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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013herently introduce temporal artifacts. In this study, the effect of UCA attachmenton nonlinear frequency emissions was investigated as a potentialreal-time discriminatory attachment marker.Methods—Nonlinear UCA behavior was studied using singleelementtransducers and acoustically transparent Opticells (Nalge NuncInternational, Rochester, NY). Attachment Opticells were coated withstreptavidin (to provide a site for attachment) followed by incubation with5% bovine serum albumin (BSA) solution to reduce nonspecific binding.The coated Opticell was then incubated with Targestar-B microbubbles(Targeson Inc) followed by phosphate-buffered saline washing in triplicateand attachment counting/confirmation via light microscopy. An Opticellcoated with BSA alone was used as a negative specificity control with anequivalent concentration of microbubbles (≈1 9 microbubbles/mL) added.Nonlinear bubble behavior was investigated by transmitting 4- and 5-MHz64-cycle pulses with a spherically focused single-element transducer(Panametrics, Waltham, MA) and receiving signals with a 3.5-MHz sphericallyfocused single-element transducer. Frequency spectra were thencompared after normalization to the fundamental peak.Results—Secondary harmonics (2f0) were evident in all caseswith no differences in relative amplitudes observed between attachedand unattached UCAs. Generating subharmonic signals (f0/2; 2.0/2.5MHz) proved difficult for both UCA groups. However, at 4 MHz, unattachedbubbles began to show subharmonic behavior at 470 kPa with aclear peak at 694 kPa. No definitive subharmonic peak was observedusing attached UCAs. Excitation at 5 MHz did generate some nonlinearbehavior in the subharmonic range, but differentiation of the subharmonicpeak was difficult, presumably due to reflections generated bythe Opticell surface.Conclusions—Targeted UCA attachment does not appear toaffect the second harmonic but may potentially inhibit the subharmonic.This criterion may be useful for real-time identification of microbubbleattachment.1513519 Correlation of Ultrasound Contrast Agent–Derived BloodFlow Parameters With Immunohistochemical Markers inMurine Xenografts: Influence of the Imaging Mode, TumorModel, and Subcutaneous LocationJohn Eisenbrey, 1 * Christian Wilson, 1,3 Raymond Ro, 1,4 TraciFox, 2 Ji-Bin Liu, 1 See-Ying Chiou, 1 Flemming Forsberg 11Radiology, 2 Radiological Sciences, Jefferson College of HealthProfessions, Thomas Jefferson University, Philadelphia, PennsylvaniaUSA; 3 College of Physicians and Surgeons, ColumbiaUniversity, New York, New York USA; 4 School of BiomedicalEngineering, Sciences, and Health Systems, Drexel University,Philadelphia, Pennsylvania USAS87Objectives—To compare ultrasound contrast agent (UCA)-derived blood flow parameters to immunohistochemical markers in gliomaand breast cancer murine xenograft models.Methods—Breast cancer (NMU) or glioma (C6) cells were implantedin either the abdomen or thigh of 144 Sprague Dawley rats andrandomly separated into groups of 6, 8, or 10 days post implantation (12rats per time point × 2 cell lines × 2 implant locations). Imaging was performedusing power Doppler imaging (PDI), harmonic imaging (HI), andmicroflow imaging (MFI) on with an Aplio scanner with a 7.5-MHz lineararray (Toshiba America Medical Systems, Tustin, CA) during bolus tailvein injection of the UCA Optison (GE Healthcare, Princeton, NJ; 0.4mL/kg). Contrast kinetic blood flow parameters consisting of maximumintensity, time to peak, perfusion, and time-integrated intensity (TII) werecalculated from time-intensity curves using parametric analysis on a pixelby-pixelbasis and averaged over the tumor area. These values were comparedto 4 immunohistochemical markers (basic fibroblast growth factor,CD31, cyclooxygenase 2, and vascular endothelial growth factor [VEGF])determined after tumor excision.Results—When analyzing the entire data set, a significant inversecorrelation was only observed between TII and VEGF for all 3 imagingmodes (R = –0.35, –0.54, and –0.32 for PDI, HI, and MFI, respectively).When grouping data by tumor type, the NMU group correlationsbecame nonsignificant, while the correlation within the C6 group increased(R = –0.43, –0.54, and –0.52 for PDI, HI, and MFI, respectively). Whengrouping by tumor location, a significant correlation was not observed forthe thigh-implanted group, while the correlation within the abdominaltumor group again strengthened relative to the entire data set (R = –0.41,–0.58, and –0.38 for PDI, HI, and MFI, respectively). Consistent with theabove trends, the strongest correlation of TII to VEGF for all subgroupswas found to be