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Transjugular liver biopsy—results of 22 cases using ultrasoundas the means to confirm the biopsy needle locationDickson TSF, Chu SK, Kin SM, Pik WK, Ting H, Lun SN, Lun CH,Fai YH, Wai CC, Raymand L, Sha WL, Kuen TW, Lilian L, QueenMary Hospital, Hong Kong, China

Objectives: To evaluate the efficacy and complication rates of tran-sjugular liver biopsy (TJLB), using ultrasound (USG) as an alternativemethod versus fluoroscopy, for confirmation of the biopsy needlelocation.Methods: A retrospective study on 72 patients underwent TJLB inDepartment of Radiology, Queen Mary Hospital, Hong Kong, fromJanuary 2000 to February 2005. Data concerning the efficacy andcomplication of TJLB using USG to confirm the biopsy needle locationis compared with those using fluoroscopy.Results: Seventy-one procedures were performed in 72 patients withone failure due to thrombosed right internal jugular vein. Among these71 procedures, 21 procedures were performed after USG confirmed thebiopsy needle location. The mean platelet counts for USG-guidancegroup and fluoroscopy-guidance group were both larger than 88, andthere was insignificant difference between their mean INR values (p �0.4833). Histologic diagnosis was made in 90.5% (N � 19) of theUSG-guidance group and 94% (N � 45) of the fluoroscopic-guidancegroup. Only one complication (4.8%) was resulted in the USG-guid-ance group, while five complications (10%) were noted in the fluoro-scopic-guidance group.Conclusions: The efficacy of those TJLB using USG to confirm thebiopsy needle location was comparable with that using fluoroscopy,while the complication rate was reduced.

2295

Effectiveness of 18 gauge cutting needle biopsy under ultrasoundguidance in diagnosis of pancreatic cancerJung S-H, Park WK, Chang JC, Kim JW, College of Medicine,Yeungnam University, Korea

Objectives: The objective of this study was to evaluate the accuracyand complication rate of ultrasound-guided percutaneous cutting needlebiopsies of the pancreas in patients with a suspected pancreatic disease.Methods: Thirty-five ultrasound-guided biopsies were performed in 32consecutive patients over a period of 36 months. Twenty-nine of the 32patients had malignant lesions (90.6%), the others had serous adenoma,tuberculosis and autoimmune pancreatitis. All procedures were doneunder ultrasound guidance. A high-speed biopsy gun with 18 gaugecutting-type needles was used. Based on final pathologic diagnosis asthe standard of reference, the diagnostic efficacy was determined.Complications during and afterward up to the patient’s discharge fromhospital were noted.Results: Cutting needle biopsy of the pancreas resulted in a correctdiagnosis in 32 of 35 biopsies, and an overall accuracy of 91.4%. Onlyone patient of 31 had complication related to the biopsy (3.2%).Conclusions: Ultrasound-guided cutting needle biopsy is a safe andreliable tool for the pretherapeutic evaluation of pancreatic lesions.

2296

Three-dimensional ultrasonography guidance: Does it improveneedle visualization?Won HJ, Byun JH, Kim AY, Shin YM, Kim PN, Ha HK, Lee M-G,Asan Medical Center, University of Ulsan College of Medicine, Korea

Objectives: We sought to compare needle visualization with conven-tional two-dimensional (2D) US and three-dimensional (3D) US usingan in vitro experiment.

Methods: An experiment using both conventional 2D and 3D US wasconducted in a phantom made with agarose gel and target material.Various 3D rendering techniques were also tested within the degreethat permits target identification. The needle tip echogenicity and shaftvisualization were scored by two independent observers. The experi-ment was performed using a total of six needles of differing gauges anddesign.Results: Both the needle tip and shaft were better visualized with 3DUS comparing with 2D US. Best scores was recorded when MIP(maximum intensity projection) mode and transparent mode was com-bined. 3D US guidance was more helpful with finer gauge needles.There were no statistically significant differences regarding needledesign.Conclusions: 3D US guidance confers an advantage of needle visibil-ity compared with conventional 2D US, especially for the finer gaugeneedles.

