categorical Course
SC 2 THY-1
New Approach in Thyroid Imaging
GBR 101
Chairpersons:Jin Young Kwak Severance Hospital, Korea
Keypoints of 2015 ATA Guideline: What We Should Know
Ji-Hoon Kim
2015 ATA guideline comprises 4 parts as follow:
thyroid nodule guidelines, differentiated thyroid
cancer: initial management guidelines, differentiated
thyroid cancer: long-term management and
advanced cancer management guidelines, and
directions of future research.
2015 ATA guideline presented the new
ultrasonographic classification of thyroid nodule
based on solidity and echogenicity along with
suspicious feature. It recommended the molecular
testings very carefully. It emphasized the necessity
for the clinician to communicate with patients for
the management and treatment decision. It showed
definite tendency toward conservative (less invasive)
management and treatment in addition to the
introduction of alternative treatment to surgery,
including PEIT, RFA, and laser. For the work-up for
the patients with advanced primary thyroid cancer
and those with recurrent thyroid cancer, cross
sectional imaging such as CT/MR become to be
regarded as important imaging tools.
In this lecture, important non-radiologic consensus
that radiologist should know will be covered. In
addition, radiologic consensus of 2015 ATA guideline
will be presented in comparison with that of 2016
KSThR guideline.
229
13:20 - 13:40
KSUM Open 2016
HS-1
Thyroid Hands-on: Advanced Anatomy
15:20 - 16:10 / 16:20 - 17:10
GBR 101
Moderator: Jung Hwan Baek Asan Medical Center, Korea
Thyroid and Perithyroid Anatomy
Jung Hwan Baek
Image-guided procedures have been common
treatment tolls for thyroid and neck tumors. Among
them, ultrasonography (US)-guided procedures
such as ethanol ablation, radiofrequency ablation,
nerve block, and core needle biopsy have been widely
applied in the diagnosis and treatment of thyroid
and neck lesions. For a safe and effective US-guided
procedures, knowledge of neck anatomy, particularly
the nerves, vessels, esophagus and other critical
structures, is mandatory. Although US-guided
procedures are most common tools for thyroid and
230
neck tumors, most previous reports evaluated neck
anatomy based on surgery, cadavers, computed
tomography, or magnetic resonance imaging
rather than US. Therefore, the purpose of this
hands-on session is to elucidate US-based thyroid
and perithyroid anatomy during the US-guided
procedures. Knowledge of these areas would be
helpful for maximizing the efficacy and minimizing
the complications of US-guided procedures for the
thyroid and neck lesions.
Scientific Sessions
SS 1 CV
Cardiovascular
9:30 - 10:10
Room 203
Chairperson:
Sang Il Choi Seoul National University Bundang
Hospital, Korea
SS 1 CV-1
09:30 - 09:40
Ultrasound Fusion Imaging with Real-Time
Navigation for EVAR Surveillance
Jin Hyun Joh
Department of Surgery, Kyung Hee University
Hospital at Gangdong, Korea
SS 1 CV-2
09:40 - 09:50
Value of Contrast Enhanced Ultrasound in Long
Term Surveillance for Endoleaks after Aortic
Endovascular Aneurysm Repair: An Interesting
Case Illustration
Wey Chyi Teoh1, Andrew Tan
Singapore
INTRODUCTION: Aortic endovascular aneurysm
repairs (EVAR), with significantly lower operative
mortality compared to traditional open repair
techniques have gained popular acceptance. Post
EVAR, life-long surveillance; typically performed
with multi-phasic contrast-enhanced CT aortogram
is necessary to observe for endoleaks. However,
contrast CT imaging confers an ionizing burden
and is not suitable for patients at risk of developing
contrast nephropathy. Contrast-enhanced ultrasound
(CEUS) offers a viable alternative which is radiation
free and can be used in patients with impaired renal
function.
CASE: Our patient is a 85-year-old Chinese
gentleman who underwent EVAR 5 years ago for an
infrarenal aortic aneurysm. As the patient had renal
impairment, follow up was performed with CEUS.
Three years after EVAR, CEUS demonstrated a type
II endoleak from a lumbar artery. As there was a
concurrent increase in aneurysm size, treatment was
attempted with embolisation. Post-embolisation,
CEUS demonstrated a persistent type II endoleak,
again from a lumbar artery but visually less sizable
when compared to previous study. As such, the
decision was made to place the patient under
watchful surveillance. On the fifth year of ultrasound
surveillance, the aneurysm showed an abrupt size
increase when compared to the immediate past
study. This time round, CEUS demonstrated a new
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Scientific Sessions
PURPOSE: Endovascular aneurysm repair (EVAR)
offers the advantage of lower perioperative
morbidity and mortality but carries the cost of
device-related complications. These complications
mandate a lifelong surveillance of EVAR patients
and their endografts. Ultrasound can be an effective
alternative to computed tomographic angiography
(CTA) for surveillance. Recently, a virtual navigation
system that combines real-time ultrasound with
reconstructed CT image was introduced. The purpose
of this study is to evaluate the feasibility of this realtime ultrasound navigation (RT-USN) system for
EVAR surveillance.
METHODS: We invited three patients who
underwent EVAR for ultrasound surveillance. All of
the ultrasound examinations were performed using
a multi-frequency probe (LOGIQ E9, GE Healthcare,
Milwaukee, WI). To fuse the ultrasound image
and CT axial image, a spatial coregistration was
performed at the origin of left renal artery. Triplex
scanning was performed to evaluate the devicerelated complications and to measure the aneurysm
diameter.
RESULTS: Correct coregistration was achieved in
all patients. RT-USN system could scan devicerelated complications including endoleak, stentgraft position, endograft patency. In one patient, CT
image could not differentiate the endoleak into wall
calcification. But The RT-USN system could delineate
correctly. RT-USN showed the newly developed
endoleak and resolution of endoleak during the
follow up in reaming two patients, respectively.
Aneurysm diameter could be correctly measured
with perpendicular axis.
CONCLUSION: The RT-USN system can be used
to evaluate the device-related complications and to
measure the aneurysm diameter after EVAR. This
can be a feasible imaging tool for EVAR surveillance.
KSUM Open 2016
type I endoleak which was subsequently confirmed
on angiography.
DISCUSSION: It is unusual but not rare for a type
I endoleak to develop a few years after EVAR. We
felt that in our case, the persistent type II endoleak
had caused an initial gradual size increase in the
aneurysm, which eventually lead to misalignment
and failure of the stent; resulting in development
of a new type I endoleak and sudden size increase.
Our case also reaffirmed the value, viability and
sensitivity of CEUS in long-term surveillance of post
EVAR endoleaks.
SS 1 CV-3
09:50 - 10:00
Noninvasive Measurement of Regional Pulse
Wave Velocity in Human Ascending Aorta with
Ultrasound Imaging
Chengwu Huang1, Dong Guo2, Feng Lan3,
Hongjia Zhang2, Jianwen Luo1
1
University, China
2
Department of Cardiac Surgery, Capital Medical
University, Beijing Anzhen Hospital, China
3
Department of Beijing Institute of Heart, Lung and
Blood Vessel Diseases, China
PURPOSE: Aortic stiffness is predictive of various
cardiovascular events and typically quantified by
estimation of pulse wave velocity (PWV). Accurate
and noninvasive techniques for measurement of
local/regional PWV, instead of global PWV, is
desirable. This study aimed at investigating the
feasibility of regional PWV measurement in human
ascending aorta in vivo using an ultrasound-based
pulse wave imaging (PWI) technique (Luo et al, IEEE
TUFFC 2012).
MATERIALS AND METHODS: Proximal ascending
aortas of 76 healthy subjects (23-71 years old)
were scanned with transthoracic echocardiography
in parasternal long-axis view, and ultrasound
radiofrequency (RF) data were acquired with high
temporal resolution (~404Hz), using a SonixMDP
system (Analogic Corp.) and a SA4-2/24 phase
array probe. Aortic distensions were derived from
the wall motions estimated utilizing a RF-based
speckle tracking algorithm. Systolic foot and dicrotic
232
notch, the two common reference time-points on the
distension waveforms, were identified to determine
the arrival times of the pulse wave. Linear regression
between the arrival times and travel distances of the
pulse wave gave the regional PWV estimates for the
imaged aortic segment.
RESULTS: The ascending aortic PWV derived
from the systolic foot (PWV sf) and dicrotic notch
(PWVdn) were 4.58 ± 1.38 m/s and 6.51 ± 1.90 m/s
respectively, and both were positively correlated with
age (P<0.05). The measurements were reproducible,
and the PWVdn showed significant correlation with
aortic diameter (r=0.53, P<0.0001) and relative
distension (r=-0.44, P=0.0002). Additionally,
the PWV difference (PWVdn-PWVsf), reflecting the
aortic stiffness change from diastole to late systole
over the cardiac cycle, was also correlated with age
(P<0.0001).
CONCLUSION: The feasibility of ascending aortic
PWV measurement using PWI was illustrated,
suggesting the potential of the technique in
assessment of cardiovascular diseases associated
with ascending aortic stiffness.
SS 1 CV-4
10:00 - 10:10
A Comparison of Popliteal Arteries Between
Fractured and Sound Legs by Ultrasound in
Patients with Femur Fracture
Kwang Jae Lee, Yong-Soon Yoon, Eun-Sil Kim,
Jung-Hoo Lee
Medical Center, Seonam University College of
Medicine, Korea
OBJECTIVE: Reduced physical activity and
muscle atrophy is common in patients with femur
fracture. The aim of this study is to assess whether
immobilization after femur fracture surgery leads to
atherosclerotic change in popliteal artery.
METHODS: Fourteen patients who admitted for
rehabilitation after surgical treatment of femur
fracture (8 males and 6 females; mean age, 80.4 ±
4.3 years) were enrolled. We evaluated intima-media
thickness (IMT) of popliteal artery in longitudinal
and transverse plane bilaterally using ultrasound.
And peak systolic velocity (PSV) was measured by
Scientific Sessions
duplex ultrasound.
RESULTS: Mean IMT of popliteal artery was thicker
in the fracture side than in the non-fracture side (1.37
± 0.39 mm vs. 1.11 ± 0.52 mm) significantly (p<.05).
And mean PSV of that was increased in the fracture
side than in the non-fracture side (52.44 ± 18.55 cm/s
vs. 44.47 ± 14.27 cm/s), but there was no statistical
significance (p>.05).
CONCLUSION: Femur fracture and consequential
immobilization affected popliteal artery IMT, and it
was highly related to progression of atherosclerotic
plaque formation.
SS 2 PED
Pediatric
10:30 - 11:40
Room 201
Chairpersons:
Choon-Sik Yoon Gangnam Severance Hospital,
Korea
Hye-Kyung Yoon Kangwon National University
Hospital, Korea
SS 2 PED-1
10:30 - 10:40
PURPOSE: To define incidence of cerebellar
hemorrhage (CBH) in preterm infants (PI) and to
evaluate the US detection rates of CBH according to
findings on MRI at term-equivalent age.
MATERIALS AND METHODS: From January 2009
to March 2016, 624 PI who underwent brain MRI
at term-equivalent age were enrolled in study. MRI
at term-equivalent age and serial postnatal US were
retrospectively reviewed regarding the presence of
CBH. CBH was classified into 3 groups according to
MR findings (Group1, spotty CBH without atrophy;
SS 2 PED-2
10:40 - 10:50
Correlation of Postnatal US and MR Findings of
Isolated Ventriculomegaly
Jeong Rye Kim, Ah Young Jung, Jin Seong Lee,
Young Ah Cho, Hee Mang Yoon
Department of Radiology, Asan Medical Center,
Korea
PURPOSE: Fetal ventriculomegaly is relatively
common finding on prenatal ultrasound which
can arise from variety of disorders. Isolated
ventriculomegaly without associated CNS
abnormalities can be a transient condition. However
ventriculomegaly with associated CNS anomalies
including migration anomalies may have poorer
outcome. Most neonates with fetal ventriculomegaly
are referred for cranial ultrasound and/or brain
MRI after birth to further evaluation. The purpose of
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Scientific Sessions
Ultrasonographic Detection of Cerebellar
Hemorrhage in Preterm Infants: Comparison with
MR Findings
Ji Eun Park, Young Jin Ryu, Yu Jin Kim,
Young Hun Choi, Jung-Eun Cheon, Woo Sun Kim,
In-One Kim
Hospital, Korea
Group2, CBH with minimal atrophy; Group3, CBH
with moderate/severe atrophy). Cerebral white
matter signal abnormalities (CWMCA) and GMH/
IVH were assessed on MRI of preterms with CBH.
Significant supratentorial MRI changes were defined
as moderate to severe CWMCA or grade 3 to 4
hemorrhage. Perinatal clinical events including
BPD, sepsis, NEC, PDA, cardiac resuscitation and
emergent C/S were evaluated.
RESULTS: Of 624 PI, CBH was seen on MRI in 30
(4.8%) infants (M:F=19:11; mean GA, 27.3 wks). 5
cases of CBH were detected on US (0.8%). 4 cases
were detected through mastoid and 1 case through
anterior fontanelle. Among 30 infants where CBH
was confirmed on MRI, 7, 12 and 11 were classified
into group 1, 2 and 3, respectively. CBH was detected
on US in 1 case of group 2 and 4 cases of group 3 (US
detection rate according to group; 1, 0%; 2, 8.3%; 3,
36.4%; p=0.039). Significant CWMCA were more
frequently seen in group 3 (p=0.079). Among clinical
events, only sepsis was more commonly associated
with group 3 (p=0.001).
CONCLUSION: MRI was superior to US in
detecting CBH in PI and spotty CBH was only
detected on MRI. CBH with moderate/severe
atrophy was significantly associated with significant
supratentorial abnormalities and sepsis.
KSUM Open 2016
this article was to correlate the cranial US and MR
findings in patients with fetal diagnosis of isolated
ventriculomegaly.
MATERIALS AND METHODS: Neonates with
fetal diagnosis of isolated fetal ventriculomegaly
who underwent subsequent postnatal US and MRI
were included in the study, and total 228 patient
were identified. Exclusion criteria for the study
were the following: patients with condition which
can cause ventriculomegaly, including hemorrhage,
corpus callosum agenesis, meningitis, and Chiari 2
malformation. We evaluated US and MRI features
and clinical data of the patients.
RESULTS: Total 60 patients were identified as
isolated ventriculomegaly on neonatal brain
sonography. On subsequent MRI, intracranial
hemorrhage which were not detected on sonography
(n=9), polymicrogyria (n=4), polymicrogyria with
heterotopia (n=2), heterotopia only (n=4), joubert
syndrome (n=1), arachnoid cyst (n=2), findings
suggestive of CMV infection (n=9, among them, three
patients also had polymicrogyria and one patient
had lissencephaly). No additional abnormality was
detected on MRI in the rest of the patients (n=29).
CONCLUSION: Isolated ventriculomegaly diagnosed
on sonography were associated variable intracranial
pathologies in more than half of patients (51.7%).
Congenital anomalies which may be missed on
sonography were detected on subsequent MRI (25%).
Although sonography is useful diagnostic tool with
easy accessibility, MRI adds important additional
information in neonates with sonographic diagnosis
of isolated ventriculomegaly.
SS 2 PED-3
respiration on LS measurement in children with liver
diseases.
MATERIALS AND METHODS: A total of 66 children
who underwent SWE for LS measurement by two
radiologists between April 2015 and August 2015
were included. Two operators (operator 1 and 2) were
independently measured LS values from the same
location of the liver. Each operator performed more
than three measurements in each patient. Operator 2
performed LS measurements during free-breathing
and breath-hold states in each patient. Median LS
value of three measurements were calculated in two
operators. Reproducibility of the LS measurement
and interobsever agreement were determined by
using 95% Bland-Altman limits of agreement and
intraclass correlation coefficients (ICCs). The effect
of the respiration on reproducibility of the LS values
was assessed by using the paired t-test.
RESULTS: Interobserver agreement between median
LS values performed by two radiologists showed ICC
value of 0.909 (95% confidence interval (CI), 0.8590.943). The 95% limit of agreement between median
LS values measured by two operators was 3.85 kPa
(16.1% of mean LS value). There was a significant
difference between median LS values measured
during breath-hold status and free-breathing status
(P<.001)
CONCLUSION: LS measured by SWE showed
almost perfect agreement between two operators
and the measurement error was 3.85 kPa. The freebreathing technique can significantly underestimate
LS values compared with the breath-hold technique.
SS 2 PED-4
11:00 - 11:10
Reproducibility of the Supersonic Shear-Wave
Elastography for Evaluation of the Liver Stiffness
in Children
Hee Mang Yoon, Jeong Rye Kim, Ah Young Jung,
Jin Seong Lee, Young Ah Cho
Korea
UltraFast Doppler Ultrasonography for Arterial
Evaluation in Children: Comparison with
Conventional Doppler Ultrasonography
Yu Jin Kim, Young Hun Choi, Jung-Eun Cheon,
Woo Sun Kim, In-One Kim, Ji-Eun Park,
Youngjin Ryu
Hospital, Korea
PURPOSE: To evaluate interobserver variation
in liver stiffness (LS) measurement by Shearwave elastography (SWE) and to assess effect of
PURPOSE: To evaluate the utility of UltraFast
Doppler ultrasonography (US) for Doppler
assessment of hepatic and renal arteries in children.
234
10:50 - 11:00
Scientific Sessions
MATERIALS AND METHODS: In March 2016,
Doppler US examinations for 15 arteries (9 hepatic
arteries and 6 renal arteries) were performed in 7
patients (3 boys and 4 girls, mean age 5.4 years).
Doppler assessment of each artery was performed
under free breathing by using both UltraFast Doppler
and conventional Doppler US techniques. Peak
systolic velocity, end-diastolic velocity and resistive
index were compared between the two techniques,
using a paired-t test. Doppler acquisition times were
also compared.
R E S U LT S : T h e p e a k s y s t o l i c v e l o c i t y w a s
significantly lower in the UltraFast Doppler than
conventional Doppler US (36.85 ± 13.80 cm/s vs.
39.23 ± 12.87 cm/s, p=0.014). The end-diastolic
velocity showed no significant difference between the
two techniques (11.16 ± 4.17 cm/s vs. 10.74 ± 3.88
cm/s, p=0.327). UltraFast Doppler US showed lower
resistive index values than conventional Doppler US
(0.69 ± 0.07 vs. 0.72 ± 0.07, p=0.005). With respect
to the acquisition time, UltraFast Doppler required a
shorter time (the preset acquisition time, 4 sec) than
conventional Doppler US (mean 110 sec, range 16269 sec).
CONCLUSION: When compared with the
conventional Doppler US, UltraFast Doppler
ultrasonography was associated with lower peak
systolic velocity and resistive index values and a
shorter acquisition time for arterial evaluation in
children.
SS 2 PED-5
11:10 - 11:20
PURPOSE: To comparatively evaluate the new
Korean Thyroid Imaging Reporting and Data System
(K-TIRADS) and conventional Korean Society of
Thyroid Radiology (KSThR) guidelines regarding
malignancy risk stratification of thyroid nodules in
235
Scientific Sessions
Ultrasonographic Malignancy Risk Stratification
of Thyroid Nodules in Children: Comparison
between K-TIRADS and KSThR Guidelines
Young Jin Ryu, Ji Eun Park, Yu Jin Kim,
Jung-Eun Cheon, Young Hun Choi, Woo Sun Kim,
In-One Kim
Hospital, Korea
children.
MATERIALS AND METHODS: From January
2011 to February 2016, a total of 50 thyroid nodules
in 46 children (mean age, 13.6 years, range 4-18
years) with final diagnoses were included in this
study. Ultrasonographic features of 50 nodules
were retrospectively assessed and each nodule was
classified according to the K-TIRADS (five categories
from 1 to 5) and KSThR (three categories; probably
benign, indeterminate, suspicious malignancy).
The malignancy risks of the thyroid nodules were
assessed according to the categories, respectively.
RESULTS: Of the 50 thyroid nodules, 29 (58%)
were benign and 21 (42%) were malignant. The
probably benign nodules on KSThR guidelines
(n=5) were all categorized into K-TIRADS 2. Among
the indeterminate nodules (n=25), 20 nodules
were assigned to K-TIRADS 3 and 5 nodules were
assigned to K-TIRADS 4. Suspicious malignant
nodules (n=20) were classified to K-TIRADS 4 (n=6)
or 5 (n=14). The malignancy rates with KSThR
guidelines were 0% for probably benign nodules, 16%
for indeterminate nodules and 85% for suspicious
malignancy, while the malignancy rates of K-TIRADS
category 2, 3, 4, 5 nodules were 0%, 10%, 63.6%
and 85.7%, respectively. The AUC of K-TIRADS was
slightly higher than that of KSThR (AUC = 0.885 and
0.869, respectively) without significant difference (P
=0.608). Six nodules of 1 to 1.5 cm in diameter which
belong to the indeterminate category and K-TIRADS
3 were all confirmed as benign and would have
avoided FNA if K-TIRADS had been applied.
CONCLUSION: Application of K-TIRADS to
thyroid nodules of children was feasible and
resulted in more detailed stratification than KSThR
guidelines. Introduction of K-TIRADS may reduce an
unnecessary FNA.
KSUM Open 2016
SS 2 PED-6
11:20 - 11:30
Effect of Body Mass Index in the Diagnosis of
Nutcracker Syndrome in Children
Mi-Jung Lee1, Mu Sook Lee2, Myung-Joon Kim1,
Hyun Joo Shin1, Haesung Yoon1
1
Department of Radiology, Severance Hospital,
Korea
2
Department of Radiology, Jeju National University
Hospital, Korea
PURPOSE: To find the effect of body mass index
(BMI) for the diagnosis of Nutcracker syndrome
(NCS) during Doppler ultrasonography in children.
MATERIALS AND METHODS: We retrospectively
reviewed medical records and imaging findings
of children who underwent renal Doppler
ultrasonography for the evaluation of NCS in two
hospitals. For the diagnosis of Nutcracker syndrome,
diameter and velocity change and ratio at the
aortomesenteric portion were recorded. For the
comparison of BMI, BMI percentile were graded
from 1 (<5 percentile) to 8 (>95 percentile).
RESULTS: One-hundred-two patients (M:F =
49:53; age 3-20 year with mean of 10.4 years)
were included in this study. When using the cutoff
ratio of 3 in both diameter and velocity criteria,
39 were diagnosed as NCS (NCS group) and 63
were not (control group). When comparing these
two groups, height, weight, BMI, or age were not
different. And only BMI percentile grades were
lower in the NCS group (3.62 ± 1.41 vs. 4.30 ± 1.63;
p=0.032). In correlation analysis, BMI percentile
grades and left renal vein diameter ratio (Pearson
coefficient =-0.273, p=0.005) or distended diameter
itself (Pearson coefficient =- 0.234, p=0.018)
demonstrated negative correlation. However, BMI
percentile grades were not correlated with velocity
parameters.
CONCLUSION: When diagnosing NCS using
the diameter and velocity criteria on Doppler
ultrasonography, BMI percentile grades is correlated
with diameter criteria and can affect the diagnosis of
NCS.
236
SS 2 PED-7
11:30 - 11:40
Ultrasonographic Findings of Inguinal Hernia
Containing Ovary or Omental Fat in Girls
Su-Mi Shin
PURPOSE: To characterize the ultrasonographic
findings of inguinal hernia containing ovary or
omental fat in girls.
MATERIALS AND METHODS: We studied 46
female children who were diagnosed the inguinal
hernia on ultrasonography between March 2009
and December 2015. Inguinal ultrasonographic
findings were retrospectively analyzed as follows: the
location, the contents of hernia, the diameter of canal
of Nuck, the incidence of spontaneous resolution,
and the incidence of incarceration and strangulation
of the herniated contents. Patients were divided into
three groups with contents of hernia. The two groups
containing ovary and omental fat were compared
using Pearson χ2 test, Fisher’s exact test and MannWhitney test, as appropriate.
RESULTS: The contents of hernia were ovary in
13 (28%), omental fat in 30 (65%) and bowel in 3
(7%) of the 46 girls. The ovarian herniation group
was significantly the younger age (average age, 10.1
months: 4.9 years, P=.000), the lower incidence of
spontaneous resolution of the herniated contents
(21%: 91%, P=.000) and the shorter duration
between ultrasonographic diagnosis and operation
(average 5.7 days: 55.8 days, P=.032) than the
omental fat herniation group. The diameter of canal
of Nuck and the location were not significantly
different between the two groups.
CONCLUSION: Ultrasonography is useful for the
diagnosis of inguinal hernia containing ovary or
omental fat in girls. The group of ovarian herniation
shows the younger age, the lower incidence of
spontaneous resolution of the herniated contents
and the shorter duration between ultrasonographic
diagnosis and operation.
Scientific Sessions
SS 2 GU
Genitourinary
11:40 - 12:00
Room 201
Chairperson:
Sung Eun Rha The Catholic University of Korea,
SS 2 GU-1
11:40 - 11:50
A Comparison of Ultrasound Guided
Transperineal and Transrectal Prostate Biopsy
for Detection of Prostate Cancer: A Prospective
Randomized Controlled Trial
Le-Hang Guo, Hui-Xiong Xu, Hui-Jun Fu
Hospital, China
SS 2 GU-2
11:50 - 12:00
The Use of VTIQ as New Tissue Strain Analytics
Measurement in Testicular Lesions
Dirk-Andre Clevert
Department of University of Munich-Grosshadern
Campus, Radiology, Germany
PURPOSE: Virtual touch tissue imaging quantification (VTIQ) is a newly developed technique for
the sonographic quantification of tissue elasticity. It
has been used in the assessment of breast lesions.
The purpose of this study was to determine the
diagnostic performance of VTIQ in indeterminate
testicular lesions.
MATERIALS AND METHODS: Twenty five patients with known testicular pathology underwent
conventional B-mode sonography with additional
VTIQ of the testicular lesions using a Siemens
Acuson S2000™ and S3000™ (Siemens Medical
Solutions, Mountain View, CA, USA) system.
Tissue mechanical properties were analyzed in
the VTIQ examination. The pathologic diagnosis
was established after surgery or in the follow-up
examination for suspected benign lesions.
RESULTS: Over 42 months, 22 focal testicular
lesions (median lesion size, 18 mm; range, 4-36 mm
in 20 patients (median age, 43 years; range, 22-81
years) were examined. Lesions were hyperechoic (n
=1), hypoechoic (n=14), isoechoic (n=1), of mixed
echogenicity (n=3) or anechoic (n=3). Histological
examination showed one benign lesion (6.25%) with
a mean size of 7 mm and 15 malignant lesions (93.75
%) with a mean size of 20 mm. Mean shear wave
velocity for normal testicular tissue was 1.17 m/s. No
value of the shear wave velocity could be measured
in cystic lesions. The rest of the benign lesions
showed a mean shear wave velocity of 2.37 m/s. The
value of the shear wave velocity in germ cell tumours
showed a mean shear wave velocity of 1.94 m/s and
for seminoma it showed a mean shear wave velocity
237
Scientific Sessions
PURPOSE: By comparing cancer detection rate
(CDR), complication rate, pain tolerance and
operating complexity of transperineal prostate
biopsy (TPBx)and transrectal prostate biopsy (TRBx),
this random controlled trial provided references for
clinicians to select an appropriate biopsy approach.
MATERIALS AND METHODS: According to sample
size estimation, 339 patients suspicious of prostate
cancer were assigned to TPBx (n=173) and TRBx
group (n=166) randomly. The CDR, complication
rate, visual analogue scale (VAS) score, most
painful procedure, the number of failed puncture
and additional anesthesia, and operating time were
recorded. The trial protocol was registered with
Clinicaltrials.gov.
RESULTS: The two groups were equivalent in CDR
(P=0.566), and there was no significant differences
in the proportion of each pathological pattern (all
P>0.05). The minor complication rates of the two
groups were comparable (P=0.504). However, the
major complication rate was proved higher in TRBx
group (P=0.034). Mild rectal bleeding occurred more
frequently in TRBx group (P<0.001) and mild pain
occurred more frequently in TPBx group (P<0.001).
Compared with TRBx group, TPBx group was more
time consuming and painful (both P<0.001), and
had a higher rate of repeated biopsy (P<0.001) or
additional anesthesia (P<0.001).
CONCLUSION: The CDR and overall complications
rate of TPBx and TRBx approaches were comparable.
TRBx was at a higher risk of major complications.
TPBx were more time consuming, painful and easier
being interrupted by repeated biopsy or additional
anesthesia.
KSUM Open 2016
of 2.42 m/s.
CONCLUSION: VTIQ is a reliable new method for
measuring qualitative and quantitative stiffness of
testis lesions and tissue. The qualitative shear-wave
elastography features were highly reproducible and
showed good diagnostic performance in unclear
testicular lesions. The VTIQ technique is also useful
in assessing small testicular nodules and pseudo
lesions.
SC 1 BR
Breast
13:20 - 14:20
GBR 103
Chairpersons:
Sun Mi Kim Seoul National University Bundang
Hospital, Korea
Seung Ja Kim Sheikh Khalifa Specialty Hospital,
UAE
SC 1 BR-2
13:30 - 13:40
Comparison and Combination of Two Ultrasound
Techniques of Automated Breast Volume Scanner
and Hand Held Ultrasound: With and Without
Knowledge of MRI
Yoonsoo Kim, Bong Joo Kang, Sung Hun Kim
PURPOSE: The aim of this study is to compare
and combine of the two preoperative ultrasound
techniques of handheld ultrasound (HHUS) and
automated breast volume scanner (ABVS) with or
without knowledge of MRI.
MATERIALS AND METHODS: We enrolled breast
cancer patients who underwent HHUS and ABVS
for newly detected lesions found via preoperative
breast MRI. Of the study population, all patients
underwent mammography and 1 st HHUS before
the MR examinations. And, whole breast ABVS
and 2 nd HHUS were performed depending on the
MRI information. We retrospectively reviewed
the detection rate and diagnostic accuracy of each
ultrasound modality with and without knowledge of
MRI. And we compare the results of each modality
238
and conjunctively and disjunctively combine the
results of two modalities.
RESULTS: From March to September on 2014, both
ABVS and HHUS were performed for 40 patients
with 120 suspicious lesions detected via breast
MRI. 76 malignant, 44 borderline or benign lesions
were included. With knowledge of MRI, cancer
detection sensitivities of HHUS, ABVS, conjunctive
and disjunctive combination were higher than
those without knowledge of MRI (94.7%, 98.7%,
100%, 93.4% vs. 65.8%, 64.5%, 67.1%, 63.2%). With
knowledge of MRI, cancer detection specificities
of HHUS, ABVS, conjunctive and disjunctive
combination were lower than those without
knowledge of MRI (13.6%, 6.8%, 6.8%, 13.6% vs.
59.1%, 68.2%, 56.8%, 75%). In patients with small
sized lesion and DCIS, ultrasound without knowledge
of MRI showed lower detection rate than ultrasound
with knowledge of MRI (p value < 0.05).
CONCLUSION: With knowledge of MRI, the
conjunctive combination of HHUS and ABVS showed
high sensitivity. And, ABVS is comparable for the
preoperative evaluation with and without knowledge
of MRI.
SC 1 BR-3
13:40 - 13:50
How and When to Use a Computer-Aided
Diagnosis System in Breast Ultrasound?
Yoonsoo Kim, Bong Joo Kang, Ji Eun Baek,
Hyun Sil Lee, Sung Hun Kim
PURPOSE: We aimed to show how the computeraided diagnosis system standardized analysis and
classification identifies the breast lesion. In addition,
we investigated the merits and pitfalls of using it in
conjunction with a breast ultrasound.
MATERIALS AND METHODS: We enrolled patients
with planned ultrasonography for screening or
diagnostic purposes in this institution consecutively.
In patients with breast lesions who underwent
breast ultrasound, the S-detectTM using the Samsung
Ultrasound RS80A breast ultrasound scan was
performed. On the basis of the first BI-RADS for
breast lesions and in the primary analysis and
Scientific Sessions
classification, application of the S-detect TM should
be conducted as a second analysis and classification.
A comparison of the results between the first and
secondary analyses was performed and yielded the
first and secondary integration results, respectively.
RESULTS: From October 2015 to February 2016,
197 cases from 163 patients were included in this
study. In 72.6% of the cases (143/197), results of
the ultrasonography without S-detectTM (first) and
ultrasonography with S-detect TM (second) were
consistent. In 23.9% of the cases (47/197), the
radiologists preferred the ultrasonographic result
without S-detectTM due to known typical feature of
some lesions; postoperative or postbiopsy changes,
fat necrosis, band-like interposing fat, papillary
neoplasm, involuting fibroadenoma, mastitis, DCIS,
hamartoma, and FCC/others were included in these
cases. In 3.6% of the cases (7/197), the radiologists
preferred the ultrasonographic result with S-detectTM.
When we used S-detectTM in conjunction with a breast
ultrasound, the specificity was improved (76.1% to
79.8%) without sensitivity change (88.9%). Accuracy
could be improved with additional clinicoradiological
information and knowledge when using S-detectTM in
conjunction with a breast ultrasound.
CONCLUSION: It is appropriate to use computeraided diagnosis system in conjunction with breast
ultrasound with knowledge of the merits and
potential limitations of computer-aided diagnosis
system.
SC 1 BR-4
13:50 - 14:00
PURPOSE: To evaluate the diagnostic performances
of S-DetectTM when applied to breast US.
MATERIALS AND METHODS: US features of the
breast masses were retrospectively analyzed by a
radiologist and S-DetectTM. Final assessments from
S-Detect TM were in dichotomized form, ‘possibly
benign’ and ‘possibly malignant’. Diagnostic
SC 1 BR-5
14:00 - 14:10
Ultrasound-Guided Preoperative SAVI SCOUT
Reflector Placement for Intraoperative Guidance
for Nonpalpable Breast Lesions: Preliminary
Data of Prospective Multi-Institutional Clinical
Evaluation
Jiyon Lee, Hilde Toth, Freya Schnabel,
Jennifer Chun Kim, Kathleen Allen,
Peter Blumencraz, Steven Shivers, Charles Cox
Department of Radiology, NYU School of Medicine,
USA
PURPOSE: To prospectively determine the technical
and clinical efficacy of the SAVI SCOUT®surgical
guidance system as a novel, electromagnetic wavebased alternative to radioactive seed localization
(RSL) and traditional wire localization.
MATERIALS AND METHODS: SCOUT is an
FDA-cleared medical device, comprising 1.2 cm
electromagnetic wave reflective device (reflector),
handpiece, and console. The reflector is placed at
lesion under US/mammographic guidance. From
3/2/2015 - 11/12/2015, 89 patients (ages 29-89
years) from 11 institutions underwent this IRBapproved, HIPAA compliant procedure under USguidance to place SCOUT reflectors up to 7 days
prior to surgery. Seventeen surgeons used the
handpiece and confirmatory audible signals emitted
by the console to guide dissection approach and
ascertain lesion and reflector retrieval. Primary study
endpoints included successful reflector placement,
intraoperative localization, and retrieval.
RESULTS: Reflectors were successfully placed and
intraoperatively retrieved in 100% (89/89) patients
at mean of 1.2 days (0-7) prior to surgery, and at
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Scientific Sessions
Clinical Application of S-DetectTM to Breast
Masses on US: A Study Evaluating the Diagnostic
Performances and Agreement with a Dedicated
Breast Radiologist
Kiwook Kim, Jung Hyun Yoon
performances of the radiologist and S-DetectTM was
calculated.
RESULTS: Benign masses among category 4a
had higher rates of possibly benign assessment
on S-DetectTM for the radiologist, 63.5% to 36.5%.
Specificity, PPV, and accuracy was significantly
higher in S-DetectTM. AUC was higher in S-DetectTM.
CONCLUSION: S-Detect TM may be used as an
additional diagnostic tool to improve the specificity
of breast US.
KSUM Open 2016
mean depth of 1.8 cm (0.35-7.5 cm) from skin. There
was no observed reflector migration. For the 89, final
pathology shows benign in 21 (23.4%), DCIS in 15
(17%), invasive in 22 (24.6%), and DCIS/invasive in
31 (35%). Of 64 with preoperative cancer diagnosis,
53 (83%) had initial clear margins.
CONCLUSION: SCOUT is an accurate and convenient
alternative to radioactive seed and traditional wire
localization procedures for nonpalpable breast
lesions. Early data shows high rates of technical and
clinical efficacy in image-guided reflector placement,
intraoperative retrieval, and surgical success rates.
Ongoing accrual is in progress for planned enrollment
of 150 patients. The SAVI SCOUT® surgical guidance
system is a novel, safe, and accurate alternative for
surgical guidance of non-palpable lesions using no
wires or radioactive materials. Additional important
advantages include the decoupling of reflector
placement and surgery dates, thereby increasing
satisfaction and improving workflow efficiency.
SC 1 BR-6
14:10 - 14:20
Combined Use of Ultrasonography and
Virtual Touch Tissue Imaging Quantification
to Differentiate Benign and Malignant Breast
Lesions Small than 10 mm
Zeng Zeng
Hospital of Tongji University, China
PURPOSE: We aimed to determine the value of
using ultrasonography combined with virtual touch
tissue imaging quantification (VTIQ) in diagnosing
the breast lesions smaller than 10 mm.
MATERIALS AND METHODS: A total of 98 breast
lesions which were smaller than 10 mm of 97
consecutive patients were examined by conventional
ultrasound, then VTIQ were performed using a
manual freehand compression technique.
RESULTS: Pathological examination revealed 29
malignant lesions (29.59%) and 69 benign lesions
(70.41%). When compared with benign lesions,
malignant lesions were more frequently taller than
wide, poorly defined, and markedly hypoechoic (P
<0.01). Color Doppler, echo texture, sonographic
calcification, posterior echo features were not
240
significantly different. The mean VTIQ value for
malignant nodules was 4.88 m/s (range, 1.75-9.34
m/s) significantly higher than that of benign ones
2.68 m/s (range, 1.18-4.67 m/s). The cutoff point
for the differential diagnosis was 3.27 m/s, with
sensitivity, specificity, diagnostic accuracy, PPV, NPV
of 86.20%, 95.65%, 92.86%, 89.29%, and 94.29%
respectively. The combination of VTIQ with a poorly
defined boundary had the highest sensitivity and
specificity of 93.33% and 100%.
CONCLUSION: For breast lesions which were
smaller than 10 mm, combined use of a poorly
defined boundary and VTIQ has high specificity
and accuracy in differentiating benign lesions from
malignant ones. The taller than wide shape, poorly
defined boundary, markedly hypoechogenecity, and
VTIQ value are all useful sonographic features.
YIA
Young Investigator Award
14:20 - 14:50
GBR 103
Chairperson:
Se Hyung Kim Seoul National University Hospital,
Korea
YIA-1
14:20-14:30
Assessment of Respiratory Motion Effect on
Focal Liver Lesions Using Image Fusion of
Computed Tomography and Ultrasonography
Hyun Jeong Park1, Min Woo Lee2, Tae Wook Kang2,
Jiwon Ryu3, Jaeil Kim3, Won-Chul Bang3,
Young-Taek Oh1, Jung-Woo Chang1, Byung Ihn Choi1
1
Department of Radiology, Chung-Ang University
Hospital, Korea
2
Korea
3
Department of Medical Engineering, Samsung
Electronics Co., Ltd., Korea
PURPOSE: To assess whether the registration error
and motion of focal hepatic lesion (FHL) are affected
by respiratory motion and the location of the FHL
using image fusion of computed tomography (CT)
Scientific Sessions
and ultrasonography (US) images.
M AT E R I A L S A N D M E T H O D S : T h i s t w o institutional prospective study was approved by
institutional review boards and informed consent was
obtained from each patient. A total of 103 patients
with FHLs underwent image fusion of real-time
US and pre-acquired CT images at end-inspiratory
phase and three-dimensional volume data containing
the FHL were obtained with an US transducer
during end-inspiratory and end-expiratory phase.
Univariate and multivariate analyses were performed
to assess independent factors affecting the degree of
registration error and the FHL motion.
RESULTS: The distance of the FHL from CPV at
end-inspiratory and at end-expiratory phase, and the
degree of diaphragm motion were factors affecting
the degree of registration error (p=0.019, p=0.031,
and p<0.0001, respectively) and the FHL motion
(p=0.028, p=0.041, and p<0.0001, respectively).
CONCLUSION: The registration error and the
motion of FHL are affected by the degree of
respiratory motion and the location of the FHL.
Image fusion should be performed with caution
when the degree of respiratory motion is large and
the FHL is located in the periphery of the liver.
YIA-2
14:30 - 14:40
PURPOSE: To investigate the factors that influence
false-negative or false-positive shear-wave
elastography (SWE) results for diagnosing breast
non-mass lesions (NMLs) detected by B-mode US.
