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  Most popular articles (Since February 13, 2018)

 
 
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REVIEW ARTICLE
A review of medical doppler ultrasonography of blood flow in general and especially in common carotid artery
Ammar A Oglat, MZ Matjafri, Nursakinah Suardi, Mohammad A Oqlat, Mostafa A Abdelrahman, Ahmad A Oqlat
January-March 2018, 26(1):3-13
DOI:10.4103/JMU.JMU_11_17  
Medical Doppler ultrasound is usually utilized in the clinical adjusting to evaluate and estimate blood flow in both the major (large) and the minor (tiny) vessels of the body. The normal and abnormal sign waveforms can be shown by spectral Doppler technique. The sign waveform is individual to each vessel. Thus, it is significant for the operator and the clinicians to understand the normal and abnormal diagnostic in a spectral Doppler show. The aim of this review is to explain the physical principles behind the medical Doppler ultrasound, also, to use some of the mathematical formulas utilized in the medical Doppler ultrasound examination. Furthermore, we discussed the color and spectral flow model of Doppler ultrasound. Finally, we explained spectral Doppler sign waveforms to show both the normal and abnormal signs waveforms that are individual to the common carotid artery, because these signs are important for both the radiologist and sonographer to perceive both the normal and abnormal in a spectral Doppler show.
  13,034 1,454 11
BRIEF COMMUNICATION
Large multilocular cystic lesions in the uterine cervix: Differential diagnosis and significance
Ahmed Samy El-Agwany
July-September 2018, 26(3):153-156
DOI:10.4103/JMU.JMU_38_18  PMID:30283202
Introduction: Cervical nabothian cysts are common in women of reproductive age. Although cysts are generally small and asymptomatic, large ones are extremely rare and may be misdiagnosed as malignancy. Case Study: We report a case of large multiple complex nabothian cyst, which was suspected as malignant one on imaging and examination. Pelvic examination and ultrasonography revealed ballooned cervix with multiple large complex nabothian follicles. There was an associated large adnexal mass with ascites. The patient was treated with total hysterectomy and omentectomy after aspiration of the fluid from the cervical cysts for debulking and limiting complications. Pathology revealed granulosa cell ovarian tumor, omental panniculitis, and cervical nabothian follicles. Conclusion: Large nabothian cysts should be kept in mind for differential diagnosis of cervical tumors. Ultrasonography is of value for the diagnosis of giant nabothian cysts and can aid in exclusion of malignancy. Differentiation between a malignant cystic lesion, such as an adenoma malignum, and a benign cystic lesion is crucial but difficult. Cervical nabothian follicles can be multiple and attain a large size up to 4 cm each. It is commonly benign but we should keep in mind the rare adenoma malignum on imaging and histopathology.
  9,449 403 -
CASE REPORTS
Huge broad ligament fibroid with paracervical extension: A safe approach by same setting myomectomy before hysterectomy
Ahmed Samy El-Agwany
January-March 2018, 26(1):45-47
DOI:10.4103/JMU.JMU_2_18  
The broad ligament is the most common extrauterine site for leiomyoma but with low incidence rate. We present a patient with complaints of lower abdominal pain and abdominal distension. Abdominal examination revealed a huge firm mass arising from the pelvis corresponding to 24-week size. The cervix was deviated and elevated but felt separable of the mass. Ultrasonographic examination showed 20 cm fibroid beside the uterus suggesting broad ligament fibroid. On laparotomy, the uterus was elevated up and deviated laterally by the mass. A 20 cm broad ligament fibroid was seen extending deep in the pelvis and up filling all the broad ligament. Myomectomy was performed initially to decompress the mass for easy hysterectomy and carefully evaluating the ureter avoiding its injury. Total hysterectomy with bilateral salpingo-oophorectomy was done. This case was reported because of the rare incidence of broad ligament leiomyoma and the difficulty in its operative management.
