Journal of Medical Ultrasound (J Med Ultrasound)

EDUCATIONAL FORUM
	Gastrointestinal stromal tumors: How to increase the preoperative endoscopic ultrasonography diagnostic rate	p. 177
	Chia-Sheng Chu DOI:10.4103/JMU.JMU_104_18
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ORIGINAL ARTICLES
	Sonographic evaluation of urolithiasis formation with positive family history in the population of Lahore	p. 181
	Iqra Manzoor, Raham Bacha, Syed Amir Gilani, Sajid Shaheen Malik, Mehreen Fatima, Faiza Farooq, Rabiya Ashraf DOI:10.4103/JMU.JMU_14_18   Background: The purpose of the research is to know the sonographic evaluation of urolithiasis formation with positive family history in population of Lahore because urolithiasis is a major problem in Pakistan. According to a survey in 1985–1987 the incidence rate reaches to 8.3/100,000 individuals in the Punjab. In Pakistan, urolithiasis is the sixth major cause of surgery. The study was conducted to rule out the role of positive family history in people suffering from urolithiasis. Materials and Methods: This was an observational cross-sectional study conducted at the Radiology department of the University of Lahore teaching hospital and Gilani Ultrasound center-Afro-Asian Institute, Lahore, Pakistan. A total of 125 patients were included in the study which were diagnosed with urolithiasis and individuals with any other abnormality were excluded from the study. The duration of the study was from January 2017 to April 2017. Data were tabulated and analyzed using SPSS version 24. The data were reported using descriptive and inferential statistics. The quantitative variable like age was assessed using mean standard deviation and standard errors. The qualitative variables like gender were reported using percentages and frequencies. Results: Urolithiasis is commonly seen in the males (77 individuals out of 125) as compared to females (48 individuals out of 125) and mid pole of right kidney is the most common site of the renal stones deposition (13.6%), and the relationship of father is mostly seen as familial history (39.2%). Conclusion: It is concluded that positive family history is the major predisposing factor in urolithiasis and one of the cause in the development of stones in the urinary tract or in other words people who have a history of urolithiasis in blood relations have more tendency of stone formation in any part of their lives. Its positive aspect is that we can do a screening in blood relations, especially whose parents or family members diagnosed with stones and can do preventive measures for that. Moreover, its negative aspect is that there are several causes of the stone formation in the urinary tract.
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	The contributions of arterial cross-sectional area and time-averaged flow velocity to arterial blood flow	p. 186
	Ethan C Hill, Terry J Housh, Cory M Smith, Joshua L Keller, Richard J Schmidt, Glen O Johnson DOI:10.4103/JMU.JMU_20_18   Background: Ultrasound has been used for noninvasive assessments of endothelial function in both clinical and athletic settings and to identify changes in muscle blood flow in response to exercise, nutritional supplementation, and occlusion. The purposes of the present study were to examine the reliability and relative contributions of arterial cross-sectional area and time-averaged flow velocity to predict muscle blood flow as a result of fatiguing exercise in men and women. Methods: Eighteen healthy men and 18 healthy women performed 50 consecutive eccentric repetitions of the elbow flexors at 60% of their pretest eccentric peak torque at a velocity of 180° s−1. Test-retest reliability and stepwise linear regression analyses were performed to determine the ability of arterial cross-sectional area and time-averaged flow velocity to predict brachial artery muscle blood flow for the men, women, and combined sample. Results: There was no systematic test versus retest mean differences (P > 0.05) for any of the ultrasound determined variables. The two-variable regression models significantly improved the ability to predict muscle blood flow and were associated with smaller standard error of the estimates (3.7%–10.1% vs. 16.8%–37.0% of the mean baseline muscle blood flow values) compared to the one-variable models. Conclusions: The findings of the present study supported the use of ultrasound for reliable assessments of arterial diameter, arterial cross-sectional area, time-averaged flow velocity, and muscle blood flow from the brachial artery in men and women. Furthermore, time-averaged flow velocity was a more powerful predictor of muscle blood flow than arterial cross-sectional area.
