Diana Gaitini

• Diana Gaitini, MD, FAIUM
• Managing Director at Rambam Medical Center

This chapter is a comprehensive review of the basics of ultrasound imaging. It contains general principles of the physics and main ultrasonographic techniques that are useful to practice dermatologic ultrasound. There is a glossary of common ultrasound terms and information on the new developments in the field.

Point-of-Care-Ultrasound (PoCUS) is performed by the clinician at the patient's bedside and is an essential diagnostic tool in many medical subspecialties, in hospital-based care, emergencies, trauma, and in general practice. A simple, novel approach for implementation of PoCUS of the oral cavity and maxillofacial complex is introduced. Relevant in...

Background: Point shear-wave elastography (pSWE) is a new method to assess the degree of liver fibrosis. It has been shown to be effective in detecting stiffness in viral hepatitis. Objectives: To determine the feasibility of pSWE for assessing liver stiffness and fibrosis in liver diseases of different etiologies. Methods: This prospective si...

Transthoracic parametric Doppler (TPD), unlike conventional ultrasonography, measures signals originating from movements of pulmonary blood vessel walls. In this pilot study, we tested TPD in 15 patients diagnosed with pulmonary embolism on computed tomography pulmonary angiography. Results were mapped to the upper, middle, and lower thirds of the...

OBJECTIVE. To evaluate the potential for surveillance of abdominal aortic aneurysms without ionizing radiation exposure and without the risks of iodinated contrast administration, the accuracy of fusion of CT angiography (CTA) with ultrasound (US) was compared with conventional US in 14 patients. CONCLUSION. The mean measurement difference between...

Objective: The standard of care for the diagnosis and follow-up of urolithiasis is unenhanced CT. The hypothesis of this study was that that by using image fusion of subsequent ultrasound (US) with the initial unenhanced CT, ureteral stones can be precisely localized. Conclusion: Of the 25 stones founds on unenhanced CT studies, 22 (88%) were co...

Background: Staging and monitoring of patients with hidradenitis suppurativa (HS) have been traditionally based on clinical findings. However, the physical examination may show important limitations because of its poor sensitivity for differentiating between different lesion subtypes, and its low sensitivity to define the disease's activity. Obje...

Background: Ethanolic extract of licorice root has been shown to reduce low-density lipoprotein (LDL) oxidation in atherosclerotic mice and in both hypercholesterolemic and normal lipidemic humans. Objective: This study examined the effect of licorice-root extract on carotid intima-media thickness (CIMT) in individuals with hypercholesterolemia....

Objectives: To support standardization for performing dermatologic ultrasound examinations. Methods: An international working group, called DERMUS (Dermatologic Ultrasound), was formed, composed of physicians who have been working on a regular basis and publishing in peer-reviewed articles on dermatologic ultrasound. A questionnaire on 5 critica...

Purpose: To evaluate compliance with a management strategy for use in emergency department (ED) patients with suspected deep vein thrombosis (DVT) based on Wells score (WS), d-dimer concentrations, and sonographic (US) examinations. Methods: Retrospective and prospective data on risk factors, physical examination findings, d-dimer concentrations...

The purpose of this study was to determine the value of dynamic high-resolution sonography for evaluation of temporomandibular joint (TMJ) disk displacement compared to magnetic resonance imaging (MRI) with the mouth closed and during the maximal mandibular range of motion. Dynamic high-resolution sonography with the mouth closed and during the max...

The aim of the current work was to quantify the ultrasonic properties of the whole breast in vivo as a function of age. Forty-four women were scanned using a computerized ultrasonic scanner developed in our laboratory. Raster scans in two orthogonal views, mediolateral and craniocaudal, were obtained using the ultrasonic through-transmission method...

Joint ultrasound indications are rapidly expanding because of the technological improvements of modern equipments, high availability, and low cost compared with sophisticated imaging techniques. Proper operator skills and high-resolution transducers are demanded. Color and power Doppler examinations are recommended in every joint study; static imag...

Background: High-variable-frequency ultrasound is used as an imaging tool for various cutaneous disorders. We utilized this tool in pachyonychia congenita (PC) patients, who typically present with plantar hyperkeratosis and often severely debilitating pain, compared to patients with epidermolytic palmoplantar keratoderma (EPPK) and mal de Meleda (...