MATERIALS AND METHODS: This retrospective
study enrolled 152 NMLs pathologically confirmed
by biopsy or surgery. For each lesion, B-mode US
and SWE were performed. Quantitative (mean
elasticity [Emean]) and qualitative (maximum stiffness
color) SWE parameters were assessed, and positive
SWE result for malignancy was determined using the
YIA-3
14:40 - 14:50
Long Term Follow-Up of Breast Cancer Survivors
Detected by Screening Program in Korean
Women Aged 40-49 Years in Comparison that
Detected by Symptom
So Yeon Won1, Seung Ii Kim2, Hyung Seok Park2,
Eun-Kyung Kim1, Hee Jung Moon1,
Jung Hyun Yoon1, Min Jung Kim1
1
Korea
2
Department of Surgery, Severance Hospital, Korea
PURPOSE: To evaluate long-term follow-up of breast
cancer survivors detected by screening program,
including screening ultrasound about breast cancer
for aged 40-49 Korean women by comparing overall
survival and disease free survival of patients with
241
Scientific Sessions
Shear-Wave Elastography in Diagnosis of Breast
Non-Mass Lesions: Influencing Factors for FalseNegative and False-Positive Results
So Yoon Park, Ji Soo Choi, Boo-Kyung Han,
Eun Young Ko, Eun Sook Ko
Korea
criterion of ‘Emean > 85.1 kPa’ or ‘stiff color (green to
red)’. Final SWE results were matched to pathologic
results. Multivariate logistic regression analysis
was performed to determine influencing factors for
false-negative and false-positive results of SWE for
diagnosing breast NMLs.
RESULTS: Of 152 NMLs, 80 (52.6%) were malignant
and 72 (47.4%) were benign. For the diagnosis
of breast NMLs by using SWE parameters, falsenegative rates of malignant NMLs (22.5-32.5%)
were higher than false-positive rates of benign
NMLs (6.9-18.1%). In multivariate analysis, smaller
lesion size (Emean: odds ratio [OR]=0.91, P=0.01; stiff
color: OR=0.91, P= 0.02) and presence of associated
calcifications (Emean: OR=6.01, P=0.02; stiff color:
OR=4.38, P= 0.04) were significantly associated
with false-negative SWE results of malignant
NMLs. Shorter distance from the nipple (E mean :
OR=0.84, P=0.04; stiff color: OR=0.93, P= 0.05)
was significantly associated with false-positive SWE
results for benign NMLs.
CONCLUSION: Smaller lesion size of malignant
NMLs, presence of associated calcifications of
malignant NMLs and shorter distance from the
nipple of benign NMLs are significant influencing
factors for false SWE results of breast NMLs.
Therefore, these factors need to be considered when
performing SWE for breast NMLs.
KSUM Open 2016
breast cancer diagnosed by screening versus by
symptom.
MATERIALS AND METHODS: This study included
915 women who examined ultrasound or ultrasound
guided biopsy and diagnosed with breast cancer and
had surgery at age 40-49years in our institution
between January 2003 and November 2008.
Patients’ medical record were retrospectively
reviewed for detection modality, diagnosis date,
operation date, expire date, recurrence date and
last follow up date. Overall survival and disease
free survival were analyzed and compared between
symptom group and screening group (Mammography
and Ultrasound), and between symptom vs.
mammography or ultrasound respectively.
RESULTS: There was no statistically significant
difference of 5 year and 10 year overall survival
and disease free survival between symptom group
and screening group (p=0.357 and p=0.071,
respectively) or mammography group (p=0.829,
0.327, respectively). On the other hand, there
was statistically significant difference of overall
survival and disease free survival between symptom
group and ultrasound group (p= 0.045 and 0.015
respectively).
CONCLUSION: The result that there’s no difference
between symptom group and mammography group
is consistent with latest changes in negative about
screening mammography in 40-49 years women.
On the other hand, benefit of screening ultrasound
about overall survival and disease free survival about
breast cancer suggests meaningful role of ultrasound
by screening tool in Korean women aged 40-49.
242
SS 3 PHY
Physics
13:20 - 14:50
GBR 101
Chairperson:
Yangmo Yoo Sogang University, Korea
SS 3 PHY-1
13:20 - 13:30
Sonophoresis with Specialized Cavitation Seed
Gilsu Song, Jinho Kim, Ohrum Cha, Jongbum Seo
Department of Biomedical Engineering, Yonsei
University, Korea
PURPOSE: In the previous studies, we have shown
that sonophoresis with mcirobubbles can enhance
drug delivery efficiency using commercial ultrasound
contrast agents (UCAs). However, cavitation of UCA
microbubble was not concentrated on the surface
of skin since many of bubbles were floating due to
low density of UCA microbubbles. In this study,
dense liquid phase core liposome was proposed as an
alternative cavitation seed for sonophoresis.
MATERIALS AND METHODS: Perfluoro-hexane
core liposome whose shell composed of mixture
of phosphate lipids and one commercial UCA
(Deffinity ® ) were mixed to ferulic acid added
phosphate buffer saline (10,000 ppm) at a volume
ratio of 1:1,000. Porcine skin samples whose
thickness was approximately 2 mm were prepared
for Franz diffusion cell experiment. Single-element
transducer with a one-half-inch diameter was used
in experiments at 1.02 MHz. An acoustic rarefaction
pressure of 2 MPa at a focus with a 1% duty cycle
and 100 Hz pulse repetition frequency was used to
generate an acoustic intensity of 1.2 W/cm2 for 20
minutes at 12 mm above skin sample. One milliliter
receptor solution was extracted to analyze the
efficiency of sonophoresis every ten minutes during
ultrasound sonication. High performance liquid
chromatography (HPLC) was used for quantitative
evaluation.
RESULTS: The delivered ferulic acid by sonophoresis
with the proposed cavitation seed was approximately
2,000 times greater in average compared to that of
diffusion. Visible size bubbles on the skin surface
could be occasionally observed with naked eyes and
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disappeared during sonication period. Perfluorohexane core liposomes are heavier than solution, so
that they are mostly seen on skin surface.
CONCLUSION: Vaporization of liquid phase
liposome and cavitation of vaporized microbubbles
seem to cause significant increase of transporting
ferulic acid through porcine skin. Hence, the
proposed liquid phase perfluro-carbone core
liposome could be extremely effective cavitation seed
for sonophoresis.
SS 3 PHY-2
13:30 - 13:40
A Novel Method for Vessel Cross-Sectional Shear
Wave Imaging (VCS-SWI): A Feasibility Study
Qiong He, Guoyang Li, Yanping Cao, Jianwen Luo
University, China
SS 3 PHY-3
13:40 - 13:50
A New Arterial Wall Motion Tracking Method
using An Adaptive Reference Frame Selection in
Ultrafast Imaging System
Hyunah Seo, Jinbum Kang, Yangmo Yoo
Department of Electronic Engineering, Sogang Univ.,
Korea
PURPOSE: As incidences of cardiovascular
disease rise, it becomes increasingly important
to predict a state of cardiovascular disease for
early diagnosis. Arterial wall stiffness has a strong
relationship with atherosclerosis. For that reason,
various cardiovascular imaging methods have been
developed for evaluating arterial wall displacement.
One of the various methods, motion tracking method
using adjacent frame is commonly performed.
However, this method accumulates estimation errors
because of the displacement of sub-pixels in the
frames so that it leads to degrade the performance.
In this study, a new arterial wall displacement
tracking method using adaptive reference selection
(ARS) in ultrafast imaging is presented.
MATERIALS AND METHODS: In the proposed
method, the reference frame is determined based
on the correlation coefficient, which is calculated
from object frame. Then, the axial displacement is
obtained by applying phase shift estimation from
243
Scientific Sessions
PURPOSE: Shear wave imaging (SWI) was
developed for visualizing the viscoelastic properties
of soft tissues. Many studies have investigated
the applications of SWI on vascular elastography.
However, these studies are mainly focused on
longitudinal-section, and the radial motion and
reflected waves are not directly considered in crosssection. It is important to investigate the SWI
in cross-section when evaluating the anisotropy
of vessel wall or complete plaque composition.
Therefore, we proposed a novel method based on
coordinate transformation and directional filter to
achieve the vessel cross-sectional shear wave imaging
(VCS-SWI). Its feasibility was investigated through
phantom, ex-vivo and in-vivo studies.
MATERIALS AND METHODS: A Verasonics V1
System equipped with an L10-5 transducer was
used to induce shear wave in a homogeneous vesselmimicking polyvinyl-alcohol phantom, ex-vivo
swine abdominal aorta and in-vivo healthy human
common carotid artery (CCA) using a single-focus
push. Coherent-plane-wave-compounding images
were acquired with three steering angles (~5k fps).
The centroid of the vessel was chosen manually,
then the RF-data were transformed from Cartesian
to polar coordinate systems so as to perform radial
displacement estimation using 2D normalized crosscorrelation method. Directional filter was applied in
polar coordinates to obtain the forward shear wave in
circumferential direction. Finally, the circumferential
shear wave velocity (SWV) and the dispersion curve
were obtained from the radial displacements, and
the shear wave propagation were visualized after
transformation back to Cartesian coordinate system.
RESULTS: The results shows that the shear waves
are guided along the circumferential direction
of vessel wall. The propagation is symmetric
with respect to the push location in phantom
but asymmetric in the abdominal aorta and CCA
(clockwise and counter-clockwise SWVs are the same
in the phantom but different in biological vessels).
CONCLUSION: The proposed method is proved
feasible and promising for VCS-SWI. More research
will be carried out to understand the difference in the
phantom and biological vessels.
KSUM Open 2016
cross-correlation.
RESULTS: To evaluate the performance of the
proposed method, phantom and in-vivo studies were
conducted using pre-beamformed radio-frequency
(RF) data acquired from an ultrasound research
platform (Vantage, Verasonics Inc., Redmond,
WA, USA) with a linear array probe (L7-4, Philips).
The carotid vessel phantom that is composed of a
compliant photopolymer material and a gel-like
supporting photosensitive was designed using RP
frame work for in-vitro study. In the phantom and
in-vivo study, axial displacements were acquired
using the inter-frame method, the fixed reference
method and the proposed method with respect to
the waveform similarity and correlation coefficient
from M-mode, respectively. In the both studies, they
were found that the arterial wall displacement of the
pre-determined observation points using the ARS
method showed improved results since the interval
between the observation points and the peak location
at the same cardiac cycle phase were constant.
CONCLUSION: These results indicate that the
proposed ARS method in ultrafast imaging enables
the arterial wall displacement estimation without
accumulating errors.
SS 3 PHY-4
the surface of an elasticity QA phantom (Model
049, CIRS, USA) and swept in a sinusoid-like
trajectory along elevational direction during the data
acquisition. The 3D coordinates and orientations
of probe were obtained from the EMTS (SonixGPS)
for each frame. A correlation-based algorithm was
adopted to obtain a series of normalized axial strain
images. The 3D strain map was then reconstructed
by using the 3D coordinates and orientations of
probe corresponding to each strain image. The
slice plot and isosurface plot of strain map were
generated. The inclusion volume was estimated from
the isosurface plot and compared with the true one.
RESULTS: The slice plots of axial strain of the
inclusions with Young’s moduli of 80, 45, 14,
and 8 kPa (background: 25 kPa) show a good
discrimination between the inclusions and
background. The inclusion’s volumes estimated from
the isosurface plots (531, 522, 534 and 534 mm3,
respectively) are close to the true one (523.6 mm3)
with average errors within 1.5%.
CONCLUSION: In conclusion, freehand 3D
elastography with 1D linear array is achieved by
using electromagnetic tracking.
SS 3 PHY-5
14:00 - 14:10
Freehand 3D Elastography with 1D Linear Array
Based on Electromagnetic Tracking
Fu-Feng Lee, Qiong He, Jianwen Luo
Department of Medical Engineering, Tsinghua
University, China
A New High Pulse-Repetition Frequency Ultrafast
Sliding Compound Doppler Imaging Method for
Fast Flow Characterization
Jinbum Kang, Yangmo Yoo
Department of Electronic Engineering, Sogang
University, Korea
PURPOSE: Recent improvement in hardware ability
and scanning protocol has advanced conventional
2D elastography to 3D level, which provides an
intuitive visualization of inclusions. A 2D linear
array or sliding stage is typically required for 3D
elastography. In this study, we proposed a novel
method based on electromagnetic tracking system
(EMTS) for freehand 3D elastography with 1D linear
array.
MATERIALS AND METHODS: A SonixMDP system
equipped with SonixGPS (Ultrasonix, Canada)
and 1D linear array probe (L14-5, f0 = 10 MHz)
were utilized. The probe was slightly attached to
PURPOSE: Ultrafast Doppler imaging based on
plane-wave angle compounding (UDI-AC) can
evaluate cardiovascular diseases using high frame
rates. In particular, it provides a fully-quantifiable
flow analysis over a large region of interest with
high spatio-temporal resolution. However, the
pulse-repetition frequency (PRF) in the UDI-AC
method is limited since it leverages between the
number of angles (N ) and acquisition time. In this
paper, we present a new high PRF ultrafast Doppler
imaging method based on the plane- wave, slidingangle compounding method (HDI-SAC) to improve
quantitative flow analysis.
244
13:50 - 14:00
Scientific Sessions
MATERIALS AND METHODS: In the HDI-SAC
method, the angle compounding is consecutively
updated so that there are no reductions in frame
rate, Doppler pulse-repetition frequency (PRF),
or sensitivity. In addition, by updating a new
compounding set with a certain time difference (i.e.,
time lag or L ), the HDI-SAC method allows various
PRFs with the same acquisition data to enable a fully
qualitative, retrospective flow assessment.
RESULTS: To evaluate the performance of the
proposed HDI-SAC method, phantom and in
vivo studies were conducted with diverse flow
circumstances. In the phantom study, the HDISAC method showed improved hemodynamic
representation without losing either resolution
or sensitivity compared to the UDI-AC method.
In the femoral artery and vein experiments, the
acquired flow data from the HDI-SAC method in a
full cardiac cycle was retrospectively analyzed by
a PW spectrogram, and arterial and venous flows
were successfully assessed with optimal velocity
estimation.
CONCLUSION: These results indicate that the HDISAC method can improve flow visualization and
quantification with a higher frame rate, PRF and
sensitivity in cardiovascular imaging.
SS 3 PHY-6
14:10 - 14:20
Compressed Sensing for High Frame Rate and
High Image Quality Ultrasound Imaging
Jing Liu, Qiong He, Jianwen Luo
Department of Medical Engineering, Tsinghua
University, China
SS 3 PHY-7
14:20 - 14:30
Improvement of Primary Healthcare System
Using Wireless Mobile Ultrasound Device: A
Pilot Study (Example of KOICA-CTS Program in
Vietnam)
Seon-Jeong Min1, Jeong-Won Ryu2
1
Department of Radiology, Hallym University Sacred
Heart Hospital, Korea
2
THE PURPOSE OF THIS EXHIBIT IS:
To understand basic concept and physics of wireless
mobile ultrasound system
To understand importance of Point-of-Care (PoC)
sonographic examination in acute care medicine
245
Scientific Sessions
PURPOSE: High frame rate is important for
imaging of motion tissue and blood flow; however,
the improvement of frame rate is usually at the
cost of spatial resolution or contrast. In this study,
compressed sensing based synthetic transmit
aperture (CS-STA) is proposed to achieve high frame
rate and high image quality ultrasound imaging
based on the compressed sensing (CS), which allows
a much lower sampling frequency than the Nyquist
sampling frequency under certain conditions.
MATERIALS AND METHODS: Using CS reconstruction method, CS-STA reconstructs a synthetic
transmit aperture (STA) image with a higher frame
rate from fewer randomly apodized plane waves.
Because of the recovered STA image, CS-STA keeps
the high resolution of STA. Moreover, the contrast
can be improved because all elements are active in
plane wave firing. CS-STA was compared with STA
and conventional focused imaging on Verasonics V1
system with a 128-element linear array by imaging
a CIRS phantom, thyroid and biceps brachii muscle
of a human subject. STA and the focused mode were
implemented with 128 firings, while CS-STA was
implemented with 64 and 32 firings.
RESULTS: In both the phantom and in vivo
experiments, STA achieves the highest spatial
resolution but lowest contrast. In the focal depth,
the focused mode achieves the highest contrast and
comparable spatial resolution. However, the contrast
and spatial resolution deteriorate in the unfocused
region. With two or four times fewer firings, CS-STA
retains the spatial resolution of STA at all depths
and improves the contrast significantly. Even though
the contrast of CS-STA is not as high as that of the
focused mode in the focal depth, the contrast of CSSTA is higher than that of the focused mode in the
unfocused region.
CONCLUSION: The proposed CS-STA method is
proved to be capable of simultaneously achieving
high frame rate, high image quality ultrasound
imaging.
KSUM Open 2016
To understand ODA and KOICA CTS (Creative
Technology Solution) program
To learn usefulness of wireless mobile ultrasound
device as a tool of improvement of primary health
outcomes in resource-limited areas (countries)
CONTENT ORGANIZATION:
Introduction
Difference of previous portable ultrasound system
and wireless mobile ultrasound system
Definition of Point-of-Care (PoC) sonographic
examination
Usefulness of wireless mobile ultrasound system in
improvement of primary healthcare system
KOICA-CTS program
Conclusion
References
Conclusion with major teaching points:
The major teaching points of this exhibit are:
Usefulness of wireless mobile US device as a strong
tool of PoC US
Improvement of primary health outcomes and role of
wireless mobile US device
Good example of KOICA CTS program related with
improvement of primary health care
246
SS 4 HN
Head & Neck
10:30 - 11:00
GBR 101
Chairpersons:
So Lyung Jung The Catholic University of Korea,
Young Hen Lee Korea University Ansan Hospital,
Korea
SS 4 HN-1
10:30 - 10:40
Ultrasonography of Major Salivary Glands in the
Sjogren Syndrome
Jeong Kyu Kim1, Jung-Yoon Choe2, Hoon Kyu Oh3
1
Department of Otorhinolaryngology, Daegu Catholic
2
Department of Internal Medicine, Daegu Catholic
3
Department of Pathology, Daegu Catholic University
PURPOSE: To evaluate diagnostic accuracy of
ultrasonography for Sjogren syndrome and to
assess correlation of ultrasonography with minor
salivary gland biopsy, salivary flow rate, xerostomia
symptoms, Sjogren syndrome disease activity index,
and physician’s global assessment
MATERIALS AND METHODS: We performed
a cross-sectional study in a prospective cohort of
patients with suspected Sjogren syndrome. The
parenchymal echogenicity of the bilateral parotid
and submandibular glands was graded from 0 to
4. Receiver operating characteristic (ROC) curve
analysis was performed to evaluate the diagnostic
value of the ultrasonography. Spearman’s rank
correlation was used to assess correlation of
ultrasonography with minor salivary gland biopsy,
salivary flow rate, xerostomia symptoms, Sjogren
syndrome disease activity index, and physician’s
global assessment.
RESULTS: Of 50 patients enrolled, 33 patients were
classified to have Sjogren syndrome by American
College of Rheumatology classification criteria. ROC
curve analysis showed that the sum of the grades for
the 4 glands had the best diagnostic value. The sum
of the grades >8 was optimal cutoff with sensitivity
74.2% and specificity 70.6%. A significant correlation
Scientific Sessions
was observed only with salivary flow rate (r=-0.415,
P=0.002).
CONCLUSION: The ultrasonography of major
salivary glands showed good diagnostic value for
Sjogren syndrome and correlated with salivary flow
rate.
SS 4 HN-2
10:40 - 10:50
Association of Xerostomia and Ultrasonographic
Features of the Major Salivary Glands after
Radioactive Iodine Ablation for Papillary Thyroid
Carcinoma
Sang Soo Roh, Dong Wook Kim
Hospital, Korea
10:50 - 11:00
US-Guided Fine Needle Aspiration versus
US-Guided Core Needle Biopsy for Distant
Metastases in Cervical Lymph Nodes from Other
than Head / Neck Region: A Propensity Score
Matching Study
Kyeong Hwa Ryu, Jeong Hyun Lee,
Jung Hwan Baek, Young Jun Choi, Mi Sun Chung,
Kye Jin Park
Korea
PURPOSE: To compare US-guided fine needle
aspiration (USFNA) and US-guided core needle
biopsy (USCNB) to determine therapeutic strategies
in patients with distant metastases in cervical
lymph nodes suspected by imaging modalities using
propensity score analysis
study was approved by the institutional review
board and informed consent was waived from
its retrospective nature. From 2004 to 2013,
108 patients who underwent USFNA and 1,058
underwent USCNB were enrolled. The primary
outcome of our study was defined as the need for
additional biopsy to determine therapeutic strategies.
To evaluate procedure (USFNA and USCNB) on
outcome, we performed univariate and multivariate
logistic regression analysis, and performed a 1:1
propensity score matching of USFNA and USCNB.
RESULTS: Cases needing additional biopsy to
determine therapeutic strategies were 6.5% (7/101)
for USFNA and 1.6% (17/1041) for USCNB. Before
matching, USCNB (p=.001) showed significantly
better outcome. After 1:1 propensity score matching
of 103 patients from each group, USCNB consistently
showed significant association with better outcome
than USFNA. (before PSM, odds ratio (OR)=4.489,
95% confidence interval (CI) [1.803-11.177], P=.001;
after PSM, OR=1.060, 95% CI [1.013- 1.109],
P=.012).
CONCLUSION: USCNB is significantly better than
USFNA in determining therapeutic strategies in
patients with distant metastases in cervical lymph
nodes from other than head and neck region
suspected by imaging modalities.
247
Scientific Sessions
PURPOSE: This study aimed to evaluate the
association of xerostomia and ultrasonographic (US)
features of the major salivary glands (MSGs) after
radioactive iodine ablation (RIA) in patients with
papillary thyroid carcinoma (PTC).
256 consecutive patients who underwent total
thyroidectomy, RIA, and neck US examinations. US
changes in the parotid and submandibular glands
after RIA were evaluated retrospectively by a single
radiologist based on direct comparison between
sonograms obtained before and after RIA. Clinical
data, including xerostomia, were investigated
retrospectively by the same radiologist according to
electronic medical record review.
RESULTS: Of the 256 patients, 111 (43.4%) showed
US changes in the MSGs after RIA. Of the 256
patients, xerostomia was undetermined in 85. The
prevalence rate of xerostomia was 36.8% (63/171).
Between those with and without xerostomia, there
were no significant differences in the gender, age,
dose of RIA, number of RIA sessions, number
of involved MSGs, or presence of involved
submandibular gland (p>0.05). In addition, no
significant association was found between xerostomia
and US changes in the MSGs after RIA.
CONCLUSION: US may be unhelpful for evaluating
xerostomia or other salivary gland dysfunction after
RIA in patients with PTC.
SS 4 HN-3
KSUM Open 2016
SS 4 THY
Thyroid
11:00 - 12:00
GBR 101
Chairpersons:
So Lyung Jung The Catholic University of Korea,
Young Hen Lee Korea University Ansan Hospital,
Korea
SS 4 THY-1
11:00 - 11:10
A Multicenter, Prospective Validation Study
for the Korean Thyroid Imaging Reporting and
Data System in Patients with Thyroid Nodules
(K-TIRADS)
Eun Ju Ha1, Won-Jin Moon2, Dong Gyu Na3,
Yeong Hen Lee4, Nami Choi2, Jae Kyun Kim5
1
Department of Radiology, Ajou University Hospital,
Korea
2
Center, Korea
3
Department of Radiology, Human Medical Imaging
and Intervention Center, Korea
4
Hospital, Korea
5
Hospital, Korea
PURPOSE: We sought to validate a new risk
stratification system for thyroid nodules, the Korean
Thyroid Imaging Reporting and Data System
(K-TIRADS), using a prospective design.
MATERIALS AND METHODS: From June 2013 to
May 2015, in total, consecutive 902 thyroid nodules
were enrolled from four institutions. We analyzed
the type and predictive value of ultrasonography
(US) predictors according to the combination of the
solidity and echogenicity of nodules, calculated the
malignant risk and diagnostic performance for each
category of K-TIRADS, and compared the efficacy of
fine-needle aspiration (FNA) with a three-tier risk
categorization system.
RESULTS: The malignant risk of thyroid nodules
was significantly higher in solid hypoechoic nodules
than partially cystic or isohyperechoic nodules (each
p<0.001). The presence of any suspicious US features
had a significantly higher malignancy risk (73.4%) in
248
solid hypoechoic nodules than in partially cystic or
isohyperechoic nodules (4.3-38.5%; p< 0.001). The
calculated malignancy risk in K-TIRADS categories
5, 4, 3, and 2 nodules were 73.4%, 19.0%, 3.5%, and
0.0%, respectively, and the sensitivity, specificity,
positive predictive value, negative predictive value,
and accuracy for malignancy were 95.5%, 58.6%,
44.5%, 96.9%, and 69.5%, respectively, in K-TIRADS
categories 4 and 5. The efficacy of FNA for detecting
malignancy based on K-TIRADS was significantly
increased, from 18.6% (101/544) to 22.5% (101/449),
compared with the three-tier risk categorization
system (p<0.001).
CONCLUSION: The proposed new risk stratification
system based on solidity and echogenicity was useful
with respect to risk stratification of thyroid nodules
and the decision for FNA. The malignancy risk of
K-TIRADSwas reproducible in this prospective
multicenter study.
SS 4 THY-2
11:10 - 11:20
Interobserver Variability of Descriptive
Parameters for the Ultrasonographic Assessment
of Thyroid Nodules According to the Korean
Thyroid Imaging Reporting and Data System
Jung Min Bae, Soo Yeon Hahn, Jung Hee Shin,
Eun Young Ko, So Yoon Park, Seung Hee Choi
Korea
PURPOSE: The objective of our study was to
investigate the interobserver variability of descriptive
parameters for the diagnosis of thyroid nodules
according to the Korean Thyroid Imaging Reporting
and Data System (K-TIRADS).
MATERIALS AND METHODS: One hundred fiftythree consecutive patients with 165 nodules were
enrolled for this study between November 2015 and
February 2016. The real time ultrasonographic (US)
images were prospectively evaluated and recorded
according to the K-TIRADS. Afterwards, one blinded
radiologist retrospectively analyzed the static US
images. Interobserver variability was calculated
for each descriptive parameter and for the final
K-TIRADS assessment. Cytology and/or histology
for all benign (n=79) and histology for all malignant
Scientific Sessions
nodules (n=86) served as the standard of reference.
RESULTS: For overall interobserver variability,
echogenicity, shape, and margin had moderate
agreement (κ=0.55, 0.58, and 0.56, respectively);
composition, calcification, and final assessment
showed substantial agreement (κ=0.63, 0.74, and
0.67, respectively); spongiform and orientation
had almost perfect agreement (κ=0.81 and 0.86,
respectively). For the interobserver variability of
descriptive parameters, there was slight agreement
on predominantly cystic composition (κ=0.15), and
fair agreement on cystic composition (κ=0.39) and
ill-defined margin (κ=0.28). For the interobserver
variability of final K-TIRADS assessment, category
4 showed fair agreement (κ=0.28), while category
2 and 5 showed perfect (κ=0.83) and substantial
agreement (κ=0.77), respectively.
CONCLUSION: Overall interobserver variability of
descriptive parameters according to the K-TIRADS
showed equal or more than a moderate degree of
agreement in the assessment of thyroid nodules.
However, there was a discrepancy in describing the
proportion of cystic composition within the nodules
and the presence of ill-defined margin between
observers.
SS 4 THY-3
11:20 - 11:30
PURPOSE: To compare the diagnostic performances
and agreements for three different guidelines used
for thyroid nodules using suspicious US features
when assessed by observers with various degree of
experience.
SS 4 THY-4
11:30 - 11:40
The Thyroid Imaging Reporting and Data
System (TIRADS) on US, but not the BRAFV600E
Mutation, is Associated with Lateral Lymph Node
Metastasis in PTC
Young Jean Park, Eun-Kyung Kim, Hee Jung Moon,
Jung Hyun Yoon, Jin Young Kwak
PURPOSE: To investigate 1) the association
between clinical-pathologic prognostic factors and
the BRAF mutation found in fine needle aspirates,
based on both its presence and its corresponding
cycle threshold (C t) value, and 2) the association
between prognostic factors and suspicious US
features classified by the TIRADS in papillary thyroid
249
Scientific Sessions
Diagnostic Performances and Interobserver
Agreement According to Observer Experience:
A Comparison Study Using Three Guidelines for
Management of Thyroid Nodules
Jieun Koh1, Soo-Yeon Kim2, Hye Sun Lee3,
Eun-Kyung Kim1, Jin Young Kwak1, Hee Jung Moon1,
Jung Hyun Yoon1
1
Korea
2
Hospital, Korea
3
Department of Biostastistics Collaboration Unit,
Severance Hospital, Korea
MATERIALS AND METHODS: This IRB-approved
retrospective study included 370 thyroid nodules
(≥10 mm) for image review. Four observers, grouped
as experienced (two staff radiologists, 19 and 15
years) and inexperienced (two fellows, 2 and 1
year) group evaluated the US features and made
final assessments according to the Kim criteria,
TIRADS by Kwak, and the 2015 ATA guideline.
Diagnostic performances and agreements according
to experience were calculated and compared for the
three guidelines.
R E S U LT S : T h e e x p e r i e n c e d g r o u p s h o w e d
significantly higher specificity, PPV, and accuracy
using the Kim criteria and the 2015 ATA guideline
(P<0.001). No significant differences were seen in
diagnostic performances according to experiences
when using TIRADS. AUC for the experienced group
using the 2015 ATA guideline was significantly
higher than the inexperienced group (0.833 vs.
0.770, P=0.012). The experienced group showed fair
agreement using the 2015 ATA guideline, which was
significantly lower than the moderate agreement for
the inexperienced group (κ=0.341 to 0.550).
CONCLUSION: The three guidelines for thyroid
nodules have overall good diagnostic performances,
but the performances can show significant
differences according to the experience of the
observer when using the 2015 ATA guideline, with
fair agreements even for experienced performers.
KSUM Open 2016
carcinoma (PTC).
MATERIALS AND METHODS: The institutional
review board approved this study, and the
requirement for informed consent was waived.
Between December 2010 and June 2014, 258
consecutive patients with PTC larger than 1 cm
and who underwent preoperative ultrasound (US)guided fine needle aspiration (FNA) were included.
Variables were compared between patients with and
without the BRAF mutation Multivariate analyses
were performed to investigate 1) the association
between clinical-pathologic prognostic factors and
the BRAF mutation found in fine needle aspirates,
based on both its presence and corresponding C t
values, and 2) the association between prognostic
factors and suspicious TIRADS US features.
RESULTS: BRAF-positive patients had a higher
proportion of multiple tumors (P=.017). The number
of suspicious US features classified by the TIRADS
was an independent factor for predicting lateral
lymph node metastasis (LNM), both in all 258
patients (odds ratio [OR]=1.902, P=.005) and in
214 BRAF-positive patients (OR=1.686, P=.037).
The BRAF mutation status or BRAF C t values were
not associated with any of the clinical-pathologic
prognostic factors.
CONCLUSION: A higher number of suspicious
US features classified by the TIRADS, but not the
BRAFV600E mutation, are associated with lateral LNM
in patients with PTC, and can aid in the preoperative
identification of patients at increased risk of lateral
lymph node metastasis.
SS 4 THY-5
11:40 - 11:50
Simultaneous Fine-Needle Aspiration and Core
Needle Biopsy for First-Line Diagnostic Method
in Thyroid Nodules
Dong Gyu Na
MATERIALS AND METHODS: Simultaneous FNA
and CNB was performed in 973 thyroid nodules
from January 2010 to December 2014. Among these
nodules, this study included consecutive 782 nodules
(426 macronodules ≥ 1 cm and 356 micronodules
< 1 cm) and excluded 156 nodules with prior
inconclusive FNA results and 35 nodules in which
the procedure was performed after a prior FNA. We
compared the rate of inconclusive results (Bethesda
category 1 or 3) and diagnostic performance of
FNA, CNB, and combined FNA/CNB for thyroid
malignancy. McNemar’s test and receiver operating
characteristics were used for statistical analysis.
RESULTS: CNB showed a lower rate of inconclusive
results than FNA in overall nodules (10.2% vs.
23.7%), micronodules, and macronodules (P<0.001,
respectively). Combined FNA/CNB showed a lower
rate of inconclusive results (4.9%) compared with
FNA or CNB alone in overall nodules, micronodules,
and macronodules (P<0.001, respectively). The
sensitivity of FNA, CNB, combined FNA/CNB for
malignancy (Bethesda category 4, 5, and 6) was
85.1%, 97.5%, and 98.2%. CNB and combined FNA/
CNB demonstrated a higher diagnostic performance
for the diagnosis of malignancy than FNA regardless
of the nodule size (P<0.001). There was no significant
difference of diagnostic performance between CNB
alone and combined FNA/CNB (P≥0.156).
CONCLUSION: CNB and combined FNA/CNB
showed lower inconclusive results and higher
diagnostic performance than FNA. Although
combined FNA/CNB could slightly reduce the
inconclusive results (5.3%), it showed a similar
diagnostic performance for malignancy compared
with CNB alone. Considering the small added benefit
of simultaneous FNA/CNB, CNB alone could be an
effective first-line method for thyroid nodules.
PURPOSE: To evaluate the diagnostic efficacy of
simultaneous fine-needle aspiration (FNA) and core
needle biopsy (CNB) for the first-line diagnosis of
thyroid nodules which had no prior inconclusive
FNA results.
250
Scientific Sessions
SS 4 THY-6
11:50 - 12:00
Core Needle Biopsy as a First-Line Biopsy
Method for Initially Detected Thyroid Nodule:
A Comparative Study Using Propensity Score
Matching
Hyun Kyung Lim1, So Lyung Jung2, Jung Hee Shin3,
Soo Yeon Hahn3
1
Department of Radiology, Soonchunhyang
University Seoul Hospital, Korea
2
3
Korea
SS 5 MSK
Musculoskeletal
10:30 - 11:20
GBR 102
Chairpersons:
Sang-Hoon Lee Asan Medical Center, Korea
Young Cheol Yoon Samsung Medical Center, Korea
SS 5 MSK-1
10:30 - 10:40
Correlation between Imaging Methods and
Clinical Impairment in Patients with Frozen
Shoulder
Jae Hwal Rim, Gi Young Park
Department of Rehabilitation Medicine, Daegu
Catholic University Medical Center, Korea
PURPOSE: Frozen shoulder (FS) is a shoulder
disorder characterized by pain and limitation of
movement due to fibrous thickening and contraction
of the joint capsule. Imaging studies including
arthrography, ultrasound (US), and magnetic
resonance imaging (MRI) have been performed to
accurately diagnose FS. The purpose of this study
was to evaluate the relationship between the clinical
impairment and the specific finding of diagnostic
imaging methods in patients with FS.
MATERIALS AND METHODS: Forty-seven patients
who were clinically diagnosed as unilateral FS
were recruited. All patients were assessed using
visual analogue scale (VAS), passive shoulder range
of motions(ROM), Cyriax staging (CS), and the
Constant-Murley Shoulder Function Assessment
Score (CMS). On MRI, the thickness of axillary
recess (AR), coracohumeral ligament (CHL), and
the enhancing portion in rotator cuff interval
251
Scientific Sessions
PURPOSE: To evaluate the role of CNB as a firstline diagnostic method for initially detected thyroid
nodules compared with fine-needle aspiration
MATERIALS AND METHODS: A total of consecutive
2898 initially detected thyroid nodules in 2662
patients, which were evaluated with ultrasoundguided FNA or CNB were included. A propensity
score matching analysis was performed to reduce
the effects of selection bias, and 753 CNB nodules in
731 patients and 753 FNA nodules in 698 patients
were finally enrolled. We compared diagnostic
performance, inconclusive results, and complication
between CNB and FNA groups. Subgroup analysis
according to the nodule size was also performed.
RESULTS: After matching, Nondiagnostic results
ratio of CNB group was 2.0% (n=15) and significantly
lower than that of FNA (8.2%, n=62) (P<0.001).
The diagnostic accuracy, sensitivity, specificity,
positive predictive value, and negative predictive
value for malignancy in CNB group were 89.0%,
70.2%, 98.8%, 96.7%, and 86.5%. There was no
difference in diagnostic performance between FNA
and CNB group. For the diagnosis of follicular/
Hurthle cell neoplasm including adenoma and
carcinoma, the sensitivity of CNB was 74.5% and,
was significantly higher than the sensitivity of FNA
(19.2%) (p<0.001). Based on subgroup analysis, the
diagnostic performance and nondiagnostic result
ratio was not significantly associated with nodule
size. For the diagnosis of follicular neoplasm or
Hurthle cell neoplasm, the sensitivity of CNB (74.5%)
was significantly higher than that (19.2%) of FNA
(P<0.001). Complication rate of CNB was 3.6%, and
there was no significant difference compared to FNA
(2.0%) (P=0.078).
CONCLUSION: CNB showed lower nondiagnostic
result rate than FNAB and show good diagnostic
performance particularly in the diagnosis of
follicular/Hurthle cell neoplasm. CNB is a useful
fist-line biopsy method for initially detected thyroid
nodule.
KSUM Open 2016
(ERCI) were measured. The AR and CHL ratio were
calculated by dividing AR and CHL thickness of
affected shoulder by those of unaffected shoulder.
RESULTS: The affected AR thickness and AR ratio
were negatively correlated with the passive shoulder
range of external rotation and internal rotation (r=0.353, -0.326, p<.05). The total score of shoulder
arthrographic criteria was negatively correlated with
the passive shoulder range of flexion, and abduction
(r=-0.388, -0.369, p<.01). In addition, The AR ratio
and the total score of shoulder arthrographic criteria
were negatively correlated with VAS during motion
and CMS (r=-0.339, -0.481, p<.05).
CONCLUSION: Thickness and ratio on US and
the total score of shoulder arthrographic criteria
were significantly correlated with passive range of
shoulder motions in patients with FS. AR ratio on US
and the total score of shoulder arthrographic criteria
were significantly correlated with VAS during motion
and CMS. MRI parameters were not correlated with
clinical assessment scores. We recommended US as
the imaging method to evaluate the patients with FS.
criteria.
RESULTS: CSA was 14.48 ± 4.36 mm2 in 31 wrists.
Sixteen US mild patients were mild in 9 and
moderate in 7 patients by EDx criteria, and 8 US
moderate patients were mild in 6, moderate in 1
and severe in 1 by EDx criteria, and 7 US severe
patients were moderate in 5 and severe in 2 by
EDx criteria. In multiple regression analysis, CSA
showed correlation with CMAP amplitude (p=.007,
regression coefficient= -0.54) and presence of PSW
(p=.02, regression coefficient= 3.26). In addition,
CSA showed correlation with positive Tinel sign (r=
-0.55, p<.05).
CONCLUSION: Severity between US and EDx
criteria was not well correlated. But CSA had
negative correlation with CMAP amplitude and
positive correlation with presence of PSW and we
also found that the larger CSA showed the more
positive in Tinel sign.
SS 5 MSK-3
10:50 - 11:00
Severity Correlation between Cross Sectional
Area and Electrodiagnostic Parameters in Carpal
Tunnel Syndrome
Kwang Jae Lee, Yong-Soon Yoon, Seung-Gyu Lim
Medical Center, Seonam University College of
Medicine, Korea
Role of Ultrasound in the Evaluation of Thenar
Muscles Length
Sabrilhakim Sidek1, Mohd Shukry Mohd Khalid1,
Rozaidi Roslan2, Shahrul Naim Sidek2
1
Department of Radiology, Medical Imaging Unit,
Faculty of Medicine, Universiti Teknologi MARA,
Selangor, Malaysia
2
Department of Mechatronics Engineering Dept.,
Kulliyyah of Engineering, International Islamic
University Malaysia, Kuala Lumpur, Malaysia
PURPOSE: To investigate the correlation between
ultrasonographic (US) cross sectional area of median
nerve at the wrist (CSA) and electrophysiologic (EDx)
parameters in patients with carpal tunnel syndrome
(CTS).
MATERIALS AND METHODS: History taking,
physical examination, nerve conduction study (NCS)
and needle EMG were done and thirty one wrists
were diagnosed with carpal tunnel syndrome and
then maximal CSA was measured by tracing method
using ultrasound independently. CSA and EDx
parameters were analyzed and classified with each
severity groups, and then evaluated the correlation
between US and EDx severity classified with each
PURPOSE: Proper functioning of the hand is
centered on the use of the thumb, which is the only
opposable finger among the five. Assessment of the
thenar muscles that is essential for thumb movement
is important not only in the medical field as to look
for any pathology, but also crucial in the engineering
field. Assessment of these muscles can be applied
to develop a prostatic thumb which can mimics
the real actions of a real thumb as closely possible.
Muscle length is one of the parameters needed to
develop a prostatic thumb. Therefore, in this study,
we utilized ultrasound technique to measure thenar
muscles length and the precision of this technique
is compared with the MRI examination as gold
SS 5 MSK-2
252
10:40 - 10:50
Scientific Sessions
standard.
MATERIALS AND METHODS: Ultrasound examination of the thenar muscles length was
performed with an iU22 scanner (Phillips Medical
System, Bothell, WA) using a 15MHz linear array
transducer on 10 healthy volunteers, 20-30 years
of age. Two radiologists performed all scans
independently. The evaluated thenar muscles
were abductor pollicis brevis, flexor pollicis brevis,
opponens pollicis and adductor pollicis. Length
of these muscles were measured in mm. Similar
subjects underwent MRI examination of the hand
and length of these muscles were measured from
the MRI scan. The position of the hand and forearm
were standardized for all subjects for both scans.
Comparison were made between the muscle length
measured by ultrasound and MRI.
RESULTS: Using statistical analysis, there was no
significant difference between the length of the
thenar muscles measured using ultrasound and MRI
(p>0.05).
CONCLUSION: Ultrasound can be used to visualized
and assess thenar muscles length. In addition,
ultrasound has better assessment of the thenar
muscles in various thumb movements in view of
accessibility and dynamic flexibility.
We acknowledged financial support under grant no.
FRGS14-160-0401 by MOHE, Malaysia.