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	Effectiveness of therapeutic ultrasound on clinical parameters and ultrasonographic cartilage thickness in knee osteoarthritis: A double-blind trial	p. 194
	Levent Özgönenel, Sibel Çaglar Okur, Yasemin Pekin Dogan, Nil Sayiner Çaglar DOI:10.4103/JMU.JMU_21_18   Objective: A double-blind placebo-controlled randomized study was conducted to assess the effectiveness of therapeutic ultrasound (US) in knee OA. Patients and Methods: Thirty-three patients (mean age 54.7 ± 14.7) were randomized to receive either continuous US (n = 15) or sham US (n = 18) as a placebo. Continuous ultrasonic waves with 1 MHZ frequency and 1 watt/cm2 power were applied for 5 min for 10 sessions. The primary outcome was pain on movement assessed by visual analog scale (VAS). The secondary outcomes were WOMAC scores and measurements of distal femoral cartilage thickness by imaging US. Results: Both groups showed reduced knee pain on movement following intervention. The VAS measurements improved significantly both in the treatment and the placebo group patients (P < 0.05 and P < 0.05). WOMAC scores improved statistically significant in all domains (pain, stiffness, physical function, and total score) in the treatment group (P< 0.05). All domains of WOMAC score showed statistically significant change when compared with the placebo group (P < 0.05). There was no change in the cartilage thickness measurements of medial femoral condyle, lateral femoral condyle, and intercondylar area in both groups after intervention. Conclusion: Results suggest that US is effective treatment modality in pain relief and improvement of function in patients with knee OA; however, US had no effect on cartilage repair.
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	An In vitro study of guidewire-related color doppler twinkling artifacts in echocardiography	p. 200
	Shu-Ping Wu, Yi-Jui Huang, Teng-Fu Tsao, Yeu-Sheng Tyan, Chun-Hung Su DOI:10.4103/JMU.JMU_23_18   Purpose: This study sought to determine the association between twinkling artifacts on color Doppler ultrasound and different types of guidewires. Materials and Methods: Twenty-two commonly used guidewires were classified into three groups according to decreasing diameter (Group 1, 0.035"; Group 2, 0.018"; and Group 3, 0.014") and tested in vitro. Severity of twinkling was visually graded into four categories (0–3, from weak to strong). Results: The percentages (tips/shafts) of twinkling artifacts were 100%/100% for Group 1; 0%/33.3% for Group 2; and 18.8%/31% for Group 3. The mean scores (tips/shafts) were 2.3/2.7 for Group 1; 0/0.3 for Group 2; and 0.3/0.4 for Group 3. Among them, both two guidewires with strong twinkling artifacts (score = 3) exhibited extensive rough surfaces on microscopic pictures. Conclusion: The twinkling artifacts were more likely to present in guidewires with larger diameters (from 0.014" to 0.035") in our study settings. The surface roughness may be the contribution to the twinkling artifact. Internal heterogeneities, such as types of material, types of coating, tip loading, and spring coil length, do not show influence on the twinkling artifact.
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	Correlation of subcutaneous fat measured on ultrasound with Body Mass Index	p. 205
	Baby Nadeem, Raham Bacha, Syed Amir Gilani DOI:10.4103/JMU.JMU_34_18   Background: Body mass index (BMI) is used for the assessment of obesity and overweight worldwide. When body fat is increased BMI is also increased. Ultrasound is a reliable method to assess body fat. We have selected only one suprapubic region for the assessment of fat which is very easy to measure even in routine pelvic and abdominal ultrasound examination. During our routine examination, we can measure abdominal fat and inform the patient about his/her health state regarding obesity. It was a hypothesis that increases in abdominal subcutaneous fat will increase in BMI. Objective: The objective is to correlate subcutaneous fats measured on ultrasound with BMI. Materials and Methods: It was a cross-sectional study, which was performed in Gilani ultrasound center, Lahore, Pakistan. A total of 384 participants were included with simple random sampling technique. Individuals of 16–60 years age of both genders were included in that study. Pregnant ladies, athletes, children, and elderly participants were not included in that study. Toshiba (Xario) and Mindray (Z5) ultrasound machine were used for subcutaneous fats measurement. Participants were scanned in the supine position. Subcutaneous fats were measured on the suprapubic region in three different trials. Compression was avoided. Compression artifacts were avoided by applying more quantity of gel between transducer and skin. Stadiometer was used for the measurement of weight and height. To calculate BMI, Quetelet index was used. BMI was calculated with that formula BMI = weight (kg) divided by height (m2). Results: The result was made by calculation of mean and standard deviation. We calculated Pearson correlation between BMI and subcutaneous fats measured on ultrasound at the suprapubic region. It showed a significant high correlation between BMI and subcutaneous fat (P = 0.0000 which is < 0.001). Conclusion: There is a significantly high correlation between BMI and subcutaneous fat measured on ultrasound. Ultrasound is a reliable method to assess subcutaneous fat. It can be a predictor of obesity like BMI.
