Volume 11 Issue 1 (February) - Australasian Society for Ultrasound ...

ASUM Ultrasound Bulletin February 2008; 11 (1): 39–43
ASM 2007 ABSTRACTS
Abstracts 37th Annual Scientific Meeting ­
Cairns, 2007: Part 2 – Part 1 published 2007 vol 10 (4)
410 Ultrasound of chronic liver disease
Richard B Allan, Flinders Medical Centre, Australia
Objective
To review the use of ultrasound in chronic liver disease.
Chronic liver disease is a common disease and the eighth
leading cause of death in the developed world. Scanning the
liver can be technically difficult due a variety of problems
and the use of small foot print transducers, tissue harmonic
imaging and spatial compounding will all improve image
quality.
Ultrasound is relatively insensitive to mild cirrhosis and
there is a poor correlation between the ultrasound appearances
and histological severity. The ultrasound appearances
of cirrhosis are variable but a coarse, heterogeneous echo
pattern is commonly seen. Surface irregularities may be seen
and alteration of the liver architecture due to regenerating
nodules may be present. Appearances may be complicated
by the presence of fatty infiltration. Increased attenuation
and increased echogenicity may be seen if there is an acute
fatty component to liver disease. While fatty liver has variable
appearances these generally fit into easily recognised
patterns.
Common complications of chronic liver disease are
portal hypertension (PHT) and hepatic malignancy. PHT is
a common sequela of chronic liver disease and ultrasound is
used extensively in its diagnosis and monitoring. Of patients,
1–5% will develop HCC and ultrasound is commonly used
as a screening modality.
Ultrasound contrast media are used extensively in Europe
and Asia and offer major improvements in the accuracy of
ultrasound. Unfortunately, these agents are not available for
general use in Australia and great opportunities for improved
assessment are not being utilised.
411 Peyronie’s disease: the long and the short of it
Michelle K Pedretti, Australia
Objective
This presentation will cover the causes, risk factors, signs,
symptoms and treatment variations of Peyronie’s disease.
Sonographic demonstration and appearances will be presented,
although Peyronie’s s disease is generally a clinical
diagnosis.
Cases of Peyronie’s disease have been documented from
as early as 1687. First described by Francois de la Peyronie,
a French surgeon, in 1743. Peyronie’s disease had previously
been classified as a form of sexual incompetence but is now
recognised as a component of erectile dysfunction.
Peyronie’s disease is a benign condition that affects
approximately 1% of the male population. It is most commonly
seen in males between the ages of 45 and 60 years of age. It
can, however, occur in the young and elderly male population.
Thought to have genetic links, its exact nature and etiology
remain uncertain. The condition may spontaneously resolve
in 1–2 years from onset. Surgical intervention is required for
those in whom the condition does not resolve.
A hard lump, comprised of plaque, in the tunica albuginea
of the penis characterises Peyronie’s disease. The plaque
is thought to originate as local inflammation and develop
into a hardened scar. Plaque development may be on any surface
of the penile shaft, though more commonly is located
on the superior surface of the penis. With penile erection the
plaque causes the penis to bend and can be associated with
pain and distortion.
412 Interventional ultrasound: the basics
Matthew W Andrews, ASUM President, Australia
Objectives
Knowledge of the ultrasound principles and skills underpinning
all ultrasound-guided interventional ultrasound
procedures.
The initial common pathway of all ultrasound-guided
procedures involves the placement of a needle tip into a target
within the body. Once the needle has been placed, a wide
variety of procedures can then be performed.
This talk reviews the current status of the multiple steps
and factors which all contribute to successful needle placement.
Examples of particular procedures will be demonstrated.
The construction of phantoms for developing skills
will also be described.
413 Liver Doppler
Richard B Allan, Flinders Medical Centre, Australia
Objective
To review the portal venous system and outline the most
effective methods for investigating common abnormalities
with ultrasound.
The liver has complex vascular arrangements and a good
understanding of the anatomy and physiology is essential
when performing a Doppler ultrasound assessment.
Liver Doppler is a technically challenging examination
due to the difficulties encountered in scanning the diseased
liver and the abnormal flow states often present. Sound
techniques utilising a thorough understanding of the technical
parameters of Doppler ultrasound is necessary to obtain
clinically useful information.
The most common pathological processes found in the
portal venous system are portal vein thrombosis (PVT) and
portal hypertension (PHT).
PVT can be accurately diagnosed with ultrasound with a
reported sensitivity of 93% and specificity of 99%.
Ultrasound is also used extensively to diagnose PHT
and a number of ultrasound findings have been described
although these have very variable performances.
While commonly used, both portal vein dilatation and
reversal of flow in the portal vein are relatively poor indicators
of PHT with sensitivities of only 40% and 1–8%
respectively.
The presence of portosystemic collaterals is the most
sensitive indicator of PHT with a sensitivity of 70–83%.
Identification of collaterals is aided by their predictable
positions and clues from flow patterns found in the por-
ASUM Ultrasound Bulletin 2008 February 11 (1)