SS 5 MSK-4
11:00 - 11:10
PURPOSE: To evaluate the clinical usefulness of
SMI (superb microvascular imaging) technology
for detection of active synovitis in the patients with
rheumatoid arthritis, compared to power Doppler
imaging (PDI).
MATERIALS AND METHODS: From July, 2015,
18 patients (5 males; mean age, 62 years) with
rheumatoid arthritis underwent ultrasound about
SS 5 MSK-5
11:10 - 11:20
Automatic Fiber Segmentation Method Based on
FCM Clustering
Qihao Zhang, Qiong He, Jianwen Luo
University, China
PURPOSE: Musculoskeletal imaging is an
important noninvasive method of exploring muscle
abnormalities. Till now, many parameters of muscle
fiber, such as length, width and angle, have to be
taken manually, which is both time-consuming and
inaccurate. Numerous methods have been developed
for automatic parameter extraction in the past few
years. However, most of these methods mainly focus
on the extraction of one particular parameter, or are
not robust enough. Therefore, we proposed a novel
method based mainly on Fuzzy C-Means clustering
and region growing to achieve the automatic
fiber segmentation and parameter extraction. Its
feasibility was investigated through simulation tests
and ex vivo studies.
MATERIALS AND METHODS: In ex vivo study,
ultrasound RF data of ox hind leg are acquired from
a SonixMDP system (Ultrasonix Canada) equipped
with an L14-5 probe (f0=7.5 MHz). The envelope
detected data of experiments were then processed by
local FCM clustering and region growing to separate
253
Scientific Sessions
The Usefulness of SMI Technology on Ultrasound
for Evaluation of Patients with Rheumatoid
Arthritis
Guen Young Lee, Su Jin Kim, Jong Bum Lee,
Sung Bin Park, Byung Ihn Choi, Jee Young Jung
Hospital, Korea
both wrists and hands (total 22 joints), who were
evaluated using both PDI and SMI using Aplio
TM 500 Ultrasound (Toshiba Medical Systems
Corporation), and rated according to the vascularity
(grade 0- 3). Sum of 22 joints grading were
compared between PDI and SMI, and correlated with
inflammatory lab results (ESR and CRP).
RESULTS: The sum of 22 joints grading was
significantly higher in SMI (mean, 13.29), compared
to PDI (mean, 6.59) (p=0.029). However, the sum
in neither SMI nor PDI was significantly correlated
with lab finding.
CONCLUSION: Although this study was performed
in a small number of patients, SMI may be useful
for detection of acute synovitis in the patients
with rheumatoid arthritis, because it could show a
vascularity more sensitively than PDI.
KSUM Open 2016
the fibers. After that, the least square method was
used to obtain the angle of muscle fibers. The length
and width were then calculated and compared to the
parameters obtained manually.
RESULTS: Simulation results proved that, using
local FCM clustering and region growing, the muscle
fibers in all directions can be recognized. The fiber
orientation under the condition of both high and low
contrast can be obtained in ex vivo experiment. And
using the least square method we can significantly
reduce the effect of speckle noise. Compared with the
parameters calculated manually, the relative error
was only less than 2% in the proposed method.
CONCLUSION: The proposed method is proved
feasible and promising for automatic extraction
several parameters of muscle fibers, such as length,
width and angle. More research will be carried out
to investigate the performance of this method under
different conditions.
Chairpersons:
Jin Young Kwak Severance Hospital, Korea
US examination and USE using carotid artery
pulsation were performed in 151 patients with 176
nodules in a prospective design. The US features
and elasticity contrast index (ECI) were assessed by
observer 1 and the ECI was reassessed by observer
2. ROC curve analysis was performed to evaluate the
diagnostic performance of ECI. Pearson correlation
coefficient was used to evaluate the interobserver and
intraobserver agreement in the measured ECI values.
RESULTS: Among a total of 176 nodules, 96 nodules
were malignant and 80 nodules were benign. The
mean ECI was significantly higher in malignant
nodules (3.01 ± 1.51) than in benign nodules (1.84
± 1.03) (p<0.001). Sensitivity, specificity, positive
predictive value, and negative predictive value for
predicting malignancy were 95.6%, 63.8%, 68.5%,
and 60.7%, respectively, with ECI cut-of value of 2.14.
The Az value for the ECI was 0.745 (95 CI: 0.6730.816). Pearson correlation coefficients between
two observers were 0.94 (p<0.001), and Pearson
correlation coefficients for intraobserver agreement
were 0.97 (p<0.001) and 0.99 (p<0.001) for observer
1 and 2, respectively. Significant interobserver and
intraobserver agreement was found in thyroid USE.
CONCLUSION: Excellent interobserver and
intraobserver agreement exists in USE using carotid
artery pulsation. USE using carotid artery pulsation
may be helpful in differential diagnosis of thyroid
nodules with reproducible results.
SC 2 THY-2
SC 2 THY-3
SC 2 THY
Thyroid
13:20 - 14:50
GBR 101
13:40 - 13:50
US Elastography Using Carotid Artery Pulsation:
Efficacy and Reproducibility Analysis in
Differential Diagnosis of Thyroid Nodules
Yoon Joo Cho, Eun Ju Ha, Miran Han
Korea
PURPOSE: To prospectively evaluate the diagnostic
performance of ultrasound elastography (USE) using
carotid arterial pulsation in the differential diagnosis
of thyroid nodules, and to determine interobserver
agreement and intraobserver reproducibility of USE.
MATERIALS AND METHODS: This study was
approved by the ethics committee of the institution,
and all patients provided written informed consent.
254
13:50 - 14:00
Shear Wave Velocity: A New Quantitative Index to
Estimate the Status of Thyroid in Diffuse Thyroid
Disease
Linyao Du, Qiao Ji, Xiu-Juan Hou, Xiao-Lei Wang
PURPOSE: The purpose of the present study was to
assess the application value of Virtual touch tissue
quantification (VTQ) in diffuse thyroid diseases
(DTD).
MATERIALS AND METHODS: 30 healthy subjects
and 74 patients with DTD were involved. The thyroid
stiffness, which was expressed by shear wave velocity
Scientific Sessions
(SWV) (m/s) was measured by VTQ and compared
between the patients and healthy people Linear
regression was performed to analyze the relationship
between SWV and thyroid serological indexes.
RESULTS: The mean SWVs of thyroid tissues in DTD
patients and healthy people were 2.56 ± 1.33 m/s and
1.74 ± 0.16 m/s, respectively (P=0.011). There was
no significant difference between the thyroid SWVs
in Graves disease (GD) and Hashimoto’s thyroiditis
(HT) patients (2.14 ± 0.31 m/s vs. 2.72 ± 1.52 m/s,
P=0.168). While the mean SWVs in patients with GD
and HT were both higher than that of the healthy
(P<0.05). Receiver operating characteristic curve
(ROC) of SWV was applied to distinguish DTD and
healthy thyroid. With a cutoff value of 2.02 m/s, the
area under the curve was 0.938. The sensitivity and
specificity were 81.12% and 100.00%, respectively.
Additionally, we found a positive liner correlation
between thyroid SWV and thyroid stimulating
hormone (TSH) in DTD patients (P<0.001).
CONCLUSION: SWV is a good indicator of the
thyroid tissue stiffness, which might be considered
helpful in screening DTD. What’s more, SWV might
have a potential in assessing the thyroid function.
SC 2 THY-4
14:00 - 14:10
PURPOSE: A new commercially available computeraided diagnosis (CAD) system (S-Detect for
Thyroid) has been developed for thyroid US. We
initially performed the clinical assessment of CAD
system for evaluating diagnostic performance of
malignant thyroid nodules and variability of nodule
characteristics on US.
MATERIALS AND METHODS: In this prospective
study, we consecutively enrolled patients with
thyroid nodules with decisive diagnosis whether
benign or malignant, from November 2015
SC 2 THY-5
14:10 - 14:20
Role of Combined Fine-Needle Aspiration
and Core Needle Biopsy Diagnosis in Thyroid
Nodules Diagnosed as Atypia / Follicular Lesion
of Undetermined Significance
Dong Gyu Na1, Ji-Hoon Kim2
1
2
Hospital, Korea
PURPOSE: To determine that combined FNA/
CNB diagnosis reduce the diagnostic surgery and
unnecessary surgery compared with 2 nd FNA or
CNB alone in thyroid nodules diagnosed as atypia/
255
Scientific Sessions
Computer-Aided Diagnosis System for
Diagnosing and Characterization of Thyroid
Nodules on Ultrasound: Initial Clinical
Assessment
Young Jun Choi, Jung Hwan Baek, Hye Sun Park,
Jeong Hyun Lee
Korea
and February 2016. A radiologist reviewed
ultrasonography images characteristics of thyroid
nodules. Another radiologist assessed same thyroid
nodules by mean of CAD system (S-Detect, Samsung
Medison), providing nodule diagnosis whether
benign or malignant and US characteristics. We
compared the diagnostic performance and variability
of US characteristics between radiologist and CAD
system and quality of nodule segmentation of CAD
system.
RESULTS: A total of 102 thyroid nodules from 89
patients were included, 59 (57.8%) were benign and
43 (42.2%) were malignant. Radiologist showed
higher diagnostic performance than CAD system
in terms of specificity and area under the ROC
curve (AUROC) (sensitivity, 88.4% versus 90.7%,
p>.99; specificity, 94.9% versus 74.6%, p=0.002;
AUROC, 0.92 versus 0.83, p=0.021; accuracy, 92.2%
versus 81.4%, respectively). The variability of US
characteristics between radiologist and CAD system
were good agreement for composition, orientation,
echogenicity, and spongiform (kappa=0.659, 0.740,
0.733, and 0.658, respectively), and fair agreement
for margin (kappa=0.239). The successful nodule
segmentation rate of CAD system was 87.3%.
CONCLUSION: Thyroid CAD system showed similar
sensitivity, lower specificity and accuracy compared
with experienced radiologist. Thyroid CAD system
have potential role to diagnose and characterize
thyroid nodule, especially in the screening settings.
KSUM Open 2016
follicular lesion of undetermined significance (AUS/
FLUS).
a total of 228 consecutive nodules in which both
2 nd FNA and CNB were performed among 494
consecutive nodules (≥1 cm) diagnosed as AUS/
FLUS from January 2010 to February 2014. We
compared the estimated rates of diagnostic surgery
and unnecessary surgery with 4 criteria (Bethesda
category 3; category 1, 3; category 3, 4, 5; category
1, 3, 4, 5), and diagnostic sensitivity for malignancy
among 2 nd FNA, CNB, and combined FNA/CNB
diagnoses.
RESULTS: CNB reduced the rate of diagnostic
surgery with criteria 1 or 2 (11% and 18.9% decrease,
P<0.013 and P<0.001, respectively) and unnecessary
surgery with criteria 2 compared with 2nd FNA alone
(P≤0.049). Combined FNA/CNB reduced the rate
of diagnostic surgery with all criteria compared with
2nd FNA (10.1%-31.1% decrease, P<0.001) and CNB
(10.1%-12.3% decrease, P<0.001), and reduced the
rate of unnecessary surgery compared with 2nd FNA
(11%-19.5% decrease, P≤0.001) and CNB (10.4%11.6%, P<0.001). With the Bethesda category 4, 5,
and 6, the sensitivity of combined FNA/CNB and
CNB alone for malignancy was higher than that of
2nd FNA (84.6% and 80.8% versus 53.8%, P=0.001
and 0.039, respectively).
CONCLUSION: Combined FNA/CNB diagnosis
was more effective for reducing diagnostic surgery
and unnecessary surgery compared with CNB
alone as well as 2 nd FNA. Combined diagnosis
with simultaneous FNA/CNB will be an effective
diagnostic tool for nodules diagnosed as AUS/FLUS.
256
SC 2 THY-6
14:20 - 14:30
Fine-Needle Aspiration versus Core-Needle
Biopsy for Diagnosis of Thyroid Malignancy and
Neoplasm: A Matched Cohort Study
Soo-Yeon Kim1, Eun-Kyung Kim2, Hee Jung Moon2,
1
Hospital, Korea
2
Korea
PURPOSE: To compare the diagnostic performances
of fine-needle aspiration (FNA) and core needle
biopsy (CNB) in the diagnosis of thyroid malignancy
and neoplasm in patients who underwent surgery for
thyroid nodules.
study was approved by the Institutional Review
Board, and the need to obtain informed consent was
waived. From July 2013 to April 2015, 3192 patients
(mean age, 44.4 ± 12.3 years; range, 10-87 years)
who underwent FNA (n=3,048) or CNB (n=144) for
diagnosis of thyroid nodules and then proceeded
with surgery were included. Surgical pathologic
diagnosis was the reference standard. Diagnostic
performances of FNA and CNB to predict malignancy
and neoplasm were compared. Propensity score
matching was used to match patients with FNA
with those with CNB because there were significant
differences in nodule characteristics between the
patients with FNA and CNB as well as the overall
number of nodules. Two-sided P values <0.05 were
considered statistically significant.
RESULTS: Before matching, the sensitivity and
accuracy of FNA were significantly higher or
comparable with those of CNB, and the specificity,
negative predictive value, and positive predictive
value were comparable. After matching, the
diagnostic performances were similar, with one
exception of specificity for predicting neoplasm being
higher with CNB than with FNA (100.0% vs. 50.0%,
P=0.046).
CONCLUSION: FNA showed comparable diagnostic
performance with CNB; therefore, there may be
no benefit in performing CNB to diagnose thyroid
malignancy and neoplasm.
Scientific Sessions
SC 2 THY-7
14:30 - 14:40
A Modified Thyroid Imaging Reporting and Data
System (mTI-RADS) for Thyroid Nodules in
Coexisting Hashimotos Thyroiditis
Hang Zhou1, Hui-Xiong Xu2, Wen-Wen Yue2,
Lin-Yao Du1, Jun-Mei Xu2, Bo-Ji Liu2, Xiao-Long Li2,
Dan Wang2
1
2
Department of Radiology, Department of Medical
Ultrasound, Shanghai Tenth Peoples Hospital,
Ultrasound Research and Education Institute, Tongji
University School of Medicine, China
14:40 - 14:50
Suspicious Thyroid Nodules with Benign Results
on Core Needle Biopsy: Malignancy Rate and
Management Strategy
Saerom Chung, Hye Sun Park, Jung Hwan Baek,
Jeong Hyun Lee, Young Jun Choi
Korea
MATERIALS AND METHODS: Between July 2008
and November 2011, 1326 thyroid nodules in 1309
patients were underwent US-guided CNB. Among
them, 166 suspicious thyroid nodules with benign
results on CNB were reviewed retrospectively. Benign
nodules were diagnosed either after surgery, with
benign findings after FNA and/or CNB that had been
repeated at least twice, or after benign pathology
CNB with a stable size at follow-up. The Bethesda
system for reporting thyroid cytopathologic results
was used to assign CNB findings. We evaluated the
diagnostic performance of CNB, and histological
findings for these nodules.
RESULTS: Of the 166 US-pathology discordant
nodules, 9 nodules confirmed as malignancy (5.4%)
and 157 nodules as benign (94.6%). There is no
difference between malignant and benign nodule
in the aspect of age, sex, number of biopsy, and
experience of operator. Among suspicious US
features, spiculated margin, microcalcifications,
and more than two suspicious features are more
commonly seen in malignant nodules (p=0.03).
Histologic analysis of benign CNB specimens
revealed fibrosis (77.6%), thyroiditis (28.7%),
calcification (10.6%), and hemosiderin deposition
(6.4%), in decreasing order.
CONCLUSION: Malignancy rate of US-CNB
discordant thyroid nodules is relatively low.
However, repeated biopsy may be necessary thyroid
nodules with spiculated margin, microcalcifications,
or more than two suspicious features on US.
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Scientific Sessions
PURPOSE: To develop a conventional ultrasound
(US) modified Thyroid Imaging Reporting and Data
System (mTI-RADS) to stratify the malignancy
risk of thyroid nodules in coexisting Hashimoto’s
thyroiditis (HT).
MATERIALS AND METHODS: The study included
138 malignant and 292 benign thyroid nodules
which had undergone US before cytological or
histopathological confirmation. The risk score (RS)
for each significant US feature was estimated by
multiplying corresponding regression coefficient, and
the score of malignancy for each nodule was defined
as the sum of these individual scores. The mTIRADS was determined according to total RS into five
categories (3, 4a, 4b, 4c, 5).
RESULTS: Marked hypoechogenicity, taller-than-wide
shape, poorly-defined margin, microcalcification or
macrocalcification and absence of halo sign were
statistically significant (all p<0.05) US features in
prediction of thyroid malignancy. The RS for each
nodule was defined as follows: RS=2.1 (if marked
hypoechogenicity) + 1.2 x (if taller-than-wide shape)
+ 1.7 x (if absence of halo sign) + 0.6 x (if poorlydefinedmargin) + 1.2 x (if microcalcification or
macrocalcification). The malignancy rates in TIRADS 3, 4a, 4b, 4c, 5 were 3.7%, 19.3%, 38.1%, 62.7%
and 94.1%, respectively, with significant differences
among different categories (P<0.001)
CONCLUSION: The mTI-RADS category may be
useful in decision-making management of thyroid
nodules in HT patients
SC 2 THY-8
KSUM Open 2016
SS 6 ABD
Abdomen
13:20 - 14:50
GBR 103
Chairpersons:
Yong Moon Shin Asan Medical Center, Korea
Mi-Suk Park Yonsei University College of Medicine,
Korea
SS 6 ABD-1
13:20 - 13:30
Dynamic Contrast-Enhanced Ultrasound of
Gastric Cancer: Correlation with Perfusion CT
Parameters - Preliminary Results
Ijin Joo, Se Hyung Kim, Jae Young Lee,
Joon Koo Han
Hospital, Korea
PURPOSE: To investigate the relationship between
quantitative parameters from dynamic contrastenhanced ultrasound (CEUS) and perfusion CT (PCT)
of gastric cancers.
MATERIALS AND METHODS: This prospective
preliminary study was approved by our institutional
review board. Ten patients with pathologically
proven gastric cancers underwent CEUS using
Sonovue and PCT studies on the same day. The CEUS
parameters (peak enhancement, total area under the
time-intensity curve (AUCTOTAL), wash-in rate (WiR),
AUC during wash-in, washout rate (WoR), AUC
during washout, time to peak (TTPUS), mean transit
time (MTTUS)) and PCT parameters (blood flow (BF),
blood volume (BV), TTP CT, MTT CT, permeability
(PMB)) were measured. The relationships between
CEUS parameters and PCT parameters were
evaluated using the Pearson’s correlation analyses. In
addition, CEUS and PCT parameters were compared
between histologic subtypes of gastric cancers using
the Student t-test.
RESULTS: Among CEUS and PCT parameters
of gastric cancers, there were significant positive
correlations between MTT US and MTT CT ; and
MTT US and BF (r=0.678, P=0.031; and r=0.756,
P=0.011, respectively), and a significant negative
correlation between TTPUS and MTTCT (r=-0.767,
P=0.010). There was significant difference in PMB
between poorly cohesive carcinoma (n=5) and other
258
histological types of adenocarcinoma (n=4) (39.1 ±
12.5 vs. 19.4 ± 3.9 mL/100 mL/min, respectively;
P=0.012). However, none of CEUS parameters
showed significant differences between histologic
subtypes (P>0.05).
CONCLUSION: Our preliminary results may suggest
that CEUS has potential to be an alternative tool
for PCT in the quantitative assessment of perfusion
information of gastric cancers.
SS 6 ABD-2
13:30 - 13:40
Visibility of Hepatic Focal Lesion: Agreement
between Kupffer Phase Images of SonazoidEnhanced Ultrasound and Hepatobiliary Phase
Images of Gadoxetic Acid-enhanced MRI
Woo-Young Yang, Hee Sun Park, Young Jun Kim,
Mi Hye Yu, Sung Il Jung, Hae Jeong Jeon
Center, Korea
PURPOSE: To evaluate the agreement between
Kupffer phase images of Sonazoid-enhanced
ultrasound and hepatobiliary phase images of
gadoxetic acid-enhanced MRI in the visibility
assessment of hepatic focal lesions.
MATERIALS AND METHODS: Ninety nine hepatic
focal lesions in 99 patients who underwent both
Sonazoid-enhanced ultrasound and gadoxetic
acid enhanced liver MRI were included in this
retrospective study. Visibility of hepatic focal
lesions on Kupffer phase images of Sonazoidenhanced ultrasound were graded as 0 (invisible),
1(vaguely visible), and 2 (clearly visible), while
that on hepatobiliary phase images of gadoxetic
acid-enhanced MRI was graded as -1 [high signal
intensity (SI)], 0 (iso SI), 1(weak low SI), and 2
(strong low SI). Agreement between both imaging
methods in the visibility assessment of hepatic focal
lesions was done using kappa statistics.
RESULTS: On Kupffer phase imaging, 26 (26.3%)
lesions were invisible, 8 (8.1%) were vaguely visible,
and 65 (65.7%) were clearly visible. On hepatobiliary
phase of MR imaging, 5 (5.1%) lesions showed high
SI, 3 (3.0%) showed iso SI, 30 (30.3%) showed
weak low SI, and 61 (61.6%) showed strong low SI.
Regarding the visibility, 74.7% (74/99) of the lesions
Scientific Sessions
showed agreement on Kupffer phase images and
hepatobiliary phase MR images. Twenty (20.2%)
lesions showing low SI on MR images were invisible
on Kupffer phase images. On the other hand, only
one lesion showing iso SI on MR was clearly visible
on Kupffer phase image. Overall inter-modality
agreement regarding the lesion visibility was fair
(weighted k=0.212)
CONCLUSION: The visibility of hepatic focal lesion
showed discrepancy in approximately 25% between
the Kupffer phase images of Sonazoid-enhanced
ultrasound and hepatobiliary phase images of
gadoxetic acid-enhanced MRI.
SS 6 ABD-3
13:40 - 13:50
Pulsed High-Intensity Focused Ultrasound
(HIFU) Treatment in The Pancreas: Preclinical
Evaluation for the Safety and Feasibility in Swine
Model
Won Chang, Jae Young Lee, Joon Koo Han,
Jae Seok Bae, Yeon Jin Cho, Jae Hwan Lee
Hospital, Korea
SS 6 ABD-4
13:50 - 14:00
A Questionnaire Study Assessing Quality of
Physicians who Perform Ultrasound Examination
for National HCC Surveillance in Korea
Moon Hyung Choi1, Seung Eun Jung1, Yeol Kim2
1
2
Department of Family Medicine, National Cancer
Center, Korea
PURPOSE: The purposes of this study was to survey
knowledge of ultrasound, experience and specialty
of doctors who could not meet the pass criteria of
quality assurance in the National Cancer Surveillance
Program (NCSP) for hepatocellular carcinoma (HCC)
in Korea and to develop more effective educational
program to enhance the effect of NCSP.
MATERIALS AND METHODS: Korean Society of
Radiology (KSR) carried out six times of hands-on
workshop for education of physicians who perform
ultrasound examination in 2015. A questionnaire,
consisting of 24 questions in multiple choice format
was distributed to 233 participants in hands-on
workshop. The participants were asked about basic
information of institutes, ultrasound equipments,
techniques and educated levels of ultrasound
examination, and knowledge about standard clinical
259
Scientific Sessions
PURPOSE: The aim of this study was to evaluate the
safety and feasibility of the new ultrasonographyguided HIFU (USg-HIFU) system (ALPIUS 900) for
treatment of the pancreas in a swine model.
MATERIALS AND METHODS: An animal study
was performed in seven swine by ablating in vivo
pancreas. To check the feasibility of HIFU for the
pancreas, first swine was euthanized just after the
treatment using acoustic intensity of 1.5 kW/cm2. In
other six animals, ablations were performed using
different acoustic intensities of 1.5 (n=3, Group 1) or
1.2 kW/cm2(n=3, Group 2), MRI study and necropsy
were performed 7 days following treatment. Blood
amylase and lipase levels were measured on days
0 and 7, performance status were observed every
day, and a necropsy was performed to assess for
unintended injury and obtain pancreatic tissue for
histological analysis.
RESULTS: All animals showed no evidence
of complications in laboratory tests or status
observation. In one case treated with acoustic
intensity of 1.5 kw/cm2, pseudocyst was noted at the
treatment site on MRI and necropsy. But, no thermal
injury to the abdominal skin, muscles or intestines
were observed.
All pathologic specimen showed coagulation necrosis
for the treated area. The areas of the ablation
were 76.1 and 29.0 mm2 in Group 1 and Group 2,
respectively and significantly larger in the Group
1(p=0.019). In five among six animals (2 and 3 in
Group 1 and 2, respectively), treated lesions were
noted on enhanced T1 weighted images of MRI. And
treated lesions were larger on MRI compared with
pathologic specimen (p=0.034, 87.3 and 40.6 mm2,
respectively).
CONCLUSION: This study showed that pancreas
ablation using new USg-HIFU system is safe and
feasible in a swine model. And coagulation necrosis
of the pancreas was successfully achieved in two
different acoustic intensities.
KSUM Open 2016
images determined by KSR.
RESULTS: A total of 187 responses were received.
Sixty-one percent of participants were older than
46 years old and 81% of them work in clinics. Fiftytwo percent of the machines that they used were
manufactured within the last five years, whereas 12
percent of the machines were manufactured over ten
years ago. Most of them had been educated about
liver ultrasound and more than half of them did not
know e-learning of liver ultrasound. They wanted to
learn about ultrasound, but they did not have enough
chance and time for learning. As they could perform
ultrasound by themselves, hands-on education was
thought to be helpful to enhance ultrasound skill.
Regarding knowledge of standard clinical images of
liver ultrasound, only 22% of participants know them
exactly.
CONCLUSION: Ultrasound examinations for HCC
surveillance are performed by many doctors who
don’t have enough skill and experience of ultrasound
examination for the liver and it may result in low
sensitivity of NCSP for HCC in Korea. More effort to
enhance skill of ultrasound is necessary in future.
and subsequently surgery for cholangiocarcinoma
suspicious lesions.
RESULTS: At present of 4 years surveillance period,
there are 7 and 6 cases of premalignant lesions
proved cases of Bil-IN and IPNB respectively. US
finding of Bil-IN includes focal bile duct narrowing
without mass, cystic dilatation peripheral bile duct
and focal bile duct obstruction associated with
parasitic egg or cell debris. IPNB presents as focal bile
duct dilatation without cause of obstruction, complex
cystic lesion with demonstrable connection to biliary
system or intraductal nodule which all of them are
hyperechogenic. The echogenic nodule from IPNB
may present at tubular-shaped due to bile ductal
alignment.
CONCLUSION: US findings of premalignant
lesions of cholangiocarcinoma varies and majority
non-specific. Understanding disease spectrum of
premalignant cholangiocarcinoma lesions on US may
help improve early detection.
SS 6 ABD-6
14:10 - 14:20
Ultrasonographic Appearance of Early
Cholangiocarcinoma
Surachate Siripongsakun, Sirachat Vidhyarkorn
Department of Radiology, Chulabhorn Hospital,
Thailand
Prevalence and Clinical Significance of
Tumefactive Gallbladder Sludge
Tae Wook Kang1, Mimi Kim1, Seong Hyun Kim1,
Dong Hyun Sinn2, Young Kon Kim1, Seung Soo Kim1
1
Korea
2
Department of Internal Medicine-G-I / Hepatology,
Samsung Medical Center, Korea
PURPOSE: To study spectrum of sonographic
findings of cholangiocarcinoma premalignant lesions
including Biliary Intraepithelial Neoplasm (Bil-IN)
and Intraductal Papillary Neoplasm of Biliary tract
(IPNB).
MATERIALS AND METHODS: Ultrasonography
(US) finding of the pathologic proved Bil-IN and
IPNB are collected and analyzed from our ongoing
cohort of cholangiocarcinoma surveillance program
at Ban-Luang districted, Nan province, Northern
Thailand, which involves 4,200 populations who
are age between 30-60 in Ban Luang district. Liver
ultrasonography is performed every 6 months for
cancer detection and the patient with abnormal
finding will be sent for CT/MRI/MRCP studies
PURPOSE: There have been no clinical guidelines
how to manage patients with tumefactive sludge seen
on ultrasonography (US) appropriately and no study
regarding the rate of malignancy in patients with
tumefactive sludge. We evaluated the prevalence
of tumefactive sludge of the gallbladder found by
US and whether any differences on demographics
and US findings between benign and malignant
tumefactive sludge.
MATERIALS AND METHODS: The institutional
review board approved this retrospective study.
The study population comprised gallbladder sludge
cohort (n=6,898) drawn from all adults (n=115, 178)
who underwent abdominal US between March, 2001
and March, 2015. Among them, tumefactive sludge
SS 6 ABD-5
260
14:00 - 14:10
Scientific Sessions
was identified according to following US findings:
a) non-movable mass like lesion, and b) absence of
posterior acoustic shadowing on B-mode US and
vascularity on color Doppler US. Follow-up was done
to reveal either true sludge or gallbladder cancer.
Risk factors of malignant tumefactive sludge based
on demographics and US findings were identified by
multivariate logistic regression analysis.
RESULTS: The prevalence of tumefactive sludge was
2.0% (135/6898) among patient with gallbladder
sludge. 28 patients (20.7%) were loss to follow-up.
Of 107 patients with tumefactive sludge, 15 patients
(14.0%) were confirmed as malignant tumefactive
sludge. Significant risk factors for malignant
tumefactive sludge included female gender
(Odds ratio [OR], 8.33; p<0.026) and absence of
hyperechoic spots within sludge (OR, 11.11; p<0.015)
on multivariate analysis.
CONCLUSION: Although tumefactive sludge
on US was rare, considerable its proportion was
malignancy. Thus, caution with follow-up should
be needed in patients with tumefactive sludge,
especially female gender and absence of hyperechoic
spots on US.
SS 6 ABD-7
14:20 - 14:30
Safety of Percutaneous Biopsy for Hepatic
Angiosarcoma: Results of a Multicenter Korean
Survey
Jeong Ah Hwang, Tae Wook Kang, Min Woo Lee
Korea
SS 6 ABD-8
14:30 - 14:40
Evaluation of Hepatic Steatosis Using Acoustic
Structure Quantification of Ultrasound in Rat
Model: Comparison with Pathology and MR
Spectroscopy
Dong Ho Lee, Jae Young Lee
Hospital, Korea
PURPOSE: To evaluate whether Acoustic structure
quantification (ASQ) technique can assess the
degree of hepatic steatosis in rat animal model using
histopathology and MR spectroscopy as reference of
standard
MATERIALS AND METHODS: Hepatic steatosis
was induced in rats by using a methionine/cholinedeficient diet for 0-6 weeks (0 weeks as a control, 0.5,
1, 2, 3, 4, 5, 6 weeks, n=4 per group). At the end of
the diet period, 1H-MR spectroscopy of the liver was
done for assessment of fatty liver degree using 3T
MR unit with micro-coil fit for rat (Trio Tim, Siemens
healthcare). ASQ measurement of the liver was also
performed by using US (Aplio XG, Toshiba medical
solution). After imaging study, rat was immediately
sacrificed and liver was excised for histopathological
examination using hematoxylin and eosin staining as
well as masson’s trichrome staining.
261
Scientific Sessions
PURPOSE: To evaluate the incidence of severe
bleeding and mortality associated with percutaneous
biopsy for hepatic angiosarcoma using a multicenter
retrospective cohort.
MATERIALS AND METHODS: A retrospective
review of 33 patients with biopsy-proven hepatic
angiosarcoma (29 male; median age, 57 yr, age
range, 24- 96 yr) was performed at 7 tertiary
academic hospitals between January 1998 and March
2015. The mean maximum tumor size was 5.5 cm
(range, 1.7-20 cm). An 18-gauge automated cutting
biopsy needle was used with a free hand technique
in all patients who underwent ultrasonography-
guided percutaneous core needle biopsy on an
inpatient basis. The incidence of severe bleeding and
procedure-related mortality according to the SIR
guidelines was evaluated.
RESULTS: The mean number of needle passes
during the procedure was 2.8 per patient (range,
1-6). The overall incidence of severe bleeding events
was 9.1% (3/33, SIR grade C or D). Two patients
were managed with blood transfusion and one
patient underwent embolization for bleeding control.
Other major complications were not encountered.
There were no cases of mortality associated with the
biopsy.
CONCLUSION: Severe bleeding was not a frequent
complication after percutaneous biopsy for
hepatic angiosarcoma. The majority of bleeding
complications could be controlled with conservative
management.
KSUM Open 2016
RESULTS: During MCD diet periods, hepatic
steatosis significantly increased on both 1H-MR
spectroscopy and histopathology (P<0.001). Focal
disturbance (FD) ratio measured by ASQ technique
had a strong negative linear correlation with hepatic
fat fraction measured with 1H-MR spectroscopy
(Spearman rho, -0.903, P<0.001). There was also
strong linear correlation between FD ratio and
degree of steatosis on histopathology (P<0.001).
CONCLUSION: Quantitative assessment of hepatic
steatosis by using ASQ technique could be possible;
as FD ratio measured using ASQ showed a strong
linear correlation with both hepatic fat fractions
obtained from 1H-MR spectroscopy and degree of
steatosis on histopathology.
SS 6 ABD-9
14:40 - 14:50
Enhanced Chemotherapy Combined with
Focused Ultrasound for Pancreatic Cancer:
In Vivo Animal Study
Eun-Joo Park1, Yun Deok Ahn2, Yuri Cheon2,
Jae Young Lee1
1
Hospital, Korea
2
weekly treatments and one week monitoring.
RESULTS: Tumor growth rate of animals treated
with FUS-only was lower than the rate of control
group while it was higher than GEM-only group.
Animals treated with GEM+FUS showed reduction of
tumor growth after two treatments. In GEM+FUS#2
group, tumor size reduced until fifth week after the
treatment procedure was completed. Additional
study, for both treatment groups, tumor size
reduced during the weekly treatments in each cycle
and increased again during the monitoring period.
Tumor in both groups showed similar growth pattern
for each treatment cycle. However, the re-growth
rate of tumor in GEM+FUS#2 group was lower than
GEM-only group. Especially, three out of 10 mouse
in GEM+FUS#2 group showed complete response
(CR).
CONCLUSION: From this study, it has been shown
that mechanical effects of FUS might enhance
therapeutic effects of chemotherapy. Additionally,
the results of repeated treatment show the potential
as a new treatment protocol for pancreatic cancer in
clinic.
PURPOSE: As the effects of focused ultrasound (FUS)
in anti-cancer drug delivery are widely studied, there
is growing interests in the mechanism of how FUS
enhances therapeutic effects of chemo-drug. In vivo
studies using animal cancer model was designed
to investigate whether non-thermal effect of FUS
more effectively enhances the chemo-treatment as a
potential treatment protocol for pancreatic cancer.
MATERIALS AND METHODS: Two steps of
experiments were performed using animals were
inoculated with CFPAC-1 as the pancreatic xenograft
model. For the first step experiments, animals were
treated in six groups: control, gemcitabine (GEM)only, FUS#1-only, FUS#2-only, GEM+FUS#1, and
GEM+FUS#2. Weekly treatments were performed
for three weeks and post-treatment monitoring was
followed for five weeks. In the second step, animals
in GEM-only and GEM+FUS#2 groups were treated
for four treatment cycles which consisted of three
262
Abdomen
SE 001
Ethanol Lavage of Large Hepatic Cysts by EUS
Guidance and a Percutaneous Approach
Sun-Ho Lee, Dong-Wan Seo, Dongwook Oh,
Tae Jun Song, Do Hyun Park, Sang Soo Lee,
Sung Koo Lee, Myung-Hwan Kim
Department of Internal Medicine-G-I/Hepatology,
Asan Medical Center, Korea
Shear Wave Elastography with a Propagation
Map in Chronic Hepatitis
Eun Sun Lee, Jong Beum Lee, Hwi Ryong Park,
Jeongin Yoo, Ji In Choi, Hyun Jung Park,
Sung Bin Park, Byung Ihn Choi
Hospital, Korea
PURPOSE: To identify diagnostic performance of
liver stiffness (LS) values assessed by means of shear
wave elastography (SWE) with a propagation map
for predicting stages of liver fibrosis, considering
transient elastography (TE) as the standard of
reference. In addition, we evaluated interobserver
correlation of LS values between two operators, an
experienced radiologist and a 3 rd year radiologic
resident.
MATERIALS AND METHODS: Our prospective study
included 100 consecutive patients with suspicious or
alleged chronic hepatitis. On the same day, patients
underwent SWE by two difference operators, and
TE by sonographers. In order to increase reliability,
we only accepted measurements showing clear
and regular propagation wave, provided by our
ultrasound machine. All operators in this study
were blinded to the opponent’s SWE and TE results.
We assessed the interobserver correlation using
interclass correlation test. The presence of significant
correlation between LS values by SWE and TE were
evaluated with Rank correlation test. In addition, we
found out the best cut-off for detecting significant
hepatic fibrosis by SWE with receiver-operating
curve analysis.
RESULTS: The correlation coefficient of interclass
correlation test between an experienced radiologist
and a resident was 0.911. There was a significant
correlation between LS values by SWE and TE
(p<0.0001, r=0.507). The best LS cut-off value
predicting significant hepatic fibrosis (F≥2) by
SWE was >1.98 m/s (AUROC=0.777) with 71.4% of
sensitivity and 75.0% of specificity.
CONCLUSION: Shear wave elastography with a
propagation is a reliable method for predicting
hepatic fibrosis regardless the operator’s skillfulness
using TE as the standard of reference.
263
PURPOSE: To evaluate the utility of ethanol
lavage treatment by using EUS-guidance and or
percutaneous approach.
MATERIALS AND METHODS: During the period of
April, 2009 to July, 2015, a total of 38 patients (M:F
= 5:33) with 48 cysts from the Asan Medical Center
were enrolled. Mean age was 65.37 ± 9.02. By the
percutaneous approach, 22 patients with 26 cysts
were treated. With EUS guidance, 13 patients with
17 cysts were treated. The other 3 patients with 5
cysts were treated with both percutaneous and EUS
guidance.
RESULTS: Median cyst volume before ethanol
therapy was 461.78 mL. During the median follow
up of 17.91 months of the percutaneous approach
group, 26 cysts showed 99.9% reduction. During
the median follow up of 24.85 months of the EUS
guidance group, 17 cysts showed 94.3% reduction.
The group which used both methods had a follow
up term of 21.67 months and 5 cysts showed nearly
100% reduction. Percutaneous catheter drainage was
feasible for cysts on both sides of the liver, especially
on the right, whereas EUS guided drainage was
feasible for cysts on the left side.
CONCLUSION: Percutaneous catheter guided
and EUS-guided ethanol lavage therapy had good
radiologic responses and both had great efficacy.
Owing to the high efficacy with low adverse events,
both of these methods could be the treatment of
choice to replace surgical treatment of large hepatic
cysts.
SE 002
KSUM Open 2016
SE 003
Lymphoma of Abdomen+
Thuy Tran Thi Bich
Department of Radiology, Ultrasound, Vietnam
PURPOSE: This is a case report. We learn ultrasonographic images of two lymphoma tumors
which are inside a 27-year-old man. How can we
distinguish between lymphoma tumors and GIST
(gastrointestinal stromal tumor) or neuromas.
MATERIALS AND METHODS: We used ultrasound
and computed tomography machines. We analyzed
features of images. The results of pathology
confirmed the final diagnosis.
RESULTS: Ultrasonographic images of lymphoma
tumors in this patent are hypoechogenic, homogeneous and hypovascular. Images of GIST show
hypervascular, inhomogeneous, sticking surrounded
organs. Both Gist and neuroma are more echogenic
than Lymphoma. Neuroma may often be seen in
retroperitoneal space. They are also different in
tomography.
CONCLUSION: We learn from this case report.
There are some specific features in ultrasound
images which are useful for diagnosing Lymphoma
and distinguish from other tumors
SE 004
Common Template Format Protocols for FAST
Department of Radiology, AL Qassimi Hospital
Ministry of Health, United Arab Emirates
PURPOSE: This Study was intended to simplify the
Reporting Format of FAST (Focused Abdominal
Sonography in Trauma) Ultrasounds so that all
the Sonographers, Radiologists, Sonographers
and Emergency Physicians use the same reporting
Template in reporting FAST. This will minimize the
misunderstandings while interpreting the report and
help in Objective Assessment during Follow up.
MATERIALS AND METHODS: All FAST scans
in our hospital are done either by Radiologists,
Emergency physicians or Surgeons depending on the
availability and situation. All of them (approximately
75) were given instructions and reporting format
264
with predetermined Templates so that they update
it after the study and record it in the HIS system. All
the data was analyzed after 2 months, then reviewed
and assessed with Objective parameters.
RESULTS: Making a common Template format helps
in Objective assessment of the Reports and avoids
the subjective errors in the FAST. Any findings out
of the reporting Template Format was included in
the Remarks session so that the findings are missed.
Hence on analysis and assessment the Common
Reporting Template Format was found to be more
effective while interpreting the report and while
following up the patient.
CONCLUSION: Common Reporting Template
Format for FAST Ultrasound increases the efficacy of
Interpretation of the Reports and helps in Objective
assessment during follow up of the Trauma cases.
SE 005
The Result of a Study of Ultrasound Findings on
Cholelithiasis Associated with Cholangitis
Undral Shinekhuu1, Badamsed Tserendorj2
1
Department of Radiology, Mongolian National
University of Health Sciences, Mongolia
2
Department of Radiology, Institute of Medical
Sciences, Mongolia
PURPOSE: To determine the ultrasound findings on
cholelithiasis associated with cholangitis.
