RSNA 1999 Ultrasound Scientific Exhibits
Written by Neil T. Specht, M.D..
This year, the RSNA Scientific Exhibits included over 100 posters relating to the field of Ultrasound. These exhibits were distributed over 11 major subject areas with the greatest concentration noted in the areas of Musculoskeletal imaging (14 exhibits), Obstetrics/Gynecology (13 exhibits), Gastrointestinal imaging (12 exhibits) and Multisystem/Special Interest (26 exhibits). The poster area has become a huge undertaking and if this area becomes much larger, a tram service will be required for easier navigation.
The presentations at this year's RSNA demonstrated the multi-national representation at this meeting. A few of the presentations which I found of particular interest are detailed below. Some of these presentations will soon be published as journal articles and are recommended reading.
Exhibit 0186BR: A Pictorial Review of the Sonographic Appearances of Benign and Malignant Axillary Lymph Nodes in Patients with Breast Cancer.
AUTHORS:
D.G. Sheppard, MD, Dundee, Scotland, United Kingdom; B.S. Edeiken, MD; G.J. Whitman, MD; N. Sneige, MD; B.D. Fornage, MD.
Comments: This excellent pictorial review demonstrated differing imaging characteristics of axillary nodes in an attempt to identify characteristics which would favor benignity versus malignancy in patients with known breast carcinoma. Benign characteristics included echogenic hilum, lack of displacement or compression of central fat, concentric cortical rim, length/short (L/S) axis ratio >2, short axis measurement <1cm. Malignant characteristics included an eccentric cortical widening >2mm, absence of an identifiable hilum, displacement or compression of the central fat, L/S ratio <2, lobulated contour, and short axis measurement >1cm. Considerable overlap of imaging characteristics was noted with some malignant nodes displaying benign characteristics as well as benign nodes with some malignant features. The authors conclude the absence or deformity of the echogenic hilum and/or eccentric cortical hypertrophy are reliable indicators of malignancy in axillary lymph nodes in patients with breast cancer. The short axis and L/S ratio measurements are more reliable than long axis measurement in identifying metastatic axillary lymph nodes. RSNA Cum Laude Award Winner.
Exhibit 0209GI: Contrast-Enhanced US Pulse Inversion Harmonic Gray Scale Imaging in Diagnosis of Liver Masses.
AUTHORS:
A. Giovagnoni, MD, Modena, Italy; A. Martegani, MD; L. Iani, MD; C. Dal Mulin, MD; R. Romagnoli, MD; C. Del Favero, MD.
Exhibit 0295GI: Primary Epiploic Appendigitis: US, CT, MR and Barium Enema Findings and Histopathologic Findings.
AUTHORS:
J.H. Kwon, MD, Ulsan, South Korea; H.P. Kwon, MD; G.S. Kim, MD; W.H. Kim, MD.
Comments: This entity is likely much more common than previously believed. CT imaging characteristics are quite unique. Authors were invited to submit material for publication in RadioGraphics.
Exhibit 0522UR: Scrotal Ultrasound: Methods, Diagnoses, and Clinical Impact.
AUTHORS:
N. Petitti, MD, PhD, Winston-Salem, NC; M.Y. Chen, MD; E.S. Scharling, MD; D.J. Ott, MD.
Comments: Excellent pictorial review of this subject matter including images and gross pathology.
Exhibit 0560OB: Sonographic Evaluation of Choledochal Cysts: Prenatal and Postnatal Correlation.
AUTHORS:
K.B. Brewer, RDMS, Little Rock, AR; T.L. Angtuaco, MD; J.W. Allison, MD.
Exhibit 0572OB: Usefulness of Transvaginal Hysterosonography in Evaluation of Endometrial Abnormalities.
AUTHORS:
P.C. Chen, MD, Houston, TX; C.I. Caskey, MD; N.F. Maklad, MD, PhD; N. Ashrafian. RSNA Certificate of Merit Award Winner.
Exhibit 0592OB: Ultrasound Assessment of the Fetal Skeletal System: A State-of-the-Art Pictorial Review .
AUTHORS:
J.R. Mernagh, MD, Hamilton, ON; P. Mohide, MD; C. Caco, MD; M.J. Nowaczyk, MD; J. Fedoryshin, RDMS.
Comments: Excellent pictorial review of this subject matter.
Exhibit 0641MK: High-Resolution Sonography of the Rotator Cuff with Arthro-CT Scanner Correlation.
AUTHORS:
Y. Carrillon, MD, Lyon, France; J. Borne, MD; S. Bensoussan, MD; J.C. Sgandurra, MD; V.A. Tra-Minh, MD.
Exhibit 0670MK: High-Frequency US Examination of Nerve Entrapments in Osteofibrous Tunnels.
