S2 Ultrasound in Medicine and Biology Volume 39, Number 5S, 2013

patients were excluded due to the poor examination, 6 patients were

clinically LC.

Importance of the Conclusions: Dual measurement methods of LSM

and SSM were useful for the differential diagnosis of LC.

PA.01.006

The New Non-Invasive Quantification of Hepatic Steatosis With

Morbid Obesity by Acoustic Structure Quantification (ASQ)

From Ultrasound Echo Amplitude

Mio Onodera

Morioka, Iwate, Japan

Brief Description of the Purpose of the Study: Non-alcoholic fatty

liver disease (NAFLD) has increased during recent years. A quantitative

andnon-invasivemethod for theultrasounddiagnosisofNAFLDisneeded.

We quantitated the liver parenchyma of hepatic steatosis using Acoustic

structure quantification (ASQ), and studied its efficacy. Especially, we

studied the efficacy analysis of hepatic steatosis and its follow-up.

Methods: Subjects comprised 42 patients with Non-alcoholic fatty liver

disease (NAFLD) and 20 healthy controls. They underwent liver biopsy,

abdominal CT exam, abdominal ultrasonic exam and enrolled in this

study between August 2010 and August 2012. An AplioXG ultrasound

scanner (ToshibaMedical Systems, Otawara, Japan) was combined with

a 3.75 MHz transducer for ultrasonographic investigations in this study.

ASQ mode and its analysis parameter called ‘‘focal disturbance ratio

(FD-Ratio)’’. In those cases, we could compare ultrasound findings,

histopathological findings and CT findings (CT number; CTN). The

hepatic fat droplet area and size were measured using the Image-J soft-

ware package (NIH, USA).

Main Results:Mean FD-Ratio was 0.036 0.02 and 0.266 0.08 in the

NAFLD and control groups, respectively. FD-Ratio was significantly

lower in the NAFLD than in the control groups (p, 0.0001). FD-Ratio

was positively correlated significantly with CTN (r50.53. p , 0.01).

FD-Ratio was negatively correlated significantly with fatty area of the

liver (r5-0.75. p , 0.01). During 6 months follow-up after treatment

of obesity, we obtained a statistically significant decrease in body weight

(28.36 11.6kg) and excess weight loss was 47%. FD-Ratiowas measur-

able in all case, and significantly increased from 0.018 6 0.008 to

0.1026 0.056 (p, 0.01) in 6 month after surgery. L/S-Ratio increased

from 0.86 6 0.3 to 1.06 6 0.9 (p , 0.01).

Importance of the Conclusions: The results suggest that ASQ is useful

for evaluating the tissue characteristics of hepatic steatosis and its

follow-up.

PA.01.008

The Usefulness of Abdominal Ultrasound for the Evaluation

of Patients With Acute Pancreatitis

A. Popescu, I. Sporea, S. Bota, O. Gradinaru-Tascau, M. Popescu,

R. Sirli, M. Danila

Department of Gastroenterology and Hepatology, ‘‘Victor Babes’’

University of Medicine and Pharmacy Timisoara, Romania

Brief Description of the Purpose of the Study: To assess the useful-

ness of abdominal ultrasound for the evaluation of patients with acute

pancreatitis (AP).

Methods: Our retrospective study included 819 hospitalized patients

with AP. The etiology of AP was: biliary - 46.6%, alcoholic - 31.9%

and non-alcoholic/non-biliary - 21.5% of cases. According to the At-

lanta criteria, 60.5% of patients had mild and 38.5% severe AP. Ultra-

sound examination was performed in emergency at admission and in

follow-up at 2-3 days.

Main Results: The pancreas was visible by ultrasound in 71.4% of all

patients at admission, in a significantly higher number of cases in

mild AP as compared with severe AP: 79.6% vs. 58.5%, p , 0.0001.

In patients with the final diagnosis of biliary pancreatitis, the ultrasound

examination performed in emergency established the etiology in 86.8%

of cases. From de ultrasound signs, an enlarged, hyperechoic, bursa

omentalis (described at any moment during hospitalization), as

a predictor of severity, was observed in a significantly higher number

of patients with severe AP vs. mild AP: 14.2% vs. 5.6%, p , 0.0001.

Importance of the Conclusions: Abdominal ultrasound examination

was a useful method for the emergency evaluation of patients with

AP, the pancreas being visible in 71.4% of patients and biliary etiology

being established in emergency, in 86.8% of cases. The large hypere-

choic bursa omentalis is a useful ultrasound sign for prediction of severe

outcome of AP.

PA.01.009

Focal Disorders of the Gallbladder: Diagnosis by

Ultrasonography. Where Can We Get?

L. N. Elias, M. B. G. Funari, M. J. Francisco Neto, R. G. Garcia,

A. Maurano, A. Rahal Junior

Hospital Israelita Albertb Einstein

Introduction: Awide spectrum of injuries originates from gallbladder;

benign changes such as inflammatory, benign tumors, tumorlike lesions

and malignant neoplasms. Ultrasonography is typically the initial

imaging modality to assess these diseases, showing high sensitivity

and specificity for this purpose.Wewill show awide range of focal alter-

ations of the gallbladder, characterized and diagnosed by US, at the

Department of Diagnostic Imaging of our hospital.

Methods Involved:US Studies conducted at the emergency department

and outpatient clinic of a private hospital.

Discussion: The different presentations of focal lesions of the gall-

bladder should bewell known by the sonographer, than he can diagnoses

benign conditions, indicate further studies in equivocal cases, or even

aiming at the preoperative staging. This method, if operated by a radiol-

ogist familiar with these lesions, defines diagnosis and in most cases.

Conclusion of the Presentation: This pictorial essay illustrates the

findings by ultrasound of the various types of focal lesions that origi-

nates in the gallbladder. Knowledge of these findings allows early diag-

nosis, with direct impact on patients prognosis.

PA.01.012

Nutcracker Syndrome: The Application of Ultrasonography

with Doppler and Case Report

M. A. P. Figueiredo, L. D. Do Olival, N. L. Leal, C. Fernandez,

N. Genova, A. B. Alla, C. A. S. Junior

S~ao Luiz Jabaquara, S~ao Paulo, SP, Brasil

Brief Description of the Purpose of the Report:Nutcracker syndrome

is caused by compression of the left renal vein through the superior

mesenteric arteries and aorta. Usually manifested by chronic pelvic

pain, lower back pain and left varicocele, hematuria and proteinuria.

Occurs more often in women between 30 and 40 years.

Medical History:We report the case of a male patient of 16 years, who

sought our doppler ultrasound clinic complaining of left testicular pain,

which diagnosed the left renal vein narrowing between the superior

mesenteric artery and the aorta, with consequent hypertension of the

left gonadal plexus, suggestive of Nutcracker syndrome.

Diagnosis: Nutcracker syndrome is caused by the narrowing in the

anatomical passage formed by the aorta and to the superior mesenteric

artery, causing increased pressure in the territory of the left renal vein.

Various imaging tests can aid in the diagnosis, such as Doppler ultra-

sound, computed tomography, magnetic resonance and phlebography.

Discussion and Summary of the Case: The type of treatment that must

be adopted is still controversial, and there are several surgical options,

such as the use of intravascular stent and conservative behaviour.

Usually late diagnosis, this syndrome should be included in the investi-

gation of patients with hematuria of unknown origin.