  8,598 297 1
Tumefactive sludge mimicking gallbladder neoplasm: A case report and review of the literature
Cheng-Chi Lee, Jen-Chieh Huang, Jeng-Shiann Shin, Ming-Je Wu
April-June 2018, 26(2):103-106
DOI:10.4103/JMU.JMU_19_18  
Biliary sludge (or very thick bile) is mainly comprised of calcium bilirubinate granules and lesser amounts of cholesterol crystals, and it can produce a layer of low amplitude of echoes in the most dependent part of the gallbladder (GB). In tumefactive biliary sludge, low-amplitude echoes do not form a fluid–fluid level but instead tend to give the appearance of a polypoid mass that is bounded by a smooth margin, round, and lobulated. Differential diagnoses for an echogenic mass in the GB lumen include GB carcinoma, tumefactive sludge, and gangrenous cholecystitis. In this case report, we describe a rare case in which biliary sludge did not form a fluid–fluid level but tended to accumulate and appear as a polypoid mass within the lumen of the GB. The lesion was finally identified as being tumefactive sludge mimicking neoplasm of the GB.
  7,502 339 -
EDUCATIONAL FORUM
Benign neoplasm of kidney: Angiomyolipoma
Shih-Feng Wang, Wah-On Lo
July-September 2018, 26(3):119-122
DOI:10.4103/JMU.JMU_48_18  PMID:30283196
Angiomyolipoma is one of the renal benign neoplasms. The most of the angiomyolipomas are asymptomatic and found incidentally with ultrasound. They are more prevalent in patients with tuberous sclerosis. It is very important to make differential diagnosis from other renal neoplasm such as renal cell carcinoma. Growth rate is higher among pregnant women suggest that the hormones may play a role in the stimulation of angiomyolipoma. The most common serious presentation is rupture and hemorrhage, and sometimes it can lead to shock. Adequate diagnosis, treatment, and follow-up are very important in the face of renal angiomyolipoma.
  6,482 488 3
GUIDELINE
The AFSUMB consensus statements and recommendations for the clinical practice of contrast-enhanced ultrasound using sonazoid
Jae Young Lee, Yasunori Minami, Byung Ihn Choi, Won Jae Lee, Yi-Hong Chou, Woo Kyoung Jeong, Mi-Suk Park, Nobuki Kudo, Min Woo Lee, Ken Kamata, Hiroko Iijima, So Yeon Kim, Kazushi Numata, Katsutoshi Sugimoto, Hitoshi Maruyama, Yasukiyo Sumino, Chikara Ogawa, Masayuki Kitano, Ijin Joo, Junichi Arita, Ja-Der Liang, Hsi-Ming Lin, Christian Nolsoe, Odd Helge Gilja, Masatoshi Kudo
April-June 2020, 28(2):59-82
DOI:10.4103/JMU.JMU_124_19  
The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
  5,284 149 -
ORIGINAL ARTICLES
Correlational study of nonalcoholic fatty liver disease diagnosed by ultrasonography with lipid profile and body mass index in adult nepalese population
Umesh P Khanal, Bigyan Paudel, Ghanshyam Gurung, Yong-Sin Hu, Chiung-Wen Kuo
January-March 2019, 27(1):19-25
DOI:10.4103/JMU.JMU_53_18  PMID:31031531
Objective: The purpose of this study was to categorize patients into different grades of nonalcoholic fatty liver disease (NAFLD) by ultrasonography and to compare the findings with their serum lipid profile. Materials and Methods: Descriptive, cross-sectional study design was used. One hundred and nine patients without a history of alcohol consumption of age more than 16 years attending general health checkup were selected at Tribhuvan University Teaching Hospital, Maharajganj, Kathmandu, as per the exclusion and inclusion criteria. Ultrasound scanning of the patients was done and their liver size, as well as grading of fatty liver, was done. Data were collected in predesigned pro forma and were analyzed using Statistical Package for the Social Sciences (SPSS) 16.0, IBM (SPSS Inc., Chicago, IL). Results: In this study, the mean age of fatty liver in males was found to be 44.3 years and in females was found to be 51.9 years. 22.9% of patients with NAFLD had increased liver size. Significant association with increasing grades of fatty liver was found with increasing levels of cholesterol (P = 0.028), low-density lipoprotein (LDL) (P = 0.017), liver size (P = 0.001), and body mass index (BMI) (P = 0.045) in patients diagnosed with NAFLD. No significant association with increasing grades of fatty liver was found with increasing levels of triglyceride (P = 0.32) and high-density lipoprotein (P = 0.25). Conclusion: Ultrasound is a safe and first-line modality for the evaluation of fatty liver and its grading. Increasing grades of fatty liver had significant association with increasing levels of cholesterol LDL, increasing liver size, and BMI of patients.