Wednesday, May 31, 2006SCIENTIFIC SESSIONS

GB AND BILIARY DISEASE

2297

High resolution ultrasonographic evaluation of the gallbladder:Value of advanced imaging techniquesKim SJ, Lee JY, Choi BI, Choi JY, Lee JM, Kim SH, Han JK, SeoulNational University Hospital, Korea

Objectives: A prospective study was to determine the role of com-pound imaging (CI), speckle reduction imaging (SRI) and tissue har-monic imaging (THI) in high-resolution gallbladder ultrasound.Methods: In 39 patients, gallbladders were examined with conven-tional, CI, CI combined by SRI and CI combined by THI, using 7 to 10MHz linear transducer. The overall image qualities, sharpness of an-terior wall, depiction of wall layers and degree of internal artifact wereevaluated. In case of gallbladder lesion, its conspicuity, sharpness ofmargin and intensity of posterior shadowing were evaluated. Tworadiologists independently evaluated and graded each finding with fourscales. The Wilcoxon signed test was used.Results: CI provided better results than conventional imaging in allcategories except intensity of posterior shadowing of gallstone (p �0.01). CI well depicted gallbladder wall layers in 34 of 39 cases anddepicted them better than conventional ultrasound in 31 of 39 cases. CIalso improved conspicuity and margin’s sharpness of lesions. Com-bined use of CI and THI provided better overall image quality and lessinternal artifact than CI (p � 0.05).Conclusions: CI was superior to conventional imaging in evaluatinggallbladder with high frequency transducer. Combined use of CI andTHI was helpful to enhance overall image quality and reduce artifact.

2298

Preoperative diagnosis and staging of gallbladder lesions by highresolution ultrasonography using leading edge 2d technology andhigh frequency probe: Initial experienceLee JY, Choi BI, Han JK, Kim WH, Lee JM, Kim SH, Choi JY,Seoul National University Hospital, Korea

Objectives: To investigate diagnostic performance of high resolutionultrasonography using leading edge 2D technology and high frequencyprobe in the preoperative diagnosis and staging of gallbladder lesions.Methods: This study was prospectively performed about patients whowere referred to our department with clinical suspicion of gallbladdercancer. Using recent 2D technologies (speckle reduction, compound

Abstracts P149

and harmonic imaging) and high MHz probe, all patients were scannedby one radiologist and then operated on (n � 21) or underwent biopsy(n � 2). Imaging findings were compared with pathologic findings.ROC curve analysis was performed about preoperative diagnosis, andconfidence of muscle layer disruption. Interclass correlation was donebetween pre- and poststaging.Results: Total 24 lesions of 23 patients were enrolled (seven cancers,seven large adenomas and four large cholesterol polyps, five adeno-myomatosis and one ulcerophlegmonous cholecystitis). AUC by ROCcurve analysis for diagnostic confidence was 0.696 (p � 0.121). AUCfor evaluation of muscle disruption was 0.984 (p � 0.000). Pre- andpoststaging were well correlated in cancer group [ICC � 0.800 (p �0.011)].Conclusions: High resolution ultrasonography using leading edge 2Dtechnologies and high frequency probe is believed to be a powerful toolin the preoperative diagnosis and staging of gallbladder lesions bydetailed depiction of muscle layers and intramural pathology.

2299

Ultrasonic contour mapping of the luminal surface of the gallbladderBirnholz JC, Diagnostic Ultrasound Consultants, United States ofAmerica

Objectives: Investigate the use of surface rendered images of the gallbladder interior for identification of focal and diffuse inflammation andsclerosis.Methods: Forty female fertility patients had prospective, supine, in-tercostal 6 MHz imaging of the gall bladder during suspended breath-ing. The GB is sectioned digitally on its long axis and rotated forviewing of the upper (hepatic) luminal surface, which is graded visuallyas “smooth”, “mildly” or “moderately to extremely” ridged.Results: Technically satisfactory images are obtained in all patients; 12had laparoscopic visualization (six had adhesions), seven had hepato-biliary Tc99m cholescintigraphy with CCK (four abnormal), five hadstones and nine had surgery (each with pathologic findings of chroniccholecystitis). All of the surgical patients had extensive ridging, focaland geographic or furrows oriented transverse to the long axis. At leastmild ridging was present in all of the symptomatic patients, includingthose with normal HIDA studies. Smooth surfaces were found in sixasymptomatic (young) patients, including three of six who were preg-nant.Conclusions: Ridging of the mucosa appears to be a sensitive indicatorof chronic cholecystitis. This technique can be applied in routinepractice and may be enhanced by dynamic imaging after a fatty meal orCCK administration.