MATERIALS AND METHODS: We evaluated
the ultrasound findings of the 30 patients, who
are diagnosed with cholelithiasis associated with
cholangitis at Ultrasound Section of Department of
Radiology of Third Central Hospital named after P.N.
Shastin, Ulaanbaatar, Mongolia between years of
2013 to 2015.
RESULTS: When we evaluated the ultrasound
findings 50.0% of the patients gallbladder were
removed by surgery, in 40.0% gallbladder was
enlarged, in 66.7% wall of the gallbladder was
thickened, in 100% common bile duct was dilated, in
33.3% common bile duct stone had a shadow without
echogenicity, in 43.3% common bile duct stone had
no shadow or echogenicity, in 23.3% no stone was
detected in common bile duct, in 36.7% common bile
duct wall was irregular, in 86.7% extrahepatic ducts
were dilated.
CONCLUSION: The findings of biliary sludge,
dilatation of common bile duct, presence of common
bile duct stone without echogenicity or shadow were
dominantly detected.
SE 006
Research in Ultrasound Symptoms of Fatty Liver
and Hepatic Steatosis
Delgermaa Batsuuri, Badamsed Tserendorj
University of Medical Sciences, Mongolia
Role of Ultrasonography in Evaluation of
Obstructive Jaundice
Prakash Sharma, Subita Lalchan,
Prabhat Kumar Tiwari
Department of Radiology, Manipal Teaching Hospital,
Nepal
OBJECTIVE: To evaluate the diagnostic accuracy of
Ultrasonography in assessing the level and cause of
obstruction in patients with obstructive jaundice
MATERIALS AND METHODS: 45 patients with
clinical and laboratory features of biliary obstruction
were included for statistical analysis. All these
patients were evaluated with ultrasonography (USG).
The levels of biliary obstruction were grouped
as hilar, suprapancreatic and intra-pancreatic.
Similarly, the probable causes were grouped
as malignant or benign. Findings of USG were
corroborated with cholangiographic, per-operative
and/or histopathological findings (FNAC/Biopsy).
RESULTS: Most of the patients were in the age group
of 61-80 years. There were 24 females (53%) and
21 males (47%). Accuracy of USG in identification
of hilar, suprapancreatic and intrapancreatic
level of obstruction was 95.5%, 88.8% and 86.6%
respectively. Sensitivity and Specificity of USG
in identifying the hilar level of obstruction was
91.6% and 93.9% respectively. Similarly, sensitivity
of USG in identifying the supra-pancreatic level
of obstruction was 88.88% and specificity was
88.88%. At the intrapancreatic level sensitivity was
83.33% and specificity was 90.47%. Benign causes
were seen in 53% and malignant causes in 47% of
patients. Accuracy rate of USG in identifying the
cause of obstruction was 82.2%.Choledocholithiasis
was the commonest cause for obstruction seen in
48.4% of patients. Carcinoma head of pancreas
and cholangiocarcinoma were common malignant
causes of obstruction (13.3%). Sensitivity of USG in
detecting malignant biliary obstruction was 80.95%
and specificity was 83.33%.
CONCLUSION: Overall accuracy, sensitivity and
specificity of USG in identification of hilar level of
obstruction were higher than suprapancreatic and
intrapancreatic level
265
PURPOSE: The purpose of this research was to
analyze ultrasound symptoms of patient with fatty
liver and hepatic steatosis.
MATERIALS AND METHODS: The ultrasound
symptoms of total 58 patients of which 24 patients
with fatty liver, 34 patients with hepatic steatosis was
analyzed and the patient history cards were recorded
at the Ultrasound division, Radiology Department of
the 3rd National Hospital of Mongolia, Shastin, P.H.
from 2013 to 2015.
RESULTS: From the fattening symptoms of liver
such as enlarging liver (P<0.01), increased density
of liver (P<0.05), distraction in similarities of liver
structure (P<0.01), unidentified boundaries of liver
(P<0.05), angle of liver was rounded, especially
angle of the left lobe (P<0.01) were probable to
be statistically true. From the hepatic steatosis
symptoms of liver, enlarging liver (P<0.01), evenly
decreased density of liver (P<0.001), similarities
in structure of liver (P<0.001), angle of liver was
rounded, especially angle of the left lobe (P<0.01),
widened inferior cava vein (P<0.001), normal size of
spleen (P<0.001) these ultrasound symptoms were
also probable to be statistically true.
CONCLUSION: When fattening occurs in the liver,
similar structure was distracted, density increased,
boundaries were undefined but even and when there
is hepatic steatosis, the density of liver was decreased
evenly, inferior vein cava was widened, and such
symptoms are identified to be differentiated from
some common diseases of liver.
SE 007
KSUM Open 2016
SE 008
Clinical Applications for Ultrasound Fusion
Imaging of the Liver
Jia Ren Perry Liew, Yan Rong Yong, Charlyn Chee,
Yan Ne Ong, Wey Chyi Teoh
Singapore
LEARNING OBJECTIVES: To demonstrate
the various clinical scenarios in which real-time
ultrasound fusion technology for liver imaging has
been applied in our institution practice.
BACKGROUND: Ultrasound has excellent temporal
resolution, providing real time feedback as the
patient is being imaged. However, ultrasound
is highly operator dependent and lacks the wide
anatomical perspective that computed tomography
(CT) and magnetic resonance imaging (MRI)
can convey. Fusion is performed by using a local
magnetic field, a position sensor mounted on the
ultrasound probe and a co-registration software.
The commonly used method is to match anatomical
structures identified on ultrasound with its CT/
MRI counterpart. Once registered, simultaneous
and accurate display of both ultrasound and its
counterpart CT/MR images can be appreciated in a
real time setting.
FINDINGS: In our institution, we routinely perform
ultrasound fusion for these indications:
i) To determine if an ultrasound detected lesion
corresponds with a significant CT/MR finding.
ii) To re-look and attempt to match a significant CT/
MRI finding on ultrasound.
iii) For interventional guidance, particularly for
ablation treatment.
A case series is shown to demonstrate these
applications.
CONCLUSION: While fusion technology has been
around for some time, there is now increased
acceptance as further developments have translated
to improved image quality, faster application and
easier usability; making it practical for routine
practice. Advantages of this technology include
increased accuracy of imaged guided interventions,
better characterization and localization of lesions
which are otherwise previously poorly seen or
indeterminate on a single modality. This confers a
266
potential for earlier diagnosis and treatment.
SE 009
Setting Ultrasound Diagnostic Criteria for
Pancreatic Cancer
Buyandelger Bayansan, Badamsed Tserendorj
Department of Radiology, Mongolian Radiological
Society, Mongolia
PURPOSE: Research objectives are to set ultrasound
diagnostic criteria for pancreatic cancer.
MATERIALS AND METHODS: In 2013-2015, we
had processed survey cards and evaluated them
for ultrasound findings of 35 patients diagnosed by
pancreas cancer in Ultrasound Cabinet of Radiology
Department in State Central Hospital No.3 named
after Shastin.
RESULTS: By considering ultrasound findings
of pancreatic cancer, the following ultrasound
findings could be statistical true probability: in
74.4% of the ultrasound findings cancer is in head
and body of pancreas (P<0.001), in 60.0% of them
irregular shaped cancer (P<0.01), and cancer density
decreased (P<0.05), in 80.0% of them cancer
size more than 2.1 cm (P<0.001), in 68% of them
irregular margin of cancer (P<0.01), in 65.7% of
them bile duct enlargement (P<0.05), in 57.1% of
them gallbladder enlargement (P<0.05).
CONCUSION: It is determined that the following
findings are criteria to diagnose or to differential
diagnose pancreatic cancers: location, shape, size,
margin, structure and density of focal or mass of
pancreatic cancer; inner or external hepatic ducts
enlargement; pancreatic duct enlargement and
lymph nodes changes of abdominal vein or aorta.
SE 010
Ultrasound Guided Procedures: PCD, PTBC,
Central Line and Chemoport; 584 Patients
Virasack Rajpho1, Darehyun Hwang2
1
Science, University of Health Science, University of
Lao PDR, Lao People's Democratic Republic
2
Department of Intervention, Dongtan Sacred Heart
Hospital, Korea
BACKGROUND: 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.
MATERIALS AND METHODS: We evaluated 584
patients (age mean 61.14, range 1-88 years, M:F
=365: 219) who underwent ultrasonography-guided
procedures between January 2007 and December
2012. The procedures are PCD (n=257), PTBD
(n=210), central line (n=88), and chemoport (n=29).
RESULTS: The procedural initial success rate
was 99%. Puncture 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 punctured another
site. Actually, secondary success rate was 100%
CONCUSION: Ultrasound guided procedures: PCD,
PTBD, Central line and chemoport are very safe
and high success rate. Ultrasound is very useful
and important tool for interventional procedures;
PCD,PTBD, central line and chemoport
2. To understand the technical advances such as
automatic fusion imaging.
3. Overview of clinical applications of fusion imaging
for liver tumors and in depth review of the
scientific evidence of usefulness of fusion imaging.
Many authors reported the feasibility and
performance of this updated techniques and
technical improvements for more precise and easier
fusion are under development. In this presentation,
we will review basic principles of fusion imaging
and describe updated techniques such as automatic
fusion. We will review the clinical applications
of fusion imaging, especially for interventional
procedures for hepatic tumors, and the scientific
evidences for the benefits of fusion imaging will also
be evaluated.
IMAGING FINDINGS OR PROCEDURE DETAILS:
1. Basic principles of fusion imaging
2. Updated techniques for fusion imaging
3. Clinical applications of fusion imaging
Fusion imaging of US and CT/MRI can enable
physicians to perform more accurate and easy
percutaneous procedures for hepatic tumors with
confidence. Technical advances such as automatic
fusion can enhance the usefulness and availability of
this novel tool.
SE 012
1. To review the basics of fusion imaging of US and
MRI.
THE PURPOSE OF THIS EXHIBIT IS:
To understand basic concept and physics of wireless
mobile hand-held ultrasound (MHHUS) system.
To understand importance of Point-of-Care (PoC)
ultrasonography in acute care medicine.
To understand the feasibility of PoC ultrasonography
and its education for beginner using wireless
MHHUS device.
To learn possibility of visual stethoscope: Can
Ultrasound Fusion Imaging with MRI: Technical
Advances and Clinical Applications
Moon Hyung Choi, Joon-Il Choi, Michael Yong Park,
Soon Nam Oh, Sung Eun Rha, Seung Eun Jung,
Jae Young Byun
267
SE 011
Application of Wireless Mobile HandHeld Ultrasound System in Point-of Care
Ultrasonography and Its Education
Jeong-Won Ryu2
1
Department of Radiology, Dongtan Sacred Heart
Hospital, Korea
2
KSUM Open 2016
wireless MHHUS device replace stethoscope as a
tool of primary medical care in resource-limited
areas(countries).
INTRODUCTION: Difference of previous portable
ultrasound system and MHHUS system
Definition of Point-of-Care (PoC) sonography
Usefulness of wireless MHHUS system in PoC
ultrasonography
Application of wireless MHHUS system in PoC US
and its education
Education of stethoscope in medical college
New era of medical education program: Visual
stethoscope
The major teaching points of this exhibit are:
Importance of PoC ultrasonography
Usefulness of wireless MHHUS device as a strong
tool of PoC US
Application of wireless MHHUS system in PoC US
and its education
The earlier the better: why early introduction in
education is more important than ever
SE 013
A Randomized Controlled Trial of Comparison
on Ultrasonography Evaluation of Pancreas
According to Patient Position: Supine versus
Sitting
Seung-Hwa Lee, Dong-Hwan Kim, Eun-Seong Seo
Department of Center for Health Promotion, SeoHae
Hospital, Korea
BACKGROUND: Abdominal Ultrasonography
(USG) is one of the useful tools to examine abdomen
organs such as liver, gall bladder, both kidneys,
spleen. However, it is difficult to examine completely
pancreas, especially tail portion due to bowel gas.
The purpose of present study was to compare quality
of USG evaluation of pancreas according to position
of patient.
METHODS: This was a prospective, non-blinded,
randomized controlled trial. A total of 507 healthy
Korean subjects were randomly assigned into
two groups: when USG evaluation of pancreas
was performed by the examiner; one group
receiving supine position (n=254), and the other
group receiving sitting position (n=253). Quality
268
of pancreatic USG evaluation was evaluated as
detection rate of abnormal finding and quality grade
of image.
RESULTS: There were significant differences in
detection rate and image quality grade according to
position of subjects. The detection rate was higher
in the Sitting group than that in the Supine group
(24.3% vs. 11.5%, P=0.014). In addition, the portion
of high grade of image quality was higher than the
sitting group compared to the supine group (68.8%
vs. 34.1%, P=0.007). There were no significant
differences in detection rate and image quality grade
of other abdominal organs.
CONCLUSIONS: USG has many advantage including
non-invasive, non-radiation hazard, real-time
imaging tool. However, pancreas may not be fully
evaluated due to conditions of patient abdomen (e.g.,
bowel gas, food material in stomach). In conclusion,
the result of present study suggests that position
change of patient (from supine to sitting) may be
useful to evaluating the pancreas by performing to
examine abdominal USG. To clarify the relationship
between the position of examinee and the pancreatic
evaluation, large-scale prospective study should be
required.
KEYWORDS: Ultrasonography; Patient Position,
Pancreas evaluation
SE 014
Is the Spleen Stiffness Value Acquired Using
Acoustic Radiation Force Impulse (ARFI)
Technology Predictive of the Presence of
Esophageal Varices in Patients with Cirrhosis of
Various Etiologies?
Heejin Kwon, Sangyun Lee, Jinhan Cho,
Jongyeong Oh
Department of Radiology, Dong-A University
Hospital, Korea
This study aimed to determine the accuracy of
the spleen stiffness value acquired using acoustic
radiation force impulse (ARFI) technology in
predicting the presence of esophageal varices (EVs)
in patients with liver cirrhosis of various etiologies.
Of the 366 enrolled patients, 192 had hepatitis B
virus, 74 had hepatitis C virus, and 100 had alcohol-
related cirrhosis. All patients underwent biochemical
tests, gastrointestinal endoscopy, and liver and
spleen elastography by ARFI. We evaluated the
correlation between the presence of EVs and factors
including liver and spleen stiffness measured by
ARFI, biochemical tests, and other noninvasive
measurements, such as aspartate aminotransferase
(AST), alanine aminotransferase (ALT), platelet
count (PLT), spleen diameter (SD), PLT to SD ratio,
AST to ALT ratio (AAR) score, the AST to PLT ratio
index (APRI) score.
A univariate analysis revealed that the AAR
score, APRI score, PLT, PLT/SD ratio, and spleen
elastography variables were all independently
associated with EVs (p<0.05). On multivariate
analysis, only spleen elastography was associated
with EVs (p=0.001). However, r cirrhosis, spleen
stiffness was not reliable for prediction of EVs.
Spleen elastography measured using ARFI may
serve as a non-invasive method for determining the
presence of EVs. However, it is not an appropriate
predictor for EVs in alcoholic cirrhosis.
SE 015
Prospective Comparison of Liver Stiffness
Measurements of Virtual Touch Quantification
(VTQ) Elastography and Elastography Point
Quantification (ElastPQ) for the Evaluation of
Hepatic Fibrosis
Hyunsuk Yoo, Jeong Min Lee, Jeong Hee Yoon,
Dong Ho Lee, Won Chang
Hospital, Korea
SE 016
Does CT Have Any Added Value after
Sonographic Diagnosis of Acute Right Side
Colonic Diverticulitis?
Ju Hwa Min, Hyun Cheol Kim, Sang Won Kim,
Dal Mo Yang
Department of Radiology, Kyung Hee University
Hospital at Gangdong, Korea
PURPOSE: The purpose of this study was to assess
the additional value of supplementary CT in patient
with diagnosing acute right side colonic diverticulitis
by sonography.
M AT E R I A L S A N D M E T H O D S : A t o t a l 1 8 3
consecutive adult patients (mean age, 40.9 years;
range, 19-76 years) with right lower quadrant
pain who underwent both initial sonography and
supplementary CT within 24 hours were enrolled in
this study. Two radiologists retrospectively assessed
following imaging findings of acute diverticulitis in
269
OBJECTIVE: To prospectively compare technical
success rate and reliable measurements of Virtual
Touch Quantification (VTQ) Elastography and
Elastography Point Quantification (ElastPQ),
and to evaluate correlation of liver stiffness (LS)
measurements obtained by the two elastography
techniques.
MATERIALS AND METHODS: Our study included
total of 85 patients, 80 of whom were previously
diagnosed with chronic liver disease. The technical
success rate and reliable measurements of the two
kinds of point shear wave elastography (pSWE)
techniques were compared by χ2 analysis. LS values
measured using the two techniques were compared
and correlated via Wilcoxon signed-rank test,
Spearman correlation coefficient, and 95% BlandAltman limit of agreement. The intraobserver
reproducibility of ElastPQ was determined by 95%
Bland-Altman limit of agreement and intraclass
correlation coefficient (ICC).
RESULTS: The two pSWE techniques showed
similar results in the technical success rate (98.8%
for VTQ vs. 95.3% for ElastPQ, P=.823) and reliable
LS measurements (95.3% for VTQ vs. 90.6% for
ElastPQ, P=.509). The mean LS measurements
obtained by VTQ (1.71 ± .47 m/s) and ElastPQ (1.66
± .41 m/s) were not significantly different (P=.209).
The LS measurements made by the two techniques
showed strong correlation (r=0.820); in addition,
the 95% limit of agreement of the two methods was
27.5% of the mean. Finally, the ICC of repeat ElastPQ
measurements was 0.991.
CONCLUSION: VTQ and ElastPQ showed similar
technical success rate and reliable measurements and
also yielded strongly correlated LS measurements.
However, due to large limit of agreement, the two
methods cannot be used interchangeably.
KSUM Open 2016
each sonography and CT; inflamed diverticulum,
colonic wall thickening, pericolic fat infiltration,
pericolic abscess. And then each patient was
classified as non-diverticulitis, simple diverticulitis,
or complicated diverticulitis. Sonography and CT
were independently reviewed at two-week intervals.
The additional value of supplementary CT was
assessed by performing head-to-head comparisons
between sonographic and CT results.
RESULTS: Acute diverticulitis was finally diagnosed
in 73 patients. Sonography had 89.04%, 99.09%,
and 95.08% sensitivity, specificity, and accuracy,
respectively. CT had 94.52%, 100.00%, and 97.81%
sensitivity, specificity, and accuracy, respectively.
Those did not show significant difference between
the two modalities (p=0.366, 0.605 and 0.259,
respectively). In addition, net sensitivity (97.26%)
of both sonography and CT were not significantly
different from sensitivity of sonography (p=0.101).
Agreement between the sonography and CT for the
classification of diverticulitis and the four imaging
findings was excellent (all kappa>0.8).
CONCLUSION: Initial sonography can be effective
in patients with acute right side diverticulitis.
Supplementary CT may not be needed when
sonography is conclusive for diagnosing acute right
side diverticulitis.
LESIONS INTO 4 GROUPS AS FOLLOWINGS:
1. Fluid collections; hematomas, seromas, urinomas,
cysts
2. Neoplasms; benign and malignant mesenchymal
tumors, metastasis
3. Miscellaneous conditions including skin appendage
lesions, vascular or infectious lesions
4. Hernias
We explain US imaging findings of various
pathologic conditions of abdominal wall, and also
explain other additional imaging findings using CT
and MR. The clinical history, location of the lesion
and characteristic imaging features are key points to
reach the correct diagnosis. We also performed the
radiologic-pathologic correlations, if the lesions were
pathologically proven.
Abdominal wall masses are not uncommon diseases
that manifest solitary or multiple, palpable or
non-palpable lesions. Imaging diagnosis using
multimodality imaging can play an important role to
detect and characterize the various abdominal wall
masses, and ultrasonography can serve the some
helpful features differentiating from malignancy.
SE 018
SE 017
Ultrasonography Features of Benign Hepatic
Lesions
Seonga Wi, Daejung Kim
Ultrasonography (US) is an easy and convenient
method to determine the presence or absence of
abdominal wall lesions and it is useful for differential
diagnosis with its characteristic imaging findings.
The purposes of this exhibition are to review the
spectrum of imaging findings, to understand
differential diagnosis of abdominal wall masses,
and to identify some ultrasonographic features
suggesting malignancy.
WE CATEGORIZED THE ABDOMINAL WALL
OBJECTIVES: To review ultrasonography findings
of benign focal hepatic lesions.
METHODS: Typical and atypical ultrasonography
findings of benign focal hepatic lesions, compared
to CT and MR findings, are presented. And also
differential diagnosis and imaging key facts for
differential diagnosis are presented.
RESULTS:
- Hepatic cyst
- Focal fat deposition or sparing
- Hemangioma
- Focal nodular hyperplasia
- Biliary hamartomas
- Hepatic abscess
CONCLUSIONS: Radiologists are often confronted
with determining the clinical significance of
Imaging Findings of Abdominal Wall Masses:
Differential Diagnosis on US
Youe Ree Kim, Young Hwan Lee, Soo Yeon Jeong,
Kwon Ha Yoon
Department of Radiology, Wonkwang University
School of Medicine & Hospital, Korea
270
focal hepatic lesions that are detected with
ultrasonography. To decide for proceeding or ceasing
further work up is very important. We presented
critical information used to make this decision in this
exhibition.
SE 019
Results of the Research on Chest Ultrasound
Findings for the Diagnosis of Pneumonia
Zolboo Baatarjav1, Tumur-Ochir Tsedv-Ochir2,
Tseren Dorj Badamsed3
1
2
Department of Pulmonary, State Third Central
Hospital, Mongolia
3
Department of Radiology, State Third Central
Hospital, Mongolia
SE 020
Spontaneous Intra-Abdominal Hematoma
Presenting as Mass in Ultrasonography
Seonga Wi, Dae Kim
OBJECTIVES: To present the cases of spontaneous
intra-abdominal hematomas mimicked mass on
ultrasonography.
METHODS: To review the ultrasonography and CT
image features that spontaneous intra-abdominal
hematomas mimicked mass. And to review the
literatures of ultrasonography imaging features on
intra-abdominal hematomas and ultrasonography
role.
RESULTS:
- Hematoma in adrenal gland
- Hematoma in liver
- Hematoma in retroperitoneal space
CONCLUSIONS: Ultrasonography investigations
allow the detection of intra-abdominal hemorrhages
and help establish the organ which is involved, the
site, the extent. But spontaneous hematomas often
mimicked mass on ultrasonography and further work
up was necessary. This exhibition provided variable
ultrasonography image features for reviewing the
literature and ultrasonography role.
271
PURPOSE: The purpose of this research to study and
identify the findings of pneumonia observed on chest
ultrasound.
PATIENTS AND METHODS: We selected 71
patients who had been hospitalized for pneumonia
at Pulmonary Department at Shastin Memorial
State Third Central Hospital during 2013-2015.
We used Japanese portable ultrasound machines
Aloka SSD 500 and Toshiba 310A with convex array
3.5 MHz probe for chest ultrasound diagnosis. By
using the results from the treatments and diagnosis,
performing an analysis on chest ultrasound was
possible. Moreover, we developed a specific card
with findings seen on ultrasound examination
performed for patients with pneumonia and with the
help of those cards we had been able to evaluate our
survey. The diagnosis of pneumonia was confirmed
by clinical laboratory, Chest PA and computed
tomography.
RESULTS: The symptoms of pneumonia observed
during chest ultrasound are:
-air bronchogram in 63 (88.7% ± 3.8)
-fluid bronchogram in 9 (12.7% ± 3.9)
-pleural effusion in pneumonia affected area of the
lung in 33 (46.5% ± 5.9)
-oncogenic obstructive pneumonia in 5 (7.0% ± 3.0)
-necrotizing pneumonia with multiple small
abscesses in 12 (16.9% ± 4.5)
-multiple accumulations beneath pulmonary pleura
in 14 (19.7% ± 4.7)
CONCLUSION: Following findings were found with
chest ultrasonography in patients: air bronchogram,
fluid bronchogram, fluid accumulation in
inflammation, oncogenic obstructive pneumonia,
necrotizing pneumonia with multiple small
abscesses, and multiple accumulations in pleural
space. The domination of air bronchogram symptom
is statistically true for patients with pneumonia.
(P<0.001)
KSUM Open 2016
Breast
SE 021
Granulomatous Mastitis: Difficult to DiagnoseDifficult to Treat. Applying Triple Test for Better
Outcome
Asif Momin, Shenaz Momin
Department of Radiology, Chief of Imaging, Prince
Aly Khan Hospital, India
PURPOSE: To highlight the ultrasound appearance of
Idiopathic Granulomatous Mastitis & to differentiate
from other mimics. Using clinical & radiological
basis with histopathological correlation to identify
granulomatous mastitis as a distinct entity
MATERIALS AND METHODS: Histopathologically
diagnosed 25 cases of Idiopathic Granulomatous
Mastitis were studied. Data included history, clinical
diagnosis, ultrasound, FNAC, core and excision
biopsy, axillary lymph node FNAC in few cases
to obtain material specifically for labelling it as
tuberculosis.
RESULTS: Patient population included females in
the age group of 22 to 60 years. Patients presented
with painful breast lump, painless lump and
additional inflammatory changes with discharging
sinuses seen in a few. Clinically these were suspected
to have inflammatory carcinoma or mastitis.
Ultrasound features included irregular hypoechoic
mass in 55%, multiple hypoechoic masses in
25%, parenchymal heterogeneity in 15%, mixed
echogenicity with parenchymal deformity in rest of
the cases. Mammography done in a few cases showed
an ill-defined mass in 45.5% and asymmetrical
density in 31.8%. Diagnosis was confirmed in all
patients on histopathology.
CONCLUSION: Idiopathic Granulomatous Mastitis
is an uncommon benign chronic inflammatory
disease. It is a strong mimicker of inflammatory
breast carcinoma in younger age group and other
infective conditions like mastitis of various etiologies.
Differentiation from tuberculosis is imperative as the
treatment options considerably differ. It is possible
to distinguish between these two entities on clinical
and radiological basis with FNAC/biopsy of breast
lump and lymph node as an adjunct. USG plays a
272
major role in diagnosis and helps pathologists to
increase their confidence in reporting.
SE 023
Combined Use of Ultrasound (US) Elastography
and Doppler US at MR Directed (Second-Look)
US Examination: Influence on Diagnostic
Performance of Radiologists for Distinguishing
Benign from Malignant Breast Masses
Hye Shin Ahn1, Mijung Jang2, Sun Mi Kim2,
Bo La Yun2, Mirinae Seo3
1
Hospital, Korea
2
3
PURPOSE: To investigate the clinical utility of the
combined use of US elastography and Doppler US
at MR targeted Second-Look US in distinguishing
benign from malignant breast masses and in making
the decision for biopsy recommendations.
MATERIALS AND METHODS: From August 2013
to October 2014, Breast Imaging Reporting and Data
System (BI-RADS) category 4 or 5 lesions detected
on pre-operative MR imaging for patients who
diagnosed as breast cancer were included. A medical
record of 72 biopsy-proved cases in 51 women (age
range 32-81 years, mean age, 48 years) with secondlook US including B-mode US, US elastography, and
Doppler US images was retrospectively reviewed.
Two experienced breast radiologists were reviewed
images, respectively. Reviewer independently scored
the likelihood of malignancy for four data sets (ie,
B-mode US alone, B-mode US + US elastography,
B-mode US + Doppler US, and B-mode US + US
elastography + Doppler US). The area under the
receiver operating characteristic curve (Az) values,
sensitivities, and specificities of each data set were
compared.
RESULTS: The Az value of B-mode US + US
elastography + Doppler US (reviewer 1, 0.825;
reviewer 2, 0.811) was greater than that of B-mode
US alone (reviewer 1, 0.633; reviewer 2, 0.653) in
both of 2 reviewers (P=0.0002 and 0.0012). The
sensitivity of B-mode alone and B-mode US + US
elastography + Doppler US was similar in both of
2 reviewers. However, the specificity of B-mode
+ Doppler US (42.9%) and B-mode US + US
elastography + Doppler US (42.9%) was significantly
higher than that of B-mode alone (24.5%) in reviewer
2 (P = 0.035 and 0.049).
CONCLUSION: Combined use of US elastography
and Doppler US increases diagnostic accuracy at MR
directed (second-look) US in distinguishing benign
from malignant breast masses. B-mode + Doppler
US + US elastography could be increase specificity
in decision making for biopsy recommendation at
B-mode US.
SE 024
Tuberculous Lymphadenitis in the Left Axilla
Misdiagnosed as Metastasis: A Case Report and
Review of Literature
Hui Li
Department of Radiology, Shandong Medical
Imaging Research Institute Affiliated To Shandong
University, China
US-Guided Core Biopsy in BI-RADS 3 & 4 Breast
Lesions: Four-Year Outcome Analysis in a Single
Institution
Seung Hee Choi, Boo-Kyung Han, Eun Young Ko,
Korea
PURPOSE: To evaluate the distribution of BIRADS category and the histologic outcome of BIRADS 4 and 3 lesions undergoing ultrasound-guided
breast core biopsy (UCB) during 4 years in a single
institution and to analyze the annual trend of BIRADS distribution and malignancy rate in each
category.
MATERIALS AND METHODS: We identified
6,932 lesions of 6,340 subjects undergoing UCB
procedures from 2012 to 2015 at a single tertiary
hospital. Breast Imaging Reporting and Data System
(BI-RADS) category and histological results for each
target lesion were assessed. Numbers of total targets
and BI-RADS 4 and 3 lesions and malignancy and
high-risk lesion rate in each category were assessed.
The mode of presentation was recorded per a lesion.
RESULTS: Among total 6,932 lesions, annual
number of biopsies was 1,538, 1,787, 2,079, 1,528
from 2012 to 2015. BI-RADS 4 and 3 lesions were
61.1% and 20.6%, respectively and the annual trend
was not different between each year as 58.1-64.1%
and 15.0-23.8%. Mean total PPV was 38.0% (range,
34.8-43.3%) and mean malignancy rate in BI-RADS
4 and BI-RADS 3 was 32.9% (range, 31.2-35.6%)
and 1.5% (range, 0.5-3.0%), respectively and the
annual trend was not different.
CONCLUSION: The annual trend using UCB showed
a similar trend for lesion distribution and PPV. The
PPV of total UCB was reasonable as 38.0% and the
malignancy rate in BI-RADS 3 lesions was acceptable
as 1.5%.
273
PURPOSE: To discuss the sonographic features
of the tuberculous lymphadenitis in the axilla and
review the literature to distinguish from metastatic
lymph nodes due to breast cancer.
MATERIALS AND METHODS: A 61-year-old
Chinese woman presented to our institution with
lumps in her left axilla who was diagnosed as
metastases from the left breast carcinoma in another
hospital and planned to accept a operation. An
ultrasonic examination was performed before the
operation.
RESULTS: TB was be put forward and which was
verified by pathology after surgery.
CONCLUSION: It must be considered about some
particular infections (especially TB) during the
ultrasonic examinations of swelling axillary lymph
nodes (LNs), especially there is no significant lump
in the breasts, but the swelling LNs tend to be round,
hypoechogenic, and rich in blood flow.
SE 025
KSUM Open 2016
SE 026
Effect of Calcifications on Shear Wave
Elastography in Benign Breast Lesions
Seung Hee Choi, Eun Young Ko, Boo-Kyung Han,
Korea
PURPOSE: To investigate the effect of calcifications
on shear wave elastography (SWE) in benign breast
lesions.
reviewed ultrasound (US) images of 506 consecutive
patients who had breast US with SWE between
October 2013 and March 2014 and who had
confirmed benign breast lesions by histologically
(n=171) or by stable benign US findings for more
than 2 years (n=317). We excluded 39 patients who
did not have mammography and finally included 467
patients with 488 benign lesions. We analyzed US
findings of the lesions: type (mass or nonmass), size,
BI-RADS category and the results of elastography
(E mean). The measurement of elasticity was done
by setting 2mm size region of interest (ROI) at
the stiffest area of the lesions. We compared the
Emean of the benign breast lesions with and without
calcifications and the presence of calcifications
within the lesion was confirmed on mammography.
We also analyzed the influence of other US factors on
the Emean of the benign lesions.
RESULTS: Calcifications were present in 60 (12.3%)
lesions and absent in 428 (87.7%) lesions. E mean
was 60.1 ± 63.4 kPa (range, 4.4-234.2 kPa) in the
lesions with calcifications and 28.6 ± 30.5 kPa (range,
2-235.1 kPa) in the lesions without calcifications.
E mean o f t h e l e s i o n s w i t h c a l c i f i c a t i o n s w a s
significantly higher than that of the lesions without
calcifications (P<0.001). Emean was not significantly
different according to the size, shape and BIRADS
category of the lesions (P=0.748, P=0.089, P=
0.589).
CONCLUSION: The benign breast lesions with
c a l c i f i c a t i o n s c a n s h o w h i g h E mean o n S W E .
Elastography should be carefully interpreted
considering the presence of calcifications in benign
breast lesions, not to misdiagnose as malignancy.
274
SE 027
US-Guided 14G Core Biopsy for Breast: Results
of 7 Years-Experience and Long Term Follow-Up
Inha Jung, Eunkyung Kim
PURPOSE: This study assessed the outcomes of USguided core needle biopsy (CNB) for breast lesions
that had at least a 2-year follow-up to determine
the false-negative rate and evaluate the diagnostic
accuracy of CNB.
analyzed a total of 9,070 breast masses from 7,041
women who had undergone US-guided 14G CNB and
had at least 2-year follow-up. The pathology of CNB
was correlated with the result of surgical excision
or vacuum-assisted biopsy, or long-term imaging
follow-up. The false-negative rate and underestimate
rate were calculated.
RESULTS: In total of 9,070 CNBs, the benign
pathology was 64%, high-risk was 3%, and malignant
result was 32%. Of 5,856 benign CNBs, additional
malignancy was found at excision in 92 lesions and
false-negative rate was 2.9% (92 of 3,095). The
underestimate rate was 42% (140 0f 328) for DCIS
and 27% (79 of 289) for high-risk. There was no
delay in diagnosis because the radiologist noted the
suspicious imaging finding despite the benign CNB
pathology (discordant between imaging and CNB)
and recommended surgical excision or vacuumassisted biopsy.
CONCLUSION: US-guided 14G CNB provides the
optimal diagnostic information. Imaging-histological
correlation and appropriate imaging follow-up
should be performed.
SE 028
Ultrasound-Guided Photoacoustic Imaging for
the Selective Detection of EGFR-Expressing
Breast Cancer and Lymph Node Metastases
Meihua Zhang1, Hoe Suk Kim1, Tiefeng Jin2, Ann Yi3,
Woo Kyung Moon1
1
Hospital, Korea
2
Department of Science and Radiology, College of
Medicine, Seoul National University, Korea
3
Hospital HealthCare System Gangnam Center,
Korea
We assessed the use of ultrasound (US)-guided
photoacoustic imaging(PAI) and anti-EGFR
antibody-conjugated gold nanorods (anti-EGFRGNs) to non-invasively detect EGFR-expressing
primary tumor masses and regional lymph node
(LN) metastases in breast cancer-bearing mice
generated by injecting MCF-7 (EGFR-negative)
or MDA-MB-231 (EGFR-positive) cells using a
preclinical Vevo 2100 LAZR Imaging system. AntiEGFR-GNs provided a significant enhancement
in the PA signal in MDA-MB-231 tumor and the
axillary LN metastases relative to MCF-7 tumor and
non-LN metastases. Our results demonstrate that
US-guided PAI using anti-EGFR-GNs is feasible
and highly sensitive for the selective visualization
of EGFR-expressing primary tumors as well as LN
micrometastases.
SE 029
275
Predictive Value of Tumor Vascularity Measured
with Doppler Sonography in Neoadjuvant
Chemotherapy of Breast Cancer
Alisher Kakhkharov1, Jamoliddin Kahhorov2,
Fatima Kakhkharova3
1
Department of Oncology and Radiology/Breast
Cancer Unit, Tashkent Medical Academy/Tashkent
City Oncology Center, Uzbekistan
2
Department of Therapeutic Radiology and Oncology,
Tashkent Medical Academy/National Scientific
Oncology Center, Uzbekistan
3
Department of Radiology, National Scientific
Oncology Center, Uzbekistan
BACKGROUND: Tumor vascularity plays great role
not only in its growth and metastases development
but also in tumor response to treatment. One of the
important indicators of chemotherapy response is
pathological complete response (pCR) which strongly
correlated with recurrence-free and overall survival.
The aim of study was to determine correlation
between tumor vascularity and pCR in neoadjuvant
chemotherapy of breast cancer.
MATERIALS AND METHODS: Retrospective
analysis of 43 patients with locally advanced breast
cancer (LABC) treated in Tashkent city oncology
center in 2014-2015 was conducted. Sonography was
done according to standard method and Doppler
mapping with 7-14 MHz probe usage (Mindray
DC N3 ultrasound system). Doppler sonography
was conducted before starting neoadjuvant
chemotherapy and on 12 days after 2 nd and 4 th
cycles of chemotherapy. AC regimen (Doxorubicin
60 mg/m² and Cyclophosphamide 600 mg/m²)
every 3 weeks was used in neoadjuvant setting. On
14 days after completion of 4 chemotherapy cycles
breast cancer operation was performed. Histological
response was evaluated according to NSABP B-18
classification.
RESULTS: Breast cancer was hypovascular in 15
cases (34.8%) and hypervascular in 28 cases (65.2%).
The high arterial blood flow speed in tumor ranged
from 6.8-47.3 cm/s, the less arterial blood flow speed
was 0.6-7.4 cm/s. The rate of pCR was higher in
group of patients with primary hypervascular breast
tumors than in hypovascular tumors (82.1% vs.
46.6% respectively P< 0.001). It was also found that
KSUM Open 2016
the greater decrease of vascularity after neoadjuvant
chemotherapy were the higher probability of pCR is
(p <0.050).
CONCLUSION: Information about blood
supplement of tumor obtained with Doppler
sonography in patients with LABC can help to
predict the response to neoadjuvant chemotherapy.
Vascularity of tumors and its chemotherapy related
changes have strong correlation with pCR.
SE 031
Quantitative Assessment of Tumor Vascularity
of the Breast Masses Using Superb MicroVascular Imaging (SMI) and Contrast-Enhanced
Ultrasound
Ah Young Park1, Bo Kyoung Seo1, Kyu Ran Cho2,
Ok Hee Woo3
1
Hospital, Korea
2
Department of Radiology, Korea University Anam
Hospital, Korea
3
Department of Radiology, Korea University Guro
Hospital, Korea
Tumor vascularity of breast masses plays an
important role in differentiation of benign from
malignant tumors, treatment monitoring, and
prediction of prognosis. Therefore, quantitative
assessment of tumor vascularity with non-invasive
radiological examination is essential. Superb microvascular imaging (SMI) is an advanced Doppler
ultrasound technique. It has a multi-dimensional
filter to eliminate clutter and improves sensitivity
of microvessels. Contrast-enhanced ultrasound has
been used as one of the most sensitive imaging tools
for evaluation of tumor hemodynamics.
In this exhibit, we will show how to assess
quantitatively tumor vascularity of the breast masses
using SMI, and contrast-enhanced ultrasound and to
demonstrate clinical applications.
276
SE 032
Analysis of Background Parenchymal
Echogenicity in Breast Ultrasound: Correlation
with Mammographic Breast Density and
Background Parenchymal Enhancement in
Breast MR
Kyunghee Ko, Hae Kyoung Jung, Youdong Kim
OBJECTIVE: To analysis the relationship between
background parenchymal echotexture (BP echo) in
breast ultrasound and mammographic breast density
(MGD) and background parenchymal enhancement
(BPE) in breast MR.
MATERIALS AND METHODS: We studied 138
women (mean age 51.6 yrs, range from 26-79 years)
with newly diagnosed invasive breast cancer who had
performed preoperative mammography, ultrasound
and MR from June 2013 to June 2015. MGD was
described in four categories by using BI-RADS
lexicon. Two radiologists blinded to the patient’s
clinical and radiologic findings classified BP echo as
homogeneous or heterogeneous, and degree of BPE
as minimal, mild, moderate, or marked in consensus.
RESULTS: Of the 138 women, 74 (54%) were
premenopausal and 64 (46%) were postmenopausal.
Premenopausal women were more likely to have
heterogeneous BP echo (60/74, 81%) compared with
postmenopausal women (10/64, 16%) (p=0.000).
Among 103 patients with dense breasts in MGD,
34 (33%) showed homogeneous BP echo in US. BP
echo showed significant correlation with BPE in
both premenopausal and postmenopausal women
(p=0.000). However, MGD showed no significant
correlation with BP echo or BPE, regardless of
menopausal states. MGD grades were higher than
the respective BPE in 49%(68/138).
CONCLUSION: A significant association exists
between BP echo and BPE regardless of menopausal
status. MGD grades tend to be higher than the
respective BPE grades and BP echo patterns.
SE 033
Diagnostic Performance of Shear-Wave
Sonoelastography and B-Mode Ultrasound
to Differentiate Benign and Malignant Breast
Lesions: The Emphasis on the Cutoff Value of
Quantitative and Qualitative Parameters
Eun Jee Song, Yu-Mee Sohn, Mirinae Seo
Comparison of Strain and Shear-Wave
Elastography of the Breast Masses for
Differentiation of Benign and Malignancy
Mirinae Seo, Hye Shin Ahn, Sung Hee Park,
Byung Ihn Choi, Jong Beum Lee
Hospital, Korea
PURPOSE: To prospectively compare the diagnostic
performance of strain and shear-wave elastography
of the breast masses for differentiation of benign and
malignancy.