  4,852 366 2
CASE REPORTS
Nonoperative choice of anterior cruciate ligament partial tear: Ultrasound-guided platelet-rich plasma injection
Chi-Kai You, Chen-Liang Chou, Wei-Ting Wu, Yu-Chun Hsu
July-September 2019, 27(3):148-150
DOI:10.4103/JMU.JMU_121_18  PMID:31867179
Anterior cruciate ligament (ACL) injury is one of the common musculoskeletal injuries. The most serious condition shall be managed by surgery, while the partial tear prefers conservative treatment, rehabilitation, exercise training, or platelet-rich plasma (PRP) injection. We describe the case of a 25-year-old female started to have right knee pain for a long time and the ACL partial tear was diagnosed through the magnetic resonance imaging (MRI). After three times of PRP injection through ultrasound guidance, the pain, instability, and enhancements of ACL tear in the postintervention MRI were decreased. This case confirms the effect of PRP combined with conservative treatment under the accuracy procedure and may provide another choice for the treatment of the ACL tear.
  4,872 344 -
ORIGINAL ARTICLES
Sonographic estimation of amniotic fluid volume using the amniotic fluid index and the single deepest pocket in a resource-limited setting
Geofery Luntsi, Falmata Ali Burabe, Prince Ame Ogenyi, Joseph Dlama Zira, Nwobi Ivor Chigozie, Flavious Bobuin Nkubli, Maikudi Dauda
April-June 2019, 27(2):63-68
DOI:10.4103/JMU.JMU_26_18  PMID:31316214
Objective: To determine the normal value of amniotic fluid (AF) volume among pregnant women in a Northern Nigerian population and to determine if there is a relationship between AF index (AFI) and single deepest pocket (SDP) with anthropometric variables. Materials and Methods: A prospective cross-sectional study was conducted among singleton pregnant women at late second and third trimester attending the antenatal clinic in Abubakar Tafawa Balewa Teaching Hospital, Bauchi, from December 2016 to April 2017. The mean AFI and SDP were measured by sonography. Ethical approval was obtained from the institution and informed consent was sought for from all the participants. Descriptive statistics, i.e. mean, standard deviation, and correlation coefficient, were used for the analysis. Results: A total of 206 women, aged between 18 and 40 years, with fetal gestational ages between 22 and 39 weeks were included in the study. The values for AFI in the study ranged from 12 to 28.7 cm, with a mean value of 19.84 ± 3.64 cm, and SDP ranged from 3.7 to 9.1 cm with a mean value of 6.04 ± 1.12 cm. This study found a weak relationship between the anthropometric variables and AFI and SDP and a strong relationship between AFI and SDP with a correlation coefficient of R = 0.901 and P = 0.014. Conclusion: This study found the mean values for AF volume using AFI and SDP in the studied population to be 19.84 ± 3.64 cm and 6.04 ± 1.12 cm, respectively; a strong positive relationship between AFI and SDP; and a negative relationship between body mass index with AFI and SDP.
  4,217 293 -
LETTERS TO EDITOR
Conservative management of infected postpartum uterine dehiscence after cesarean section
Ahmed Samy El-Agwany
January-March 2018, 26(1):59-61
DOI:10.4103/JMU.JMU_5_18  
There is an increase in cesarean rates worldwide. Parallel to this, the complications increased. Among these complications, uterine dehiscence and pelvic hematoma with abscess collection have increased. Diagnosis using methods such as ultrasonography, magnetic resonance imaging, and computer-aided tomography can be made. Treatment includes resuturing the uterine incision line, hysterectomy, or conservative treatment accompanied by broad-spectrum antibiotics administration. We evaluated three cases that were diagnosed by ultrasound as a dehiscent scar postpartum after cesarean section and they were managed conservatively with regular follow-up.