Plasmapheresis (PA) and low-density lipoprotein apheresis (LDL-A) were assessed in five children with homozygous familial hypercholesterolemia (HFH) previously receiving statins. LDL-A required smaller extracorporeal blood volumes. Mean HDL-cholesterol reduction post-procedure was 32% and 60% with LDL-A and PA, respectively. Non-HDL-C reduction was...

Scrotal ultrasound (US) is the technique of choice for imaging the scrotal contents. US is widely used in the characterization of scrotal pathologies as a supplement to the clinical examination. Modem US equipment, precise technical performance, and knowledge of sonographic anatomy and pathology, as in any US examination, are the basis for a correc...

High-resolution gray scale and color Doppler ultrasound can be a useful tool in dermatology. Technical requirements and useful sonographic concepts are discussed in this chapter. An ultrasound glossary, tips and teaching points are provided to improve the understanding of this technique.

The feasibility of implementing image subtraction in through-transmission breast sonography was examined. Acoustic mammograms of women with suspicious findings were obtained using through-transmission imaging. Precontrast images were initially acquired. Then a perflutren liquid microsphere contrast agent solution was injected intravenously, and new...

The feasibility of implementing image subtraction in through-transmission breast sonography was examined. Acoustic mammograms of women with suspicious findings were obtained using through-transmission imaging. Precontrast images were initially acquired. Then a perflutren liquid microsphere contrast agent solution was injected intravenously, and new...

PURPOSE We retrospectively reviewed our experience in the procedure in the pediatric population. The aims of the study were to assess the sensitivity, specificity and accuracy rate of the procedure, the complication related to the biopsy and the sedation, and the availability of the procedure. METHOD AND MATERIALS We retrospectively studied US gu...

Ultrasound (US) of the shoulder is the most commonly requested examination in musculoskeletal US diagnosis. Sports injuries and degenerative and inflammatory processes are the main sources of shoulder pain and functional limitations. Because of its availability, low cost, dynamic examination process, absence of radiation exposure, and ease of patie...

Background Lypopolysaccharides (LPS)- induced cartilage damage is widely used as a model to investigate the effectiveness of cartilage protective agents in vitro. Overwhelming liver LPS of intestinal origin break impaired liver barriers, achieve blood stream in low but sustained accounts and spread to joints. That results in lipopolysaccharide (LPS...

Therapy of Hodgkin lymphoma (HL) is designed to prolong survival and minimize toxicity. A total of 124 patients with newly diagnosed HL and adverse prognostic factors were prospectively studied between July, 1999 and August, 2005. Patients with early unfavorable and advanced disease were eligible for the study. Patients were assigned to therapy bas...

The purpose of this study was to evaluate the accuracy of color-coded duplex sonography for the diagnosis of Crohn disease relapse and complications compared to multidetector computed tomography (CT). The Institutional Ethics Committee approved the protocol research, and written consent forms were obtained. Patients with a diagnosis of Crohn diseas...

1564 Background Therapy of Hodgkin lymphoma (HL) is designed to prolong survival and minimize toxicity; however, an intense debate is ongoing over whether ABVD or BEACOPP should be used upfront and whether a long-term survival benefit is obtained with the BEACOPP regimen. The current study was aimed to personalize therapy based on individual risk...

The goal of this review is to present the state of the art in imaging tests for the diagnosis of acute appendicitis. Relevant publications regarding performance and advantages/disadvantages of imaging modalities for the diagnosis of appendicitis in different clinical situations were reviewed. Articles were extracted from a computerized database (ME...

The purpose of this research is to develop a computerized method to quantify carotid plaque neovascularization on contrast-enhanced ultrasound images and to compare the results with the histopathologic analysis of the plaque. Twenty-seven patients (age range, 48-84 years; mean [± SD] age, 68.4 ± 9.72 years) were recruited before endarterectomy. Con...

This study aimed to evaluate the presence of cardiovascular risk factors in children with a parental history of premature ischemic heart disease (two- or three-vessel disease diagnosed before the age of 55 in men and 65 in women). A prospective cross-sectional study was performed on 55 children. The following parameters were assessed: body mass ind...

