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   2018| January-March  | Volume 26 | Issue 1  
    Online since March 28, 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.
  16,250 1,922 25
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.
  12,169 388 2
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.
  5,620 363 4
CASE REPORTS
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.
  5,055 341 2
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.
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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.
  4,016 321 3
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  
  3,800 342 2
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.
  3,753 384 1
Clinical and echocardiography features of diagnosed in adulthood isolated left ventricular noncompaction: A case series study
Wen-Hung Huang, Kuo-Tzu Sung, Jui-Peng Tsai, Chi-In Lo, Chih-Chung Hsiao, Jen-Yuan Kuo, Cheng-Huang Su, Ming-Ren Chen, Chung-Lieh Hung
January-March 2018, 26(1):37-41
DOI:10.4103/JMU.JMU_1_18  
Background: Left ventricular noncompaction cardiomyopathy (LVNC) is a primary genetic cardiomyopathy with morphologically unique characteristics, including loose “spongy” meshwork. Subjects carrying these disorders were typically presented with triad of heart failure, cardiac arrhythmias, and consequences of mural thrombi formation. The clinical and echocardiographic features regarding LVNC, however, are not widely known. Methods: A retrospective survey involving 11 patients who fulfilled echocardiographic criteria for LVNC defined by Jenni et al. was conducted at MacKay Memorial Hospital from January 2009 to March 2017. Parameters assessed by echocardiography and clinical data were further analyzed. Results: Significantly depressed left ventricular systolic function assessed by echocardiography was noticed in a majority of our adult study cases. Conclusion: Considering the fatal complications LVNC may lead to, it is essential for clinical cardiologists to early identify suspicious individuals, and the establishment of definitive criteria and early treatment is essential.
  2,834 278 1
High-intensity focused ultrasound thermal lesion detection using entropy imaging of ultrasound radio frequency signal time series
Maryam Mohammadi Monfared, Hamid Behnam, Parisa Rangraz, Jahan Tavakkoli
January-March 2018, 26(1):24-30
DOI:10.4103/JMU.JMU_3_17  
Background: During the past few decades, high-intensity focused ultrasound (HIFU) modality has been gaining surging interest in various therapeutic applications such as non- or minimally-invasive cancer treatment. Among other attributes, robust and real-time HIFU treatment monitoring and lesion detection have become essential issues for successful clinical acceptance of the modality. More recently, ultrasound radio frequency (RF) time series imaging has been studied by a number of researchers. Materials and Methods: The objective of this study is to investigate the applicability of entropy parameter of RF time series of ultrasound backscattered signals, a. k. a. Entropy imaging, toward HIFU thermal lesion detection. To this end, five fresh ex vivo porcine muscle tissue samples were exposed to HIFU exposures with total acoustic powers ranging from 30 to 110 Watts. The contrast-to-speckle ratio (CSR) values of the entropy images and their corresponding B-mode images of pre-, during- and post-HIFU exposure for each acoustic power were calculated. Results: The novelty of this study is the use of Entropy parameter on ultrasound RF time series for the first time. Statistically significant differences were obtained between the CSR values for the B mode and entropy images at various acoustic powers. In case of 110 Watt, a CSR value 3.4 times higher than B-mode images was accomplished using the proposed method. Furthermore, the proposed method is compared with the scaling parameter of Nakagami imaging and same data which are used in this study. Conclusion: Entropy has the potential for using as an imaging parameter for differentiating lesions in HIFU surgery.
  2,605 263 2
CASE REPORTS
Sonographic findings of malignant appendix tumors in seven cases
Kyung Su Kwag, Hyuk Jung Kim, Suk Ki Jang, Jae Woo Yeon, Soya Paik, Byeong Geon Jeon, Ki Ho Kim, Ji Hoon Park, Eun Shin
January-March 2018, 26(1):52-55
DOI:10.4103/JMU.JMU_16_17  
We report the sonographic features of confirmed malignant appendiceal tumors in seven cases. The histologic diagnoses of these tumors were mucinous cystadenocarcinoma (n = 2), colonic type adenocarcinoma (n = 4), and signet-ring cell carcinoma (n = 1). The 2 mucinous cystadenocarcinomas showed mucocele type, which had markedly enlarged inner luminal diameters (mean, 23 mm; range, 15–31 mm) and thick, irregular walls (mean wall thickness, 5.5 mm; range, 5–6 mm). In contrast, the 5 nonmucinous carcinomas (4 adenocarcinomas and 1 signet-ring cell carcinoma) showed nonmucocele type, which had relatively small inner luminal diameters (mean ± standard deviation [SD], 6.6 ± 4.5 mm; range, 2–15 mm) and prominent wall thickening (mean wall thickness ± SD, 6.2 ± 2.3 mm; range, 3–10 mm). Of the 5 nonmucinous tumors, only one had a discernible mass, three had thick irregular walls, two had loss of the wall layer pattern, and four had submucosal hypoechogenicity. Regardless of the histologic type, five of the seven malignant appendiceal tumors showed a severe periappendiceal fat infiltration or periappendiceal abscess, suggestive of perforation.Although the sonographic findings of the malignant appendiceal tumors were nonspecific, some of the sonographic features seen in these seven cases may help radiologists consider the possibility of underlying malignant appendiceal tumors.
  2,437 230 -
Posterior fossa hemorrhage in a term neonate with hemophilia A
Ping-Hung Tsai, Hui-Ju Chen, Che-Sheng Ho, Nan-Chang Chiu
January-March 2018, 26(1):56-58
DOI:10.4103/JMU.JMU_10_18  
Posterior fossa hemorrhage is rare in term baby and difficult to assess. The clinical signs are nonspecific and usually delay the diagnosis. We present a 5-day-old male neonate of posterior fossa hemorrhage with the initial presentations of fever and seizure and early deduced by cranial ultrasonography findings as hyperechoic, asymmetric, ill-defined density and complicated with hydrocephalus. Magnetic resonance imaging of the head verified the diagnosis. Hemophilia A was confirmed thereafter by serology.
  2,356 218 -
LETTERS TO EDITOR
Breast pain and ultrasound: If normal result, exploring the uterus is a good reflex
Andrianah Emmylou Prisca Gabrielle, Rajaonarison Ny Ony Narindra Lova Hasina, Rasolohery Honjaniana, Tomboravo Christian, Ahmad Ahmad
January-March 2018, 26(1):62-62
DOI:10.4103/JMU.JMU_8_18  
  1,808 184 -
IMAGING FOR RESIDENTS-QUIZ
A 2-year-old girl with intermittent vomiting
Tristan Reddan
January-March 2018, 26(1):63-63
DOI:10.4103/JMU.JMU_15_18  
  1,746 186 -
CME TEST
CME Test

January-March 2018, 26(1):64-64
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