  4,204 299 2
ORIGINAL ARTICLES
Genetic burden and outcome of cystic hygromas detected antenatally: Results of 93 pregnancies from a single center in the Northern Region of Turkey
Huri Sema Aymelek, Gönül Oğur, Miǧraci Tosun, Ümmet Abur, Engin Altundaǧ, Handan Çelik, Emel Kurtoǧlu, Erdal Malatyalıoǧlu, Ömer Salih Akar, Tayfun Alper
October-December 2019, 27(4):181-186
DOI:10.4103/JMU.JMU_114_18  PMID:31867191
Objective: Genetic burden, fetal malformations, and fetal outcomes of 93 fetuses with cystic hygroma (CH) are reported from a single center in Turkey. Patients and Methods: Pregnancies, having a diagnosis of fetal CH, detected between January 2010 and October 2016, were included in the study except fetuses having increased nuchal translucency. Fetal age/gender, maternal age, the age of pregnancy, types of fetal malformations, karyotype, and outcomes were evaluated. Results: The average gestational age was 16.2 weeks. Nearly 47% of the pregnancies had multiple congenital anomalies, of which 58% had a chromosomal anomaly. Chromosomal anomaly rate was 68.2% in patients with hydrops fetalis. Aneuploidies were major chromosomal defects. All trisomies were of regular type except one with Robertsonian translocation (46, XY, +13, rob[13;14][q10;q10]). Seventy-four percentage pregnancies were terminated due to either fetal/karyotype anomaly. Conclusion: Characteristics of fetal CH were similar in different ethnical backgrounds. Aneuploidy is the dominant chromosomal constitution of fetal CH. Little information was known about the genes involved. Gene dosage effect implies that fetal CH is a complex genetic situation involving multiple genes interactions. For proper genetic counseling, each fetus with CH should be karyotyped, and fetal ultrasound examination should be performed. In the case of normal chromosome set, application of aCGH should be considered.
  4,189 212 1
LETTERS TO EDITOR
Ultrasound imaging for temporomandibular joint disc anterior displacement
Keng-Hua Tu, Hung-Jui Chuang, Li-An Lai, Ming-Yen Hsiao
April-June 2018, 26(2):109-110
DOI:10.4103/JMU.JMU_18_18  
  3,992 354 -
ORIGINAL ARTICLES
Ultrasound findings in thyroid nodules: A radio–cytopathologic correlation
Arpana , Om Biju Panta, Ghanashyam Gurung, Sunil Pradhan
April-June 2018, 26(2):90-93
DOI:10.4103/JMU.JMU_7_17  
Introduction: Ultrasound (USG) can be a good screening tool to identify high-risk nodule requiring fine-needle aspiration cytology (FNAC). The study aimed to assess the association of USG characteristic of thyroid nodule with malignancy. Methods: A cross-sectional study was performed from August 2011 to July 2012 at Tribhuvan University Teaching Hospital. Patients referred for USG of the neck with thyroid nodule more than 10 mm were offered FNAC and included in the study after taking informed consent. USG characteristics were compared with histopathologic diagnosis of benign or malignant nodule. Results: USG characteristics significantly (P < 0.05) associated with malignancy were as follows: size of thyroid nodule more than 30 mm, ill-defined margin, solid echotexture, hypoechoic lesion, microcalcification, and any form of increased vascularity. High sensitivity was seen in microcalcification, hypoechoic echogenicity, and ill-defined margin and high specificity was seen in ill-defined margin and solid echotexture. Relatively high sensitivity and specificity was found in ill-defined margin. Conclusions: Texture, size, margin, echogenicity, and vascularity are important factors for discriminating benign from malignant nodule. Hypoechogenicity, vascularity of any type, ill-defined margin, and microcalcification were independent predictors of malignancy. None of the characteristics were sensitive and specific to be used independently as screening tool to identify high risk of malignancy.
  3,788 316 1
CASE REPORTS
Soft-tissue sarcoma masquerading as a haematoma
Mark Charnock
January-March 2019, 27(1):50-53
DOI:10.4103/JMU.JMU_65_18  PMID:31031537
Sarcomas commonly occur in the buttock and thigh, although the clinical presentation varies with no specific symptoms other than a painless lump. This case study reports on a soft-tissue sarcoma that was initially thought to be a haematoma on ultrasound, despite being rescanned 6 weeks later. The patient presented back to their general practitioner 8 months later with the subsequent ultrasound showing an irregular and hypervascular soft-tissue mass. Further imaging and ultrasound-guided biopsy led to a surgical excision of a myxofibrosarcoma. This case demonstrates the difficulty of differentiating between a haematoma and sarcoma, especially in patients presenting with a history of trauma.
