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  Citation statistics : Table of Contents
   2018| July-September  | Volume 26 | Issue 3  
    Online since September 14, 2018

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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.
  12 5,118 545
Comment on an intrauterine gestational sac surrounded by thin myometrium at fundus
Ibrahim A Abdelazim, Bassam Nussair, Gulmira Zhurabekova, Shikanova Svetlana, Mohannad Abu-Faza, Waheeb Naser
July-September 2018, 26(3):168-169
DOI:10.4103/JMU.JMU_58_18  PMID:30283207
  7 2,414 218
A new scatter particle and mixture fluid for preparing blood mimicking fluid for wall-less flow phantom
Ammar A Oglat, MZ Matjafri, Nursakinah Suardi, Mostafa A Abdelrahman, Mohammad A Oqlat, Ahmad A Oqlat
July-September 2018, 26(3):134-142
DOI:10.4103/JMU.JMU_7_18  PMID:30283199
Background: To examine the blood flow and detection of the issues related to it by medical ultrasound, it is extremely important to have suitable blood mimicking fluid (BMF) to be used in vitro and to have a movable or portable Doppler flow phantom to use it as a standardizing tool. As known, the main drawbacks of the currently commercial BMF used in the research studies are high in cost and the long time needed for preparation, which is at least 5–7 h. Moreover, there are only two common scatter particles using in BMF as suspension materials such as nylon (Orgasol) and polystyrene. Thus, we need to prepare BMF with both a new mixture fluid and new scatter particle to be as a reflecting factor of ultrasonic waves, for evaluating the speed of sound of the blood flow in the same method like in the research study of ultrasound with relatively low-cost and less consuming time of preparation. However, both the acoustical and physical features of the Doppler flow phantom components (BMF and tissue mimicking material) must correspond the features of the human tissues to make the examination significance. In addition, the BMF must also represent the hemodynamic features of real human blood. Methods: In this experiment, a new adequate ternary mixture liquid for preparation of BMF applied and suspended with a new scatter particle material, this scatter particle material called poly (4-methylstyrene), it used to be adequate with the mixture density and for saving neutrally buoyant. This BMF was prepared for use in the test objects or Doppler flow phantom. The poly (4-methylstyrene) particles were applied for suspension in a mixture liquid or fluid based on three items, which were distilled water, propylene glycol (PG), and polyethylene glycol (PEG) (200 Mw). The diameter of poly (4-methylstyrene) particles is 3–8 μm, which determined by specific sieve in a unit of μm, and the density is 1.040 g/ml. Results: Speed of sound, viscosity, density, Backscatter power and attenuation features of mixture fluid or liquid which used for preparing a BMF were measured, discussed, and agreed with draft International Electrotechnical Commission values. Conclusions: There are three various types of ternary items of mixture fluid (water, PG, and PEG [200 Mw]), and a new type of scatter particle material poly (4-methylstyrene) was utilized for preparing the BMF. The scatter particles and mixture fluid prepared and measured at a temperature that simulates the body temperature 37°C. Moreover, one of the advantages of this new blood that is being cheaper than the commercially available BMF products because the PG and the polyethylene glycol (200 Mw) are much cheaper and more available than glycerol and the Dextran that used usually. In addition, new BMF needs less time for preparation compared to the commercial one.
  7 3,385 357
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.
  4 9,830 611
Ultrasound-guided aspiration of a paralabral cyst at the spinoglenoid notch with suprascapular nerve compressive neuropathy
Tze-Chao Wee, Chueh-Hung Wu
July-September 2018, 26(3):166-167
DOI:10.4103/JMU.JMU_39_18  PMID:30283206
  4 4,647 319
Color doppler ultrasonography to evaluate hypoechoic areas in pressure ulcers: A report of two cases
Koichi Yabunaka, Gojiro Nakagami, Tomomitsu Miyagaki, Sanae Sasaki, Chieko Hayashi, Hiromi Sanada
July-September 2018, 26(3):163-165
DOI:10.4103/JMU.JMU_60_18  PMID:30283205
Ultrasound (US) is frequently used for evaluating inflammation of subcutaneous tissue caused by pressure ulcers (PUs), but color Doppler mode (CDM) helps to better identify inflammatory edema in subcutaneous fat and necrotic tissue in PUs. We report two cases where inflammatory edema in subcutaneous fat and necrotic tissue in PUs are identified using small US equipment with CDM. Case 1 – An 82-year-old male presented with cerebral infarction and a Category III PU in the sacral region. B-mode gray-scale US imaging (B-mode imaging) revealed a thickened layer of subcutaneous fat with fat lobules and homogeneous cobblestone appearance with fluid accumulation within the echo-free space. CDM did not identify any color signal (CS) in hypoechoic areas. Case 2 – A 29-year-old female presented with cytopenia and decreased renal function with a Category IV PU with undermining in the coccyx region. B-mode imaging distinguished the necrotic tissue, indicating a diffuse hypoechoic area with no layers, unclear borders, and uneven gray level (cloud-like image) in the subcutaneous fat. Similar B-mode imaging findings were obtained in inflammatory edema with cobblestone appearance. CDM did not detect a CS in the hypoechoic areas but confirmed peripheral hypervascularity. CDM imaging identified inflammatory edema in the subcutaneous fat and necrotic tissue in PUs. Specifically, CDM may better evaluate early-stage PUs with necrotic tissue by distinguishing necrosis from intense inflammatory edema.