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BRIEF COMMUNICATION
	Special ultrasound phantom for interventional training: Construction, advantages, and application	p. 210
	Musaad Taha Qurash, Nur Yazmin Yaacob, Nik Azuan, Yasir Sabah Khaleel, Rozman Zakaria DOI:10.4103/JMU.JMU_40_18   Interventional radiology procedures are becoming more challenging over time; thus, there is a need for excellent and reliable training methods. Training on live patients is neither safe nor an ethical solution. Alternatives are many and varied, but the most popular is ultrasound guided simulators. This report shows how a simple, homemade, low-cost phantom material, and construction modules can provide several advantages over ordinary gelatin phantoms. A new layering technique and target synthesis are described for the biopsy phantom, including tips on decreasing the needle pass artifact as well as controlling the mixture echogenicity.
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CASE REPORTS
	Timely identified early migration of peripherally inserted central catheter by focused ultrasound	p. 215
	Chang-Chih Shih, Sy-Jou Chen, Yuan-Pin Hsu DOI:10.4103/JMU.JMU_62_18   A peripherally inserted central venous catheter (PICC) has been widely applied to central venous assess. There were some known complications such as phlebitis, leakage, blockage, dislodgment, breakage, or malposition of PICC. Catheter migration was assessed by using chest radiograph or administering contrast medium. Herein, we report a 77-year-old woman presenting to emergency department with odynophagia and left neck swelling of 3 days duration. The initial impression was deep neck infection. Focused ultrasound identified a hyperechoic tube with thrombosis in left jugular vein, which indicated migration of PICC. Clinical symptoms immediately resolved after removal of PICC and anticoagulation therapy.
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	A Case of tubular adenoma of gallbladder diagnosed using contrast-enhanced ultrasonography	p. 218
	Lo-Yi Lin, Hong-Jen Chiou, Yi-Hong Chou, Hsin-Kai Wang, Yi-Chen Lai, Yun-Hui Lin DOI:10.4103/JMU.JMU_47_18   Contrast-enhanced ultrasound (CEUS) has been used to diagnose gallbladder (GB) diseases for recent years because it is sensitive to visualize vascularity. Herein, we report a case who had a 1.7 cm × 1.2 cm polypoid lesion located in the gallbladder fundus with a feeding artery located in the stalk. On CEUS, the lesion showed early arterial phase enhancement (time to peak enhancement 18 s), persisting throughout the venous and delay phases. This enhancing pattern suggested that the lesion was a GB adenoma rather than a GB carcinoma. Cholecystectomy was performed, and pathology of the tissue revealed tubular adenoma of the GB.
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LETTERS TO EDITOR
	Perineal endometriosis: A rarity	p. 222
	Reddy Ravikanth DOI:10.4103/JMU.JMU_31_18
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	Varicocele with concomitant ipsilateral intratesticular spermatocele: A rarity	p. 224
	Reddy Ravikanth DOI:10.4103/JMU.JMU_32_18
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CORRESPONDENCE
	Comment on sonographic evaluation of abdominal organs in sickle cell disease	p. 226
	Beuy Joob, Viroj Wiwanitkit DOI:10.4103/JMU.JMU_59_18
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	Reply to comment on sonographic evaluation of abdominal organs in sickle cell disease	p. 227
	Geofery Luntsi, Charles Ugwoke Eze DOI:10.4103/JMU.JMU_67_18
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IMAGING FOR RESIDENTS-ANSWER
	A female laborer with right anterior shoulder pain	p. 229
	Ronald Christopher A. Cua, Ming Yen Hsiao DOI:10.4103/JMU.JMU_37_18
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IMAGING FOR RESIDENTS - QUIZ
	A man with numbness in the hands	p. 231
	Siam Tongprasert, Montana Buntragulpoontawee DOI:10.4103/JMU.JMU_55_18
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CME TEST
	CME Test	p. 232
	DOI:10.4103/0929-6441.247294
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INDEXES
	Author Index
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	Keyword Index
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	Title Index
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