  3,878 179 -
Role of penile doppler as a diagnostic tool in penile fracture
Mohamed Azmi Hassali, Ahmed Ibrahim Nouri, Azhar Amir Hamzah, Ashutosh Kumar Verma
January-March 2018, 26(1):48-51
DOI:10.4103/JMU.JMU_9_18  
Penile fracture is defined as a traumatic rupture of either corpus cavernosum or the tunica albuginea; sometimes it can be both. It may be caused by exotic masturbation acts, sexual intercourse, or other trauma to this area. This can be accompanied by injury to the urethra, which is the cause of hematuria as a symptom for some patients. Typically, diagnosis of penile rupture or fracture depends on clinical examination and history told by the patients. We are stating the importance of medical imaging in the diagnosis of patients with penile fracture by presenting a case of patient suffered from penile fracture after a fall on his penis where it affected the erection of two-third of his penis. In which, the proper diagnosis by imaging studies and taking actions accordingly can save the patients from unnecessary surgeries that indeed increase the bill of the medical care directly and indirectly. Therefore, most patients can be diagnosed cost-effectively and treated surgically without a need to delay surgery, which is often the case if one was to resort to other investigations. Investigations such as retrograde urethrography for suspected urethral injury should only be used when the diagnosis of penile fracture is in doubt.
  3,449 277 2
ORIGINAL ARTICLES
Effectiveness of therapeutic ultrasound on clinical parameters and ultrasonographic cartilage thickness in knee osteoarthritis: A double-blind trial
Levent Ozgonenel, Sibel Çaglar Okur, Yasemin Pekin Dogan, Nil Sayiner Çaglar
October-December 2018, 26(4):194-199
DOI:10.4103/JMU.JMU_21_18  PMID:30662150
Objective: A double-blind placebo-controlled randomized study was conducted to assess the effectiveness of therapeutic ultrasound (US) in knee OA. Patients and Methods: Thirty-three patients (mean age 54.7 ± 14.7) were randomized to receive either continuous US (n = 15) or sham US (n = 18) as a placebo. Continuous ultrasonic waves with 1 MHZ frequency and 1 watt/cm2 power were applied for 5 min for 10 sessions. The primary outcome was pain on movement assessed by visual analog scale (VAS). The secondary outcomes were WOMAC scores and measurements of distal femoral cartilage thickness by imaging US. Results: Both groups showed reduced knee pain on movement following intervention. The VAS measurements improved significantly both in the treatment and the placebo group patients (P < 0.05 and P < 0.05). WOMAC scores improved statistically significant in all domains (pain, stiffness, physical function, and total score) in the treatment group (P < 0.05). All domains of WOMAC score showed statistically significant change when compared with the placebo group (P < 0.05). There was no change in the cartilage thickness measurements of medial femoral condyle, lateral femoral condyle, and intercondylar area in both groups after intervention. Conclusion: Results suggest that US is effective treatment modality in pain relief and improvement of function in patients with knee OA; however, US had no effect on cartilage repair.
  3,305 342 1
BRIEF COMMUNICATION
Failure analysis for ultrasound machines in a radiology department after implementation of predictive maintenance method
Greg Chu, Vivian Li, Amy Hui, Christina Lam, Eva Chan, Martin Law, Lawrance Yip, Wendy Lam
January-March 2018, 26(1):42-44
DOI:10.4103/JMU.JMU_13_18  
Objective: The objective of the study was to perform quantitative failure and fault analysis to the diagnostic ultrasound (US) scanners in a radiology department after the implementation of the predictive maintenance (PdM) method; to study the reduction trend of machine failure; to understand machine operating parameters affecting the failure; to further optimize the method to maximize the machine clinically service time. Materials and Methods: The PdM method has been implemented to the 5 US machines since 2013. Log books were used to record machine failures and their root causes together with the time spent on repair, all of which were retrieved, categorized, and analyzed for the period between 2013 and 2016. Results: There were a total of 108 cases of failure occurred in these 5 US machines during the 4-year study period. The average number of failure per month for all these machines was 2.4. Failure analysis showed that there were 33 cases (30.5%) due to software, 44 cases (40.7%) due to hardware, and 31 cases (28.7%) due to US probe. There was a statistically significant negative correlation between the time spent on regular quality assurance (QA) by hospital physicists with the time spent on faulty parts replacement over the study period (P = 0.007). However, there was no statistically significant correlation between regular QA time and total yearly breakdown case (P = 0.12), although there has been a decreasing trend observed in the yearly total breakdown. Conclusion: There has been a significant improvement on the machine failure of US machines attributed to the concerted effort of sonographers and physicists in our department to practice the PdM method, in that system component repair time has been reduced, and a decreasing trend in the number of system breakdown has been observed.