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Color Doppler twinkling artifacts from gallstones: In vitroanalysis regarding their biochemical composition andarchitectureKim HJ, Lee JY, Choi BI, Han JK, Seoul National University, Korea

Objectives: The purpose of this study was to investigate the relation-ship between twinkling artifact seen behind gallstones on color Dopplersonography and biochemical composition or architecture of gallstones.Methods: Fifty-two gallstones removed from 26 patients were in-cluded in this study (14 cholesterol stones, 24 mixed stones, 14 pigmentstones). Color Doppler ultrasonography was performed to evaluate howintensive twinkling artifacts each stones had. To investigate if twin-kling artifacts are related with the architectures of stones, micro-CTwas performed for the largest stones in each patient.Results: On color Doppler sonography, most of mixed stones (19/24)and about half of cholesterol stones (8/14) showed grades of 2 or 3

twinkle artifacts, whereas most of pigment stones (13/14) produced noartifact or grade 1 artifacts (p � .001). In micro-CT images, all stoneswith strong twinkling artifact (n � 15) had either layering appearanceor radiating internal architecture, whereas stones with weak or noartifact (n � 11) had either homogeneous architecture or large amountsof peripheral or central calcification.Conclusions: This study showed that there is a relationship betweenthe twinkling artifact and biochemical composition and the internalarchitecture of stones. The existence of color Doppler twinkling arti-facts from gallstones could play a role in predicting their composition.

2301

Comet-tail artifacts and color Doppler twinkling artifacts fromgallbladder wall: Clinical observations, specimenultrasonography and pathologic correlationPark HS, Lee JY, Choi BI, Lee JM, Kim SH, Han JK, Seoul NationalUniversity Hospital, Korea

Objectives: To determine the relationship between comet-tail artifactand color Doppler twinkling artifact occurring from gallbladder wall.Methods: A prospective study was performed with 72 patients whohad comet-tail artifacts arising from the gallbladder wall and 34 pa-tients who didn’t have the artifacts on ultrasonography. Grayscale andcolor Doppler images were obtained. Investigators determined whethertwinkling artifacts occur on comet-tail artifacts or not and whethertwinkling artifacts occur from the place where comet-tail artifacts werenot seen. Twenty-one patients underwent cholecystectomy. Sono-graphic and histopathologic evaluations were performed on the ex-tracted gallbladders.Results: Total 242 comet-tail artifacts in 72 patients were evaluated.Color Doppler twinkling artifacts were seen on all comet-tail artifacts,either transiently or persistently. Seventeen twinkling artifacts wereseen from intramural echogenic foci where comet-tail artifacts were notseen. On specimen sonography, all specimens showing twinkling arti-facts (n � 8) had cholesterol crystal deposition in either adenomyoma(n � 3) or adenomyomatous hyperplasia (n � 5), whereas specimensthat did not show twinkling artifacts (n � 13) did not have cholesterolcrystal depositions in their wall, regardless of the presence of Rokitan-sky-Aschoff sinus.Conclusions: Color Doppler twinkling artifacts are closely related tocomet-tail artifacts, and it may be a sensitive diagnostic feature indi-cating cholesterol crystal deposition within adenomyoma or adenomyo-matous hyperplasia.

2302

Atypical types of cholecystitisMomin A, Saifi SG, Dalvi R, Prince Aly Khan Hospital, Mumbai,India

Objectives: To study various unusual types of cholecystitis.Methods: All the patients proven to have cholecystitis were studied tocategorise them in unusual histological types.Results: We studied 15 cases and we found three unusual types,namely, eosinophilic cholecystitis, xantogranulomatous cholecyctitis,unusual suppurative cholecystitis and diffuse form of adenomyomato-sis along with transient cholecystitis associated with either viral feveror dengue fever.Conclusions: Cholecystitis, in some cases, can mimic carcinoma ofgall bladder and liver abscess involving gall bladder fossa, while inothers can help to establish underlying cause of illness like dengue,viral or enteric fever.

P150 Ultrasound in Medicine and Biology Volume 32, Number 5S, 2006