AUTHORS:
C. Martinoli, MD, Genova, Italy; S. Bianchi, MD; F. Pretolesi, MD; L.E. Derchi, MD. RSNA Certificate of Merit Award Winner. Authors were invited to submit material for publication in RadioGraphics.
Exhibit 0687MK: High-Frequency US Examination of Tendons.
AUTHORS:
C. Martinoli, MD, Genova, Italy; S. Bianchi, MD; F. Pretolesi, MD; L.E. Derchi, MD.
Comments: This exhibit and exhibit 0670MK were exquisite presentations and reveal where we have advanced in the field of musculoskeletal ultrasound imaging. The detail depicted in these two exhibits was the best I have seen and represents the State-of-the Art in musculoskeletal ultrasound imaging. Material presented in these two presentations included entrapment syndromes (carpal tunnel, cubital tunnel, tarsal tunnel), tendon imaging and various tendinopathies including inflammatory and post-traumatic conditions. I am sure this material will be found in future journal publications and should not be missed. RSNA Magna Cum Laude Award Winner. Authors were invited to submit material for publication in RadioGraphics.
Exhibit 0798NR: Differential Diagnosis of Small and Round Cervical Lymph Nodes: Comparison of Power Doppler US with Contrast-enhanced CT and Pathologic Results.
AUTHORS:
T. Sakaguchi, MD, Kumamoto, Japan; Y. Yamashita, MD; K. Katahira, MD; Y. Baba, MD; A Arakawa, MD; M. Takahashi, MD.
Comments: This exhibit compared Power Doppler US with Contrast-enhanced CT in evaluation of small and round cervical lymph nodes. These investigators found no statistical difference in using L/S axis ratios to differentiate between reactive and metastatic nodes. The presence or absence of a central echogenic hilus was also not helpful in node differentiation. The vascular patterns noted on Power Doppler evaluation included the hilar vascular pattern, avascular pattern, peripheral vascular pattern, spotty vascular pattern, or a combination of vascular flow types. The hilar vascular pattern was more frequently seen in benign disease, the peripheral, spotty pattern was more indicative of malignant disease and the avascular pattern was seen in both benign and malignant disease. Contrast-enhanced CT patterns included homogeneous, heterogeneous and ring enhancement patterns. Ring enhancement was specific for metastatic nodes with no reactive node displaying this pattern of enhancement. Homogeneous enhancement favored benign disease and heterogeneous enhancement favored malignant disease. Both imaging modalities were jointly correlated with histopathology and most malignant nodes without CT ring enhancement were shown to have peripheral or spotty US vascular patterns. RSNA Certificate of Merit Award Winner.
Exhibit 1082VI: Transvaginal and Transrectal Ultrasound Guided Trocar Drainage of Infected Deep Pelvic Collections: A Quick and Simple Alternative to Seldinger Technique.
AUTHORS:
E.A. Rafferty, MD, Boston, MA; M.J. O»Neill, MD; I.C. Yoder, MD; D.A. Gervais, MD; P.R. Mueller, MD.
Comments: For those of us involved in the field of interventional ultrasound, this provided a simple and effective description of a way to use existing materials for single-stick, catheter over trocar introduction for drainage of deep pelvic collections rather than using the Seldinger technique. The plastic sheath supplied with the needle/catheter system is cut lengthwise and secured with elastic bands to the intracavitary probe (with the slice in the plastic facing outward) in the same orientation as the needle guide if this were an US guided aspiration. The biopsy guide imaging set-up is used during trocar/catheter placement. Once the trocar and catheter are introduced into the fluid collection under real-time visualization, the catheter is secured in place and the catheter is stripped from the plastic housing through the longitudinal slice in the tube upon withdrawal of the probe. Until the catheter companies devise a single-stick US guided set-up, this technique should prove to be an effective alternative and has the added benefit of reducing procedure time.
Exhibit 1099VI: Extracranial Carotid and Vertebral Arteries: The Role of Color Doppler Ultrasound in Disease Evaluation.
P.S. Sidhu, MD, London, England; S.M. Ryan, MD; S.M. Ellis, MD; H.D. Richardson, MD.
Comments: Excellent review of this subject matter including plaque characterization, carotid occlusion, dissection, subclavian steal and imaging pitfalls. Authors were invited to submit material for publication in RadioGraphics.
Exhibit 1144VI: Sonography of the Vertebral Arteries: A Window to Disease of the Proximal Great Vessels - M.M. Horrow, MD, Philadelphia, PA J. Spigel, MD J. Stassi, MD J.D. Brody, DO; CL Kirby, MD; H.K. Rosenberg, MD.
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