Value of ultrasound shear wave elastography in the diagnosis of adenomyosis

Ult cover with borderJournal Ultrasound is now indexed on PubMed Central

S Acar, E Millar, M Mitkova and V Mitkov, Diagnostic Imaging Department, Milton Keynes University Hospital, UK and Ultrasound Diagnostics Department, Russian Medical Academy of Postgraduate Education, Moscow, Russia

The aim of the study was to assess the accuracy of ultrasound shear wave elastography in the diagnosis of adenomyosis. 153 patients were examined. 97 patients were with suspected adenomyosis and 56 patients were with unremarkable myometrium. Adenomyosis was confirmed in 39 cases (A subgroup) and excluded in 14 cases (B subgroup) in the main group based on morphological examination. All patients underwent ultrasound examination using an Aixplorer (Supersonic Imagine, France) scanner with application of shear wave elastography during transvaginal scanning. Retrospective analysis of the elastography criteria against the findings from morphological/histological examination was performed.

The following values of Young’s modulus were found in subgroup A (adenomyosis): Emean – 72.7 (22.6–274.2) kPa (median, 5–95th percentiles), Emax – 94.8 (29.3–300.0) kPa, SD – 9.9 (2.6–26.3) kPa; in subgroup B (non adenomyosis) –28.3 (12.7–59.5) kPa, 33.6 (16.0–80.8) kPa, 3.0 (1.4–15.6) kPa; in control group – 24.4 (17.9–32.4) kPa, 29.8 (21.6–40.8) kPa, 2.3 (1.3–6.1) kPa, respectively (P < 0.05 for all comparison with subgroup В and control group). The Emean cut-off value for adenomyosis diagnosis was 34.6 kPa. The sensitivity, specificity, positive predictive value, negative predictive value, and area under curve (AUC) were 89.7%, 92.9%, 97.2%, 76.5%, and 0.908. The Emax cut-off value was 45.4 kPa (89.7%, 92.9%, 97.2%, 76.5%, and 0.907 respectively).

This study showed a significant increase of the myometrial stiffness estimated with shear wave elastography use in patients with adenomyosis.

The full article is available in the November 2016 issue of Journal Ultrasound.

ECHOES by Hazel Edwards

The utility of ultrasound elastography in differentiation of endometriomas and hemorrhagic ovarian cysts. Batur A, Yavuz A, Ozgokce M, et al.  J Med Ultrason 2016; 43: 395-400.

This study aimed to differentiate between endometriomas and haemorrhagic cysts by using shear wave elastography. The researchers evaluated 78 ovarian cysts in 70 women and achieved a sensitivity and specificity of 82.1% and 79.2% respectively.  Endometriomas are much stiffer than haemorrhagic cysts.  The clinical value is that unnecessary surgery may be avoided.

More Echoes are available in the November 2016 issue of Journal Ultrasound.

Cyst-like change in the thyroid cartilage – a developmental variant in children

Ult cover with borderJournal Ultrasound is now indexed on PubMed Central

Karen Chetcuti and Shivaram Avula, Radiology Department, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK

Neck sonography is frequently encountered on ultrasound lists in the paediatric patient population. Anecdotally, one of the most frequent clinical indications is the investigation of a neck lump. While performing an ultrasound of the neck, structures other than those routinely assessed, such as the thyroid cartilage and mandibular cortex also come into view. Occasionally, pathology in these structures is also encountered, albeit less frequently. The purpose of this case report and review is to illustrate the ultrasound, CT and MRI appearances of cyst like changes in the thyroid cartilage that are encountered in children, particularly in early adolescence.

Full article is now available in the November 2016 issue of Journal Ultrasound. 

ECHOES by Hazel Edwards

Is an endometrial thickness of ≥4 mm on transvaginal ultrasound scan an appropriate threshold for investigation of postmenopausal bleeding? Russell M, Choudhar M, Roberts M.  Gynecol Surg 2016; 13: 193-197.

In the absence of national agreement on the optimum threshhold value for endometrial thickness in symptomatic postmenopausal women, this study of over 1000 women suggests a thickness of 4 mm or above on transvaginal ultrasound will detect the majority of cancers with minimal unnecessary invasive investigations.

More Echoes available in the November 2016 issue of Journal Ultrasound.