  3 3,250 272
The most appropriate time delay after microbubble contrast agent intravenous injection to maximize liver metastasis conspicuity on contrast-enhanced ultrasound
Emilio Quaia, Antonio Giulio Gennari
July-September 2018, 26(3):128-133
DOI:10.4103/JMU.JMU_12_17  PMID:30283198
Purpose: To identify the most appropriate time delay after microbubble contrast agent injection to maximize liver metastasis conspicuity on contrast-enhanced ultrasound (CEUS). Methods: Twenty-five consecutive patients (12 male and 13 female; age: 50 ± 13 years) with a known primary tumor and evidence of liver metastases on unenhanced ultrasound (US) underwent CEUS. CEUS consisted of continuous liver parenchyma scanning during arterial (15–35 s after microbubble injection), portal venous (40–120 s), and late phase (from 120 s up to microbubble disappearance). Subjective conspicuity index (ranging from 1 to 5) and objective conspicuity index (Ilesion–Iliver/Iliver, I = signal intensity) were calculated on reference frames selected on arterial phase and every 20 s on portal venous and late phase. Results: A total number of 40 liver metastases were identified after microbubble injection. The highest liver metastasis conspicuity was observed on early portal venous phase (40–60 s after microbubble injection) both on visual (mean subjective conspicuity index ± standard deviation [SD] = 4.36 ± 0.75, reader 1; 4.25 ± 0.65, reader 2) and quantitative analysis (mean objective conspicuity index ± SD = −0.99 ± 0.001). Conclusion: The early portal venous phase (40–60 s after microbubble injection) provides the best liver metastases' conspicuity after microbubble contrast agent injection.
  3 2,752 295
Sonographic diagnosis of a colovesical fistula due to sigmoid colon cancer
Dal Mo Yang, Hyun Cheol Kim, Sang Won Kim, Sung Jig Lim, Ji Su Kim
July-September 2018, 26(3):160-162
DOI:10.4103/JMU.JMU_42_18  PMID:30283204
Based on sonographic findings, colovesical fistula was diagnosed in a 71-year-old man with sigmoid colon cancer. Gray-scale sonography revealed an irregular thickening of the sigmoid colon wall abutting the urinary bladder which also showed thickening in the region of contact. Color Doppler sonography showed a twinkling artifact within the thickened bladder wall. Contrast-enhanced computed tomography scan showed luminal communication between the sigmoid colon and the bladder in the region of thickening.
  2 2,894 218
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.
  2 3,991 320
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.
  1 13,413 524
A single static breast model education of ultrasound skill in final year medical students of Burapha University
Sornsupha Limchareon, Sutasinee Kongprompsuk
July-September 2018, 26(3):143-146
DOI:10.4103/JMU.JMU_11_18  PMID:30283200
Background: Ultrasound (US) is widely used among physicians. There has been no standardized curriculum in US for undergraduate medical students. This study aimed to assess the US image acquisition skill of final year medical students after adding 2 weeks dedicated radiology rotation. Methods: At our institution, there are two hospital affiliations. Two-week radiology rotation was added for the final-year students of one affiliation. These students had a chance to do the US in real-life clinical settings proctored by radiologists. At the end of the academic year, US image acquisition skill was assessed by objective structured clinical examination (OSCE) in students from both affiliations. Results: From 48-final-year medical students, 28 students finished the 2 week radiology rotation. OSCE mean score of the students who received radiology rotation was significantly higher than other groups with a score of 65.5 compared to 53.3, respectively (P = 0.006). The student background characteristics had no relationship with the OSCE score (P = 0.565). Conclusion: Results showed that exposure through a dedicated radiology rotation in only 2 weeks is helpful to improve the US skill of the medical students regardless of their background performances. Exposure to live patients is essential for students' experiences. OSCE can be used as a standardized assessment tool.
  1 2,516 232
Curvilinear probe endobronchial ultrasound for sampling of parenchymal lung lesions
Breda Cushen, Mohammed Ahmed, Antoinette Flannery, David Breen
July-September 2018, 26(3):157-159
DOI:10.4103/JMU.JMU_24_18  PMID:30283203
Lung cancer is the leading cause of cancer related deaths in most countries. It can frequently be mimicked by other nonmalignant pulmonary lesions; and therefore, in the case of radiologically localized lesions a pathological diagnosis is preferable before proceeding to surgical resection. Curvilinear probe endobronchial ultrasound is widely used to sample lymph nodes, but in this case, we report that it can be beneficial for sampling parenchymal lung lesions not accessible at bronchoscopy in the absence of lymphadenopathy.
  - 2,731 214
CME Test

July-September 2018, 26(3):175-175
  - 1,596 165
Reply to comment on an intrauterine gestational sac surrounded by thin myometrium at fundus
Shih-Ting Lai, Chih-Ping Chen, Chen-Ju Lin, Yen-Ni Chen, Shin-Wen Chen
July-September 2018, 26(3):170-170
DOI:10.4103/JMU.JMU_75_18  PMID:30283208
  - 1,741 140
A female laborer with right anterior shoulder pain
Ronald Christopher A Cua, Ming Yen Hsiao
July-September 2018, 26(3):174-174
DOI:10.4103/JMU.JMU_36_18  PMID:30283210
  - 1,844 201
Skeletal defect at mid-trimester ultrasound scan
Pedro Brandao, Elisa Soares, Catarina Estevinho, Marília Freixo, Ana Sofia Portela-Carvalho, Maria João Ferreira
July-September 2018, 26(3):171-173
DOI:10.4103/JMU.JMU_45_18  PMID:30283209
  - 3,462 288