Through-transmitted ultrasonic waves can be used for computed projection imaging of the breast. The goal of this research was to analyze the acoustic properties changes associated with the propagation of ultrasonic waves through media before and after ultrasound contrast agent (UCA) injection and to study the feasibility of a new imaging method com...

The findings of interim fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) predict progression-free survival of patients with Hodgkin's lymphoma. Historically, the assessment was based on a static all-or-none scoring system. However, the clinical significance of any positivity in interim FDG-PET/CT has not been defined. Ninety...

Although guidelines for venous thromboembolism prevention are available, the implementation of anticoagulant prophylaxis in patients with advanced cancer has yet to be more clearly defined. We aim to determine the incidence of lower extremity deep vein thrombosis (DVT) diagnosed by Doppler sonography (USD) in asymptomatic nonambulatory patients wit...

Although uncommon, mycotic aneurysms in infants can be lethal because of the high risk of rapid expansion and rupture. Most catheter-associated mycotic aneurysms reported in the first year of life develop following umbilical artery catheterizations. We describe the sonographic detection of an early stage mycotic aneurysm in a 4-month-old following...

Haematologica 2010 [Epub ahead of print] doi:10.3324/haematol.2009.016105 Publisher's Disclaimer. E-publishing ahead of print is increasingly important for the rapid dissemination of science. Haematologica is, therefore, E-publishing PDF files of an early version of manuscripts that have completed a regular peer review and have been accepted for pu...

The purpose of this study was to examine the triage role of scrotal Doppler ultrasonography (DUS) as the primary preoperative diagnostic tool in patients presenting to the emergency department (ED) with acute scrotum. Patients who presented to the ED with acute scrotum and underwent scrotal DUS in the ultrasound unit over a 3-year period (2004-2007...

To review the literature concerning the need for a cancer screening battery to diagnose a hidden cancer in patients presenting with idiopathic venous thromboembolism (VTE). Data from computerized database programs (Medline, Ovid) was retrieved. A review of the literature regarding studies on cancer screening in patients with idiopathic VTE was perf...

Objective: We report the role of the imaging department at a level 1 trauma center during the Second Lebanon War (summer 2006). Our institution received 849 military and civilian casualties, an average of 25 war-injured patients per day, 338 with acute traumatic stress disorders and 511 physically injured, coming in waves after a rocket attack or...

The purpose of this study was to assess the accuracy of sonographic pneumothorax detection by radiology residents as a part of extended focused assessment with sonography for trauma (eFAST). In a prospective study, a sonographic search for pneumothoraces was performed as part of a standard FAST examination by the on-call resident. Each lung field w...

Fever of unknown origin (FUO) is a challenging diagnostic problem. Timely identification and precise localization of the causing process are critical for appropriate patient management. The present prospective study evaluates the role of PET/CT using (18)F-FDG in the investigation of FUO. A total of 48 consecutive patients (25 men, 23 women; age ra...

PURPOSE Acute scrotum is not a rare complaint in the ED. The diagnosis is difficult due to the diversity of etiologies with this clinical presentation. Doppler ultrasonography study (DUS) is considered the mainstay diagnostic imaging modality for the assessment of acute scrotum. Our purpose was to assess the role of scrotal DUS in the evaluation of...

Interim PET-CT is used to predict the progression-free survival in HL (Gallamini, JCO 2007). However, what constitutes a functionally positive interim PET-CT has not been established. Does a single focus of reduced residual uptake predict and justify an escalation of therapy? In this study, 96 patients [47 females, 49 males; median age 30 (17–57) y...

Previous studies reported decreased serum IGF-1 levels in cirrhosis. We aimed to correlate GH-stimulated IGF-1 responses with both MELD and Child-Pugh scores and determine the impact of portal hypertension and nutrition on IGF-1 responses. Fifty-three patients (56+/-2 yrs) with cirrhosis were enrolled. Serum IGF-1 levels were measured by RIA before...

The objective of our study was to evaluate the accuracy of color Doppler sonography and contrast-enhanced MDCT in the diagnosis of acute appendicitis in adults and their utility as a triage tool in lower abdominal pain. We reviewed the medical records of 420 consecutive adult patients, 271 women and 149 men, 18 years old or older, referred from the...