  3,305 327 -
REVIEW ARTICLE
A review of suspension-Scattered particles used in blood-mimicking fluid for doppler ultrasound imaging
Ammar A Oglat, Nursakinah Suardi, MZ Matjafri, Mohammad A Oqlat, Mostafa A Abdelrahman, Ahmad A Oqlat
April-June 2018, 26(2):68-76
DOI:10.4103/JMU.JMU_1_17  
Doppler ultrasound imaging system description and calibration need blood-mimicking fluids (BMFs) for the test target of medical ultrasound diagnostic tools, with known interior features and acoustic and physical properties of this fluid (BMF). Physical and acoustical properties determined in the International Electrotechnical Commission (IEC) standard are specified as constant values, the materials used in the BMF preparation should have values similar to the IEC standard values. However, BMF is ready-made commercially from a field of medical usage, which may not be appropriate in the layout of ultrasound system or for an estimate of novel imaging mechanism. It is often eligible to have the capability to make sound properties and mimic blood arrangement for specific applications. In this review, sufficient BMF materials, liquids, and measures are described which have been generated by utilizing diverse operation mechanism and materials that have sculptured a range of biological systems.
  3,234 377 1
ORIGINAL ARTICLES
Ultrasonographic reference values for assessing normal sciatic nerve ultrasonography in the normal population
Jun Chen, Jiapeng Liu, Jiao Zeng, Shan Wu, Jun Ren
April-June 2018, 26(2):85-89
DOI:10.4103/JMU.JMU_6_17  
Objective: High-resolution ultrasonography (HRUS) has been used recently to characterize median and ulnar nerves but is seldom used to characterize the lower extremity nerves. The reference standard for normal the lower extremity nerves has not been established. Thus, this study measured the cross-sectional areas (CSAs) of the sciatic nerve of 200 healthy male or female volunteers, aged 18–80 using HRUS. These data provide basic clinical data for the use of high-resolution ultrasound for the future diagnosis, treatment, and prognostic evaluation of peripheral neuropathies. Methods: Two hundred healthy volunteers with 400 lower extremities were studied with HRUS. According to their age, the subjects were assigned to young group (18-30 years, n = 75), middle group. (31-60 years, n = 70), and old group(61-80 year, n = 55).Age, sex, height, weight were recorded and CSAs of sciatic nerve were obtained at every predetermined sites. Results: The mean CSAs of sciatic nerves at GS and MGPF were 0.527 ± 0.028 cm2 and 0.444 ± 0.026 cm2 respectively. Pearson's correlation analysis showed that the mean CSAs were correlated with height and weight. There was no difference in mean CSAs among the three groups (P > 0.05). Women had smaller CSAs of the normal Sciatic nerves than men in two measuring sites (GS, MGPF) (P < 0.05). Conclusion: Peripheral nerve ultrasonography is a reliable and reproducible diagnostic method in the hands of experienced examiners. Normal values for the sciatic nerve nerves are provided by our study. Thus, reference values of Sciatic nerve CSA of the lower extremity can facilitate the analysis of abnormal nerve conditions.
  3,191 397 3
REVIEW ARTICLE
Reliability of ultrasound for the detection of rheumatoid arthritis
Rabia Hassan, Sobia Hussain, Raham Bacha, Syed Amir Gillani, Sajid Shaheen Malik
January-March 2019, 27(1):3-12
DOI:10.4103/JMU.JMU_112_18  PMID:31031529
The aim of this review article was to investigate the pooled sensitivity and specificity of musculoskeletal ultrasound (MSUS) for the detection of synovitis and early bone erosion in the small joint in rheumatoid arthritis (RA). In addition, investigate the pooled sensitivity and specificity of Power Doppler ultrasonography (PDUS) for the detection of synovial hypervascularity in small joints in RA. A systematic literature search of PubMed, Wiley online library, Google Scholar, Research gate, E-book, BioMed Central, the Journal of Rheumatology and Springer Link were investigated from 2001 to 2017. Original researches related to the article written in English including RA, synovitis, bone erosion, grayscale, and PDUS were included in this study. The sample size, study design, sensitivity, and specificity were analyzed. The review summarizes the value of MSUS for the detection of RA as it is the first choice of modality. Results show the acceptable reliability of US for the diagnosis of early bone erosions, synovitis, and synovial hypervascularity.