METHOD AND MATERIALS: Between December
2015 and February 2016, 38 women (mean age
47.4 years, range 20-79 years) with 46 breast
masses (mean size 47 mm, range 4-51 mm)(25
benign, 21 malignancy) underwent both strain and
shear-wave US elastography examinations with
a US unit (Aplio 500, Toshiba Medical Systems,
Otawara, Japan) by one radiologist prior to biopsy.
For strain elastography, the strain ratio of breast
lesions (fat lesion ratio) was calculated. With shearwave elastography, quantitative elasticity values in
kiloPascal units measured was recorded. Diagnostic
performance of the two systems in distinguishing
benign from malignant masses was compared using
receiver operating characteristic (ROC) curve analysis
and McNemar’s test using histological analysis as
reference standard.
RESULTS: The area under the ROC curve (AUC)
for the strain elastography (AUC=0.923) was
similar than that of the shear-wave elastography
(AUC=0.876) without statistical significance
(difference between areas 0.047, 95% CI -0.045 to
0.138, P=0.318). The best cut-off values, yielding
the maximal sum of sensitivity and specificity, were
between values in kiloPascal units of 67.8 and strain
ratio of 2.5. The sensitivity of the strain elastography
system was higher than that of the shear-wave
elastography [95.2% (20 of 21) and 76.2% (16 of
21), P=0.375]. The specificity of the shear-wave
elastography system was higher than that of the
strain elastography [92.0% (23 of 25) vs. 80.0% (20
of 25), P=0.125].
CONCLUSION: These preliminary results
showed that strain and shear-wave elastography
277
PURPOSE: To investigate the most effective cutoff
value of quantitative and qualitative shear-wave
elastography (SWE) to differentiate benign and
malignant breast lesions and evaluate diagnostic
performance of quantitative and qualitative SWE in
addition to B-mode ultrasound.
MATERIALS AND METHODS: From August 2013 to
September 2015, 209 breast lesions were evaluated
with B-mode ultrasound (US) and SWE. Pathologic
reports were determined by ultrasound (US)-guided
core needle biopsy or surgical excision. Qualitative
(four-color pattern) and quantitative analyses
(Emean, Emax, SD and E ratio) were performed.
Their cut-off values were defined using Youden’s
index. The diagnostic performance of B-mode US
and combination of B-mode US with four-color
pattern or quantitative parameters were compared.
RESULTS: Of the 209 breast lesions, 102 were
benign lesions and 107 were malignant lesions.
The Emax, Emean, SD and E ratio were 67.32 kPa,
55.05 kPa, 7.53 and 3.26, respectively, for benign
lesions and 178.92 kPa, 140.96 kPa, 22.87 and 9.84,
respectively, for malignant lesions (p<0.001). The
optimal cutoff value for qualitative parameter was
determined to be 145.7 kPa, 89.1 kPa, 11.9 and 3.84,
respectively, in the order of Emax, Emean, SD and
E ratio. The optimal cutoff of color pattern was
between 3 and 4. Combined B-mode ultrasound and
Emax had the highest improvement, from 17.65% to
98.04% for specificity, and from 58.85% to 82.78%
for accuracy with decrease in sensitivity compared
with the results of B-mode assessment.
CONCLUSION: Quantitative and qualitative SWE
combined with B-mode US increased the accuracy
to improve differentiation of benign from malignant
lesions. Emax (cutoff, 145.7) appeared to be the most
discriminatory parameter.
SE 034
KSUM Open 2016
systems showed similar diagnostic performance in
distinguishing benign from malignant breast masses.
However the strain elastography showed better
sensitivity and shear-wave elastography showed
better specificity.
SE 035
Three-Dimensional (3D) Shear Wave
Elastography: The Strength and Usefulness in
Differentiating Benign and Malignant Breast
Masses
Gayoung Choi1, Ok Hee Woo1, Hye Seon Shin1,
1
Hospital, Korea
2
Hospital, Korea
3
Hospital, Korea
PURPOSE:
1) To understand fundamentals of 3D and 2D shearwave elastography in diagnosing benign and
malignant breast masses.
2) To illustrate key advantages and shortcomings of
3D over 2D shear-wave elastography.
CONTENT ORGANIZATION:
1) Basic physics of shear-wave elastography in
comparison of 3D and 2D.
2) Key advantages and shortcomings of 3D shearwave elastography.
3) Comprehensive understanding of 3D and 2D
shear-wave elastography through review of
representative images.
SUMMARY: Shear-wave elastography of breast is the
state of the art technique. Recently, three-dimensional
evaluation is suggested as highly reproducible and
accurate technique in characterization of breast
masses. More comprehensive and precise preprocedural evaluation of breast masses using
3D shear-wave elastography can help to avoid
unnecessary additional exams and procedures, and
at the same time, guide to prompt further evaluation,
which also may lower patient anxiety.
278
SE 036
3D Shear-Wave Elastography for Differentiating
Benign from Malignant Breast Masses in
Comparison with 2D SWE
Hyeyoung Choi, Yu-Mee Sohn, Mirinae Seo
PURPOSE: To evaluate the diagnostic performances
of each 3D image of shear-wave elastography (SWE)
for differentiating benign from malignant breast
masses in comparison with that of 2D SWE.
METHOD AND MATERIALS: The study included
142 breast lesions in 135 patients who underwent
B-mode ultrasound and SWE before biopsy from
December 2014 to February 2016. We retrospectively
reviewed the quantitative elasticity values (maximum
and mean elasticity in the stiffest portion of mass,
Emax and Emean) of both 2D and each 3D SWE
(axial, transverse and coronal images) and pathologic
findings. Histopathologic findings were regarded as
reference standard. Diagnostic performances of each
data set were evaluated using the area under the
ROC curve (AUC) and sensitivity and specificity were
compared using McNemar’s test.
RESULTS: Of 142 lesions, 70 (49.3%) were
malignant and 72 (50.7%) were benign. Malignant
masses showed higher values of Emax and Emean
than benign masses on both 2D and each 3D SWE,
with statistically significant differences (P<0.001).
The AUC of 2D, 3D axial, 3D transverse SWE was
significantly higher than that of 3D coronal SWE
(p<0.05). However, there were no significant
differences between AUC for 2D, 3D axial, and 3D
transverse SWE (Emax, 0.811 vs. 0.775 vs. 0.768;
Emean, 0.801 vs. 0.780 vs. 0.783). The sensitivities
were not significantly different between 2D and
each 3D SWE (76.4%, 75.0%, 78.6%, 69.3%). The
specificity of 2D and 3D axial SWE was higher than
that of the 3D transverse and coronal SWE (83.1%,
77.5% vs 68.3%, 6.43%, p<0.05).
CONCLUSION: 2D and 3D SWE showed equal
diagnostic performance in distinguishing benign
from malignant masses. However, the 2D and
3D axial SWE showed better specificity than 3D
transverse and coronal SWE.
SE 037
Foreign Bodies of the Breast: In Vivo and In Vitro
Radiologic-Clinical Correlation
Ji Min Kim1, Shin Young Kim1, Deuk Young Lee2,
Jong Eun Lee3
1
2
Department of Surgery, Yonsei Angelot Women's
Clinic, Korea
3
SE 038
Efficiency of US Elastography and Color Doppler
US in Distinguishing Fibroadenoma from TripleNegative Breast Cancer
Soo Hyun Yeo1, Woo Kyung Moon2, Ga Ram Kim3
1
Department of Radiology, Keimyung University
Dongsan Medical Center, Korea
2
Hospital, Korea
3
Department of Radiology, Inha University Hospital,
Korea
PURPOSE: To evaluate the efficacy of the combined
use of ultrasonographic elastography (USE) and color
Doppler ultrasonography (USD) in distinguishing
fibroadenoma from triple-negative breast cancer
(TNBC) less than 2 cm in size, and the influence in
making decision of further management at B-mode
ultrasonography (US)
PATIENTS AND METHODS: 180 biopsy-proven
fibroadenomas and TNBCs with B-mode US, USE
and USD images were included. Three blinded
readers assessed the findings of B-mode US, USE,
USD and B-mode combined USE, USD (USED)
image according to the Breast Imaging Reporting
and Data System (BI-RADS) lexicon independently.
Interobserver agreement was assessed by intraclass
correlation coefficient(ICC). The sensitivity,
specificity, accuracy and area under the receiver
operating characteristic (ROC) curve (Az) values of
each data sets were compared.
RESULTS: ICCs are excellent, measuring 0.826 for
BI-RADS category of B-mode US, 0.942 for USE,
0.809 for USD and 0.914 for that of USED. ICCs are
excellent, measuring 0.826 for BI-RADS category
of B-mode US, 0.942 for USE, 0.809 for USD and
0.914 for that of USED. The sensitivity, specificity
and accuracy were 97.04%, 28.52% and 62.77% for
B-mode US, 93.33%, 77.40% and 85.37 for USE, and
91.11%, 30.37% and 60.74% for USD, respectively
279
PURPOSE: Foreign body in breast is very rare, but
it happens infrequently. Patients with foreign body
visited hospital for pain or palpability, or abnormal
outside image. Not only there were various imaging
findings, but also some of them showed specific
radiologic findings depend on materials. Therefore
we would like to present radiologic features of
various foreign bodies with in vivo and in vitro
correlation.
CONTENTS: We compared radiologic images of
materials in patients and in pork belly.
1. Remnant surgical materials with each “in vitro ”
correlation and explanation of US artifact
i) Remnant silastic drain after benign mass
excision with mammography images
ii) Absorbable suture thread after lumpectomy,
which mistaken into drain tube with
ultrasonography, mammography and CT
images
iii) Hemovac drain, medical clip and chemoport
in breast cancer patients with mammography,
ultrasonography, MRI and CT images
2. Parasite infection such as sparganosis. In addition,
we would compare typical and atypical (presented
as calcific nodule) radiologic features with gross
specimen with mammography and ultrasonography
images.
3. Plastic material with actual images and
explanation of US artifact - such as polyacrylamide
gel, paraffin, plastic silicon or saline implant bag
with mammography, ultrasonography, MRI and CT
images.
4. Procedure related foreign bodies with explanation
of US artifact - 14G biopsy needle, air in biopsy tract.
CONCLUSION: Awareness of foreign body in breast
is very important because it can be associated with
clinical symptom, underdiagnosis of other entities
due to their artifact. Therefore, we should aware
specific radiologic features and close follow up
imaging are extremely important.
KSUM Open 2016
and those of USED were 91.85%, 48.14% and
70.00%. The average Az of USE was greater than that
of USD or B-mode US.
CONCLUSION: Combine d use of USE and/
or USD can increase the diagnostic accuracy of
radiologist’s performance in distinguishing small
size fibroadenoma from TNBC. Especially, combined
use of USE is more useful than the use of USD in the
differentiation of fibroadenoma from triple negative
breast cancer less than 2 cm in size.
SE 040
It's Time to Pay Attention to Special Breast
Cancer
Hyunjeong Kim1, Shinyoung Kim1, Sangmi Lee2,
Deukyoung Lee3, Jongeun Lee4
1
2
Department of Nuclear Medicine, Soonchunhyang
3
Department of Surgery, Yeonsei Angelot, Korea
4
Breast cancer is the second leading cause of cancer
mortality in women, as well as most common
malignancy in women. The most common pathologic
subtype of breast cancer originate in the terminal
duct lobular unit in milk ducts, and this subtype
account for 60-80% of primary breast cancers.
This common subtype breast cancer is called
invasive ductal carcinoma, and classed as a not
otherwise specified (NOS). And other rare groups of
malignancies are classed as special type, including
invasive lobular carcinoma, medullary carcinoma,
mucinous carcinoma, invasive/encapsulated
papillary carcinoma, tubular carcinoma, metaplastic
carcinoma, apocrine carcinoma, adenoid cystic
carcinoma, secretory carcinoma and lymphoma.
These rare malignancies can manifest as benign, so
it is important that radiologists have an accurate
diagnosis. Although many clinical and pathologic
findings have been reported, to our knowledge, there
are few reports of imaging findings for these types of
tumor.
Here, we report multimodality imaging findings of
280
special type breast cancers, including mammography,
sonography, MRI and PET-CT with histologic
findings.
Awareness of this imaging findings and clinical
features can assist in differentiating these special
type breast cancers from NOS, and also help
determine appropriate treatment options and
management.
SE 042
Breast Tubular Carcinoma
Nomuundari Ganbat, Tuvshinjargal Dashjamts
Department of Radiology, Ulaanbaatar Songdo
Hospital, Mongolia
INTRODUCTION: Invasive breast cancer is
a heterogeneous disease regarding its clinical
presentation, pathological classification and
clinical course. Most tumors are derived from
mammary ductal epithelium, mainly the terminal
duct-lobular unit and up to 75% of the diagnosed
infiltrating ductal carcinoma are defined as invasive
ductal carcinoma. Invasive lobular carcinoma,
which comprises up to 15%, is the second most
common epithelial type. Many risk factors for the
development of breast cancer have been identified
through epidemiological studies. Gene profiling led
to the discovery of different molecular subtypes with
phenotypic diversity concerning clinical outcome,
including response to treatment, disease-free survival
and overall survival. Nowadays, local advanced
disease is not frequently seen as in the past because
of the availability of information and the widespread
use of screening mammography. However, advanced
local disease may be found as in the present report.
CASE REPORT: A 45-year-old woman was followed
in our outpatient-clinic. She complained about left
breast pain. She had no personal or family history of
breast or ovarian cancer. On physical examination,
an irregular palpable mass on her left breast 11 o′
clock direction was observed. There were no palpable
lymph nodes. A skin biopsy was performed because
of breast cancer suspicion. Molecular analysis
showed an invasive tubular carcinoma.
SE 043
Primary Breast Fibrosarcoma Mimicking Invasive
Ductal Carcinoma in a Patient with Interstitial
Injection Mammoplasty: Focusing on the
Sonographic and MR Findings
Soo Young Chae1, Ok Hee Woo1, Hye Seon Shin1,
1
Hospital, Korea
2
Hospital, Korea
3
Hospital, Korea
Primary breast sarcoma is a rare disease of the breast
that comprises a heterogeneous group of malignant
mesenchymal neoplasms, including angiosarcoma,
liposarcoma, leiomyosarcoma, fibrosarcoma,
sarcomas with bone and cartilage, and malignant
fibrous histiocytoma. Given that there are various
malignant mesenchymal neoplasms in the breast,
fibrosarcoma is a diagnosis of exclusion. The exact
incidence of primary breast sarcoma has not been
reported, but it approximately accounts for less than
1% of all breast cancers. Primary breast sarcoma
usually present as a palpable, rapidly enlarging and
unilateral mass without lymph node metastasis.
On sonography, it commonly appears as oval solid
hypoechoic masses with indistinct margins, and
exhibits posterior acoustic enhancement and internal
hypervascularity. Herein, we report an unusual case
of primary breast fibrosarcoma, mimicking invasive
ductal carcinoma in a 79-year-old female patient
with a previous history of interstitial injection
mammoplasty.
SE 044
Malignant Lesions in Premammary Zone of the
Breast: The Great Mimickers of Benign Lesions
Jin Hwa Lee1, Bo Ra Kim1, Su Jin Kim2, Miri Lee3,
Se Heon Cho3
1
Hospital, Korea
2
Department of Pathology, Dong-A University
Hospital, Korea
3
Department of Surgery, Dong-A University Hospital,
Korea
Premammary zone of the breast, composed of the
skin and the subcutaneous fat layer, is well-visualized
on ultrasonography (US). Most of premammary
lesions of the breast are benign and from non-ductal
origins. However, malignant tumors arising from
mesenchymal tissue and primary breast cancers,
though relatively uncommon, are also detected on
US, which can mimic benign imaging findings. In
this report, we will introduce two cases of malignant
premammary lesions which mimicked benign US
features - leiomyosarcoma of mesenchymal origin,
and mucinous carcinoma of ductal origin.
SE 045
Mammographic and Ultrasonographic Findings
of Thread-Embedding Procedure for Breast
Augmentation: Case report
So Yoon Park, Boo-Kyung Han, Eun Young Ko,
Korea
281
Thread-embedding breast augmentation is used in
oriental medicine by inserting absorbable suture
materials within the subcutaneous fat and muscle of
anterior chest wall. We report 3 cases of foreign body
granulomas after thread-embedding procedure for
breast augmentation. They were usually located in
subcutaneous fat layer, within the pectoralis major
muscle and interpectoral space of bilateral axillary
tail.
KSUM Open 2016
SE 046
Breast Cancer in a Cowden Syndrome Patient:
Imaging and Clinical Findings
Ikjung Hwang1, Young Mi Park1, Sun Jeong Moon1,
Suk Jung Kim2, Hyun Kyung Jung2, Sun Joo Lee1,
Hye Jung Choo1, Dong Wook Kim1,
Hae Woong Jeong1, Sang Suk Han1
1
Hospital, Korea
2
Department of Radiology, Inje University Haeundae
Paik Hospital, Korea
Cowden syndrome is an uncommon, autosomal
dominant disease and the most common phosphatase
and tensin homolog (PTEN) hamartomatous
tumor syndrome. It is characterized by multiple
hamartomas of the skin, mucous membrane,
brain, breast, thyroid, and gastrointestinal tract.
Its most relevant clinical feature is an increased
risk of developing malignancies, especially breast,
colon, and thyroid cancers. We present a case of
Cowden syndrome with multiorgan involvement
and a novel germline PTEN mutation. A 49-yearold female patient visited our hospital for breast
cancer screening. She underwent hysterectomy
owing to uterine myoma 10 years earlier, and
thyroidectomy for multiple nodular hyperplasia one
year earlier. Mammogram showed heterogeneously
dense fibroglandular tissue without abnormal
findings. Breast sonogram done for the patient’s
request showed an 1.3 cm-sized, oval hypoechoic
mass with microlobulated margin in the upper
center of the left breast. An ultrasound-guided
core biopsy was performed for the lesion which
was diagnosed with invasive apocrine-type ductal
carcinoma of intermediate grade and triple negative
immunohistochemical type. PET-CT scan for the
preoperative evaluation demonstrated a mild
hypermetabolic lesion in the left breast (SUVmax
2.2). Incidentally, a hypermetabolic mass lesion in
the right cerebellum was detected on PET-CT scan.
Subsequent brain MRI demonstrated asymptomatic
hamartomatous hyperplasia in her right cerebellum,
which was typical of Lhermitte-Duclos disease.
Four years later, she presented with cobblestonelike papillomatous papules on the lower gums.
Gastrointestinal endoscopy and colonoscopy revealed
282
multiple hamartomas in the stomach and colon. She
was diagnosed with Cowden syndrome and a novel
PTEN mutation was confirmed by direct sequencing.
SE 047
Imaging Findings of Adenoid Cystic Carcinoma
of the Breast: A Case Report
Gayoung Lee1, Young Mi Park1, Suk Jung Kim2,
Hyun Kyung Jung2, Sun Joo Lee1, Hye Jung Choo1,
Dong Wook Kim1, Hae Woong Jeong1,
Sang Suk Han1
1
Hospital, Korea
2
Department of Radiology, Inje University Haeundae
Paik Hospital, Korea
Adenoid cystic carcinoma (ACC) of the breast is
very rare, accounting for only 0.1% of all breast
carcinomas, and indolent tumor with a favorable
prognosis. This unusual neoplasm of the breast has
certain histopathologic and biological characteristics
that distinguish it from more common histologic
types. Due to its rarity, the imaging characteristics
of this subtype of breast carcinoma have been
considered in a few studies, mainly consisted of case
reports. Here, we present the imaging findings of
ACC of the breast in a 53-year-old female patient.
The patient visited our hospital for cancer screening.
Her mammograms showed two isodense masses
with irregular shape and spiculated margin in the
right upper outer quadrant. Ultrasonogram showed
two irregular hypoechoic masses with indistinct
margin and no posterior acoustic features. One of
them showed non-parallel orientation. Ultrasoundguided core needle biopsy of one mass revealed
ACC. MRI showed two, irregular circumscribed
masses with homogeneous enhancement and early
fast and delayed plateau kinetics, measured about
1.6 cm and 1.9 cm. PET-CT scan showed focal mild
hypermetabolic lesions (SUVmax 2.0 and 3.1,
respectively). Subsequently, the patient underwent
breast conservation surgery and sentinel lymph node
dissection. Pathology from the surgery depicted two
ACCs with basal-like immunohistochemical type,
and no metastatic lymph node. The patient was
treated with radiotherapy following the surgery.
No recurrence and metastasis were found after 18
months of follow-up.
SE 048
A Rare Case of Hidradenocarcinoma Arising in
the Male Breast: Sonographic Findings and a
Brief Review
Hyun Ji Lee1, Okhee Woo1, Hye Seon Shin1,
1
Hospital, Korea
2
Hospital, Korea
3
Hospital, Korea
SE 049
Ultrasound Guided Procedures in Angiography
Room: Arteriovenous Procedure, PCD, PTBD,
PTGBD and Chemoport; 837 Patients
Virasack Rajpho, Daehyun Hwang
Sicence, University of Healthscience, Lao PDR, Lao
People's Democratic Republic
PURPOSE: 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.
MATERIALS AND METHODS: We evaluated
837 patients (age mean 61.14, range 1-88 years,
M:F=365:219) who underwent ultrasono-guided
procedures between January 2013 and December
2015. The procedures are ateriovenous procedure
(n=320), PCD (n=203), PTBD (74) PTGBD (60).
RESULTS: The procedural initial success rate was
99%. Puncture failed in 2 cases. There were total
occlusion in jugular vein. Previous many procedures
and occlusion in jugular vein. We changed another
site. We could puncture another site. Actually,
secondary success rate was 100%
CONCLUSION: Ultrasound guided procedures:
are arteriovenous procedure (n=320), PCD
(n=203), PTBD (74) PTGBD (60) are very safe
and high success rate. Ultrasound is very useful
and important tool for interventional procedures;
Healcearrion (Wireless ultrasound) is very useful,
and cost effectiveness ultrasound.
283
Hidradenocarcinomas are rare, aggressive
intradermal malignant tumors of sweat glands with
reported incidence of 0.05% in the United States.
Lesions on the face, trunk, abdomen, extremities,
scalp and groin have been reported. These tumors
can derive from preexisting hidradenomas but also
appear de novo, typically present as asymptomatic
solitary cutaneous lesion and either maintain a
stable size or may grow slowly. At some point, with
unknown mechanism, the lesion may demonstrate
highly aggressive course with local expansion and
regional or distant metastasis. Despite wide-excision,
local recurrence is common and the 5-year disease
free survival rate is less than 30%. Less than 70 cases
are reported in the literature to date, so there is
little information about natural history and optimal
management for this disease. Herein, we report a
rare case of hidradenocarcinomas in a 65-year-old
male patient presenting as a growing mass in the
left breast, which appears complex echoic mass on
ultrasound.
Cardiovascular
KSUM Open 2016
SE 050
Ultrasound Comparison of Carotid IntimaMedia Thickness Between Type 2 Diabetic and
Normoglicemic Population
Erdembileg Tsevegmid1, Otgon Ginj2,
Uurtuya Shuumarjav3
1
Department of Radiology, School of Medicine,
MNUMS, Gurvan Gal Teaching Hospital of MNUMS,
Mongolia
2
Department of Radiology, National Center for
Maternal and Child Health of Mongolia, Mongolia
3
Department of Physiology, Mongolian National
BACKGROUND: Subjects with type 2 diabetes are
at an increased risk of vascular complications. The
use of carotid ultrasound remains an attractive, noninvasive method to monitor atherosclerotic disease
progression and for treatment of type 2 diabetes,
with intima-media thickness routinely used as the
gold standard to detect pathology.
MATERIALS AND METHODS: The case-control
study included 88 adults with diabetes or impaired
glucose tolerance, aged 35-69, and 75 sex and
agematched normoglycemic subjects from Han-Uul
district of UB. Age, gender, duration of diabetes,
history of hypertension and smoking, drinking
was recorded. Body mass index, glycosylated
haemoglobin (HbA1c), total cholesterol, triglyceride
low and high density cholesterol were determined in
all the patients. CCA-IMT determination was done
by Carotid Doppler Ultrasonography.
RESULTS: There were 50 (31%) males and 113 (69%)
females. Mean ages with diabetes 51.5, without
diabetes 50.1. In subjects with mean IMT on left side
0.084 mm and in subjects without diabetes mean
IMT was 0.69 mm. In correlation between IMT and
HbA1c showed groups are statistically different Ð=
0.0001. In correlation test by gender the IMT in
female and male groups (t=-4.6; p=0.0001) IMT
in male group was thicker than female. In smoking
subjects IMT was 0,086 cm, in nonsmoking group
0,074cm(t= 3.3, p= 0,01) This result shows that IMT
was higher in smoking group than in nonsmoking
group in control group. But in diabetic subjects we
could not find this difference.
CONCLUSION: The IMT is greater in subjects with
284
diabetes compare to non diabetic groups. The IMT
was thicker in males than in females. In smoking
group the IMT was higher than in nonsmoking
group.
SE 051
A Comparative Study for the Measurement of the
Systolic and Diastolic Ankle-Brachial Pressure
Index in Diabetic Patients with Calcified and NonCalcified Tibial Arteries
Akram Asbeutah1, Abdullah Almajran2, Sami Asfar3
1
Department of Radiology, Kuwait University, Kuwait
2
Department of Community Medicine & Statistical
Sciences, Kuwait University, Kuwait
3
Department of Surgery, Kuwait University, Kuwait
OBJRCTIVE: Ankle-brachial pressure index-systolic
(ABI-s) can be falsely elevated in the presence of
calcified arteries in some diabetic patients and
therefore losses its value in this cohort of patients.
We aim at investigating the feasibility of using the
diastolic instead of the systolic pressure to calculate
the ABI in diabetic patients with calcified arteries.
METHODS: A total of 51 patients were chosen
from the diabetic foot clinic, none had history of
claudication or any vascular procedure. 26 of these
patients had calcified tibial arteries by Duplex scan
(Group A) and 25 patients did not have calcifications
in their tibial arteries (Group B). ABI measurement
was performed using “boso ABI-system 100
machine”. Systolic ABI (ABI-s) and diastolic ABI
(ABI-d) were calculated based on bilateral brachial
and ankle oscillometric pressures. ABI is considered
normal when it is ≥ 0.9 and ≤ 1.3. Independent t-test
was used to test the difference between ABI-s and
ABI-d. Statistical significance is considered when P<
.05.
RESULTS: The mean age of all participants (±SD)
was 64.7 ± 8.2 years (50-82 years). ABI-s averaged
1.3 ± 0.10 (1.18-1.58) in group A, and 1.07 ± 0.05
(range, 1-1.16) in group B patients. While ABI-d
averaged 1.07 ± 0.05 (range, 1.1-1.17) in group A,
and 1.06 ± 0.05(1-1.14) in B patients. In group A,
independent test comparing ABI-s with ABI-d was
statistically significant (P<.001) whereas in group B
patients it was not (P>.05, .34-.45).
CONCLUSION: In the presence of calcified arteries,
measuring ABI-d is a more realistic parameter than
ABI-s for assessment of peripheral arterial disease.
SE 052
Regional Pulse Wave Velocity Imaging: A
Quantitative Method to Evaluate the Focal
Vascular Sclerosis
Shuai Huang1, Zhenzhou Li2, Chaochao Zhu1,
Xiang Wu1, Qingfeng Gao1, Zi Tao1, Minhua Lu1
1
Department of Medical Engineering, Guangdong
Key Laboratory for Biomedical Measurements
and Ultrasound Imaging, School of Biomedical
Engineering, Shenzhen University Shenzhen, China
2
SE 053
Orthogonal Golay Pairs-Coded Diverging Wave
Compounding for High-Quality and High-FrameRate Ultrasound Imaging
Feifei Zhao, Jianwen Luo
University, China
Coherent compounding diverging wave (DW)
imaging is applicable to cardiac imaging for its high
temporal resolution, while its main drawback is low
image quality in deep depth. Coded excitation with
complementary Golay codes has been demonstrated
to improve the penetration and image quality for
conventional focus imaging, however, at expense of
two-fold frame rate decrease. The objectives of this
study is to improve the image quality in DW imaging
using orthogonal Golay pairs while keeping the frame
rate.
We proposed to transmit DWs in two steering angles
simultaneously coded with two orthogonal Golay
codes. In the next step, complementary codes of
orthogonal Golay pair were applied to diverging
waves transmit with the same angles. Then pulse
compression and angular compounding were
performed. So two coded DWs were acquired in two
transmits which kept the frame rate. To validate the
proposed method, a 2 MHz 64 element phased array
transducer was simulated in Field II. 10 dB noises
were added into channel data before beamforming
performed. Point-spread-function (PSF) simulation
was considered to prove the orthogonality of Golay
pairs. A standard phantom (CIRS, Model 040GSE,
0.5 dB/MHz/cm) was used in phantom study using
transducer with the same parameters as in the
simulation based on the ultrasound advanced open
platform (ULA-OP). The image quality of Golay
pairs-coded excitation was compared with that of
non-coded excitation in one or multiple DW transmit
285
Pulse wave velocity (PWV) is the propagation
velocity of the pressure wave along the artery due to
the heartbeat or inflowing blood. With the regional
pulse wave velocity (rPWV) non-invasively measured
by ultrasound, regional arterial stiffness can be
calculated with the Moens-Korteweg equation
and therefore to evaluate the vascular sclerosis.
Hence, the rPWV is regarded as a diagnostic
index of cardiovascular diseases. In this study, the
propagation of the pulse wave was visualized along
the left carotid artery wall using ultrafast imaging
with plane wave transmissions. The frame rate of
ultrasound imaging was 5000 Hz. An open-platform
ultrasound scanner (Verasonic™, Kirkland, WA)
and a linear probe with central frequency at 7.8125
MHz (L4-11) were used. The probe has 128 active
elements and all elements were utilized to acquire
RF ultrasound signals of the artery in vivo . The time
to acquire RF data was nearly 2 s containing more
than one cardiac cycle. The sampling rate of RF
ultrasound signals was 31.25 MHz. The displacement
of the arterial wall was tracked using a qualityguided displacement tracking algorithm and then
the rPWV was estimated. The width of the region
carotid artery along the long axis direction was 38.4
mm with intervals of 0.3 mm. Three healthy(n=
3, age: 22 ± 4 years old) and three volunteer with
arteriosclerotic plaques (n=3, age: 45 ± 14 years
old) were included in this study. The mean rPWV of
the healthy volunteers was found to be 6.5±1.6 m/s
and the value was 4.8±2.1 m/s for the patients with
arteriosclerotic plaques. We will further discuss the
stiffness of the vessel wall and the arteriosclerotic
plaques to determine if it can provide valuable
diagnostic information.
KSUM Open 2016
sequences, mainly referring to SNR and contrast.
The PSF simulation validated that two steering
angles (±20°) DW coded by orthogonal Golay pairs
in one transmit could be separated. Qualitatively, the
cyst phantom images showed contrast improvement
in deep depth by using orthogonal Golay pair- coded
excitation. Quantitatively, the Golay pair-coded DW
imaging obtained better SNR and contrast, which
ensured both good image quality and high frame
rate.
findings were statistically significant (p<0.05).
CONCLUSION: Ultrasound guidance is only
recommended method to ensure successful
cannulation upto now. However, preprocedural CT
scan could predict safe cannulation of right internal
jugular vein in more than half of the patients, and
seemed to have its role on preoperative planning.
Genitourinary
SE 054
Anatomical Variations of the Internal Jugular Vein
on Ultrasound and CT for Performing Vascular
Cannulation
Byung Wook Park, Hyangkyoung Kim
Department of Surgery, Chung-Ang University
Hospital, Korea
PURPOSE: Anatomical variations contribute a
significant role in safe and successful internal jugular
vein catheterization. For reducing complication
and improving patient care, use of ultrasound
for the placement of central venous catheter is
recommended. We analyzed anatomical variations
of the internal jugular vein on US and chest/neck-CT
and aimed to find out if pre-procedural CT scan has
predictive value of successful blind approach.
METHODS: Among patients who performed central
venous catheter insertion, anatomical variations
of internal jugular vein on US and CT images were
reviewed in 212 patients. Ultrasound examinations
were performed with the standard position for right
internal jugular vein cannulation. Anatomical types
on US were compared with CT finding which is taken
without head rotation.
RESULTS: The vein was located lateral to the artery
in 120 (56.6%) cases on US and 94 (44.3%) cases
on CT (favorable anatomy). Overlapping of vein
on artery was observed in 92 (43.4%) on US and
117 (55.2%) on CT (unfavorable anatomy). A neck
rotation decreased the degree of overlap of the
internal jugular artery relative to the internal jugular
vein that was 49 of 212 patients. Positive predictive
value of favorable anatomy on preprocedural CT was
66.74%, and the correlation of between CT and US
286
SE 055
The Study of the Ultrasound Findings of Renal
Hematoma Caused by Trauma
Oyundari Idersaikhan1, Badamsed Tserendorj2
1
2
Sciences, Mongolia
PURPOSE: To study the ultrasound findings of
newly developed parenchymal and subcapsular renal
hematoma caused by trauma.
MATERILAS AND METHODS: We developed study
chart for the ultrasound findings of the 14 patients,
who are diagnosed with newly developed traumatic
parenchymal and subcapsular renal hematoma at
Ultrasound Section of Department of Radiology of
Third Central Hospital named after P.N. Shastin and
“Achtan” Clinic Hospital, Ulaanbaatar, Mongolia
between years of 2014 to 2016. The diagnosis is
confirmed with computed tomography and surgery.
R E S U LT S : T h e 4 5 . 5 % o f n e w l y d e v e l o p e d
parenchymal hematoma was on lower pole, 36.4%
was on upper pole and in 18.1% it occurred in middle
third of the parenchyma. The 66.6% of subcapsular
hematoma was under the capsule or outside of
the parenchyma appears as well demarcated,
homogeneous, linear shaped, hyperechoic lesion
with the length of 2.5-3 cm and the width of 1-1,5
cm. In 33.3% it appears as well demarcated, crescent
shaped, homogeneous, hyperechoic lesion with the
length of 2 cm, width of 1.5 cm. In the case of newly
developed parenchymal hematoma, 54.6% was
measured in 2-3 cm, 27.3% was measured in 3.1-
4 cm and 18.18% was measured in 4.1-5 cm. The
27.3% were oval shaped, 72.7% were ill-defined,
81.2% were homogeneous, 63.63% had irregular
margins. In 90.9% the echogenicity of the lesion was
higher comparing to the renal parenchyma.
CONCLUSION: 1. Our study revealed following US
findings in case of newly developed subcapsular
hematoma such as linear and crescent shape,
hyperechoic lesion. 2. Also in case of renal
parenchymal hematoma we revealed homogeneous,
irregular margin and ill-defined lesion in US
examination.
SE 056
The Result of the Study of Ultrasound
Assessment of Normal Renal Parameters in
Mongolian Ethnic
Oyuntogos Batdelger1, Badamsed Tserendorj2,
Oyundari Idersaikhan1, Undral Shinekhuu1,
Bolormaa Damdinsuren3, Uranzaya Ganbold4
1
2
Department of Radiology, The Third Central Hospital
of Mongolia, Mongolia
3
Department of Radiology, Occupational Health
Center, Mongolia
4
Department of Radiology, The First Central Hospital
of Mongolia, Mongolia
SE 057
Comparative Study of Sonographic Prostate
Volume and Intravesical Prostatatic Protrusion in
the Patients with Lower Urinary Tract Symptoms
Sumiran Shrestha, Sudeep Thapa
Department of Radiology, Padma Nursing Home,
Nepal
OBJECTIVE: To compare the usefulness between
sonologically measured prostate volume and
intravesical prostatic protrusion and to determine
which one of them is better in assessment of lower
urinary tract symptoms.
METHODS: In this prospective study, 100 men with
lower urinary tract symptoms were included. Their
symptoms were assessed by international prostate
symptom score. Transabdominal ultrasound was
done to measure prostate volume, intravesical
prostatic protrusion and postvoid residual urine.
Intravesical prostatic protrusion and prostate volume
were correlated with international prostate symptom
score and other variables using Pearson’s correlation
coefficient.
RESULTS: Of 100 men with mean age of 63.79 ±
11.29 years with lower urinary tract symptoms due
to benign prostatic hyperplasia, the international
prostate symptom score ranged from 6 to 33 with
the mean of 19.27 ± 7.11 and quality of life score of
4.18 ± 1.03 ranging from 2 to 6. The prostate volume
was measured between 23 to 88 ml with the mean
of 45.71 ± 15.47 ml. Intravesical prostatic protrusion
287
PURPOSE: To determine the correlation between
age, gender and normal renal ultrasound parameters
in Mongolian ethnics.
MATERIALS AND METHODS: We developed study
chart for the 76 patients between the age of 11-50,
who had no complaints and were confirmed healthy
by urine analysis and evaluated at Ultrasound
Section of Department of Radiology of Third Central
Hospital, Ulaanbaatar, Mongolia between years of
2015 to 2016.
RESULTS: Our study demonstrated that women
(n=12) with the age of 31- 40 have following
parameters, length of the right kidney- 9.6 ± 0.03
cm, width- 4.1 ± 0.01 cm, thickness 4.1 ± 0.03 cm,
length of the left kidney- 9.6 ± 0.02 cm, width- 4.2
± 0.02 cm, thickness 4.5 ± 0.03 cm. Parameters for
men (n=7) are, length of the right kidney- 9.6 ± 0.03
cm, width- 4.0 ± 0.02 cm, thickness 3.9 ± 0.0 cm,
length of the left kidney- 9.9 ± 0.02 cm, width- 4.1 ±
0.02 cm, thickness 4.4 ± 0.03 cm. Women with age
of 41-50 (n=7) had following parameters length of
the right kidney- 10.1 ± 0.03 cm, width- 4.1 ± 0.02
cm, thickness 3.6 ± 0.01 cm, length of the left kidney10 ± 0.02 cm, width- 4. 1± 0.01 cm, thickness 4 ± 0.02
cm.
CONCLUSION: 1.There was no correlation
between the age, gender and normal renal
ultrasound parameters in Mongolian ethnics. 2.
We demonstrated that for Mongolian person, the
length of kidney is 9.6-10.0 cm, width is 4.0-4.5 cm,
thickness is 3.4-4.6 cm.
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ranged from 2.5 to 26 mm with the mean of 11.34
± 5.78 mm. There was positive correlation between
intravesical prostatic protrusion and international
prostate symptom score, which was statistically
significant (Pearson correlation 0.463; p<0.001).
There was mild positive correlation between
prostate volume and international prostate symptom
score, which was statistically significant (Pearson
correlation 0.2; p<0.001).
CONCLUSION: The intravesical prostatic protrusion
assessed by transabdominal ultrasound is more
accurate than prostate volume in evaluating
bothersome symptoms in men with benign prostatic
hyperplasia.
SE 058
Comparison of Prostate Volume and Blood PSA
Level in Mongolian Non-Diabetic Screening
Patients and Type II Diabetic Patients at Their
Initial Diagnosis
Darkhijav Yanjiv1, Tugsjargal Purevsukh2,
Battsengel Darkhantsetseg1,
Gombosuren Orkhon1, Bayanzul Nergui1,
Ganbat Nomuundari1, Tuvshinjargal Dashjamts2
1
Department of Radiology, Ulaanbaatar Songdo
Hospital, Mongolia
2
BACKGROUND: While Type II diabetes is
recognized as rapidly growing public health concern
among Mongolian male, little is investigated on
association of diabetes with prostate hyperplasia.
Discrimination of patients at risk for developing
prostate hyperplasia is essential for their successful
monitoring and early operative management.
AIM: We compare non-diabetic and diabetic male
patients in regard to their body composition, PSA
level and prostate volume to determine the baseline
reference which is needed to correctly discriminate
patients with hyperplasia at first US examination.
MATERIALS AND METHODS: We reviewed data
of male patients at health screening examination
at Ulaanbaatar Songdo Hospital in 2013. Their
demographics, fasting blood glucose level, prostate
characteristics at US examination, prostate volume,
288
PSA and Body-mass-index were evaluated using
WindowsExcel.
RESULTS: From 269 screening patients, in 154
data on fasting glucose level were available, from
which in 22 diabetes type II was diagnosed. Diabetic
group has mean age of 45.9 ± 6.8, BMI 31.34 ± 3.83,
glucose 145.05 ± 37.6 mmol/L, prostate volume
22.09 ± 8.4 ml. Non-diabetic screening patients
showed mean age of 39.31 ± 10.0, BMI 26.78 ± 3.62,
glucose 91.8 ± 7.9 mmol/L, prostate volume 20.8 ± 7
ml.
CONCLUSION: Diabetic patients demonstrated
larger prostate volumes and higher PSA levels at
their initial diagnosis than non-diabetic screening
patients, which underlines the need to follow up
diabetic patients for prostate hyperplasia.