The use of 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in primary gastric lymphoma (PGL) is challenging due to physiologic FDG activity in the stomach and variability in the degree of uptake in various histologic subtypes. This study assesses FDG avidity and PET/CT patterns in newly diagnosed PGL. Sixty-two...

The purpose of this study was to estimate tissue changes during radiofrequency (RF) ablation by correlating echo frequency shifts and temperature elevations. Experiments were performed on phantoms (tissue mimicking gel) and in-vitro turkey breast. Heating was performed with a modified RF-ablation system. Intermittent RF was applied and the temperat...

The purpose of this study was to determine the diagnostic accuracy of sonographically guided biopsy of [(18)F]fluorodeoxyglucose (FDG)-avid foci on positron emission tomography (PET)/computed tomography (CT) in patients with lymphoma. We retrospectively reviewed the medical records of 56 patients with lymphoma (25 male and 31 female; mean age, 48.5...

The purpose of this presentation is to highlight the color Doppler duplex sonographic features of procedure-related and blunt or penetrating trauma-related vascular injuries. Different kinds of vascular complications such as pseudoaneurysms, arteriovenous fistulas, dissection, and thrombosis are discussed. Cases of vascular injuries in the extremit...

Ultrasound in trauma, whether in the case of an individual patient or that of a multiple-casualty incident, has an important role in evaluation and immediate triage. The ultrasound examination in the trauma room is brief and focused and should answer a single relevant question: “Is there a hemoperitoneum?” In this article, the usefulness of focused...

This article reviews the role of color Doppler duplex sonography (CDDS) in the diagnosis of vascular trauma, illustrating the sonographic appearances of peripheral and central arterial and venous injuries, procedure-related and trauma-related injuries. Different types of vascular injuries are discussed and examination techniques are described. Trau...

As opposed to the conventional pulse-echo (B-scan) technique, through-transmitted ultrasonic waves can provide quantitative information on the acoustic properties of tissues. Additionally, in order to improve the specificity of ultrasonic imaging, the use of microbubbles as an ultrasound contrast agent (UCA) combined with the B-mode technique has b...

The role of interim FDG PET/CT for the evaluation of response and prediction of prognosis during the treatment of Hodgkin lymphoma has been demonstrated in several studies; however, its function in aggressive non-Hodgkin lymphoma has not been established. This study assesses the value of interim FDG-PET/CT performed after 2 cycles of chemotherapy f...

The purpose of this study was to evaluate the role of focused assessment with sonography for trauma (FAST) as a triage tool in multiple-casualty incidents (MCIs) for a single international conflict. The charts of 849 casualties that arrived at our level 1 trauma referral center were reviewed. Casualties were initially triaged according to the Injur...

To investigate the relationship between US and ERCP in the measurement of common bile duct (CBD) width after application of Compound and Harmonic imaging on ultrasound. We prospectively evaluated the CBD width as measured on endoscopic retrograde cholangiopancreatography (ERCP) and ultrasonography (US), applying Compound and Harmonic US techniques,...

Nephrectomy, immuno-chemotherapy and resection of residual disease have been the treatment of choice for patients with metastatic renal cell carcinoma during the past decades. The aim of this study was to report the long-term results of this treatment approach. Sixty-two patients with metastatic renal cell carcinoma participated in a Phase II study...

The purpose of this article is to review the spectrum of image-based diagnostic tools used in the investigation of suspected deep vein thrombosis (DVT). Summary of the experience gained by the author as well as relevant publications, regarding vein imaging modalities taken from a computerized database, was reviewed. The imaging modalities reviewed...

The treatment of patients with Hodgkin lymphoma (HL) is currently based on pretreatment risk stratification aimed at reducing late therapy-related toxicity. Functional Gallium67 scintigraphy was previously used for an interim assessment of response to therapy. Recently, an interim FDG-PET was suggested as a prognostic parameter for a failure-free s...

The purpose of this study was to evaluate the accuracy of sonographically guided percutaneous core biopsy of soft tissue masses. We retrospectively reviewed the medical records of patients who underwent sonographically guided biopsy of soft tissue masses at our institution during a 50-month period. Core biopsy histopathologic results were compared...