  3,034 347 3
ORIGINAL ARTICLES
Sonographic evaluation of some abdominal organs in sickle cell disease patients in a tertiary health institution in Northeastern Nigeria
Geofery Luntsi, Charles Ugwoke Eze, Muhammad Sani Ahmadu, Audu Abdullahi Bukar, Kalu Ochie
January-March 2018, 26(1):31-36
DOI:10.4103/JMU.JMU_5_17  
Background: Sonographic evaluation of abdominal organs is an important work up in managing sickle cell disease (SCD) patients. This study aimed at evaluating abdominal organs by sonography among SCD patients. Methodology: A cross-sectional study was carried out in Maiduguri, Nigeria from April 2014 to July 2015. Two hundred and fifty-two patients participated in the study, with 126 controls and 126 SCD patients. There were 131 (52%) males, and 121 (48%) females, with age range 3–38 years. Measurements were done using ultrasound machine with probe frequencies ranging from 1–4MHz and 4–9MHz in supine, right and left oblique positions for optimum visualization of the abdominal organs. Results: Participants within the age range of 10–15 years had the highest frequency with 88 (34.9%), followed by those within the age group of 17–23 years with 86 (34.1%), and the least were those within the age group of 30 years and above with 8 (3.2%). Hepatomegaly was found in 53 (75.7%), and increased echogenicity of the liver was found in 50 (94.3%) of the SCD patients, P = 0.000. Gallstones were found in 45 (17.9%), gallbladder sludge was found in 51 (21.4%) and thickened gallbladder wall was found in 84 (33.3%) of the SCD patients, P = 0.000. Autosplenectomy was found in 45 (17.9%), splenomegaly in 63 (24.9%), and calcified spleen in 18 (8.7%) of the SCD patients, P = 0.000. Enlarged kidneys in SCD patients were found in 61 (98.4%) and 63 (98.4%) on the right and left kidneys, respectively. Shrunken kidneys were found in 5 (2.0%) and 4 (1.6%) of the SCD patients on the right and left kidneys, respectively, P = 0.000. Conclusion: Abdominal sonography in SCD patients revealed varied remarkable changes in the size, echotexture, intraluminal deposits and wall thickness in the liver, gallbladder, kidneys, and spleen.
  3,090 253 3
REVIEW ARTICLE
Chemical items used for preparing tissue-mimicking material of wall-less flow phantom for doppler ultrasound imaging
Ammar A Oglat, MZ Matjafri, Nursakinah Suardi, Mohammad A Oqlat, Mostafa A Abdelrahman, Ahmad A Oqlat, Omar F Farhat, Batool N Alkhateb, Raed Abdalrheem, Muntaser S Ahmad, Mohammed Y. M. Abujazar
July-September 2018, 26(3):123-127
DOI:10.4103/JMU.JMU_13_17  PMID:30283197
The wall-less flow phantoms with recognized acoustic features (attenuation and speed of sound), interior properties, and dimensions of tissue were prepared, calibrated, and characterized of Doppler ultrasound scanning demands tissue-mimicking materials (TMMs). TMM phantoms are commercially available and ready-made for medical ultrasound applications. Furthermore, the commercial TMM phantoms are proper for ultrasound purpose or estimation of diagnostic imaging techniques according to the chemical materials used for its preparation. However, preparing a desirable TMM for wall-less flow phantom using a specific chemical material according to the specific applications is required for different flow. In this review, TMM and wall-less flow phantoms prepared using different chemical materials and methods were described. The chemical materials used in Doppler ultrasound TMM and wall-less flow phantoms fabricated over the previous decades were of high interest in this review.