SE 059
US of Bladder Masses
Dong Won Kim, Seong Kuk Yoon
Hospital, Korea
Ultrasonography is a first line imaging technique
for evaluation of bladder because it is almost
universally available, in noninvasive, does not
require ionizing radiation, and is well accepted
by patients. Bladder masses may be neoplastic
(including urothelial carcinoma, squamous cell
carcinoma, adenocarcinoma, neuroendocrine tumor,
sarcoma and lymphoma as malignant tumor, and
leiomyoma and paraganglioma as benign tumor)
or may develop secondary to diverse group of nonneoplastic disorders with inflammatory, idiopathic,
and infectious causes (including inflammatory
pseudotumor, endometriosis, cystitis cystica,
tuberculosis). Although imaging findings are not
specific and significant overlap for these tumors,
patterns of growth and tumor characteristics may
allow differentiation.
SE 060
Can Differentiation of Cystitis Glandularis from
Bladder Cancer be Possible on Ultrasonography?
Jongchul Kim
Department of Radiology, Chungnam National
University Hospital, Korea
PURPOSE: The purpose of this retrospective study
was to determine whether the cystitis glandularis
can be differentiated from bladder tumor on
ultrasonography.
MATERIALS AND METHODS: Ultrasonography of
pathologically proven cystitis glandularis (n=5) &
bladder cancer (n=5) were retrospectively reviewed.
Their ultrasonography findings were described
and compared, considering their histopathologic
findings.
RESULTS: On ultrasonography, many combinations
of roughness of bladder mucosal surface, thickened
bladder wall, outer bladder wall continuity, mixed
echoes, and sparse vessels were seen in four of five
patients of cystitis glandularis, but in only one of five
patients of bladder cancer.
CONCLUSION: Considering the above mentioned
more frequent ultrasonography findings (in spite
of limitation of small numbers in this study),
ultrasonography may help the differentiation of
cystitis glandularis from bladder cancer.
SE 061
US is currently the most widely accepted primary
and valuable imaging modality if there is high clinical
suspicion for obstetric and gynecologic etiologies.
But it may be easy to be overlooked in the uterine
cervical lesions. The purpose of this presentation
is to describe the various clinical and sonographic
manifestations of uterine cervical lesions and
evaluate the usefulness of the gray scale and Doppler
US.
SE 062
Tuberculosis of Male Genitourinary Tract
Yongsoo Kim, Young Seo Cho, Sanghyuk Yim
Department of Radiology, Hanyang University Guri
Hospital, Korea
BACKGROUND INFORMATION:
In the past decade, there has been a significant rise in
the prevalence of tuberculosis as well as an increase
in the extrapulmonary manifestations worldwide.
Genitourinary tuberculosis is the most common
manifestation of extrapulmonary tuberculosis.
Diagnosis is often difficult and delayed because
tuberculosis has a variety of clinical and radiological
presentations, and it can mimic numerous other
disease entities. A high level of suspicion is required
and positive results on culture or histologic
examination of biopsy or surgical specimens is still
required in many patients for definite diagnosis.
EDUCATIONAL GOALS/TEACHING POINTS:
1. To review the ultrasonographic features of
tuberculosis affecting the kidney, adrenal gland, and
male genital tracts.
2. To know the routes of Tuberculous spread.
KEY ANATOMIC.PHYSIOLOGIC ISSUES AND
IMAGING FINDINGS/TECHNIQUES: Tuberculous
infection occur all genitourinary organs, kidney,
adrenal gland, ureter, urinary bladder, prostate,
epididymis and testes. We reviewed pathophysiology
of Tuberculous infection affecting male genitourinary
tracts. We also reviewed the characteristic
ultrasonographic and CT findings of Tuberculous
289
US Evaluation of Uterine Cervical Lesions
Sung Bin Park1, Byoung Hee Han2, Young Ho Lee2
1
Hospital, Korea
2
Department of Radiology, Cheil General Hospital,
Korea
In this presentation, we describe normal uterine
cervical anatomy, malignant uterine cervical lesions
(primary uterine cervical cancer, metastasis) and
benign uterine cervical lesions (leiomyoma, cervical
pregnancy, cervical abortion, short cervix and full
funneling). We correlate with the cross sectional
imaging such as CT, MR imaging. We also discuss
the benign and malignant multilocular cystic lesions
as special consideration.
US is a useful for evaluation of uterine cervical lesions.
Familiarity with the clinical setting and imaging feature
of uterine cervical lesions will facilitate prompt and
accurate diagnosis and treatment.
KSUM Open 2016
infection. We compared other differential diagnostic
diseases (inflammatory bowel diseases, peritoneal
diseases) to these ultrasonographic and CT
manifestations.
CONCLUSION: Tuberculous infection can mimic
numerous other disease entities. Although a positive
culture of histologic analysis of biopsy specimens is
still required in many patients to yield the definite
diagnosis, recognition and understanding of the
spectrum of imaging features of extrapulmonary
tuberculosis can aid in diagnosis.
SE 063
Prenatal Diagnosis of Aberrant Right Subclavian
Artery in the Korean Population
Mijin Song, Byoung Hee Han, Young Hwa Kim,
Myung Sook Lee, Hyeun Cha Cho, Young Ho Lee
Department of Radiology, Cheil General Hospital,
Korea
PURPOSE: This study was carried out to determine
the frequency of aberrant right subclavian artery
among the unselected fetuses and to evaluate its
association with chromosomal abnormalities and the
other congenital anomaly.
METHODS: In a 10-month period 4699 fetuses
between 20 and 34 weeks were examined at our
institute for routine antenatal sonography. Right
subclavian artery was assessed by gray scale and
color Doppler ultrasonography in the axial 3-vessel
trachea view and confirmed in the coronal plane.
RESULTS: An aberrant right subclavian artery was
detected in 18 fetuses (0.4%). All 18 fetuses with
aberrant right subclavian artery were euploid fetuses.
In 15 cases it was an isolated finding (83.3%). In two
cases (11.1%) it was accompanied by extra-cardiac
malformations. Another cardiac defect was present
in one case (5.6%).
CONCLUSIONS: In the most cases with ARSA, there
was an isolating finding. The presence of an isolated
ARSA may not be associated with an increased
incidence of chromosomal abnormalities.
290
SE 065
Value of Renal RFA with Contrast Enhanced
Ultrasound (CEUS) as a Problem Solving Tool for
a RCC in a Single Kidney and Another Case of
Chronic Renal Disease
Shenaz Momin, Asif Momin
Department of Radiology, Chief of Imaging Prince
Aly Khan Hospital, India
Our first case is a 77/M with prior history of left
nephrectomy done 7 years ago in Egypt for proven
renal cell carcinoma (RCC).
His yearly follow up CECT detected a new lesion
in the mid region of the right kidney. The patient
refused surgical option hence came to our country.
He did not have any other stigmata of Von Hippel
Lindau Syndrome. His blood parameters including
serum creatinine were within normal limits. Chest
CT scan did not show any metastatic deposit.
RFA was done using multipronged monopolar
RF ablator (RITA -Angiodynamics) using hydro
dissection using 5% DW under US guidance (Siemens
S3000) to separate right lobe of liver. Hepatic
flexure was away from the lesion. The location of the
lesion allowed us to use ultrasound rather than CT.
For better visualization colour Doppler imaging and
sulphur hexafluoride (Sonovue-Bracco) US contrast
was used during and immediately after the procedure
which helped us to achieve complete ablation of this
SOL. Follow up CT after eight days showed correct
ablation margins without any adverse effects.
At the time of discharge his renal profile was normal.
Our second case is a diabetic, hypertensive patient
with chronic renal failure, serum creatinine of 5.1.
The diagnosis of RCC was established on plain MRI
and CT guided biopsy. In view of his multiple comorbidities and poor ejection fraction decision of
RFA was taken in place of partial nephrectomy. This
case was treated with similar success.
These cases highlight the ease of using US for Renal
RFA with contrast enhancement thus avoiding
partial nephrectomy as well as iodinated contrast
respectively which would have increased morbidity
and mortality in a single kidney and other case of coexisting CRF. Long term follow up has shown the
treatment to be effective in both these cases.
SE 067
A Rare Case of Genital Filariasis in a Patient
Presenting as a Vaginal Wall Cystic Lesion:
a Case Report
Prasanna Ghimire1, Pragya Gauautam Ghimire2,
Ayushma Adhikari3
1
Department of Radiology, Nepalgunj Medical College
and Teaching Hospital, Kohalpur, Banke, Nepal
2
Department of Pathology, Nepalgunj Medical College
and Teaching Hospital, Kohalpur, Banke, Nepal
3
Department of Obstetrics and Gynecology,
Nepalgunj Medical College and Teaching Hospital,
Kohalpur, Banke, Nepal
SE 068
Feasibility of Ultrasound in Assessment of Vocal
Cord Structure and Movement
Heung Cheol Kim, Sook Namgung, Myungsun Hong,
Koeun Yang
Department of Radiology, Chuncheon Sacred Heart
Hospital, Korea
OBJECTIVE: The aim of our study was to identify
the diagnostic potential of ultrasound assessment of
vocal cord movement and structure.
METHODS: It was a retrospective study which
included 211 patients. In the first time we identified
thyroid cartilage and then performed an examination
of the vocal cord. In real time, vocal cord structure
and movement were evaluated during normal
breathing and during phonated “aaa..., eee…” letters
or Valsalva maneuver.
RESULTS: Vocal cord movement on US was
successfully evaluated in 199 (94.3%) of 211 patients.
Vocal cord movement was much more common in
women167 (97.6%) than men32 (80%). The rates of
evaluation of the true vocal cords in the patients 20
to 39 years, 40 to 59 years and 60 years and old were
68.8%, 73.6% and 65.3% respectively. And the false
vocal cord in the patients 20 to 39 years, 40 to 59
years and 60 years and old were 91.6%, 89.5% and
87.7% respectively.
CONCLUSION: Vocal cord movement and structures
can be evaluated by ultrasound with good reliability.
The efficiency of this evaluation depends on gender
and age of patients.
INTRODUCTION: Vaginal cystic lesions are
rare incidental findings detected during physical
examination and imaging. To our knowledge,
filariasis as a cause of vaginal cystic lesions has not
been previously reported in the English literature.
We present vaginal cystic lesion which posed
diagnostic dilemma and was confirmed on cytology
to being filarial in etiology.
CASE PRESENTATION: A 25-year-old multipara
female presented with vaginal bleeding following
medical termination of pregnancy. Pelvic
examination and ultrasonography revealed posterior
vaginal wall cystic lesion. Cytological study of the
aspirate from the cystic lesion yielded adult form of
microfilaria. Patient was treated with single-dose
of oral diethylcarbamazine and the lesion subsided
on follow up scans at three months thus avoiding
inadvertent surgeries.
CONCLUSIONS: Vaginal cystic lesions are rare
entities and have multiple etiologies. A high degree
of suspicion for filariasis as cause of vaginal cystic
lesions should be made in individuals hailing from or
have history of travel to endemic regions of filariasis.
KEYWORDS: Filariasis; vaginal; microfilariae;
diethylcarbamazine
Head & Neck
291
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Musculoskeletal
SE 069
US Guided Core Needle Biopsy for
Musculoskeletal Lesions, Diagnostic Accuracy
and Safety
Noh Hyuck Park, Sun Jung Kim, Ji Yeon Park
Department of Radiology, MyongJi Hospital, Korea
PURPOSE: To evaluate the diagnostic accuracy and
safety of ultrasound guided core needle biopsy for
musculoskeletal lesions.
MATERIALS AND METHODS: From April 2013 to
February 2016, we reviewed musculoskeletal cases
which were underwent US guided core needle biopsy.
The total numbers of cases were 40 (M:F= 18:22),
mean age was 53.1 year-old (14-90), Among these
patients, 7 cases were bone lesion. 33 cases were soft
tissue lesion. Gun biopsy with 14G needle (Magnum®)
was performed for each lesions under ultrasound
guidance.
RESULTS: We obtained pathologic results in all
cases, There was no nondiagnostic or insufficient
pathologic result. And, there was no significant
procedure related complication except for one case
with hematoma.
CONCLUSIONS: US guided core needle biopsy is
accurate and safe diagnostic tool in musculoskeletal
disease including soft tissue and bone lesions.
292
SE 070
Atrophy of Foot Muscles in Mongolian Patients
with Diabetes Mellitus Can Be Detected with
Ultrasonography
Bolortuya Galsandorj1 , Oyundari Idersaikhan2,
Munkhsaikhan Purevkhuu2, Sainbileg Sonomtseren3,
Munkhbaatar Dagvasmberel3
1
Department of Radiology, State First Central
Hospital, Mongolia
2
3
Department of Internal Medicine - Endocrine,
MNUMS, Mongolia
OBJECTIVE: To determine foot muscle atrophy in
diabetic patients on ultrasound.
METHODOLOGY: Patients of diabetic mellitus
(DM) with (n=25, age 56 ± 9) or without (n=40,
age 50 ± 14) peripheral neuropathy (PN) and the
control subjects (n=30, age 42 ± 10) were enrolled.
Age, gender, BMI, diabetes duration and HbA1C
were recorded. Detection and grading of neuropathy
were done according to Neuropathy Disability Score
and Neuropathy Symptom Score. Doppler evaluated
arterial status and ABI were recorded. The thickness
and cross sectional area of the extensor digitorum
brevis (EDB) muscle were measured in all three
groups using ultrasonography.
RESULTS: The average HbA1C was 10.1 ± 2.1%
and 9.9 ± 2.1% in patients of DM with or without
PN, respectively, which means that the control of
diabetes was poor. There were significant differences
in BMI (30.7 ± 8.8 in DM with PN group, 28.9 ±
5.4 in DM without PN group, 25.3 ± 3.5 in control
group) among three groups (all p<0.01). ABI and
Doppler scan measurements were similar among
three groups. The ultrasonographic thickness and
cross sectional area of EDB muscle in patients of
DM with PN were significantly smaller than those in
patients of DM without PN group (all P<0.01). The
ultrasonographic thickness and cross sectional area
of EDB muscle in patients of DM without PN were
significantly smaller than those of control subjects (all
P<0.01).
CONCLUSIONS: Atrophy of foot muscle in
diabetic patients can be detected by high frequency
ultrasonography.
SE 071
Ultrasound Shear Wave Imaging: Quantitative
Monitoring of the Progress of Amyotrophic
Lateral Sclerosis?
Chaochao Zhu1, Zhenzhou Li2, Shuai Huang1,
Qingfeng Gao1, Xiang Wu1, Zi Tao1, Minhua Lu1
1
Department of Medical Engineering, Guangdong
Key Laboratory for Biomedical Measurements
and Ultrasound Imaging, School of Biomedical
Engineering, Shenzhen University Shenzhen, China
2
SE 072
Sonographic Appearance of Palpable Superficial
Masses
Norharifah Zainal, Angela Anthony, Kho Ying Ying,
Sanamandra Sarat Kumar
Department of Radiology, Singapore General
Hospital, Singapore
PURPOSE: Ultrasound is the modality of choice
to evaluate superficial soft masses due to its cost
effectiveness, dynamic capabilities and its high
resolution. Our objective is to provide pictorial
review which illustrates spectrum of ultrasound
findings of superficial soft tissue masses encountered
in our clinical practice with correlative imaging and
histopathology if any.
METHODS: Lump ultrasound cases that were
performed at our institution between January 2008
and December 2013 were retrospectively reviewed.
All studies were performed using Philips IU22 and
Toshiba machine, with a high frequency linear
transducer. Colour Doppler was used to assess the
vascularity of the lumps.
RESULTS: After reviewing this exhibit, reviewers
should be able to recognize normal sonographic
superficial structures anatomy. Illustrate the
appearance of superficial soft tissue masses through
ultrasound imaging and where available, MRI or
histopathological findings to confirm diagnosis.
CONCLUSIONS: Ultrasound is the ideal tool used
to evaluate palpable superficial masses. It is cost
effective, dynamic and provides high resolution
images for superficial structures. Knowledge on
the normal ultrasound anatomy and pathological
appearances are important for interpretation of these
lumps. In cases, where the mass cannot be evaluated
by ultrasound, additional imaging or biopsy is
required to analyze it further.
293
Amyotrophic lateral sclerosis (ALS) is a nervous
system disease that causes muscle weakness and
impacts physical function. Electromyography is
regarded as the golden method for the early diagnosis
of ALS. During the recent years, muscle ultrasound
has been also involved in the early diagnosis and
differentiation of ALS from other neuromuscular
disorders. However, how to quantify the weakness
of the muscles of ALS patients, is still remained as a
challenge. Shear wave elastography is an ultrasoundbased technique that characterizes tissue mechanical
properties based on the propagation of remotely
induced shear waves. Various ultrasound shear
elasticity imaging techniques have been developed in
the last two decades. In this study, we utilized four
kinds of techniques with an open research ultrasound
system (Verasonics Inc., Redmond, WA), to
quantitatively evaluate the biomechanical properties
of the skeletal muscle noninvasively. A linear array
transducer L7-4 (Philips Healthcare, Andover, MA)
was used to produce 4 kinds of different push beams
(center frequency = 4.09 MHz, 600 us duration), and
then immediately switched to plane wave imaging
mode with all transducer elements (center frequency
=5.208 MHz), to track shear wave motion inside the
muscles. The shear wave speed was then estimated
and used to calculate the shear modulus of the
muscles. Elasticity of biceps brachii under different
loading was evaluated in a healthy volunteer (aged at
24 years old) and two ALS patients (aged at 61 and 74
years old, respectively). The shear wave speed along
the muscle fiber was 2.07 ± 0.31 m/s and 6.58 ± 0.65
in relaxed and contraction situation, respectively, for
the healthy volunteer. We will report the results in
ALS patients and then discuss if those four different
techniques are suitable for the clinical evaluation of
the progress of muscle weakness in ALS patients.
KSUM Open 2016
SE 073
Evaluation of a Mathematical Model for a
Personalized MR-HIFU Treatment for Bone Pain
Sin Yuin Yeo1, Huub Ten Eikelder1, Daniela Modena1,
Aaldert Elevelt2, Katia Donato2, Dragan Bosnacki1,
Edmond Van Dijk2, Holger Gruell1
1
Department of Biomedical Engineering, Eindhoven
University of Technology, Netherlands
2
Department of Oncology Solutions/In-body Sensing/
Embedded Systems, Philips Research Eindhoven,
Netherlands
OBJECTIVE: Bone pain reduces the mobility
and quality of life of patients. It affects children
and adults with cancers, and elderly person with
osteoarthritis. Magnetic Resonance-guided High
Intensity Focused Ultrasound (MR-HIFU) is a
thermal ablation technique, which is non-invasive,
free of ionizing radiation and can be repeated. MRHIFU has been shown to effectively provide pain
relief in patients with bone metastases, osteoid
osteomas, and osteoarthritis. Despite that, treatment
of bone pain using MR-HIFU remains a challenge
as the standard proton resonance frequency shift
thermometry used during therapies does not provide
temperature information in the cortical bone and
bone marrow, which is essential for treatment
planning, protocol design and outcome. Here, we
present a preclinical evaluation of a mathematical
model, which can be used to simulate MR-HIFU
treatment and estimate the temperature increase in
bone prior to therapies.
MATERIALS AND METHODS: Experiments were
performed on a 3T MR-HIFU platform (Philips
Sonalleve ®) using 4mm treatment cells. Ex vivo
bovine bones with temperature probes inserted in the
cortical bone were ablated using 60W for 20s. For
the in vivo experiments, rabbit femurs were ablated
using 20-60W for 16s and histological analysis
(hematoxylin and eosin, H & E) was performed at 7
days post treatments.
RESULTS: The ex vivo bovine cortical bone
temperatures estimated from our model were in
agreement with the temperatures measured by the
temperature probes. In vivo , with increasing acoustic
powers, an increasing region with hyper-intense
signal, and tissue damage were observed adjacent to
294
the bone on the T2-weighted MR and H & E images,
respectively. In line with the MRI and histological
analysis, simulation data showed comparable area
with temperatures >56°C.
CONCLUSIONS: Our simulation data are in
accordance with the experimental data, and our
model has the potential to serve as a treatment
planning tool for personalized MR-HIFU treatments.
SE 074
Strain Elastography Features of Epidermoid
Tumors in Superficial Soft Tissue: Differences
from Other Benign Soft Tissue Tumors and
Malignant Tumors
Hee Jin Park
Department of Radiology, Kangbuk Samsung
OBJECTIVE: We evaluated ultrasonographic (US)
features of superficial epidermoid tumor with a focus
on strain elastography (SE) features that will help in
the differential diagnosis of epidermoid tumor from
other benign soft tissue tumors and malignant soft
tissue tumors.
METHODS: We retrospectively evaluated US and
SE data of 103 surgically confirmed superficial
soft tissue tumors and tumor-like lesions: 29 cases
of epidermoid tumor, 46 cases of other benign
tumors, and 28 cases of malignant tumor. SE and
B-mode imaging were performed at the same time.
SE characteristics were assigned into four grades
(1-4) according to their elasticity. Inter-observer
agreement for the 4 SE scores between the two
radiologists was analyzed using kappa statistics. We
classified each SE finding as a hard lesion (SE score
3-4) or soft lesion (SE score 1-2) and compared
these findings using the Chi-square test to identify
whether a significant difference in mass hardness
existed among epidermoid tumor, other benign
tumor, and malignant tumor.
RESULTS: Overall inter-observer agreement
according to the 4 SE scores was moderate (k =
0.540), and overall agreement for the hardness [soft
(score 1-2) or hard (score 3-4)] was almost perfect (k
= 0.825). Malignant tumors showed higher SE scores
(3-4, hard nature) than epidermoid tumor or other
benign soft tissue tumors. There were no differences
in SE score between epidermoid tumor and other
benign tumors.
CONCLUSIONS: Superficial epidermoid tumor
exhibits a softer nature than malignant tumor but
does not have a different SE pattern from other
benign tumors.
SE 075
US Finding of the Superficial Lesions: Difficult to
be Categorized
Dalsu Park
Department of Radiology, s-seoul Hospital, Korea
Ultrasonography's role is rapidly more wider
from diagnostic modality to primary care just like
stethoscope. We are not usually attentioned new
roles of the superficial lesion ultrasonography. But
this section is difficult to categolized and systemized.
Superficial lesion is simple and easy but we are
forgotten importance, variety and possibilty. And I
exhibit bundle of superficial ultrasonographic lesions
contact every day practice such as foreign body, gout
arthritis, dermoid, superficial spinous ligament.
rupture, thrombophlebitis, AVM, etc.
SE 076
PURPOSE: Disorders of superficial soft tissue
tumors of the extremities are common, which are
categorized by their origin. Usually, ultrasound is
the first choice of the investigation for these disease
entities. The purpose of this exhibit is to illustrate
various cases with ultrasound imaging features of
295
Ultrasonographic Findings of Superficial Soft
Tissue Masses in Epidermis and Dermis of the
Extremities
Dasom Kim1, Sun Joo Lee1, Hye Jung Choo1,
Young Mi Park1, Kil-Ho Cho2, Sung Moon Lee3
1
Hospital, Korea
2
Department of Radiology, Yeungnam University
3
the superficial soft tissue masses confined to tumors
originating from epidermis and dermis.
MATERIALS AND METHODS: This study was
reviewed retrospectively gray-scale and color
Doppler US findings of various superficial soft tissue
tumors involving extremities. And these findings
are correlated with other imaging modality such as
CT or MRI. Some cases were confirmed by needle or
excisional biopsy.
CONTENTS ORGANIZATION: Superficial soft tissue
tumors in epidermis and dermis are categorized by
their origin and malignancy potential.
1. Epidermis
Malignant
- Merkel cell carcinoma
- Squamous cell carcinoma
- Melanoma
2. Dermis
1) Benign
- Epidermal inclusion cyst
- Eccrine spiradenoma
- Pilomatricoma
- Hiradenitis suppurativa
- Angioleiomyoma
- Neurofibromatosis
- Pilar sheath acanthoma
2) Malignant
- Epithelioid sarcoma
- Dermatofibrosarcoma protuberans
- Superficial B-cell lymphoma
CONCLUSION: We reviewed the various ultrasound
findings of the superficial soft tissue masses
originating from epidermis and dermis. Sonography
can be an important diagnostic tool in a precise
evaluation of superficial soft tissue masses, especially
when a tumor is too small to be evaluated on CT or
MRI. Through the review of this exhibit, radiologists
recognize the characteristic ultrasound findings
of each superficial soft tissue masses and it can be
helpful for the exact diagnosis.
KSUM Open 2016
SE 077
Ulnar Nerve beyond Guyon Canal with an
Emphasize on US
Dong Gun Kim1, Sun Joo Lee1, Hye Jung Choo1,
Young Mi Park1, Kil-Ho Cho2, Sung Moon Lee3,
Young Hwan Lee4
1
Hospital, Korea
2
Department of Radiology, Yeungnam University
3
4
Department of Radiology, Daegu Catholic University
PURPOSE: The aim of this exhibit is to review
ultrasonographic anatomy of ulnar nerve around
Guyon canal and related pathologic conditions.
CONTENTS ORGANIZATION:
1. To illustrate the normal anatomy and
ultrasonographic findings of ulnar nerve around
Guyon canal
2. Various pathologic conditions arising in Guyon
canal
- ganglion cysts at hamate-triquetrum or pisotriqeutrum joints
- accessory muscles; accessory palmaris muscle,
accessory abductor digiti minimi
- vascular causes; thrombosis, aneurysm,
pseudoaneurysm, hemangioma, arteriovenous
malformation
- trauma; fracture at hamate hook, repeated injury
to hypothenar eminence
- Tumor; lipoma, schwannoma, neurofibroma
SUMMARY: Guyon canal is a fibro-osseous tunnel
along the medial portion of the wrist that contains
neurovascular system, the ulnar nerve, artery and
vein. Guyon canal syndrome, ulnar nerve entrapment
at the wrist, is uncommon, but delayed diagnosis
may be a cause of unnecessary suffering or late
complication such as permanent nerve damage. To
know the anatomy in detail and imaging findings of
the common pathologic conditions is fundamental
to evaluate problems on the ulnar side of wrist and
hand. Furthermore it may be helpful to make a
diagnostic hypothesis.
296
SE 078
Sonoelastographic Evaluation of Plantar Fasciitis
after Collagen Injection Therapy
Minchul Kim, Yun Sun Choi, Myung-Won You
Department of Radiology, Eulji Hospital, Eulji
University, Korea
OBJECTIVE: To investigate whether ultrasound
elastography can demonstrate the outcome of the
treatment in comparison with gray-scale imaging.
METHODS: Sixteen patients (mean age, 46.9
years) with plantar fasciitis were prospectively
enrolled after unsuccessful conservative treatment.
Individuals graded their heel pain on a 100-mm
visual analogue scale (VAS), and underwent grayscale ultrasonography and sonoelastography.
Collagen was injected in the heels. Fascial thickness
and hypoechogenicity, perifascial edema, and
plantar fascial elasticity were evaluated. Follow-up
sonoelastography and VAS grading were done three
months after the injection. Statistical analyses were
performed by the paired t-test and the Fisher\'s exact
test. A P value < 0.05 was considered statistically
significant.
RESULTS: Mean plantar fascial thickness showed
insignificant decrease on follow-up (from 4.30
± 1.37 to 4.23 ± 1.15 mm; P=0.662). Fascial
hypoechogenicity and perifascial edema did not
change significantly after treatment. The mean strain
ratio of the plantar fascia was significantly increased
(from 0.71 ± 0.24 to 1.66 ± 0.72; P=0.001). Softening
of the plantar fascia decreased significantly after
injection (12 feet to 3 feet, P=0.004). Twelve out
of sixteen patients (75%) showed significant VAS
improvement at the follow-up.
CONCLUSIONS: Sonoelastography revealed
a hardening of the plantar fascia after collagen
injection treatment, and could aid in monitoring the
improvement of the symptoms of plantar fasciitis, in
cases where gray-scale imaging is inconclusive.
SE 079
Soft Tissue Tumors: Musculoskeletal US
Joonbum Koo
Hospital, Korea
Soft tissue is defined as the supportive tissue of
various organs and the nonepithelial, extraskeletal
structures exclusive of lymphohematopoietic tissues.
It includes fibrous connective tissue, adipose tissue,
skeletal muscle, blood/lymph vessels, and the
peripheral nervous system. Embryologically, most of
it is derived from mesoderm, with a neuroectodermal
contribution in the case of peripheral nerves.
Soft tissue tumors constitute a large and
heterogeneous group of neoplasms. Traditionally,
tumors have been classified according to histogenetic
features. (Fibrosarcoma, for example, is categorized
as a tumor arising from fibroblasts.) However,
histomorphologic, immunohistochemical, and
experimental data suggest that most, if not all,
sarcomas arise from primitive, multipotential
mesenchymal cells, which in the course of neoplastic
transformation differentiate along one or more lines.
At the clinical level, soft tissue tumors are classified
according to various parameters, including location,
growth pattern, likelihood of recurrence, presence
and distribution of metastases, patient age, and
prognosis. In general, benign soft tissue tumors occur
at least 10 times more frequently than malignant
ones, though the true incidence of soft tissue tumors
is not well documented. Imaging study shows soft
tissue tumors in this poster presentation.
A Pictorial Review of the Cystic Lesions Around
the Knee
Joonbum Koo
Hospital, Korea
One of the more common imaging findings when
evaluating the knee, whether by ultrasound or MRI,
is the “cystic lesion.” These “cystic lesions” may be
related to bursae, cysts, or other cyst-like lesions
and could be soft tissue or intraosseous in origin.
SE 081
Subungual Glomangioma of the Toe: Role of
Ultrasound Doppler for Diagnosis
Sabrilhakim Sidek, Mohd Shukry Mohd Khalid,
Mohd Farhan Hamdan, Mohammad Hanafiah,
Bushra Johari
Department of Radiology, Medical Imaging Unit,
Faculty of Medicine, Universiti Teknologi MARA,
Selangor, Malaysia
A 40-year-old gentleman, presented with
intermittent intense pain underneath his nail of
the right second toe for about 5-month durations.
This symptom caused disruption on his daily
work especially upon walking and long standing.
Examination of the toe showed slightly elevated nail
with tenderness on palpation. No discoloration of
the nail. An ultrasound of the toe had been arranged
to look for any abnormal findings. Ultrasound
examination demonstrated a well-defined, rounded
hypoechoic lesion measuring 0.6 x 0.5 cm at the
lateral subungual region (at the site on tenderness).
There was no calcification within this lesion. A
Doppler ultrasound scan was performed and showed
mixed signal within the lesion. An arterial waveform
was generated. No arteriovenous shunt pattern can
be observed. Subsequently, an MRI examination
was performed which showed homogeneously
enhancing lesion with low signal intensity on T1W
and high signal intensity on T2W sequences. Hence,
a diagnosis of subungual glomangioma was made.
Subungual glomangioma is a rare benign neoplasm
arising from the glomus body. It is commonly located
under the nail of the finger or foot. Ultrasound with
Doppler examination has certain characteristic
features and plays an essential role in the diagnosis
of this lesion.
297
SE 080
They are mostly benign lesions; however, not all
hypoechoic or T2 hyperintense lesions are cysts, and
neoplastic lesions may be missed if close attention is
not paid to the typical imaging findings. Therefore,
knowledge of the normal bursae, common cysts,
and cyst-like lesions which can occur about the
knee is essential for the appropriate diagnosis and
management in these cases.
KSUM Open 2016
Pediatric
SE 082
Cranial Ultrasound in Neonates
PURPOSE: This 20 minutes oral presentation
is aimed at giving uses of Cranial Ultrasound
in detecting normal and abnormal pathologies
including Germinal Matrix Hemorrhage and
Periventricular Leukomalacia in Neonates along with
few other abnormalities. It describes the various
techniques and views along with detailed description
how to diagnose various pathologies in the Brain.
MATERIALS AND METHODS: Cranial Ultrasound
is done as an initial screening technique for
detecting of various pathologies in term and Preterm
Neonates. Main abnormalities to be detected include
Germinal Matrix Hemorrhage and its various grades.
Corresponding images are provided to show the
details. It can also be used as a tool in diagnosing
various other abnormalities of the brain including
cysts, abscesses etc. It can also be used for objective
assessment and follow up of Hydrocephalus.
RESULTS: Cranial Ultrasound is considered as an
excellent tool in diagnosing various pathologies of
Brain in the Neonates. It has an added advantage
of having NO radiation and can be used for follow
ups. Hence it has a high sensitivity and specificity
in diagnosing the basic abnormalities of Neonatal
Brain.
CONCLUSION: Cranial Ultrasound in Neonates
is aimed at people who plan to practice it in day
to day use of it in the NICU and Outpatient clinics
for routine screening purposes and for diagnostic
purposes.
298
SE 083
Feasibility and Clinical Usefulness of ARFI
Imaging of Sternocleidomastoid Muscle in
Infants with Congenital Muscular Torticollis
Dong Rak Kwon, Gi-Young Park, Dae-Gil Kwon
Department of Rehabilitation Medicine, Daegu
Catholic University Medical Center, Korea
PURPOSE: To evaluate the feasibility of quantifying
sternocleidomastoid muscle (SCM) stiffness using
acoustic radiation force impulse (ARFI) and clinical
usefulness of ARFI in infants with congenital
muscular torticollis (CMT).
MATERIALS AND METHODS: Ten infants with a
SCM thickness of greater than 10 mm with or without
involvement of the entire length of the muscle (group
1) and 12 infants with a SCM thickness of less than
10 mm with or without involvement of any part of
the muscle (group 2) were included. After 1 week
intensive rehabilitation therapy, infants in group
1 were divided two subgroups as good responder
(group 1G) and bad responder (group 1B) according
to therapeutic response. We checked the thickness of
SCM muscles in B-mode ultrasound and local shear
wave (SWV) velocity of the SCM muscles in both
groups using ARFI imaging. Student t test was used
to compare the values.
RESULTS: The SCM thickness in group 1 was
significantly larger than that in group 2. The SWV
of GCM in group 1 was significantly higher than that
in group 2. In group 1, the SWV of SCM in affected
side was significantly higher than that in unaffected
side. In group 2, there is no difference of the SWV
of SCM between affected and unaffected side.
Before treatment, there is no significant difference
of SCM thickness between group 1G and group 1B.
After treatment, the SCM thickness in group 1G was
significantly smaller than that in group 1B. The SWV
of SCM in group 1G was significantly lower than that
in group 1B before treatment.
CONCLUSION: Quantifying muscle stiffness
of the SCM using ARFI imaging is feasible and
ARFI may be a useful adjunctive tool to B-mode
ultrasonography for predicting their rehabilitation
outcome.
SE 084
Shear Wave Elastography of Testis with
Varicocele: Preliminary Results
Haesung Yoon1, Mi-Jung Lee1, Hyun Joo Shin1,
Myung-Joon Kim1, Yong Seung Lee2
1
Korea
2
SE 085
Prenatal Diagnosis of an Umbilical Vein
Aneurysm: Case Reports
Baatartsogt Tumur3, Zolzaya Jalbuu3,
Munkhsaikhan Buyan3
1
MNUMS "Gurvan Gal" Teaching Hospital of MNUMS,
Mongolia
2
Department of Radiology, "Gurvan Gal" Teaching
Hospital, Mongolia
3
Department of Obstetrics and Gynecology, "Gurvan
Gal" Teaching Hospital, Mongolia
Aneurysm of the umbilical vein is a rare congenital
abnormality and has seldom been diagnosed
prenatally by ultrasound. We are reporting two cases
in which dilatation of the intra-abdominal umbilical
vein were detected by prenatal ultrasound at the
thirds trimester of gestational age. This was believed
to represent an umbilical vein aneurysm and was
confirmed on subsequent pathological examination
after delivery. A review of the literature concerning
these uncommon vascular abnormalities of the
umbilical cord will be presented.
PURPOSE: To measure shear wave velocity of testis
in varicocele and post varicocelectomy patients
and find the differences between patient group and
normal group.
MATERIALS AND METHODS: From April 2015
to February 2016, we retrospectively reviewed
testis ultrasound in patients who had history of
varicocele or underwent previous varicocelectomy.
We also reviewed patients with normal testis for
comparison. All of these patients underwent normal
B-mode sonography and multi-frame shear-wave
elastography of both testes using the Aixplorer ®
ultrasound system (SuperSonic Imagine, Aix en
Provence, France). Three measurements were
performed for each testis and average was recorded.
Retrograde velocity peak was measured during
valsalvar maneuver in varicocele patients. Results
were statistically evaluated using Wilcoxon signed
rank test and Mann-Whitney U test.
RESULTS: The study included 12 ipsilateral
varicocele patients, 10 bilateral varicocele patients,
24 patients with previous varicocelectomy and
16 normal patients. The age was 3-19 years with
the mean of 13.8 years. There was no remarkable
difference in shear wave velocity in contralateral
normal testis and testis with varicocele (P=0.182)
and between contralateral normal testis and testis
with previous varicocelectomy (P=0.076). Testis
with previous varicocelectomy showed significant
decrease in volume; 9.05cc (IQR 6.6-11.1) compared
to 11.1cc (IQR 8.7-13.8) in contralateral normal
testis (P=0.04). Testicular shear wave velocity was
higher in normal group compared to contralateral
normal testis in varicocele patients; 2.77 kPa (IQR
2.38-3.67) and 2.28 kPa (IQR 1.9-2.55), respectively
(P=0.026). There was no difference in shear wave
velocity between testis with varicocele and testis
with previous varicocelectomy (p=0.987). However,
retrograde peak velocity was decreased testis with
previous varicocelectomy (p=0.002).
CONCLUSION: Varicocele may occur
microstructural changes in bilateral testes and shear
wave elastography may be useful in determining the
early change by noninvasive measurement.
299
KSUM Open 2016
SE 086
Prenatal Ultrasound Detection of Congenital
Fetal Anomalies: 5 Year Results
Baatartsogt Tumur3, Munkhsaikhan Buyan3,
Mendbayar Damdinsuren3, Zolzaya Jalbuu3,
Javzandulam Badrakh3, Lkhagvasuren Purevdorj3
1
MNUMS, "Gurvan Gal" Teaching Hospital of
MNUMS, Mongolia
2
Department of Radiology, "Gurvan Gal" Teaching
Hospital of MNUMS, Mongolia
3
Department of Obstetrics and Gynecology, "Gurvan
Gal" Teaching Hospital of MNUMS, Mongolia
Congenital malformations occur in 2-4% of all
births. Despite their relatively low prevalence, fetal
anomalies are responsible for approximately 30%
of perinatal deaths in addition to considerable
infant morbidity in developed countries. Over the
last two decades, prenatal diagnosis has greatly
benefited from advances in ultrasound technology.
Therefore, we proposed to evaluate the results of
congenital fetal anomalies detected prenatally by
ultrasound in last 5 years. Single center experienced
retrospective analysis of ultrasound examination
materials of 16980 pregnant women were evaluated
in this study. Between 2011-2015 years, there were
detected the total of 483 cases of congenital fetal
anomalies. 68,7% of all cases (266) were detected
at the second trimester of the pregnancy. Of these
483 cases of congenital anomalies 41.8% were
cardiovascular system disorders, 15.9% central
nervous system disorders, 8.1% genitourinary system
disorders, 8.1% were multi organ anomalies, 7.5%
were umbilical artery abnormalities, 5.6% were fetal
facial malformations, 3.5% musculoskeletal system
anomalies, 3.1% digestive system disorders and
0.4% respiratory system disorders. The incidence
of congenital anomalies is increased significantly
comparing the year 2011 with the year 2015. There
was no significant correlation between the prevalence
of anomalies with the mother’s age.
300
SE 087
Measuring Renal Pelvis AP Diameter in Pediatric
Renal Pathologies
This Poster is intended towards learning how to
measure renal pelvis AP diameter in pediatric
urogenital anomalies. Proper positioning of the
patient along with proper positioning of the probe is
important in measuring renal pelvis AP diameters.
In order to make a consistent reproduction of results
among the ultrasound technicians and doctors the
correct reproducible method is important to have an
objective evaluation of the renal pelvis AP diameters.
SE 088
Critical Ultrasonographic Findings: Neonatal
Abdomen
Hee Jeong Kim, Young Seok Lee
Department of Radiology, Dankook University
Hospital, Korea
Ultrasonography plays an invaluable role in
evaluating pediatric patients since it is a simple,
well-established, noninvasive, and readily available
diagnostic tool.
There had been several publications regarding critical
pediatric ultrasonography findings, but most of them
were dealing with only several disease entities that
could be expected in a broad age spectrum, from
neonates to adolescents. These could provide only
limited information to practitioners because what to
expect in a specific age group was undistinguished.
Hereby we attempt to focus on critical ultrasonographic findings of neonatal abdomen, and
present comprehensive cases of gastrointestinal,
hepatobiliary, and genitourinary emergencies with
characteristic ultrasonographic findings. Some
catheter-related complications requiring an instant
attention and management will be also reviewed.
The cases included in our review are systemically
grouped as follows:
1) Gastrointestinal system: Necrotizing enterocolitis,
Spontaneous intestinal perforation, Meconium
ileus, Meconium peritonitis, Midgut volvulus,
Neonatal intussusception, Jejunal atresia,
Idiopathic hypertrophic pyloric stenosis,
Congenital megacolon, Strangulated hernia
2) Hepatobiliary system: Biliary atresia with
choledochal cyst, Infantile hemangiomatosis
3) Genitourinary system: Acute urinary retention,
Adrenal hemorrhage, Ovarian torsion
4) Catheter-related complications: Catheter-related
thrombosis, Hepatic abscess, Iatrogenic venous
gas
In spite of recent advances in various diagnostic
imaging modalities, ultrasonography remains as
the first-line diagnostic tool for most neonates,
which makes it essential for a radiologist
to provide meaningful report from a beside
ultrasonography. Thorough understanding
of these critical and characteristic neonatal
abdominal ultrasonographic findings may help
making an appropriate on-time diagnosis which
could lead to a proper management.
due to malignancy. On CDI and SMI, spoke-wheel
pattern (the central vessel radiating from the
center to the periphery), a highly specific finding
of FNH, was visually assessed and categorized as
definite, equivocal and absent by consensus of two
radiologists.