The purpose of this study was to review the literature concerning upper extremity deep venous thrombosis (UEDVT) diagnosed by color Doppler duplex sonography (CDDS) in cancer patients with indwelling central venous catheters (CVCs). From computerized databases (MEDLINE and Ovid), relevant publications regarding CDDS of the upper limb veins in cance...

Conflicting data exist on the role of nitric oxide (NO) in cerebral blood flow (CBF) autoregulation. Previous studies involving human and animal subjects seem to indicate that NO involvement is limited to the CO(2)-dependent mechanism (chemoregulation) and not to the pressure-dependent autoregulation (mechanoregulation). We tested this hypothesis i...

Duplex and color Doppler sonography (DUS) is currently the technique of choice for the diagnosis of deep venous thrombosis (DVT) in symptomatic patients, because it has proven safe and cost-effective, with a very high sensitivity and specificity (96% and 98%, respectively) for the diagnosis of proximal DVT. Several issues regarding its method and c...

14137 Background: The goal of the study was to review our clinical experience with ¹⁸ F-FDG PET/CT in patients (pts) with suspected recurrence of pancreatic cancer. Methods: Nine pts (M/F=3/6, age 47–73y) with increasing levels of CA 19–9 and/or CEA during follow-up and negative or equivocal CT scan were included. Seven pts were asymptomatic and 2...

To prospectively evaluate the accuracy of esophagography with barium in diagnosis of esophageal varices (EV) in patients with compensated cirrhosis, with endoscopic gastroduodenoscopy as the reference standard. In this study, which was approved by the local Helsinki Committee and in which all patients consented to participate, 61 patients with cirr...

PURPOSE To determine the frequency of asymptomatic deep vein thrombosis (DVT) in lung cancer and lymphoma patients undergoing chemotherapy, using Doppler sonography of lower extremities and to correlate between the presence of asymptomatic DVT to activated protein C (APC) resistance and D-dimer levels. METHOD AND MATERIALS Patients with diagnosis...

The goal of this review article is to present the state of the art in the clinical applications and technical performance and interpretation of carotid sonographic examinations. Relevant publications regarding color and duplex Doppler sonography (CDDS) of the carotid arteries extracted from a computerized database (MEDLINE) and from references cite...

The aim of this study was to assess the value of combined PET/CT compared with PET reviewed side-by-side with CT, in patients with oesophageal cancer, before and after surgery. Forty-one FDG PET/CT studies were performed in 32 patients with oesophageal cancer, before surgery (n = 18) or during follow-up after resection of the primary tumour (n = 23...

To assist in tissue characterisation for the non-invasive diagnosis of diffuse fatty liver infiltration by providing quantitative indices of ultrasonic (US) backscatter with correlation to histology. US images from patients referred to US-guided liver needle biopsy (LNB) for persistently elevated liver enzymes or serologically positive markers for...

Rising serum tumor markers may be associated with negative imaging in the presence of cancer. CT and (18)F-FDG PET may yield incongruent results in the assessment of tumor recurrence. The present study evaluates the incremental role of (18)F-FDG PET/CT for the diagnosis and management of cancer patients with increasing levels of tumor markers as th...

PURPOSE Most pediatric chest diseases are adequately evaluated with chest radiography; however, the exact location and nature of a thoracic opacity, the meaningful of a mediastinal widening or the characterization of a pleural effusion are often not allowed by a chest xRay.The purpose of this study was to evaluate the additional information provide...

The objective of this study was to compare textural to attenuation/backscatter indices of fatty liver correlated to histology to suggest the better approach for an objective noninvasive ultrasonic "biopsy". Forty-four patients with severe steatosis by histopathology were selected for this study. Ten patients had "pure" fatty liver and 34 had in add...

The purpose of this study was to characterise a benign pattern of infradiaphragmatic 18F-fluorodeoxyglucose (FDG) uptake in cancer patients using PET/CT. Infradiaphragmatic foci of FDG uptake, localised by PET/CT in regions of normal fat tissues, were demonstrated, in conjunction with fatty uptake in the neck and shoulders, in 9 of 1,241 (0.7%) pat...

Breasts are usually only incidentally included in computed tomography (CT) scans of the abdomen and chest in spite of the fact that pathologic findings are not rare. Because postpartum women are normally healthy, they rarely require examination; therefore, the presentation of lactating breasts on a CT scan is poorly known. The most common postpartu...