  2,971 353 6
ORIGINAL ARTICLES
Inter-rater and intra-rater reliability of sonographic median nerve and wrist measurements
Consuelo B Gonzalez-Suarez, Lorraine D Buenavente, Ronald Christopher A Cua, Maria Belinda C Fidel, Jan-Tyrone C Cabrera, Carina Fatima G Regala
January-March 2018, 26(1):14-23
DOI:10.4103/JMU.JMU_2_17  
Background: Electrophysiologic studies have been considered the “gold standard” in diagnosing carpal tunnel syndrome (CTS); however, reports of false-negative results, as well as discomfort for the patient during the procedure has paved the use of ultrasound, being a painless and cost-efficient tool, as an alternative means for its diagnosis. Various ultrasound parameters assessing the median nerve and wrist dimensions have been described, but description of landmarks to assess these in a reliable manner has been lacking. Methodology: A systematic search of different databases yielded data regarding ultrasound parameters for CTS diagnosis, the landmarks used, and presence of reliability testing. Based on this, three sonologists discussed the external and sonographic landmarks that will be used in measuring the median nerve measurements, bowing of the flexor retinaculum and the carpal tunnel dimensions. A pilot test with two consecutive healthy participants using the discussed ultrasound parameters was carried out, and results were subjected to inter- and intra-rater reliability testing. Modifications were accordingly made on the acquisition of ultrasound image using external landmarks. The reliability testing proper was done with ten consecutive healthy participants. Results: Based on the systematic review and the pilot study, external landmarks were used to locate the median nerve in the forearm, carpal tunnel inlet and outlet. For the forearm measurement, it was taken 10 cm proximal from the distal palmar crease. The distal palmar crease was the external landmark used for the carpal tunnel inlet, while for the carpal tunnel outlet; it was measured 1 cm distal to the distal palmar crease. Instead of using the inner edge of the hook of hamate and trapezium, the apices of these bones were used as the landmarks in measuring the carpal tunnel outlet dimensions. There was excellent intra-rater reliability (mid-forearm, carpal tunnel inlet and outlet) except for the following: cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet and outlet; and bowing of the flexor retinaculum. All the parameters had an excellent inter-rater reliability measured at the three levels (intraclass correlation [ICC]: Of 0.77–0.99) except for CSA of the median nerve at the levels of the forearm (fair-to-good with ICC of 0.71) and the carpal tunnel inlet (fair-to-good reliability of ICC: 0.43). Conclusion: There was an improved inter- and intra-rater reliability when external landmarks were used instead of sonographic landmarks.
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EDUCATIONAL FORUM
Progress in the ultrasonographic microvascular imaging
Hsu-Heng Yen
January-March 2018, 26(1):1-2
DOI:10.4103/JMU.JMU_28_18  
  2,819 294 1
ORIGINAL ARTICLES
Ultrasound evaluation of soft-tissue foreign bodies by US army medics
David L Driskell, J Barton Gillum, Jonathan D Monti, Aaron Cronin
July-September 2018, 26(3):147-152
DOI:10.4103/JMU.JMU_12_18  PMID:30283201
Objective: The study's primary objective was to determine army medics' accuracy performing bedside ultrasound (US) to detect radiolucent foreign bodies (FBs) in a soft-tissue hand model. Secondary objectives included the assessment of US stand-off pad effects on soft-tissue FB detection rates and assess established FB detectable lower limit size of 2 mm. Methods: Prospective, single blinded, observational study of US-naïve Army medics' abilities utilizing bedside US to detect wooden FBs in a chicken thigh model with or without an US stand-off pad. After a 2 h training period, medics' abilities to detect 1–3 mm FB utilizing a SonoSite®M-Turbo US and 13–6 MHz linear probe were assessed. Results: After a 2 h training period, 28 medics had a sensitivity and specificity of 73% and 78% detecting 1–3 mm FBs utilizing standard US equipment. The medics' sensitivity and specificity were both 78% in detecting radiolucent FBs 2 mm and larger without a stand-off pad. The sensitivity and specificity decreased to 48%, 62%, and 67% when utilizing a stand-off pad to detect 1, 2, and 3 mm soft-tissue FBs. Sub 2 mm detection rates decreased from 82% for 2 mm FB to 64% for 1 mm FBs without utilizing a stand-off pad. Conclusion: Army medics with minimal US experience successfully identified FBs embedded in hand models with accuracies similar to radiologists and emergency medicine physicians. However, radiolucent FB detection sensitivity and specificity decreased in US-naïve Army medics utilizing stand-off pads. In addition, this study reconfirmed the lower limit of FB detection rates at 2 mm. These results support Army medics' utilization of US to evaluate for superficial radiolucent FBs of the hand.
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