Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 2013Methods—This study will be a prospective convenience sampleof adults who received either subclavian of internal jugular CVCs asdeemed necessary by the attending physician independent of the study.Enrolled patients will undergo CVC placement by a resident or attendingphysician with a study investigator present to perform echocardiographyand interpret the study of the agitated saline flush in real time A chest x-ray will be performed to confirm CVC placement as the gold standard inconfirmation. Outcome Measures: The primary outcome of the study is thecorrelation of positive interpretation of confirmation of CVC placement onecho with correct placement as seen on chest x-ray. The other outcomemeasure is time to confirmation with echo vs time to confirmation withchest x-ray. Methods of Data Analysis: Data will be presented as medianand interquartiles (25%–75% quartiles) for continuous variables and percentageswith 95% confidence intervals (CIs) for categorical variables.Operating characteristics of bedside ultrasound in confirmation of CVCwill be reported by calculating sensitivity, specificity, and positive andnegative likelihood ratios, with respective 95% CIs. The time from procedurecompletion to confirmation by bedside ultrasound and time fromprocedure completion to confirmation by chest x-ray will be presented asmedian minutes with interquartiles. The comparison of these 2 measurementswill be performed by Mann-Whitney U test. Occurrence of adverseevents will be reported as percentages with 95% CI. Sample size was calculatedwith projected sensitivity of 0.95 with a lower CI limit of 0.90; 91patients will be enrolled in the study. Bedside ultrasounds for each enrolledsubject will be saved and reviewed by a trained sonographer blindedto the chest x-ray results. The inter-rater agreement of the blinded sonographerwith the real-time sonogram interpretations will be measured byCohen’s weighted κ.Results—This study is still undergoing Institutional ReviewBoard approval.Conclusions—None yet.1489380 Vascular Imaging of Lymph Node MetastasesRobert Bard Biofoundation, New York, New York USAObjectives—To demonstrate the appearance of benign and malignantlymphadenopathy with 3D power Doppler sonography (3D-PDS)and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Methods—One hundred twenty-five patients with invasivebreast cancer and 221 patients with postoperative lumpectomy/mastectomyfollow-up were prospectively scanned with a GE Voluson E9 unitemploying a linear 12–18-MHz probe with conventional 3D/4D imagingusing 3D angio and glass body power Doppler image reconstruction. Allpatient images were imaged by DCE-MRI with a 3T Siemens unit within1 week of the sonogram. All lesions were later confirmed by surgery.Results—3D PDS and DCE-MRI showed the nodal neovascularityin both axillae in 56 of 346 and 80 of 346 in a unilateral axilla. Thelesions were imaged well by both modalities and showed high correlationwith surgical findings. Imaging showed 136 of 346 positive axillae ascompared to 69 of 346 clinically detectable by palpation.Conclusions—3D power Doppler imaging appears to as sensitiveas DCE-MRI in detecting axillary lymphadenopathy. Vascular mappingmay be useful in preoperative lymphadenectomy planning. 3Dmapping may permit image-guided treatment.1489474 Ultrasonic Imaging of Treated Rheumatoid and PsoriaticArthritisRobert Bard Biofoundation, New York, New York USAObjectives—To follow treatment progress of arthritis with 3Dpower Doppler sonography (3D-PDS) and dynamic contrast-enhancedmagnetic resonance imaging (DCE-MRI).Methods—Nine patients with active rheumatoid arthritis of thewrist and digits and 6 patients with psoriatic arthritis of the phalanges werestudied over a 1-year period.Results—3D-PDS and DCE-MRI showed the vascularity absentposttreatment in 8 of 9 rheumatoid patients with 80% symptomaticimprovement and 4 of 6 psoriatic patients with 80% symptomatic improvement.Inflammatory neovascularity decreases occurred 1 to 2 monthsbefore 80% improvement attained in all responders.Conclusions—Vascular imaging combining DCE-MRI andDoppler ultrasound appears useful in follow-up of medical anti-inflammatorytreatments.1489583 Multimodality Imaging of Laser-Ablated Prostate TumorsRobert Bard,* Daniel Sperling Biofoundation, New York,New York USAObjectives—To follow thermal treatment progress of prostatecancers with 3D power Doppler sonography (3D-PDS) and dynamic contrast-enhancedmagnetic resonance imaging (DCE-MRI).Methods—Fifty-nine patients with Gleason grade 3 or 4 focalprostate cancer were prospectively scanned with a GE Voluson E9 unitemploying a linear 18-MHz probe with conventional 3D/4D imagingusing 3D angio and glass body power Doppler image reconstruction. Allpatient images were imaged by DCE-MRI with a 3.0-T Siemens unitwithin 1 week of the sonogram. Patients were treated with a 980-wavelengthdiode laser with end-fire heat distribution. Safety thermal zoneswere outlined to protect the rectum and neurovascular bundles.Results—3D-PDS and DCE-MRI showed the tumor vascularityabsent posttreatment in 59 of 59 patients. No posttreatment complicationswere noted.Conclusions—Vascular imaging combining DCE-MRI andDoppler ultrasound appears useful in preoperative planning and follow-upof laser ablative treatments.1489649 Multimodality Vascular Imaging of Bladder TumorsRobert Bard,* Daniel Sperling Biofoundation, New York,New York USAObjectives—To demonstrate the appearance of benign and malignantbladder masses with 3D power Doppler sonography (3D-PDS)and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Methods—Ninety-five patients with a Gleason grade 4 and/or5 base of prostate cancer and 21 patients with bladder polyps and stoneswere prospectively scanned with a GE Voluson E9 unit employing a linear12–18-MHz probe with conventional 3D/4D imaging using 3D angioand glass body power Doppler image reconstruction. Contrast-enhancedultrasound was performed on 3 patients. All patient images were imagedby DCE-MRI with a 1.5-T Siemens unit within 1 week of the sonogram.All lesions were later confirmed by cystoscopy or surgery.Results—3D-PDS and DCE-MRI showed the tumor vascularconnection from the prostate extending into the bladder base. The vascularframework of transitional cell carcinomas was generally separable fromthe previously noted base of prostate tumors. The lesions of a benign naturewere imaged well by both modalities and included intravesical diseasessuch as polyps, stones, blood clots, and intraluminal prostate debrisfollowing postoperative procedures.Conclusions—3D power Doppler imaging appears to as sensitiveas DCE-MRI in detecting bladder tumors. The role of a possiblescreening test for evaluating hematuria deserves further study. Imaging inpatients with bladder base lesions may disclose unsuspected primary prostatictumors. Vascular mapping may be useful in preoperative planning.1505305 Multimodality Imaging of Microwave-Treated Prostate TumorsRobert Bard Biofoundation, New York, New York USAObjectives—To follow the thermal treatment progress of microwavedprostate cancers with 3D power Doppler sonography (3D-PDS)and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).S84