Final week to pre-book for Ultrasound 2016


Ultrasound 2016 promises variety, interactive learning opportunities with hands-on learning experience, networking with leading ultrasound manufacturers and social events for you to learn, network and socialise with your friends and colleagues. Here are three main reasons why every healthcare professional interested in Ultrasound should attend our meeting in York from 7th – 9th December 2016:

  1. Ultrasound 2016 is the largest ultrasound conference in the UK

The 48th Annual Scientific Meeting organised by BMUS is one of the largest and most eagerly anticipated medical conferences in the UK. A dedicated team of renowned ultrasound experts – Scientific Organising Committee and led by Dr. Adrian Lim – have designed this year’s conference programme. For 2016, the scientific programme comprises of 9 different educational streams in core practice areas and 6 intensive practical training sessions. A series of keynote lectures from world renowned healthcare experts, masterclasses, satellite meetings and social events which promise education, networking and entertainment are some of the special features of this year’s conference.

  1. An excellent platform that promotes latest ultrasound research

One of the core objectives of BMUS is to promote and encourage ultrasound research. Each year, the annual meeting provides students and delegates a number of opportunities to present their research through poster and oral presentations. This year, an esteemed panel of judges have selected over 100 abstract submissions to be presented at the conference from which the best paper and poster presentations will be selected and winners awarded at the gala dinner. One of the key highlights of this conference is the BMUS Young Investigator session which aims to encourage young and upcoming researchers. The winner of this award will be given the opportunity to represent BMUS and the UK at the EUROSON 2017 Congress in Slovenia next year.

  1. A Technical Exhibition that will showcase latest ultrasound products and developments

Ultrasound 2016 is complimented by a highly regarded Technical Exhibition that caters to our wide delegate profiles. With more than 25 leading ultrasound exhibitors and manufacturers attending our conference this year, there is plenty for delegates, speakers and students to explore and learn about technology, products and other updates. Furthermore, our sponsors have organised a variety of activities such as lunchtime seminars and education, games, competitions and prizes for our delegates. We firmly believe the exhibition would be a wonderful platform for networking and gaining valuable industry insights.

Do not miss the opportunity to be a part of UK’s largest medical conference. Register on or before 27th November 2016 to secure your place and avoid long queues on the day of the conference. Should you wish to register on the day of the conference, you are still able to register at cash registration desk on all three days.

Journal Preview: A multicentre survey of the condition of ultrasound probes

Ult cover with borderJournal Ultrasound is now indexed on PubMed Central

Nicholas J Dudley and Darren J Woolley

United Lincolnshire Hospitals NHS Trust, Lincoln and Multi-Medix, Leicester, UK

The implementation of quality assurance (QA) for ultrasound scanners in the United Kingdom is patchy, but government appointed bodies require QA and there are regulatory requirements for maintenance and inspection of equipment.  Previous studies have shown high fault rates in ultrasound probes; some of these studies used electronic probe testers, but there is good evidence that over 90% of faults may be detected using simple methods.  We aimed to conduct a multicentre survey of the condition of probes, using visual inspection and assessing the in-air reverberation.

Visitors to the stand run by Multi-Medix Ltd at the BMUS Annual Scientific Meeting in 2014 were invited to participate in the study.  One or both of the authors visited participants, performing a visual inspection of probes for evidence of damage or wear and inspecting the in-air reverberation pattern for uniformity.  Probes were classified using a risk based traffic light system: green – no fault found;  amber – fault found; further action required but the probe need not be removed from use; red – the probe should be removed from use due to physical or clinical diagnostic risks.

Twelve sites and 219 probes were included in the survey.  63% of probes were classified as green; 25% as amber and 13% as red. More than one in three probes were faulty.  Simple tests, at minimal cost, have the potential to demonstrate over 90% of probe faults, making it possible for employers to comply with their duties defined by regulations, national standards and professional guidelines.

Read the full article in the November 2016 issue of Journal Ultrasound

ECHOES by Hazel Edwards

Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management. Radiologic review and recommendations of the ESUR scrotal imaging subcommittee. Rocher L, Ramchandani P, Belfield J, et al. Eur Radiol 2016; 26: 2268-2278.

Quality guidance from some expert clinicians gives essential advice on what to do with all those small incidentals found increasingly commonly on testicular ultrasound.  This is a must-read for anyone performing scrotal ultrasound.

Read more Echoes in the November 2016 issue of Journal Ultrasound