abdominally implanted C6 cells (R = –0.51, –0.55, and –0.57 for PDI, HI, and MFI, respectively).Conclusions—TII appears to correlate best with the angiogenicmarker VEGF. However, these correlations were found to depend on bothtumor type and location.1514789 Time From Nursing Request to Probe Placement DelaysUltrasound-Guided Peripheral Intravenous Catheter Placementin Emergency Department Difficult-Access PatientsGlenn Heimburger,* Leigh Patterson, Kori Brewer EmergencyMedicine, East Carolina University, Greenville, NorthCarolina USAObjectives—To assess the total time needed for ultrasound(US)-guided peripheral intravenous (IV) catheter placement by emergencymedicine (EM) physicians in difficult-access patients.Methods—Prospective convenience sample of patients presentingto an academic tertiary care center emergency department. Inclusioncriteria were the need for IV access and inability of any availablenurse to establish a peripheral IV catheter. Exclusion criteria were the needfor central venous access or unstable patients as defined by the treatingphysician. All physicians received introductory training prior to enrollingpatients. Outcomes measured were times from nursing request to probeplacement, probe placement to first skin puncture, first skin puncture tosuccessful cannulation or procedure abandonment, and total time fromnursing request to procedure completion. Number of failed nursing attempts,skin punctures, physician experience with US-guided peripheralIV catheter placements (0–4, 5–9, or ≥10 previously placed), and physiciantraining level were recorded.Results—Sixty-four patients were enrolled. The mean (±SD;range) times were: total time, 35.5 minutes (±21; 5–110 minutes); nursingrequest to probe placement, 20.9 minutes (±18; 1–100 minutes); probeplacement to first skin puncture, 5.8 minutes (±5; 1–34 minutes), and firstskin puncture to successful cannulation or procedure abandonment, 8.7minutes (±8; 1–36 minutes). Average number of failed nursing attemptswas 3.2 (range, 0–7). Average number of skin punctures was 1.5 (range,1–5). Physician training level had no effect on time. Having performed≥10 previous US-guided peripheral IV catheter placements vs 0 to 4 decreasedtotal procedure time (P = .04) and time from probe placement tofirst skin puncture (P = .04).Conclusions—The largest delay in placing a US-guided peripheralIV catheter by an EM physician after nursing failure occurs fromnursing request to probe placement. Future studies should examine if variablesexist during this period that could decrease total procedure time. Previousexperience with placing US-guided peripheral IV catheters decreasesoverall procedure time.1514851 A New Sonographic Sign for Perinatal Torsion: the “KiwiSign”Ashraf Goubran, 1,3 * Fern Karlicki, 1 Karen Letourneau, 1Ganesh Srinivasan 2 1 Ultrasound, 2 Neonatology, St BonifaceGeneral Hospital, University of Manitoba, Winnipeg, Manitoba,Canada; 3 Diagnostic Imaging, Ain Shams University,Cairo, EgyptObjectives—Perinatal torsion must be recognized in an urgentfashion if the testicle is to be salvaged. The purpose of this limited case se-
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013ries is to describe a new sonographic sign for perinatal torsion that has, toour knowledge, not been described previously.Methods—Five cases underwent grayscale, color, and pulsedDoppler evaluation for suspected torsion in the perinatal period during a26-month interval. The age of presentation ranged from birth to 30 days.The studies were performed using a Philips iU22 ultrasound machine. Alinear high-frequency transducer (17 MHz) was used for scanning. Thesecases were retrospectively analyzed with regard to clinical and sonographicfindings.Results—The grayscale appearance of the affected testicle wasquite abnormal in our cases (n = 5). We subdivided our cases into 2 groupsbased on the sonographic findings. The first group (n = 2) represented theearly phase of perinatal torsion, which we believe could have been potentiallysalvageable. The affected testicle in this group was markedly enlargedwith a heterogeneous echo texture. Linear hypoechoic striationswere seen, radially oriented from the mediastinum testicle, giving a characteristicappearance of a section in a kiwi fruit. The second group (n = 3)represented the nonsalvageable late phase of perinatal torsion, in which theaffected testicle was small and heterogeneous. Color Doppler assessmentin the affected testicle in both groups showed no flow.Conclusions—On the basis of the limited number of cases includedin our study and a review of the literature, we suggest that the “kiwisign” may become a useful finding representing the early phase of perinataltorsion. Future studies on a larger scale