RESULTS: Spoke-wheel pattern was more frequently
and more clearly visualized with SMI (definite
6, equivocal 3) compared with CDI (definite 2,
equivocal 2, absent 5). In five FNHs (4/9, 36%), SMI
demonstrated spoke-wheel pattern which was not
visualized on CDI.
CONCLUSION: Our preliminary study shows
that SMI, with its greater ability to demonstrate
spoke-wheel pattern than CDI, can be a promising,
noninvasive technique for diagnosing FNH in
children.
SE 090
PURPOSE: To investigate the utility of superb
micro-vascular imaging (SMI), a novel Doppler
US technique that can visualize low velocity
microvascular flow, for assessing pediatric focal
nodular hyperplasia (FNH).
MATERIALS AND METHODS: All nine FNH lesions
(mean size 4 cm, range 1~10 cm) in 7 patients (all
female, mean age 12, range 2~17 years) examined
using both Color Doppler imaging (CDI) and SMI
were enrolled. Diagnosis of FNH was made by either
typical MR imaging findings or biopsy. Multiple
lesions were found in 2 patients who had undergone
chemotherapy due to malignancy and had aberrant
portal vein, respectively. Solitary lesions were found
in 5 patients including one with absent portal vein
and another who had undergone chemotherapy
PURPOSE: To discuss appropriate imaging approach
to vomiting in neonates and infants
To illustrate sonographic techniques and findings of
various diseases causing vomiting
CONTENTS:
Advantage / disadvantage of ultrasonography for
evaluation of pediatric gastrointestinal tracts
Sonographic approach to bilious vomiting in neonate
up to 1 week old
Sonographic approach to bilious vomiting in infant 1
week to 3 months old
Sonographic approach to intermittent nonbilious
vomiting since birth
Sonographic approach to new onset nonbilious
vomiting
SUMMARY: Various diseases can cause vomiting in
infants and children. Ultrasound has an important
role to make a precise diagnosis of diseases, including
midgut volvulus and hypertrophic pyloric stenosis
without radiation exposure. This presentation will
be focused on the appropriate imaging approach and
sonographic findings associated with various causes
Superb Micro-Vascular Imaging in Pediatric Focal
Nodular Hyperplasia
Sookmin Hwang, So-Young Yoo,
Woo Kyoung Jeong, Tae Yeon Jeon, Ji Hye Kim
Korea
301
SE 089
Sonographic Approach to Vomiting Baby
Jihyun Bae, Jae-Yeon Hwang
KSUM Open 2016
of vomiting in neonates and infants.
SE 091
Developmental Venous Anomaly in Neonatal
Ultrasound
Wee Kyoung Kim
Developmental venous anomalies (DVAs) is widely
known benign anatomical variant of parenchymal
venous drainage in brain. It has been found
incidentally on brain MRI during workup for other
abnormalities in adult patients. Also this has been
known to be clinically insignificant except very rare
cases which had brought complication out. Usually
DVAs shows hypertrophied transparenchymal
draining vein from the cortex with surrounding hairy
structures suggesting deeper collecting venules on
contrast enhanced MRI. However ultrasonographic
features for DVAs are not as well known while
DVAs is developmental anatomic anomaly based on
embryologic origin and pathophysiologic mechanism.
Here, we try to report a case of DVAs through
neonatal brain ultrasonography with follow up study
and attempt to find US features correlating to MRI
findings and other reported literatures.
SE 092
Congenital Perineal Lipoblastoma with
Accessory Scrotum
Wee Kyoung Kim
We report a case of congenital perineal lipoblastoma.
The newborn presented with a soft tissue tumor
attached to perineal skin. The mass was evaluated by
ultrasonography and MRI. Mass was removed with
surgical excision and final diagnosis was confirmed
as perineal lipoblastoma pathologically. Also this
mass had accessory scrotum in both of external
appearance and histology. This is rare and difficult
to exact diagnose and differentiated between lipoma
and lipoblastoma by using only imaging. But we try
to suggest some helpful image findings about the
perineal lipoblastoma for differential diagnosis.
302
Physics
SE 093
Performance Demonstration of Novel Backing
Structure for Intravascular Ultrasound
Transducer
Seon Mi Ji, Jin Ho Sung, Chan Yuk Park,
Jong Seob Jeong
Department of Medical Biotechnology, Donggguk
University, Korea
Among acoustic parts of diagnostic ultrasonic
transducer including piezoelectric, matching, backing
layer and lens, the backing layer has been employed
as the thickest and heaviest component for enough
attenuation. Reducing thickness of the backing can
contribute to lower the size and weight of transducer.
Especially, it can be helpful to portable, small-sized
transducers such as intravascular ultrasound (IVUS)
transducer used for diagnosing cardiovascular
diseases. However, thin backing layer can be
suffered from insufficient attenuation and result in
unwanted reflected signals. In this study, a backing
structure capable of suppressing the generation of
reflected signal was proposed. Based on relationship
of acoustic impedance, the proposed structure can
generate reflected signals of opposite phase each
other. The generated signals can be summed together
in piezoelectric layer and dissipated by phase
cancellation. To demonstrate the performance of the
proposed backing structure, finite element method
simulation was conducted. Firstly, we designed IVUS
transducer having conventional bulk-type backing. A
center frequency of the transducer was 20 MHz and
aperture size was 1 mm2. The designed transducer
was composed of piezoelectric, double matching, and
backing layer. When thickness of the backing was
reduced from 40λ to 5λ, back-wall echo signals were
generated from the bottom surface of backing and
it affected to transmitted/received signal as noises.
The -6dB bandwidth was also decreased from 67%
to 16% due to distortion of frequency spectrum.
Subsequently, the noise signals were suppressed by
applying the proposed backing model. The signal
distortion was recovered and the -6dB bandwidth
was increased to 63% although total thickness of the
backing was maintained equally (5λ). Its waveform
was similar to the case of conventional thick backing.
Consequently, since the proposed technique can
contribute to reduce thickness of backing layer with
minimized side-effects, it can be useful to realize a
miniaturized and lightweight transducer.
polymer by means of HIFU. The thermal, electrical,
acoustic, and optical properties of phantoms were
measured successfully.
Thyroid
SE 094
Temperature-Responsive Tissue Mimicking
Phantom for High Intensity Focused Ultrasound
Therapy
Donghee Ma1, Yong Tae Kim2, Se Hwa Kim1
1
Department of Nano-Bio Measurement, KRISS
(Korea Research Institute of Standards and
Science), Korea
2
Department of Medical Metrology, KRISS, Korea
PURPOSE: To develop a clinically feasible CytologyUltrasonogaraphy (CU) system for malignancy risk
stratification based on the fine-needle aspiration
(FNA) cytology and Korean-thyroid imaging
reporting and data system (K-TIRADS) in thyroid
nodules.
2010 to May 2011, a total of consecutive 1651
thyroid nodules (≥ 1 cm) with final diagnoses were
included. For the development of the CU system,
we analyzed the malignancy risk of thyroid nodules
by combination of K-TIRADS (5 categories) and
the Bethesda system (6 categories). We assessed if
the malignancy risk of each K-TIRADS category are
different according to the FNA results of thyroid
nodules.
RESULTS: The Bethesda category 1 or 4 cytology
diagnosis did not significantly change the
malignancy risk of nodules compared with the other
nodules showing other cytology diagnoses among
the nodules with the same K-TIRADS category (P
≥0.833 and P≥0.160, respectively). The Bethesda
303
High intensity focused ultrasound (HIFU) provides
potential applications in many medical fields owing
to the capability to minimize tissue incision and
damage. However, the slow feedback of temperature
control during the therapeutic stages has regarded
as a major drawback in extensive clinical use. The
precise monitoring of temperature changes on target
biological tissues is crucial to develop a biological
tissue dosimetry for HIFU. This study aims to
develop a temperature-responsive agarose phantom
using bio-friendly materials. Because the agar gel
has shown to be a medium mimicking biological
tissue in phototherapy studies, we used the agarose
for thermal phantom. An agarose is a polysaccharide
complex which has the capacity to hold water within
its structure due to the presence of hydrophilic
group. The agarose phantom shows absorption and
scattering characteristics similar to soft tissue. Also,
the agarose phantom has been used for transferring
heat in aqueous environments. By using these
properties, we have developed an agarose-based
phantom with a thermally responsive polymer
for ultrasound-induced hyperthermia. Phantoms
were prepared with agarose (5%, w/v), sugar (040%, w/v) and self-assembled polymer solution in
a cylindrical container. The synthesized polymer
was characterized with size distribution and surface
charge. We found that temperature changes of
agarose phantom which integrated with synthesized
SE 095
Cytology-Ultrasonography (CU) Risk
Stratification System Based on FNA Cytology
and Korean-Thyroid Imaging Reporting and Data
System (K-TIRADS)
Dong Gyu Na1, Jung Hwan Baek2, Jin Yong Sung3,
Ji-Hoon Kim4
1
2
Korea
3
Department of Radiology, Daerim St. Marys
Hospital, Korea
4
Hospital, Korea
KSUM Open 2016
category 2 cytology diagnosis significantly decreased
and category 5 or 6 increased the malignancy risk
of nodules with K-TIRADS 3, 4, and 5 compared
with the other nodules of each K-TIRADS category
nodules (P<0.001, respectively). The Bethesda
category 3 increased malignancy risk of K-TIRADS 3
and 4 (P<0.001 and P0.017) nodules and decreased
malignancy risk of K-TIRADS 5 (P<0.001) nodules.
The malignancy risk of thyroid nodules could be
stratified into 4 CU categories (probably benign
<3%, low risk ≥3%, <30%, high risk ≥30%, <90%,
probably malignancy ≥90%) by combination of
K-TIRADS and FNA cytology results.
CONCLUSION: The malignancy risk of thyroid
nodules can be stratified by the CU risk stratification
system based on FNA cytology and K-TIRADS.
The proposed CU system will be helpful for the
management of thyroid nodules after FNA.
SE 096
First-Line Use of Core Needle Biopsy for HighYield Preliminary Diagnosis of Thyroid Nodules
Young Joong Kim1, Hye Yeon Han2,
Jong Myeong Yi2, Jung Hwan Baek4,
Shin Young Park3, Jae Young Seo1
1
Department of Radiology, Konyang University
Hospital, Korea
2
Department of Radiology, Daejeon Sun Hospital,
Korea
3
Department of Pathology, Konyang University
Hospital, Korea
4
Korea
PURPOSE: Although, core needle biopsy (CNB) was
introduced as a diagnostic alternative to fine needle
aspiration (FNA), the utility and safety of CNB for
thyroid nodules in a large population has yet to be
studied comprehensively. We evaluate CNB yields on
a large-scale basis to investigate its full potential in
the preliminary diagnosis of thyroid nodules.
MATERIALS AND METHODS: Between March
2005 and December 2013, 2448 initially detected
thyroid nodules from 2120 consecutive patients
who underwent CNB were evaluated. Of these, 72
thyroid nodules from 63 patients were excluded
304
due to prior FNA attempts. The inconclusive result
rate and conclusive result rate, diagnostic accuracy,
sensitivity, specificity, positive predictive value,
negative predictive value and unnecessary surgery
rate of CNB were evaluated.
RESULTS: At CNB as first-line method, the
inconclusive result rate was 11.9% (283/2376), and
the conclusive result rate was 88.1% (2093/2376).
The malignancy detection rate was 19.9% (474/2376).
And the unnecessary surgery was performed for
only two nodules (2/363, 0.05%). The diagnostic
accuracy, sensitivity, specificity, positive predictive
value, and negative predictive value of CNB for
diagnosis of malignancy were 96.7% (1160/1200),
89.7% (347/387), 100% (813/813), 100% (347/347),
and 95.3% (813/853), respectively. And there were
no major complications.
CONCLUSION: We have demonstrated that firstline use of CNB may well improve diagnostic
accuracy in thyroid nodules, reducing inconclusive
or false-negative results and unnecessary surgeries.
Such benefits underscore the promising role of CNB
in managing thyroid nodules and optimizing related
surgical decision-making.
SE 097
Nodular (N) and Non-Nodular (Non-N)
Configuration of Subacute Granulomatous
Thyroiditis (SAT): Characteristics and
Interval Change (IC) Using Follow-Up (FU)
Ultrasonography (US)
Yoo Jin Lee, Dong Wook Kim
Hospital, Korea
PURPOSE: To assess the characteristics and IC in N
and non-N SAT using FU US.
2008 to December 2014, 85 patients who were
clinically suspected of SAT underwent US by a
single radiologist. SAT was confirmed on the basis of
clinical, US, and pathological findings. In the initial
and FU US, we investigated the US findings and IC
in N and non-N SAT lesions. The IC for a SAT lesion
was classified: disappeared, decreased, increased,
negative fluctuation, positive fluctuation, and no IC.
RESULTS: Of 85 patients, 64 (75.3%) were
confirmed as SAT. In 64 SAT patients, the prevalence
of N (n=39) and non-N (n=35) lesions was similar;
10 patients exhibited both N and non-N lesions.
There was a significant difference in contour,
echogenicity, and shape between N and non-N SAT
lesions (p=0.010, p<0.0001, p=0.014), whereas no
significant difference in margin and vascularity (p
=0.090, p=0.302). Of 64 patients, 41 underwent
FU US. In both N and non-N lesions, the common
IC included disappeared (43.3%, 55.6%), decreased
(26.7%, 22.2%), and negative fluctuation (10%,
16.7%), whereas increased change was found only in
4 N lesions (13.3%). The rate of no IC was similar in
N and non-N lesions (6.7%, 5.6%).
CONCLUSION: There was no significant difference
in the IC between N and non-N SAT lesions, although
there was a significant difference in contour,
echogenicity, and shape.
SE 098
Ultrasonography Features of Thyroidal Fatty
Lesions in the Thyroid Gland: A Preliminary
Study
Jung Won Park, Dong Wook Kim
Hospital, Korea
SE 099
Ultrasound-Guided Fine Needle Aspiration
Biopsy Versus Core Needle Biopsy: Comparison
of Post-Biopsy Hematoma Rates and Risk
Factors
In Hye Chae1, Eun-Kyung Kim2, Hee Jung Moon2,
1
2
Korea
PURPOSE: To compare post-biopsy hematoma rate
between US-guided fine needle aspiration biopsy
and US-guided core needle biopsy in thyroid nodules
and to evaluate the overall ultrasonographic features
and clinical factors that contribute to post-biopsy
hematoma as procedure related complication
MATERIALS AND METHODS: From March 2013 to
September 2015, a total of 7904 US-guided biopsies
of thyroid nodules in 6897 patients (1655 men and
6249 women) had been performed at our institution.
There were 7716 US-FNA (97.6%) and 188 US-CNB
(2.4%), respectively. US-FNA was performed by
one of 4 experienced doctors or 12 less experienced
doctors (fellowship trainee) and US-CNB was
performed by one of 2 experienced doctors. We
compared the clinical and US features between two
groups; with and without post-biopsy hematoma.
We analyzed the association with these features
including the experience of the performing doctor
ad post-biopsy hematoma by multivariate logistic
regression analysis.
305
PURPOSE: No previous study has evaluated
the ultrasonography (US) features of thyroidal
fatty lesions (TFLs). This study aimed to assess
the characteristic US features of TFLs and their
prevalence.
2013 to December 2014, 940 patients underwent
preoperative neck US and computed tomography
(CT) examinations before thyroid surgery. The
diagnostic criterion for TFL was the presence of
intraglandular fatty tissue on CT images regardless
of the lesion size. A single radiologist retrospectively
analyzed all the US and CT images.
RESULTS: The prevalence of TFL was 2.1% (20/940),
with a mean largest diameter of 6.3 mm (range, 5.19.2 mm). The involved sites included the right lobe (n
=11), left lobe (n=9), and isthmus (n=0). Seventeen
cases (85%, 17/20) showed continuity with the
adjacent thyroid capsule or perithyroidal fatty tissue
on US or CT. All TFLs showed hyperechogenicity,
no calcification, no posterior shadowing and
enhancement, and an ovoid shape, and most TFLs
exhibited inhomogeneous echogenicity and smooth
margin.
CONCLUSION: TFLs characteristically appear as
ovoid, inhomogeneously hyperechoic thyroid nodules
with no calcification, no posterior shadowing and
enhancement, a smooth margin, and continuity with
the adjacent thyroid capsule or perithyroidal fatty
tissue on US.
KSUM Open 2016
RESULTS: The post-biopsy hematoma rates were
0.92% (71/7716) on US-FNA and 4.79% (9/188) on
US-CNB, respectively (P<.001). In all patients, USCNB (odds ratio, 7.475; P<.001) and presence of
vascularity of the nodule (OR, 1.721; P=.041) were
significant associated with post biopsy hematoma.
The rate of post-biopsy hematoma was not
significantly different according to the experience of
the performing doctor (OR, 1.491; P=.109). In the
experienced group who performed US-CNB, postbiopsy hematoma rates were 1.2% (20/1683) on
US-FNA and 4.9% (9/184) on US-CNB (P=.001).
Multivariate analysis revealed that US-CNB was only
significant factor of post-biopsy hematoma in the
experienced group who performed US-CNB (OR,
5.379; P<.001).
CONCLUSION: The incidence of post-biopsy
hematoma after US-guided core needle biopsy was
significantly higher than after Us-guided fine needle
aspiration biopsy. US-CNB was only significant
factor associated with post-biopsy hematoma in
thyroid nodule.
SE 100
Differentiation of Parathyroid Carcinoma
from Parathyroid Adenoma by Preoperative
Ultrasonography
Meeyoung Nam, Jung Hee Shin, Soo Yeon Hahn
Korea
PURPOSE: The purpose of this study was to
identify the differential points between parathyroid
carcinoma (PTC) and adenoma (PTA) in preoperative
patients with primary hyperparathyroidism.
MATERIALS AND METHODS: We enrolled 7
patients with PTC (3 women and 4 men; mean age,
59 years) and 32 consecutive patients with PTA (24
women and 8 men, mean age, 51 years) who were
confirmed by surgery in our institution from March
1994 to June 2015. We retrospectively compared
ultrasonography features of nodules, demographic,
clinical, and biochemical (age, gender, major
symptoms, and parathyroid hormone (PTH) and
ionized calcium level) characteristics between two
groups.
306
RESULTS: PTC was not significantly different
from PTA in terms of mean age (59.0 ± 13.5 years
versus 51.1 ± 13.2 p=0.2063), sex distribution
(male: female ratio 4:3 versus, 8:24 P=0.1716),
PTH level (2855.0 ± 6444.1 versus 1821.5 ± 7848.4
p=0.2067), and ionized calcium level (1.7 ± 0.3
versus 1.5 ± 0.2, p=0.1585). On ultrasonography,
PTC was significantly larger (3.5 ±1.7 versus
1.9±0.8 p=0.0133) and showed a higher incidence
of heterogeneous echotexture of a solid portion
(P=0.0002), irregular shape (p<0.0001), notcircumscribed margin (p<0.0001), presence of
calcifications in a mass (p=0.014), palpability
(p<0.0001), and local invasion (p=0.0004) than
PTA. However, there were no significant difference
in nodule echogenicity (p=0.3126) and presence
of suspicious lymph node (p=0.1795) between two
groups.
CONCLUSION: Parathyroid carcinoma frequently
shows a large palpable mass with heterogeneous
echotexture, irregular shape, not-circumscribed
margin, calcifications, and local infiltration on
ultrasonography. The differentiation between PTC
and PTA may be predicted by US features rather
than clinical or laboratory findings.
SE 101
Prediction of Lymph Node Metastasis in Papillary
Thyroid Carcinoma Patients by Vascular Index
on Power Doppler US, Microvessel Density, and
Vascular Endothelial Growth Factor
Ji Hye Lee, Hyun Joo Shin, Jung Hyun Yoon,
Eun-Kyung Kim, Hee Jung Moon, Jin Young Kwak
PURPOSE: Angiogenesis plays a crucial role in
tumor growth and the metastatic spread of cancer.
For papillary thyroid carcinoma (PTC) patients,
Lymph node metastasis (LNM) is associated with an
increased recurrence rate. And the purpose of this
study was to investigate whether Vascular endothelial
growth factor (VEGF), microvessel density (MVD),
and vascular index (VI) can predict LNM in PTC
patients.
MATERIALS AND METHODS: From January 2011
to October 2011, 202 PTCs underwent preoperative
staging US evaluation. And to evaluate vascularity,
we measured VI, VEGF expression and MVD.
RESULTS: The VI was significantly correlated with
MVD (P=0.009), but there were no significant
correlations to VEGF extent (P=0.696), VEGF
intensity (P=0.895), and VEGF H-score (P=0.730).
On multivariate analysis, young age showed a
significant correlation with LNM (P=<0.001; P=
<0.001; P=<0.001) and extrathyroidal extension
had a marginal correlation with LNM (P=0.058; P=
0.029; P=0.053). But, the other clinicopathologic
features, VEGF, MVD and VI failed to show any
significant correlations with LNM.
CONCLUSION: Although the VI showed significant
correlation with MVD, it was not significantly
correlated to LNM. Therefore, VEGF, MVD, and
VI may not be useful for predicting LNM in PTC
patients.
SE 102
Histogram and Gray Level Co-Occurrence Matrix
on Gray-Scale Ultrasound Images for Diagnosing
Lymphocytic Thyroiditis
Young Gyung Shin1, Jung Hyun Yoon2,
Eun-Kyung Kim2, Hee Jung Moon2, Jin Young Kwak2
1
Department of Radiology, Kosin University Gospel
Hospital, Korea
2
Korea
SE 103
Metastatic Renal Cell Carcinoma in Thyroid
Gland: Ultrasonographic Features and Role of
Image Guided Biopsy in its Diagnosis
Ok Kyu Song1, Ja Seung Koo2, Jin Young Kwak1,
Hee Jung Moon1, Jung Hyun Yoon1, Eun Kyung Kim1
1
Korea
2
Department of Pathology, Severance Hospital,
Korea
PURPOSE: To present ultrasonographic(US)
features of metastatic renal cell carcinoma(RCC)
in the thyroid gland, and to evaluate the diagnostic
yields of fine-needle aspiration (FNA) and core
needle biopsy (CNB).
MATERIALS AND METHODS: Eight patients
with nine metastatic RCC nodules in the thyroid
glands at one tertiary hospital from January 2002
to December 2015 were included in this study. US
features and clinical history were reviewed from the
medical database. The diagnostic yields of FNA and
CNB were evaluated.
RESULTS: Six men and two women were included
in the study. The mean age at diagnosis of metastatic
307
PURPOSE: To evaluate whether texture analysis
using histogram and gray level co-occurrence matrix
(GLCM) parameters can help clinicians diagnose
lymphocytic thyroiditis (LT) and differentiate LT
according to pathologic grade.
MATERIALS AND METHODS: Pre-operative
staging ultrasound was performed in 575 patients at
our institution from August to October 2013. Of 531
patients who underwent surgery, 90 were excluded
because they did not have a sufficient amount
of underlying thyroid parenchyma to establish
correct diagnoses as there were multiple nodules
in both thyroid glands. Finally, of 441 patients who
underwent surgery, background thyroid pathology
was classified into three categories (no evidence of
LT, chronic LT (CLT), and Hashimoto’s thyroiditis
(HT)). Histogram and GLCM parameters were
extracted from the ROIs on ultrasound. We divided
subjects into two groups (without LT and with LT)
and into three grades (without LT, CLT, and HT).
The diagnostic performances of the histogram and
GLCM parameters for diagnosing LT were calculated
and compared using areas under the curve (Az) and
volume under the ROC surface (VUS).
RESULTS: Of the histogram and GLCM parameters
for diagnosis of LT and differentiation of them
according to pathologic grade, the mean on
histogram had the highest Az (0.63) value and VUS
(0.303). As the degrees of LT increased, the mean
was decreased and standard deviation and entropy
were increased.
CONCLUSION: The mean on histogram from
gray-scale ultrasound showed the best diagnostic
performance in differentiating LT according to
pathologic grade as well as in diagnosing LT, without
additional use of GLCM parameters.
KSUM Open 2016
RCC in the thyroid gland was 59.8 ± 9.7 years (49-76,
median 60.5). The mean interval between surgical
resection of RCC and thyroid metastasis was 9.6 ±
5.5 years (3.5-16, median 9). The largest diameter
of the nodules ranged from 1.5 cm to 7 cm. All nine
metastatic RCC nodules showed mass formation
and did not have diffuse thyroid involvement. On
US, metastatic RCC nodules were solid (100%)
and hypoechoic (100%) with well-defined margins
(88.9%) and increased vascularity (100%, 55% of
which showed extensive vascularity). Lymph node
metastasis and direct extension to nearby structures
beyond the thyroid gland were not found. One (11%)
FNA was able to confirm metastatic malignancy
whereas all six CNBs were able to correctly diagnose
metastatic RCC.
CONCLUSION: Metastatic RCC appear as
hypoechoic solid nodules with well-defined margins
and increased vascularity on US. Characteristic US
features along with RCC history indicate a need for
tissue confirmation and CNB should be performed
for accurate and reliable diagnosis.
SE 104
Application of Breast US-CAD System to Thyroid
Nodule
Jung Min Bae, Eun Young Ko, Soo Yeon Hahn,
Jung Hee Shin
Korea
PURPOSE: To evaluate the capability of a breast USdedicated computer-assisted diagnosis (CAD) system
in evaluating thyroid nodules.
MATERIALS AND METHODS: One hundred
thirty-four patients with 139 nodules were enrolled
in this prospective study between November
2015 and February 2016. Three experienced
radiologists performed US for thyroid nodule and
recorded US features according to the K-TIRADS
in terms of size, composition, orientation, shape,
margin, echogenicity, calcification along with
final assessment. Another radiologist who did not
perform the US examination and was blind to the
final pathology applied the CAD system to the
representative US images and obtained the results
308
as “benign” or “malignant”. We evaluated the degree
of agreement between the results of radiologists and
CAD, the performance of radiologists and CAD, and
the imaging factors that were correlated with false
positive or false negative results of the CAD system.
RESULTS: Among the 139 nodules, 91 nodules
were benign and 48 nodules were malignant. When
the result of “indeterminate” by radiologist was
classified as benign, the agreement between the
radiologists and CAD was poor (k¸=0.19). CAD
system showed high sensitivity (85.4%) and negative
predictive value (85.1%) similar to the radiologists
(83.3%, 91.7%), but showed low specificity (44%)
and positive predictive value (44.6%) compared with
the radiologists (95.7%, 93.0%). False negative rate
was 14.9% (7/47), and false positive rate was 55.4%
(51/92). Among the US features, margin (p=0.02)
and calcification (p=0.003) showed correlation with
the false negative or false positive results of the CAD
system.
CONCLUSION: CAD for breast US showed high
sensitivity and negative predictive value, but showed
low specificity and positive predictive value. Thyroidspecific CAD system analyzing the US features
differently from breast US-CAD system, especially
for calcifications and margin of the lesion, is required
for better performance.
SE 105
Pyriform Sinus Fistula Mimicking Thyroid Nodule
Soo Chin Kim, Ji-hoon Kim
Hospital, Korea
PURPOSE: Pyriform sinus fistula could be
misdiagnosed as thyroid nodules. The purpose of
this study was to define the clinical and imaging
characteristics of pyriform sinus fistula focused on
intrathyroidal findings.
reviewed the imaging studies and clinical records of
9 patients. In 5 case, fistulous openings were evident
at surgery. In 2 patients, esophagography revealed
a sinus or fistulous opening into the pyriform
sinus. In 1 patient, direct laryngoscopy revealed a
fistulous opening. In 1 patient fistulous tract into
the pyriform sinus were evident at CT examination.
Four patients were children and 5 were adults (mean
age, 26 years). Two patients were female and 7 were
male. The patients underwent a variety of radiologic
studies. Four patients had US and CT studies, and
4 patients had CT or MR imaging. One patient
underwent US studies. Medical history, clinical
manifestations, endoscopic findings, and results of
the various imaging studies were investigated.
RESULTS: All lesions were located in the left thyroid
lobe. Ultrasonography showed intrathyroidal
hypoechogenic mass with hyperechogenic foci
mimicking micro or macrocalcifications. The CT
scans showed disease extending from the pyriform
sinus apex to the upper portion of the thyroid tissue.
In all patients, pyriform sinus fistula appeared
as a structure filled with air. One MR images
showed cystic mass with air-fluid level in the Lt.
parapharyngeal space extending to the upper thyroid
gland. The lesions were non-palpable on physical
examination when imaging studies obtained. Thyroid
function tests were within normal limits. Serum
TSH, free T3, freeT4 and thyroglobulin were within
normal range.
CONCLUSION: The pyriform sinus fistula
had specific ultrasonographic and CT findings.
Awareness of the fact that pyrifrom sinus fistula can
be misdiagnosed as thyroid nodules is important to
avoid unnecessary interventions.
SE 106
PURPOSE: To evaluate the diagnostic performance
of gray-scale ultrasonography (US), elastography
using carotid artery pulsation, and Doppler US
in the diagnosis of thyroid nodules based on the
Korean Thyroid Imaging Reporting and Data System
(K-TIRADS).
MATERIALS AND METHODS: A total 160 thyroid
nodules with 81 malignant and 79 benign pathologic
SE 107
The Result of the Case Study of Ultrasound
Imaging of Retrosternal Goiter
Munkhsaikhan Purevkhuu1, Badamsed Tserendorj2
1
Department of Radiology, Health Sciences
University of Mongolia, Mongolia
2
Sciences, Mongolia
PURPOSE: To study the ultrasound findings of
retrosternal goiter and to develop the diagnostic
criteria.
MATERIALS AND METHODS: We developed
309
Diagnostic Performance of Gray-Scale US,
Elastography, and Doppler US in Thyroid
Nodules: A Prospective Study
Soo Yeon Hahn, Jung Hee Shin, Eun Young Ko
Korea
results from 152 patients were included in this
prospective study. The gray-scale US images were
prospectively evaluated and categorized according to
the K-TIRADS. Elastography was performed using
carotid pulsation as the compression source. The
elasticity contrast index (ECI), which quantifies local
strain contrast within a nodule, was automatically
calculated and recorded. Doppler US was performed
to assess the vascularity. Diagnostic performances of
gray-scale US, elastography, and Doppler US were
calculated to differentiate benign and malignant
thyroid nodules.
R E S U LT S : T h e m o r e a c c u r a t e t e c h n i q u e o f
elastography was the transverse measurement
method which achieved an area under the ROC curve
of 0.760 (95% CI 0.685-0.834) and had an optimal
cut-off value of 1.97. The ECI was significantly higher
in malignant nodules than in benign thyroid nodules
(P < 0.001). The Az values of each dataset were 0.812
(95% CI, 0.742-0.883) for gray-scale US, 0.712 (95%
CI, 0.631-0.794) for ECI, 0.593 (95% CI, 0.5040.681) for stiff color, and 0.561 (95% CI, 0.5900.759) for Doppler US. The Az value for a combined
assessment of gray-scale, ECI, and Doppler US was
higher than that for the gray-scale US alone, but
without statistical significance (P = 0.082).
CONCLUSION: For differentiating benign and
malignant thyroid nodules, gray-scale US alone
based on K-TIRADS showed comparable diagnostic
performances to the combination of gray-scale US,
elastography using carotid artery pulsation, and
Doppler US.
KSUM Open 2016
study chart for the ultrasound findings of the 12
patients, who are diagnosed with retrosternal goiter
at Ultrasound Section of Department of Radiology
of Third Central Hospital named after P.N.Shastin,
Ulaanbaatar, Mongolia between years of 2014
to 2015. We evaluated the size, shape, structure,
density, relationship with surrounding structures,
vascularity and interstitial lesions of thyroid gland.
The diagnosis of retrosternal goiter is confirmed with
computer tomography, surgery and biopsy.
RESULTS: In the findings of ultrasound of retrosternal
goiter, interstitial lesions which associated with
thyroid gland (P<0.001), with capsule (P<0.01), with
calcification (P<0.05), structural regularity (P<0.05),
or with vascularity (P<0.01) were statistically
significant.
CONCLUSION:
1. Our study revealed that in the case of retrosternal
goiter 100% of ultrasound findings were interstitial
lesions which associated with thyroid gland and
75% were with encapsulation and 66.7% were with
calcification.
2. We demonstrated that location, type, size,
structure, density and boundary of the interstitial
lesion and the fact that association of interstitial
lesion with thyroid gland and displacement of
adjacent structure are the main criteria of the
differential diagnosis.
SE 108
Analysis of Thyroid US Patterns of Some Thyroid
Diseases
Bolorchimeg Ganbold1, Badamsed Tserendorj2
1
2
Sciences, Mongolia
PURPOSE: To determine the diagnostic thyroid US
patterns of Hashimoto thyroiditis, Multinodular
Goiter, Colloid nodular goiter in differentiating and
establishing diagnostic criteria.
study was conducted at Shastin Third Central
Hospital of Mongolia and Achtan Hospitals’ US
units, from 2014-2016. The study included 38
310
patients who were diagnosed by US as Multinodular
Goiter-13, Hashimoto thyroiditis-6, Colloid goiter-19,
and all diagnosis was proved by clinical symptoms,
laboratory tests and biopsy results.
RESULTS: For Multinodular Goiter cases have,
100%-diffuse thyroid enlargement, 69.2%- regular
and well defined contour of nodule, 61.5%-round
and 1-3 cm nodules on the thyroid US examination.
For Hashimoto cases, 83.3% of nodules were round
or oval shaped, heterogeneously hypo echoic. For
Colloid nodular goiter cases, 73.7%-nodules in the
right lobe, 26.3%-in the left lobe, 89.5 %-> 1.0 cm,
84.2%-round or oval shaped with regular contour,
68.4%- heterogeneously hypo echoic or mixed.
We have created main and supportive thyroid US
diagnostic and differential diagnostic pattern based
on US patterns of above thyroid diseases.
CONCLUSION: According to our study the essential
US patterns regarding the differential diagnosis of
Hashimoto thyroiditis, Multinodular Goiter, Colloid
nodular goiter are: location, shape, size, consistence,
echogenicity, and contour of the thyroid nodules. For
example Hashimoto disease the main US patterns
are a. heterogeneous, b. hypo echoic, c. round or oval
shaped nodules; the supportive US patterns are a.
any location, b. any size, c. irregular contour.
SE 109
Clinical Application of SMI for Differential
Diagnosis of Thyrotoxicosis
Masayuki Shigeta, Naoko Hidaka, Mizuho Minakata,
Harumi Daikoku, Masafumi Kitaoka
Department of Endocrinology and Metabolism,
Showa General Hospital, Japan
PURPOSE: Thyroid functions is in close relationship
with parenchymal vascularity. Thyrotoxicosis include
Graves′ disease, painless thyroiditis or autonomic
functional thyroid nodule and so on. In these
diseases, Painless thyroiditis is occupying 30% to
40% followed by Graves′ disease. Graves′ disease
and painless thyroiditis are likely to be confused
for the clinical symptoms and blood biochemical
findings which are similar at first glance. These
treatments and clinical course are different, so we
need to accurately diagnose. A new technology
provided by Toshiba′s Aplio™ 500 ultrasound
system, called SMI (Superb Micro-Vascular Imaging)
is possible to imaging very low flow states by
dedicated noise reduction algorithm. The purpose of
this study was to clarify the clinical usefulness of the
SMI for differential diagnosis of mild thyrotoxicosis
frequently encounter in daily clinical consultation or
cases.
MATERIALS AND METHOD: This study targets
healthy person(n=13), patient who afflicted Graves′
disease (n=13) or painless thyroiditis(n=7). We
evaluated the minimum blood flow of thyroid
parenchyma using an SMI after measuring the
average flow velocity of superior thyroid artery.
Thyroidal ultrasound examination using TOSHIBA
Aplio™ 500 was performed.
RESULTS: Visualization of a minimum blood flow in
healthy person was sufficiently possible. In Graves′
disease, Blood flow was increased to the overall of
thyroid, and SMI was evaluable in detail as compared
with the conventional method. On the other hand,
it was able to accurately assess the avascular area
of the lesion that had been destroyed by painless
thyroiditis.
CONCLUSION: SMI can visualize a minimum
blood flow without using the ultrasound contrast
agent, so it is useful for the differential diagnosis of
thyrotoxicosis.
SE 110
LEARNING OBJECTIVES: To provide an up-todate review of minimally invasive treatment for
benign parathyroid lesions focusing on the efficacy
and safety.
BACKGROUND: Minimally invasive procedures
such as percutaneous ethanol-, radiofrequency-,
laser-, and microwave- ablations for benign
parathyroid lesions have been introduced in recent
years to avoid the complications of traditional
SE 111
Innovative Technique in Image-Guided Ablation
of Benign Thyroid Nodules: Combined Ethanol
and Radiofrequency Ablation
Hye Sun Park, Jung Hwan Baek, Sae Rom Chung,
Young Jun Choi, Jeong Hyun Lee
Korea
LEARNING OBJECTIVES: To introduce combined
ethanol and radiofrequency ablation techniques,
possible indications, clinical outcomes and the safety
in treating benign thyroid nodules.
BACKGROUND: Combined EA and RFA technique
has been used for treatment of hepatic tumors to
make a larger ablation zone or enhance the effect of
RFA. Recently, several articles reported the efficacy
of combined EA and RFA for treatment of benign
thyroid nodules, especially in predominantly cystic
nodules.
PROCEDURE DETAILS: Additional RFA is effective
311
Efficacy and Safety of Minimally Invasive
Treatment in Patients with Benign Parathyroid
Lesions
Eun Ju Ha
Korea
methods such as surgery. However, the efficacy and
safety of these procedures are not well known until
now.
CLINICAL FINDINGS/PROCEDURE: This review
will provide an introduction to the literature,
principles and advances of minimally invasive
treatments for benign parathyroid lesions, as well
as a discussion on its efficacy, complications and
future, based on the current evidences. Several
clinical research papers evaluating the effect of
these procedures on the alleviation of parathyroid
lesions will be presented to illuminate the important
points, according to their indications (parathyroid
cyst, single parathyroid adenoma/hyperplasia,
multiple parathyroid hyperplasias, recurrent or
persistent primary/secondary hyperparathyroidism
after surgery, and patients with multiple endocrine
neoplasia type 1.
CONCLUSION: This educational review can help
operators to understand the current evidence of
minimally invasive treatment for benign parathyroid
lesions. Minimally invasive treatment may be an
effective treatment option in patients with benign
parathyroid lesions.
KSUM Open 2016
for the patients who have incompletely resolved
symptoms and residual solid portion after EA,
especially in predominantly cystic thyroid nodules.
It is important to meticulously target a residual solid
portion by RF electrode. Additional EA can be done
to treat a residual unablated area of solid thyroid
nodule after RFA due to adjacent critical structure
(i.e., trachea, esophagus, recurrent laryngeal nerve)
or the operator’s less experience of thyroid RFA.
This technique is recommended to a nodule with a
residual volume less than 5 ml and no vascularity.
During injection of ethanol, the operator should
be careful to avoid extrathyroid leakage of ethanol.
Concomitant EA and RFA technique is effective for
bleeding control during or after aspiration of internal
fluid prior to RFA of predominantly cystic thyroid
nodule. When there is internal venous oozing, EA
effectively stops bleeding and enhances the effect of
RFA.
CONCLUSION: Combined EA and RFA technique
is useful and safe in several situations. In the future,
validation of indication in more detail is necessary,
especially for predominantly cystic thyroid nodules.
SE 112
Distinguishing Benign from Malignant Thyroid
Nodules at Thyroid Ultrasound (US): Utility
of Superb Microvascular Imaging (SMI) and
US Elastography-Influence on Diagnostic
Performance
Hye Shin Ahn1, Mirinae Seo1, Sung Hee Park1,
Jong Beum Lee1, Byung Ihn Choi1
1
Hospital, Korea
2
with SMI and strain elastography were included.
Thyroid US was performed by a subspecialty
radiologist using high resolution US equipment
(Aplio 500, Toshiba Medical Systems, Otawara,
Japan) and two radiologists were reviewed images
in consensus. Reviewer scored the likelihood of
malignancy for 3 data sets (ie, B-mode US alone,
B-mode US + SMI, B-mode US + US elastography).
The area under the receiver operating characteristic
curve (Az) values and sensitivities, and specificities
of each data set were compared.
RESULTS: The mean lesion size on second-look US
was 13.2 mm (range, 7-46 mm). Among 3 date sets,
B-mode US + SMI showed the greatest Az value
(average, 0.982; range, 0.952-1.000), however it was
similar compared with those of B-mode US alone
(average, 0.962; range, 0.912-1.000) and B-mode
US + US elastography (average, 0.975; range, 0.9371.000). The sensitivity and specificity based on the
binary management decision of whether or not to
perform fine needle aspiration (FNA) of B-mode
alone was 95.9% and 15.8%, respectively. B-mode US
+ SMI + US elastography showed similar sensitivity
(95.9%), however the specificity was significantly
increase (36.8%) compared with B-mode US alone
(P=0.021).