We describe the Elisha Airway Device (EAD), a new reusable supraglottic ventilatory device. Its uniqueness consists of its ability to combine three functions in a single device: ventilation, blind and/or fiberoptic-aided intubation without interruption of ventilation, and gastric tube insertion. This study was performed in 70 ASA status I-II, Malla...

Sonography is a reliable imaging tool, complementary to plain radiography in certain pediatric chest disorders. It can assist in localizing and characterizing mediastinal, pleural, and pulmonary opacities. We have found that sonography is also valuable in elucidating postoperative chest radiography. In this series, our objective was to assess the v...

Dietary supplementation with polyphenolic antioxidants to animals was shown to be associated with inhibition of LDL oxidation and macrophage foam cell formation, and attenuation of atherosclerosis development. We investigated the effects of pomegranate juice (PJ, which contains potent tannins and anthocyanins) consumption by atherosclerotic patient...

Early detection of asymptomatic deep vein thrombosis by venous sonography may identify patients who may benefit from anticoagulant therapy and thus may prevent morbidity and mortality associated with deep vein thrombosis. The aim of this study was to examine the prevalence of deep vein thrombosis by venous sonography in asymptomatic ambulatory pati...

Repeated cycles of freezing improve the necrotizing effect of cryosurgery. We investigated whether multiple, very short periods of freezing and thawing (pulse cryocycling) enlarged the area of cell cryonecrosis within the iceball, compared with the standard method of cryocycling. Liver cryonecrosis was produced in 3 groups of rabbits by means of 2...

Pyogenic granuloma (PG) is a common benign tumor that occurs mainly on cutaneous and mucosal surfaces. Intravascular occurrence is extremely uncommon. Here we describe a PG of the basilic vein diagnosed preoperatively on the basis of color Doppler sonography.

The use of focused abdominal sonography for trauma (FAST), which detects free fluid in the abdomen and pelvis, for the assessment of blunt abdominal trauma is gaining acceptance worldwide and has been described extensively in the general medical literature. The precise application of this technique in pediatric patients, however, has yet to be esta...

To show the value of sonography in the detection of clinically unsuspected foreign bodies appearing as soft tissue masses. High-resolution B-mode and color Doppler sonography was performed in 288 patients referred with superficial soft tissue masses over a period of 2 years. In 8 lesions in 6 patients, sonography showed small curved or linear echog...

Hepatic veno-occlusive disease (HVOD) is a relatively frequent complication of bone marrow transplantation (BMT), with a reported prevalence of 1% to 54%. The role of color duplex ultrasonography (CDU) in the diagnosis and monitoring of HVOD is controversial; some authors advocate its use, whereas others find it insensitive and nonspecific. Hepatof...

This study assessed the clinical performance of a combined PET/CT system using (18)F-FDG in oncologic patients. (18)F-FDG PET/CT was used to evaluate 204 patients with 586 suspicious lesions. All patients had available follow-up data, enabling assessment of the clinical significance of hybrid PET/CT findings. Differences in interpretation between P...

To evaluate the effectiveness and safety of percutaneous ultrasonographically guided thrombin injection as treatment of unusually positioned and unusually large iatrogenic pseudoaneurysms. Five patients with iatrogenic pseudoaneurysms were evaluated by color duplex ultrasonography. Two patients had additional digital angiography, and 2 had addition...

Implications: We propose an imaging-based algorithm for the management of headache caused by the inadvertent puncture of dura that occurs sporadically during epidural analgesia. Its implementation can identify those postdural puncture headache cases that cannot benefit from epidural blood patches, and their unnecessary application can consequently...

Unlabelled: Percutaneous needle liver biopsy is an important procedure for the diagnosis and evaluation of liver disease and is frequently associated with pain. In this prospective study, we investigated the prevalence and characteristics of this pain syndrome. Fifty-four subjects, who underwent liver biopsy under ultrasound guidance, received 5 m...

To compare gallium 67 (67Ga) scintigraphy and camera-based fluorodeoxyglucose (FDG) positron emission tomography (PET) in the evaluation of patients with lymphoma. The performance of 67Ga scintigraphy and camera-based FDG PET in the detection of lymphoma was retrospectively evaluated and compared in 84 patients with lymphoma, with 219 suspected sit...