may prove that this sign canbe established as a reliable indicator to aid in surgical decision making.1515353 The Swollen Pediatric Scrotum: Ultrasound Technique andDifferential DiagnosisKelli Schmitz, 1 Kathryn Snyder, 1 David Geldermann, 2 RoyaSohaey 1 *1 Diagnostic Radiology, Oregon Health and ScienceUniversity, Portland, Oregon USA; 2 Colgate University, Hamilton,New York USAObjectives—Review the ultrasound protocol for performanceof scrotal ultrasound in pediatric patients and illustrate the ultrasound appearanceof conditions resulting in scrotal swelling. Provide a brief summaryof scrotal embryology.Methods—Retrospective review of an imaging database of pediatricpatients presenting with scrotal swelling who underwent diagnosticultrasound at a tertiary pediatric referral center. When available,surgical/pathologic correlation was obtained. Some cases were diagnosedin utero.Results—Causes for pediatric scrotal swelling include intravaginaland extravaginal torsion, epididymitis/orchitis, hydrocele (simple,inguinoscrotal, abdominoscrotal, iatrogenic, and spermatic cord), varicocele,inguinal hernia, trauma, adrenal rest, and testicular or paratesticularneoplasms.Conclusions—A variety of typical and atypical pathologicprocesses resulting in pediatric scrotal swelling will be presented in thispictorial review. Best-practice ultrasound technique will be reviewed.1515361 Suprarenal Masses in the FetusSarah Rogers, Karen Oh, Roya Sohaey* Diagnostic Radiology,Oregon Health and Science University, Portland, OregonUSAObjectives—Our objective is to review the imaging and differentialdiagnosis of fetal suprarenal masses.Methods—Prenatal ultrasound and magnetic resonance imagingof fetal suprarenal masses is presented, along with clinical informationand follow-up. Imaging pearls and differential considerations for each diagnosiswill be discussed.Results—Fetal suprarenal masses, diagnoses include congenitaladrenal hyperplasia (symmetric and asymmetric), extralobar pulmonarysequestration, neuroblastoma, partial multicystic dysplastic kidney, renalduplication, urinoma, gastric duplication cyst, and splenic cyst. Fetal adrenalmasses are often malignant, and every attempt should be made todifferentiate between them and other diagnoses. Recognizing the range ofmalignant and benign suprarenal fetal masses that can present on prenatalimaging can help guide patient counseling and management.Conclusions—The differential diagnosis of a suprarenal massis broad but can be narrowed by imaging characteristics. A pictorial reviewof suprarenal masses is presented along with technique and imaging pearlstoward accurate diagnosis.1518185 Extraovarian Adnexal Sonographic Findings in EctopicPregnancy: A ReappraisalMary Frates,* Peter Doubilet, Hope Peters, Carol BensonRadiology , Brigham and Women’s Hospital, Boston, MassachusettsUSAObjectives—To assess the frequency of extraovarian adnexalsonographic findings in patients with ectopic pregnancy using state-ofthe-artsonographic equipment.Methods—All patients with pathologic or sonographic confirmationof ectopic pregnancy between July 1, 2008, and August 31, 2011,who underwent transvaginal sonography (TVS) prior to treatment were included.The sonogram performed closest to the point of treatment was retrospectivelyreviewed for the presence of an extraovarian adnexal massand for a moderate-to-large amount of free fluid. In cases with an adnexalmass, the presence of a tubal ring, yolk sac, or embryonic cardiac activitywas recorded.Results—Our study population comprised 231 patients. A positivefinding—adnexal mass and/or free fluid—was present in 220 of 231patients (95.2%): adnexal mass in 218 of 231 (94.4%) and a moderate-tolargeamount of free fluid in 56 of 231(24.2%). Among our 231 studycases, sonography demonstrated a tubal ring in 75 (32.5%), a yolk sac in19 (8.3%), and embryonic cardiac activity in 17 (7.4%). In 140 cases(60.6%), TVS demonstrated a nonspecific adnexal mass (without tubalring, yolk sac, or cardiac activity).Conclusions—TVS demonstrates an adnexal abnormality in>95% of patients with ectopic pregnancy. The most common finding is anonspecific adnexal mass. A tubal ring is found in fewer than half of casesand a yolk sac and cardiac activity in
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Small-Animal Preclinical High-Frequ
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2013 AIUM Award WinnersJoseph H. Ho
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2013 AIUM Award WinnersDistinguishe
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Endowment for Education andResearch
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Rosa De Vermette, MD, RDCS,RDMS, RO
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