CONCLUSION: Combined use of SMI and US
elastography does not increase diagnostic accuracy
in distinguish benign from malignant thyroid
nodule, however it could be increase the specificity
in decision making for FNA without change of
sensitivity.
PURPOSE: To prospectively investigate the utility
of the combined use of SMI and US elastography
in distinguishing benign from malignant thyroid
nodules and in making decision for further
management.
MATERIALS AND METHODS: From December
2015 to January 2016, 41 thyroid nodules of 38
consecutive patients (age range 30-72 years, mean
age, 51.6 years) who underwent B-mode thyroid US
312
SE 113
Thyroid Core Needle Biopsy: Patients' Pain and
Satisfaction Compared to Fine Needle Aspiration
Jaesun Ji1, Yeo Koon Kim1, Sang Il Choi1,
Ji Hoon Kim2, Yoon Ho Song1, Joo Hyun Kim1,
Eun Hee Seo1, Gwan Hong Min1
1
2
Hospital, Korea
Ultrasonography-Guided Ethanol Ablation of
Benign Thyroid Nodules: A Single Institution
Experience
Mi Ri Kwon, Jung Hee Shin, Soo Yeon Hahn,
Jae Wook Ryu
Korea
Ultrasonography-guided ethanol ablation (EA) is
established as the first-line treatment for benign
cystic thyroid nodules. EA has a high efficacy in cystic
or predominantly cystic nodules.
The procedure, complications and outcomes of EA
performed in our institution are discussed in the
poster. From 2008 to 2015, 112 patients underwent
EA for 120 benign cystic nodules. The 10 patients
with follow-up loss were excluded, therapeutic
success rate was 81.8% (90 among 110 nodules). The
success group showed a significant higher incidence
of cystic or predominantly cystic nodules (≤20%
solid) than the failure group (73% vs. 25%). For the
failure group after EA, four patients repeated EA, five
underwent RFA and two had operation.
After successful EA, the nodules show suspicious
malignant findings on ultrasound due to collapsed
cystic portion. Radiologists should avoid unnecessary
FNA by recognizing that the EA treated nodules can
mimic malignancy.
SE 115
Papillary Thyroid Carcinoma Arising within a
Follicular Adenoma: A Case Report
Yeun Jeong Kim, Hyun Sook Hong, Sun Hye Jeong,
Eun Hye Lee, Jeong Ja Kwak
Bucheon Hospital, Korea
Papillary thyroid carcinoma (PTC) arising within
a follicular adenoma is an exceptionally rare
histopathological subtype that shows the nuclear
features of PTC within a benign-appearing,
circumscribed follicular adenoma. While it is
clinically significant, because of its malignant
nature, its ultrasonographic features have not been
described previously. A 26-year-old man presented
313
PURPOSE: The purpose of this study was to compare
the patients' pain and satisfaction between thyroid
core needle biopsy (CNB) and fine-needle aspiration
(FNA)
MATERIALS AND METHOD: Patients who had
underwent thyroid FNA (n=90, 13 males, age 52.9
± 13.4) or CNB (n=80, 18 males, age 51.4 ± 11.2)
were consecutively included. The degree of pain was
surveyed using 0 to 10 scales in both groups at three
time points (during procedure, after procedure,
and 20 minutes after procedure). The telephone
surveys were made 2 weeks after procedures for the
remaining pain and overall satisfaction. The rate of
inconclusive diagnosis (insufficient specimen [IS]
and atypia of undetermined significance [AUS]) were
recorded. Student's t test was used for analysis.
RESULTS: The pain scores were not significantly
different between two groups (mean scores ±
standard deviation, FNA vs. CNB; during procedure,
2.88 ± 1.46 vs. 2.54 ± 1.79, after procedure, 1.41 ±
1.54 vs. 1.49 ± 1.79, 20 minutes after procedure,
0.74 ± 0.82 vs. 0.90 ± 1.13, all p>0.05). There was
no case of complication in both groups. After 2
weeks, remaining pain was reported in 6 patients in
FNA group, and 4 patients in CNB group. Overall
satisfaction scores after 2 weeks were also not
different between the two groups (FNA 8.00 ± 1.92,
CNB 8.25 ± 1.69, p=0.41). The rate of inconclusive
diagnosis were 36.6% in FNA group (15 IS and 18
AUS) and 1.2% in CNB group (1 AUS) (p<0.001).
CONCLUSION: CNB showed comparable patients’
pain and overall satisfaction to FNA, and significantly
lower rates of inconclusive diagnosis. This finding
suggests that CNB may replace the role of FNA as
first approach to obtain pathologic diagnosis of
thyroid nodules.
SE 114
KSUM Open 2016
with a heterogeneous isoechoic solid nodule
with a marked hypoechoic solid focus and a low
echoic peripheral rim in the right thyroid gland on
ultrasonography. On color Doppler images, markedly
increased vascularity was seen in the hypoechoic
solid component. An ultrasound-guided gun biopsy
suggested a follicular neoplasm. In the evaluation
of a hemithyroidectomy specimen, thyroid follicles
and a thin fibrous capsule were seen, which favored
a follicular adenoma with tumor cells in a focal area
indicating papillary carcinoma. Here, we report
a case of PTC arising within a follicular adenoma
and discuss possible considerations in thyroid
ultrasonographic examinations.
as malignancy, and 36 (24.2%) were inconclusive.
Repeat US-FNA had significantly higher rates
of inconclusive diagnosis compared to US-CNB,
33.7% to 11.1% (P=0.003). Nodules with US-CNB
had significantly higher rates of surgery or followup, while those with US-FNA had higher rates of
repeated biopsy (P<0.001). Rates of cytopathologic
candidates for diagnostic lobectomy did not show
significant differences between repeat US-FNA and
US-CNB for any of the indications (all P>0.05).
CONCLUSION: US-CNB has higher diagnostic rates
than repeat US-FNA, but it does not provide superior
guidance over repeat US-FNA in deciding upon
diagnostic lobectomy for thyroid nodules with prior
AUS/FLUS cytology results.
SE 116
US-Guided Core Needle Biopsy Did Not
Reduce Diagnostic Lobectomy for Thyroid
Nodules Diagnosed as Atypia of Undetermined
Significance / Follicular Lesion of Undetermined
Significance (AUS/FLUS)
Jung Hyun Yoon
PURPOSE: To compare the histopathology results
of repeat ultrasonography (US)-guided fine needle
aspiration (FNA) and core needle biopsy (CNB),
and evaluate the role of US-CNB in deciding upon
management for prior atypia of undetermined
significance/follicular lesion of undetermined
significance (AUS/FLUS) results.
MATERIALS AND METHODS: From May 2013
to June 2015, 149 thyroid nodules in 149 patients
(mean age, 48.3 ± 13.6 years) that were diagnosed
as AUS/FLUS that had repeat US-FNA or US-CNB
performed for further diagnosis were included. Of
the 149 thyroid nodules, 86 (57.5%) had repeat USFNA and 63 (42.3%) had US-CNB. Clinical, US
features, and histopathology results were compared
between nodules with repeat US-FNA and US-CNB.
Histopathology results were divided according to
various indications for diagnostic lobectomy, and
rates of diagnosis that are candidates for diagnostic
lobectomy were compared.
RESULTS: Of the 149 thyroid nodules included,
86 (57.7%) were diagnosed as benign, 27 (18.1%)
314
Authors Index
Author Index
A
Adhikari, Ayushma: SE 067 (p291)
Ahn, Hye Shin: SE 023 (p272), SE 034
(p277), SE 112 (p312)
Ahn, Kyung-Sik: CC 7 MSK-6 (p172)
Ahn, Yun Deok: SS 6 ABD-9 (p262)
Allen, Kathleen: SC 1 BR-5 (p239)
Almajran, Abdullah: SE 051 (p284)
Anthony, Angela: SE 072 (p293)
Arakkal, Mohamed Roshan: SE 004 (p264),
SE 082 (p298), SE 087 (p300)
Asbeutah, Akram: SE 051 (p284)
Asfar, Sami: SE 051 (p284)
B
Baatarjav, Zolboo: SE 019 (p271)
Badamsed, Tseren Dorj: SE 019 (p271)
Badrakh, Javzandulam: SE 086 (p300)
Bae, Jae Seok: SS 6 ABD-3 (p259)
Bae, Jihyun: SE 090 (p301)
Bae, Jung Min: SS 4 THY-2 (p248), SE 104
(p308)
Baek, Ji Eun: SC 1 BR-3 (p238)
Baek, Jung Hwan: LS 3 Samsung Medison
- 2 (p210), HS-1 (p230), SS 4 HN-3
(p247), SE 095 (p303), SE 096 (p304),
SE 111 (p311), SC 2 THY-4 (p255),
SC 2 THY-8 (p257)
Bang, Won-Chul: YIA-1 (p240)
Batdelger, Oyuntogos: SE 056 (p287)
Batsuuri, Delgermaa: SE 006 (p265)
Bayansan, Buyandelger: SE 009 (p266)
Bich, Thuy Tran Thi: SE 003 (p264)
Blumencraz, Peter: SC 1 BR-5 (p239)
Bosnacki, Dragan: SE 073 (p294)
Buyan, Munkhsaikhan: SE 085 (p299), SE
086 (p300)
Byun, Jae Young: SE 011 (p267)
C
Cao, Yanping: SS 3 PHY-2 (p243)
Cha, Ohrum: SS 3 PHY-1 (p242)
Chae, Eun Young: CC 1 BR-2 (p22)
Chae, In Hye: SE 099 (p305)
Chae, Soo Young: SE 043 (p281)
Chang, Jin Woo: KSTU-2 (p143)
Chang, Jung-Woo: YIA-1 (p240)
Chang, Won: SS 6 ABD-3 (p259), SE 015
(p269)
Chang, Yun-Woo: CC 3 PED-2 (p46)
Chee, Charlyn: SE 008 (p266)
Cheon, Jung-Eun: SFS 3 PED-3 (p139), SS
2 PED-1 (p233), SS 2 PED-4 (p234),
SS 2 PED-5 (p235)
Cheon, Yuri: SS 6 ABD-9 (p262)
Cho, Hyeun Cha: SE 063 (p290)
Cho, Jinhan: SE 014 (p268)
Cho, Kil-Ho: SE 076 (p295), SE 077 (p296)
Cho, Kyu Ran: SE 031 (p276), SE 035
(p278), SE 043 (p281), SE 048 (p283)
Cho, Se Heon: SE 044 (p281)
Cho, Yeon Jin: SS 6 ABD-3 (p259)
Cho, Yoon Joo: SC 2 THY-2 (p254)
Cho, Young Ah: SS 2 PED-2 (p233), SS 2
PED-3 (p234)
Cho, Young Seo: SE 062 (p289)
Choe, Jung-Yoon: SS 4 HN-1 (p246)
Choi, Byung Ihn: YIA-1 (p240), SS 5 MSK-4
(p253), SE 002 (p263), SE 034 (p277),
SE 112 (p312)
Choi, Gayoung: SE 035 (p278)
Choi, Hyeyoung: SE 036 (p278)
Choi, Hyuck Jae: CC 2 GU-1 (p26)
Choi, Ji In: SE 002 (p263)
Choi, Ji Soo: CC 1 BR-4 (p24), YIA-2 (p241),
SE 025 (p273), SE 026 (p274), SE
045 (p281)
Choi, Joon-Il: DS ABD-2 (p189), SE 011
(p267)
Choi, Moon Hyung: SS 6 ABD-4 (p259), SE
011 (p267)
Choi, Nami: SS 4 THY-1 (p248)
Choi, Sang Il: SE 113 (p312)
Choi, Seung Hee: SS 4 THY-2 (p248), SE
025 (p273), SE 026 (p274)
Choi, Yoon Jung: CC 6 THY-3 (p155)
Choi, Young Hun: SS 2 PED-1 (p233), SS 2
PED-4 (p234), SS 2 PED-5 (p235)
Choi, Young Jun: SS 4 HN-3 (p247), SE 111
(p311), SC 2 THY-4 (p255), SC 2 THY8 (p257)
Choi, Yun Sun: SE 078 (p296)
Choo, Hye Jung: SE 046 (p282), SE 047
(p282), SE 076 (p295), SE 077 (p296)
Choo, Ki Seok: CC 5 CV-4 (p63)
Chun, Ho Jong: CC 5 CV-3 (p62)
Chung, Mi Sun: SS 4 HN-3 (p247)
Chung, Sae Rom: SE 111 (p311)
Chung, Saerom: SC 2 THY-8 (p257)
Clevert, Dirk-Andre: CC 5 CV-2 (p61), SS 2
GU-2 (p237)
Cox, Charles: SC 1 BR-5 (p239)
D
Dagvasmberel, Munkhbaatar: SE 070
(p292)
Daikoku, Harumi: SE 109 (p310)
Damdinsuren, Bolormaa: SE 056 (p287)
Damdinsuren, Mendbayar: SE 086 (p300)
Darkhantsetseg, Battsengel: SE 058 (p288)
Dashjamts, Tuvshinjargal: SE 042 (p280),
SE 058 (p288)
Dijk, Edmond Van: SE 073 (p294)
Donato, Katia: SE 073 (p294)
Du, Linyao: SC 2 THY-3 (p254)
Du, Lin-Yao: SC 2 THY-7 (p257)
E
Eikelder, Huub Ten: SE 073 (p294)
Elevelt, Aaldert: SE 073 (p294)
Enkhbold, Buyanjargal: SE 085 (p299), SE
086 (p300)
F
Fu, Hui-Jun: SS 2 GU-1 (p237)
G
Galsandorj, Bolortuya: SE 070 (p292)
Ganbat, Nomuundari: SE 042 (p280)
Ganbold, Bolorchimeg: SE 108 (p310)
Ganbold, Uranzaya: SE 056 (p287)
Gao, Qingfeng: SE 052 (p285), SE 071
(p293)
Ghimire, Pragya Gauautam: SE 067 (p291)
Ghimire, Prasanna: SE 067 (p291)
Ginj, Otgon: SE 050 (p284)
Gruell, Holger: SE 073 (p294)
Gruenwald, Frank: HI 3 THY-1 (p190)
Guo, Dong: SS 1 CV-3 (p232)
Guo, Le-Hang: SS 2 GU-1 (p237)
H
Ha, Eun Ju: SS 4 THY-1 (p248), SE 110
(p311), SC 2 THY-2 (p254)
Hahn, Seok: CC 7 MSK-2 (p160)
Hahn, Soo Yeon: SS 4 THY-2 (p248), SS 4
THY-6 (p251), SE 100 (p306), SE 104
(p308), SE 106 (p309), SE 114 (p313)
Hamdan, Mohd Farhan: SE 081 (p297)
Han, Boo-Kyung: YIA-2 (p241), SE 025
(p273), SE 026 (p274), SE 045 (p281)
Han, Byoung Hee: SE 061 (p289), SE 063
(p290)
Han, Hye Yeon: SE 096 (p304)
Han, Joon Koo: SS 6 ABD-1 (p258), SS 6
ABD-3 (p259)
Han, Miran: SC 2 THY-2 (p254)
Han, Na Yeon: CC 8 ABD-1 (p174)
Han, Sang Suk: SE 046 (p282), SE 047
(p282)
Hanafiah, Mohammad: SE 081 (p297)
He, Qiong: SS 3 PHY-2 (p243), SS 3 PHY4 (p244), SS 3 PHY-6 (p245), SS 5
MSK-5 (p253)
Hidaka, Naoko: SE 109 (p310)
315
KSUM Open 2016
Author Index
Holsbeeck, Marnix van: JS-1 (p146), HI 4
MSK-1 (p194)
Hong, Hyun Sook: SE 115 (p313)
Hong, Myungsun: SE 068 (p291)
Hou, Xiu-Juan: SC 2 THY-3 (p254)
Huang, Chengwu: SS 1 CV-3 (p232)
Huang, Shuai: SE 052 (p285), SE 071
(p293)
Hwang, Daehyun: SE 049 (p283)
Hwang, Dae-Hyun: SS 3 PHY-7 (p245), SE
012 (p267)
Hwang, Darehyun: SE 010 (p267)
Hwang, Ikjung: SE 046 (p282)
Hwang, Jae-Yeon: SFS 3 PED-2 (p136),
SE 090 (p301)
Hwang, Jeong Ah: SS 6 ABD-7 (p261)
Hwang, Ji Young: CC 7 MSK-5 (p166)
Hwang, Sookmin: SE 089 (p301)
I
Idersaikhan, Oyundari: SE 055 (p286), SE
056 (p287), SE 070 (p292)
J
Jalbuu, Zolzaya: SE 085 (p299), SE 086
(p300)
Jang, Mijung: SE 023 (p272)
Je, Bo-Kyung: CC 3 PED-3 (p54)
Jeon, Hae Jeong: SS 6 ABD-2 (p258)
Jeon, Tae Yeon: SE 089 (p301)
Jeong, Hae Woong: SE 046 (p282), SE 047
(p282)
Jeong, Jong Seob: SE 093 (p302)
Jeong, Soo Yeon: SE 017 (p270)
Jeong, Sun Hye: SE 115 (p313)
Jeong, Woo Kyoung: LS 2 Bracco - 1 (p207),
SE 089 (p301)
Ji, Jaesun: SE 113 (p312)
Ji, Qiao: SC 2 THY-3 (p254)
Ji, Seon Mi: SE 093 (p302)
Jin, Tiefeng: SE 028 (p275)
Joh, Jin Hyun: SS 1 CV-1 (p231)
Johari, Bushra: SE 081 (p297)
Joo, Ijin: SS 6 ABD-1 (p258)
Jung, Ah Young: SS 2 PED-2 (p233), SS 2
PED-3 (p234)
Jung, Dae Chul: MS GU-1 (p65)
Jung, Dong-Hoon: SS 3 PHY-7 (p245), SE
012 (p267)
Jung, Hae Kyoung: SE 032 (p276)
Jung, Hyun Kyung: SE 046 (p282), SE 047
(p282)
Jung, Inha: SE 027 (p274)
Jung, Jee Young: SS 5 MSK-4 (p253)
Jung, Seung Eun: SS 6 ABD-4 (p259), SE
011 (p267)
316
Jung, So Lyung: SS 4 THY-6 (p251)
Jung, Sung Il: CC 2 GU-2 (p28), SS 6 ABD2 (p258)
K
Kahhorov, Jamoliddin: SE 029 (p275)
Kakhkharov, Alisher: SE 029 (p275)
Kakhkharova, Fatima: SE 029 (p275)
Kang, Bong Joo: SFS 1 BR-1 (p91), SC 1
BR-2 (p238), SC 1 BR-3 (p238)
Kang, Byeong Seong: SFS 5 MSK-1 (p211)
Kang, Jinbum: SS 3 PHY-3 (p243), SS 3
PHY-5 (p244)
Kang, Tae Wook: YIA-1 (p240), SS 6 ABD-6
(p260), SS 6 ABD-7 (p261)
Khalid, Mohd Shukry Mohd: SS 5 MSK-3
(p252), SE 081 (p297)
Kim, Bo Ra: SE 044 (p281)
Kim, Dae: SE 020 (p271)
Kim, Daejung: SE 018 (p270)
Kim, Dasom: SE 076 (p295)
Kim, Dong Gun: SE 077 (p296)
Kim, Dong Won: SE 059 (p288)
Kim, Dong Wook: SS 4 HN-2 (p247), SE
046 (p282), SE 047 (p282), SE 097
(p304), SE 098 (p305)
Kim, Dong-Hwan: SE 013 (p268)
Kim, Eun Kyung: SE 103 (p307)
Kim, Eunkyung: SE 027 (p274)
Kim, Eun-Kyung: YIA-3 (p241), SFS 6
Multiorgan-2 (p226), SS 4 THY-3
(p249), SS 4 THY-4 (p249), SE 099
(p305), SE 101 (p306), SE 102 (p307),
SC 2 THY-6 (p256)
Kim, Eun-Sil: SS 1 CV-4 (p232)
Kim, Ga Ram: SE 038 (p279)
Kim, Hee Jeong: SE 088 (p300)
Kim, Heung Cheol: SE 068 (p291)
Kim, Hoe Suk: SE 028 (p275)
Kim, Honsoul: CC 8 ABD-3 (p185)
Kim, Hyangkyoung: SE 054 (p286)
Kim, Hyun Cheol: SE 016 (p269)
Kim, Hyunjeong: SE 040 (p280)
Kim, In-One: SS 2 PED-1 (p233), SS 2
PED-4 (p234), SS 2 PED-5 (p235)
Kim, Jae Kyun: SS 4 THY-1 (p248)
Kim, Jaeil: YIA-1 (p240)
Kim, Jeeyoung: CC 6 THY-2 (p153)
Kim, Jennifer Chun: SC 1 BR-5 (p239)
Kim, Jeong Kyu: SS 4 HN-1 (p246)
Kim, Jeong Rye: SS 2 PED-2 (p233), SS 2
PED-3 (p234)
Kim, Ji Hoon: SE 113 (p312)
Kim, Ji Hye: SE 089 (p301)
Kim, Ji Min: SE 037 (p279)
Kim, Ji-Hoon: SC 2 THY-1 (p229), SE 095
(p303), SC 2 THY-5 (p255)
Kim, Ji-hoon: SE 105 (p308)
Kim, Jinho: SS 3 PHY-1 (p242)
Kim, Jongchul: SE 060 (p289)
Kim, Joo Hyun: SE 113 (p312)
Kim, Kiwook: SC 1 BR-4 (p239)
Kim, Mimi: SS 6 ABD-6 (p260)
Kim, Min Jung: SFS 1 BR-3 (p101), YIA-3
(p241)
Kim, Minchul: SE 078 (p296)
Kim, Myung-Hwan: SE 001 (p263)
Kim, Myung-Joon: SS 2 PED-6 (p236), SE
084 (p299)
Kim, Sang Won: SE 016 (p269)
Kim, Se Hwa: SE 094 (p303)
Kim, Se Hyung: LS 2 Bracco - 2 (p208), SS
6 ABD-1 (p258)
Kim, Seong Hyun: SS 6 ABD-6 (p260)
Kim, Seung Ii: YIA-3 (p241)
Kim, Seung Soo: SS 6 ABD-6 (p260)
Kim, Shin Young: SE 037 (p279)
Kim, Shinyoung: SE 040 (p280)
Kim, So Yeon: SFS 4 ABD-3 (p204)
Kim, Soo Chin: SE 105 (p308)
Kim, Soo-Yeon: SS 4 THY-3 (p249), SC 2
THY-6 (p256)
Kim, Su Jin: SS 5 MSK-4 (p253), SE 044
(p281)
Kim, Suk Jung: SE 046 (p282), SE 047
(p282)
Kim, Sun Jung: SE 069 (p292)
Kim, Sun Mi: SE 023 (p272)
Kim, Sung Hun: SC 1 BR-2 (p238), SC 1
BR-3 (p238)
Kim, Wan Tae: SFS 5 MSK-4 (p220)
Kim, Wee Kyoung: SE 091 (p302), SE 092
(p302)
Kim, Woo Sun: SS 2 PED-1 (p233), SS 2
PED-4 (p234), SS 2 PED-5 (p235)
Kim, Yeo Koon: CC 5 CV-1 (p59), SE 113
(p312)
Kim, Yeol: SS 6 ABD-4 (p259)
Kim, Yeun Jeong: SE 115 (p313)
Kim, Yong Tae: SE 094 (p303)
Kim, Yongsoo: SE 062 (p289)
Kim, Yoonsoo: SC 1 BR-2 (p238), SC 1
BR-3 (p238)
Kim, Youdong: SE 032 (p276)
Kim, Youe Ree: SE 017 (p270)
Kim, Young Hwa: SE 063 (p290)
Kim, Young Joong: SE 096 (p304)
Kim, Young Jun: SS 6 ABD-2 (p258)
Kim, Young Kon: SS 6 ABD-6 (p260)
Kim, Young Sun: KSTU-3 (p144)
Kim, Yu Jin: SS 2 PED-1 (p233), SS 2 PED4 (p234), SS 2 PED-5 (p235)
Kitami, Masahiro: SFS 3 PED-1 (p115)
Kitaoka, Masafumi: SE 109 (p310)
Authors Index
Author Index
Ko, Eun Sook: YIA-2 (p241), SE 025 (p273),
SE 026 (p274), SE 045 (p281)
Ko, Eun Young: YIA-2 (p241), SS 4 THY-2
(p248), SE 025 (p273), SE 026 (p274),
SE 045 (p281), SE 104 (p308), SE
106 (p309)
Ko, Kyunghee: SE 032 (p276)
Koh, Jieun: SS 4 THY-3 (p249)
Koo, Ja Seung: SE 103 (p307)
Koo, Joonbum: SE 079 (p297), SE 080
(p297)
Kumar, Sanamandra Sarat: SE 072 (p293)
Kwak, Jeong Ja: SE 115 (p313)
Kwak, Jin Young: SS 4 THY-3 (p249), SS 4
THY-4 (p249), SE 099 (p305), SE 101
(p306), SE 102 (p307), SE 103 (p307),
SC 2 THY-6 (p256)
Kwon, Dae-Gil: SE 083 (p298)
Kwon, Dong Rak: SE 083 (p298)
Kwon, Heejin: SE 014 (p268)
Kwon, Mi Ri: SE 114 (p313)
L
Lalchan, Subita: SE 007 (p265)
Lan, Feng: SS 1 CV-3 (p232)
Lee, Deuk Young: SE 037 (p279)
Lee, Deukyoung: SE 040 (p280)
Lee, Dong Ho: SS 6 ABD-8 (p261), SE 015
(p269)
Lee, Eun Hye: SE 115 (p313)
Lee, Eun Sun: LS 1 Toshiba-2 (p104), SE
002 (p263)
Lee, Fu-Feng: SS 3 PHY-4 (p244)
Lee, Gayoung: SE 047 (p282)
Lee, Guen Young: SS 5 MSK-4 (p253)
Lee, Hye Sun: SS 4 THY-3 (p249)
Lee, Hyun Ji: SE 048 (p283)
Lee, Hyun Sil: SC 1 BR-3 (p238)
Lee, Jae Hwan: SS 6 ABD-3 (p259)
Lee, Jae Young: DS ABD-1 (p186), SS 6
ABD-1 (p258), SS 6 ABD-3 (p259), SS
6 ABD-8 (p261), SS 6 ABD-9 (p262)
Lee, Jeong Hyun: SS 4 HN-3 (p247), SE
111 (p311), SC 2 THY-4 (p255), SC 2
THY-8 (p257)
Lee, Jeong Min: LS 3 Samsung Medison 1 (p209), SE 015 (p269)
Lee, Ji Hye: SE 101 (p306)
Lee, Jin Hwa: SE 044 (p281)
Lee, Jin Seong: SS 2 PED-2 (p233), SS 2
PED-3 (p234)
Lee, Jiyon: HI 1 BR-1 (p73), SFS 1 BR-2
(p94), SC 1 BR-5 (p239)
Lee, Jong Beum: SE 002 (p263), SE 034
(p277), SE 112 (p312)
Lee, Jong Bum: SS 5 MSK-4 (p253)
Lee, Jong Eun: SE 037 (p279)
Lee, Jongeun: SE 040 (p280)
Lee, Joo Yong: MS GU-2 (p70)
Lee, Jung-Hoo: SS 1 CV-4 (p232)
Lee, Kwang Jae: SS 1 CV-4 (p232), SS 5
MSK-2 (p252)
Lee, Mi-Jung: SS 2 PED-6 (p236), SE 084
(p299)
Lee, Min Woo: YIA-1 (p240), SS 6 ABD-7
(p261)
Lee, Miri: SE 044 (p281)
Lee, Mu Sook: SS 2 PED-6 (p236)
Lee, Myung Sook: SE 063 (p290)
Lee, Sang Soo: SE 001 (p263)
Lee, Sangmi: SE 040 (p280)
Lee, Sangyun: SE 014 (p268)
Lee, Seung-Hwa: SE 013 (p268)
Lee, Su Hyun: CC 1 BR-1 (p21)
Lee, Sun Joo: SFS 5 MSK-3 (p214), SE
046 (p282), SE 047 (p282), SE 076
(p295), SE 077 (p296)
Lee, Sung Koo: SE 001 (p263)
Lee, Sung Moon: SE 076 (p295), SE 077
(p296)
Lee, Sun-Ho: SE 001 (p263)
Lee, Yeong Hen: SS 4 THY-1 (p248)
Lee, Yong Seung: SE 084 (p299)
Lee, Yoo Jin: SE 097 (p304)
Lee, Young Ho: SE 061 (p289), SE 063
(p290)
Lee, Young Hwan: SE 017 (p270), SE 077
(p296)
Lee, Young Seok: SE 088 (p300)
Li, Guoyang: SS 3 PHY-2 (p243)
Li, Hui: SE 024 (p273)
Li, Xiao-Long: SC 2 THY-7 (p257)
Li, Zhenzhou: SE 052 (p285), SE 071 (p293)
Liew, Jia Ren Perry: SE 008 (p266)
Lim, Hyun Kyung: SS 4 THY-6 (p251)
Lim, Seung-Gyu: SS 5 MSK-2 (p252)
Lim, Yun Jung: CC 3 PED-1 (p41)
Liu, Bo-Ji: SC 2 THY-7 (p257)
Liu, Jing: SS 3 PHY-6 (p245)
Lu, Minhua: SE 052 (p285), SE 071 (p293)
Luo, Jianwen: SS 1 CV-3 (p232), SS 3
PHY-2 (p243), SS 3 PHY-4 (p244), SS
3 PHY-6 (p245), SS 5 MSK-5 (p253),
SE 053 (p285)
M
Ma, Donghee: SE 094 (p303)
Min, Gwan Hong: SE 113 (p312)
Min, Ju Hwa: SE 016 (p269)
Min, Seon-Jeong: SS 3 PHY-7 (p245)
Minakata, Mizuho: SE 109 (p310)
Modena, Daniela: SE 073 (p294)
Momin, Asif: SE 021 (p272), SE 065 (p290)
Momin, Shenaz: SE 021 (p272), SE 065
(p290)
Moon, Hee Jung: YIA-3 (p241), SS 4 THY3 (p249), SS 4 THY-4 (p249), SE 099
(p305), SE 101 (p306), SE 102 (p307),
SE 103 (p307), SC 2 THY-6 (p256)
Moon, Sun Jeong: SE 046 (p282)
Moon, Won-Jin: SS 4 THY-1 (p248)
Moon, Woo Kyung: SE 028 (p275), SE 038
(p279)
N
Na, Dong Gyu: SS 4 THY-1 (p248), SS 4
THY-5 (p250), SE 095 (p303), SC 2
THY-5 (p255)
Nam, Meeyoung: SE 100 (p306)
Namgung, Sook: SE 068 (p291)
Nergui, Bayanzul: SE 058 (p288)
Nomuundari, Ganbat: SE 058 (p288)
O
Oh, Dongwook: SE 001 (p263)
Oh, Hoon Kyu: SS 4 HN-1 (p246)
Oh, Ji Young: SFS 5 MSK-5 (p224)
Oh, Jongyeong: SE 014 (p268)
Oh, Junghwan: CC 4 PHY-2 (p57)
Oh, Soon Nam: SE 011 (p267)
Oh, Young-Taek: YIA-1 (p240)
Ong, Yan Ne: SE 008 (p266)
Orkhon, Gombosuren: SE 058 (p288)
P
Park, Ah Young: SE 031 (p276)
Park, Byung Kwan: SFS 2 GU-3 (p113)
Park, Byung Wook: SE 054 (p286)
Park, Chan Yuk: SE 093 (p302)
Park, Dalsu: SE 075 (p295)
Park, Do Hyun: SE 001 (p263)
Park, Eun Joo: KSTU-4 (p145)
Park, Eun-Joo: SS 6 ABD-9 (p262)
Park, Gi Young: SS 5 MSK-1 (p251)
Park, Gi-Young: SE 083 (p298)
Park, Hee Jin: SE 074 (p294)
Park, Hee Sun: SFS 6 Multiorgan-1 (p225),
SS 6 ABD-2 (p258)
Park, Hwi Ryong: SE 002 (p263)
Park, Hye Sun: SE 111 (p311), SC 2 THY-4
(p255), SC 2 THY-8 (p257)
Park, Hyun Jeong: YIA-1 (p240), CC 8
ABD-2 (p177)
Park, Hyun Jung: SE 002 (p263)
Park, Hyung Seok: YIA-3 (p241)
Park, Ji Eun: SS 2 PED-1 (p233), SS 2
PED-5 (p235)
Park, Ji Yeon: SE 069 (p292)
317
KSUM Open 2016
Author Index
Park, Ji-Eun: SS 2 PED-4 (p234)
Park, Jina: CC 7 MSK-4 (p165)
Park, Jung Jae: SFS 2 GU-4 (p114)
Park, Jung Won: SE 098 (p305)
Park, Kye Jin: SS 4 HN-3 (p247)
Park, Michael Yong: SE 011 (p267)
Park, Noh Hyuck: SE 069 (p292)
Park, Shin Young: SE 096 (p304)
Park, So Yoon: YIA-2 (p241), SS 4 THY-2
(p248), SE 045 (p281)
Park, So Young: SFS 5 MSK-2 (p213)
Park, Sung Bin: SS 5 MSK-4 (p253), SE
002 (p263), SE 061 (p289)
Park, Sung Hee: SE 034 (p277), SE 112
(p312)
Park, Young Jean: SS 4 THY-4 (p249)
Park, Young Mi: SC 1 BR-1 (p147), SE 046
(p282), SE 047 (p282), SE 076 (p295),
SE 077 (p296)
Purevdorj, Lkhagvasuren: SE 086 (p300)
Purevkhuu, Munkhsaikhan: SE 070 (p292),
SE 107 (p309)
Purevsukh, Tugsjargal: SE 058 (p288)
R
Rajpho, Virasack: SE 010 (p267), SE 049
(p283)
Rha, Sung Eun: SE 011 (p267)
Rim, Jae Hwal: SS 5 MSK-1 (p251)
Roh, Sang Soo: SS 4 HN-2 (p247)
Roh, Yongrae: KSTU-1 (p142)
Roslan, Rozaidi: SS 5 MSK-3 (p252)
Ryoo, Inseon: SFS 6 Multiorgan-3 (p227)
Ryu, Jae Wook: SE 114 (p313)
Ryu, Jeong-Won: SS 3 PHY-7 (p245), SE
012 (p267)
Ryu, Jiwon: YIA-1 (p240)
Ryu, Kyeong Hwa: SS 4 HN-3 (p247)
Ryu, Young Jin: SS 2 PED-1 (p233), SS 2
PED-5 (p235)
Ryu, Youngjin: SS 2 PED-4 (p234)
S
Schnabel, Freya: SC 1 BR-5 (p239)
Seo, Bo Kyoung: LS 1 Toshiba-1 (p103), SE
031 (p276), SE 035 (p278), SE 043
(p281), SE 048 (p283)
Seo, Dong-Wan: SE 001 (p263)
Seo, Eun Hee: SE 113 (p312)
Seo, Eun-Seong: SE 013 (p268)
Seo, Hyunah: SS 3 PHY-3 (p243)
Seo, Jae Young: SE 096 (p304)
Seo, Jongbum: SS 3 PHY-1 (p242)
Seo, Mirinae: SE 023 (p272), SE 033
(p277), SE 034 (p277), SE 036 (p278),
SE 112 (p312)
318
Sharma, Prakash: SE 007 (p265)
Shigeta, Masayuki: SE 109 (p310)
Shin, Hye Seon: SE 035 (p278), SE 043
(p281), SE 048 (p283)
Shin, Hyun Joo: SS 2 PED-6 (p236), SE
084 (p299), SE 101 (p306)
Shin, Jung Hee: CC 6 THY-1 (p150), SS 4
THY-2 (p248), SS 4 THY-6 (p251), SE
100 (p306), SE 104 (p308), SE 106
(p309), SE 114 (p313)
Shin, Su-Mi: SS 2 PED-7 (p236)
Shin, Young Gyung: SE 102 (p307)
Shinekhuu, Undral: SE 005 (p264), SE 056
(p287)
Shivers, Steven: SC 1 BR-5 (p239)
Shrestha, Sumiran: SE 057 (p287)
Shuumarjav, Uurtuya: SE 050 (p284)
Sidek, Sabrilhakim: SS 5 MSK-3 (p252), SE
081 (p297)
Sidek, Shahrul Naim: SS 5 MSK-3 (p252)
Sidhu, Paul: SFS 4 ABD-2 (p203)
Sinn, Dong Hyun: SS 6 ABD-6 (p260)
Siripongsakun, Surachate: SS 6 ABD-5
(p260)
Sohn, Yu-Mee: SE 033 (p277), SE 036
(p278)
Song, Eun Jee: SE 033 (p277)
Song, Gilsu: SS 3 PHY-1 (p242)
Song, Kyoung Doo: SFS 4 ABD-1 (p196)
Song, Mijin: SE 063 (p290)
Song, Ok Kyu: SE 103 (p307)
Song, Tae Jun: SE 001 (p263)
Song, Tai-Kyong: CC 4 PHY-1 (p56)
Song, Yoon Ho: SE 113 (p312)
Song, Yoonah: CC 7 MSK-3 (p163)
Sonomtseren, Sainbileg: SE 070 (p292)
Sung, Deuk Jae: CC 2 GU-3 (p38)
Sung, Jin Ho: SE 093 (p302)
Sung, Jin Yong: SE 095 (p303)
T
Tan, Andrew: SS 1 CV-2 (p231)
Tao, Zi: SE 052 (p285), SE 071 (p293)
Teoh, Wey Chyi: SS 1 CV-2 (p231), SE 008
(p266)
Thapa, Sudeep: SE 057 (p287)
Tiwari, Prabhat Kumar: SE 007 (p265)
Toth, Hilde: SC 1 BR-5 (p239)
Tsedv-Ochir, Tumur-Ochir: SE 019 (p271)
Tserendorj, Badamsed: SE 005 (p264), SE
006 (p265), SE 009 (p266), SE 055
(p286), SE 056 (p287), SE 107 (p309),
SE 108 (p310)
Tsevegmid, Erdembileg: SE 050 (p284), SE
085 (p299), SE 086 (p300)
Tumur, Baatartsogt: SE 085 (p299), SE 086
(p300)
V
Vidhyarkorn, Sirachat: SS 6 ABD-5 (p260)
W
Wang, Dan: SC 2 THY-7 (p257)
Wang, Liang: SFS 2 GU-1 (p105), SFS 2
GU-2 (p109)
Wang, Xiao-Lei: SC 2 THY-3 (p254)
Wi, Seonga: SE 018 (p270), SE 020 (p271)
Won, So Yeon: YIA-3 (p241)
Woo, Ok Hee: SE 031 (p276), SE 035
(p278), SE 043 (p281)
Woo, Okhee: SE 048 (p283)
Wu, Xiang: SE 052 (p285), SE 071 (p293)
X
Xu, Hui-Xiong: SS 2 GU-1 (p237), SC 2
THY-7 (p257)
Xu, Jun-Mei: SC 2 THY-7 (p257)
Y
Yang, Dal Mo: SE 016 (p269)
Yang, Koeun: SE 068 (p291)
Yang, Woo-Young: SS 6 ABD-2 (p258)
Yanjiv, Darkhijav: SE 058 (p288)
Yeo, Sin Yuin: SE 073 (p294)
Yeo, Soo Hyun: SE 038 (p279)
Yi, Ann: SE 028 (p275)
Yi, Jong Myeong: SE 096 (p304)
Yim, Sanghyuk: SE 062 (p289)
Ying, Kho Ying: SE 072 (p293)
Yong, Yan Rong: SE 008 (p266)
Yoo, Hyunsuk: SE 015 (p269)
Yoo, Jeongin: SE 002 (p263)
Yoo, So-Young: SE 089 (p301)
Yoo, Yangmo: CC 4 PHY-3 (p58), SS 3
PHY-3 (p243), SS 3 PHY-5 (p244)
Yoon, Haesung: SS 2 PED-6 (p236), SE
084 (p299)
Yoon, Hee Mang: SS 2 PED-2 (p233), SS 2
PED-3 (p234)
Yoon, Jeong Hee: SE 015 (p269)
Yoon, Jung Hyun: CC 1 BR-3 (p23), YIA3 (p241), SS 4 THY-3 (p249), SS 4
THY-4 (p249), SE 099 (p305), SE 101
(p306), SE 102 (p307), SE 103 (p307),
SE 116 (p314), SC 1 BR-4 (p239), SC
2 THY-6 (p256)
Yoon, Kwon Ha: SE 017 (p270)
Yoon, Min A: CC 7 MSK-1 (p157)
Yoon, Seong Kuk: SE 059 (p288)
Yoon, Yong-Soon: SS 1 CV-4 (p232), SS 5
MSK-2 (p252)
You, Myung-Won: SE 078 (p296)
Authors Index
Author Index
Yu, Mi Hye: SS 6 ABD-2 (p258)
Yue, Wen-Wen: SC 2 THY-7 (p257)
Yun, Bo La: SE 023 (p272)
Z
Zainal, Norharifah: SE 072 (p293)
Zeng, Zeng: SC 1 BR-6 (p240)
Zhang, Hongjia: SS 1 CV-3 (p232)
Zhang, Meihua: SE 028 (p275)
Zhang, Qihao: SS 5 MSK-5 (p253)
Zhao, Feifei: SE 053 (p285)
Zhou, Hang: SC 2 THY-7 (p257)
Zhu, Chaochao: SE 052 (p285), SE 071
(p293)
319

Abstract Book

Transcription

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