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Shen Y, Wang R, Zhao C, Liu L, Sun D, Chen X. Investigations on ultrasonography in the diagnosis of nodular localized cutaneous neurofibroma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:359-367. [PMID: 38264918 DOI: 10.1002/jcu.23639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To describe the ultrasound characteristics of nodular localized cutaneous neurofibroma (NLCN). MATERIALS AND METHODS Clinical features and ultrasound characteristics of 43 lesions of 40 patients pathologically proven as NLCNs at Peking University Shenzhen Hospital from October 2014 to May 2022 were analyzed retrospectively. The location, length-to-thickness (L/T) ratio, thickness-to-width (T/W) ratio, shape, margin, capsule, echogenicity, echotexture, posterior features, vascularity, and "rat tail sign" were evaluated. RESULTS All ultrasound findings showed almost perfect agreement. More than a half of NLCNs (n = 24, 55.8%, p < 0.001) were located in the subcutaneous fat layer wholly with well-demarcation from dermis and deep fascia. Most of the NLCNs were fusiform shape (n = 27, 62.8%, p < 0.001) in the long axis and oval shape (n = 35, 81.4%, p < 0.001) in the short axis. The other ultrasound findings of NLCNs included well-defined (n = 42, 97.7%, p < 0.001), encapsulated (n = 39, 90.7%, p < 0.001), predominately hypoechoic (n = 34, 79.1%, p < 0.001), homogeneous (n = 39, 90.7%, p < 0.001), posterior enhancement (n = 29, 67.4%, p = 0.033), and avascularity (n = 37, 86.0%, p < 0.001). Only a quarter (n = 11, 25.6%, p = 0.002) of lesions were recognized with the "rat tail sign." CONCLUSION NLCNs present as fusiform shape in long axis and round shape in short axis. The common ultrasound findings of NLCNs are well-defined, encapsulated, predominately hypoechoic, homogeneous lesion with posterior enhancement, and poor blood supply. The "rat tail sign" has low sensitivity in NLCNs.
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Affiliation(s)
- Yuzhou Shen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Run Wang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Chenyang Zhao
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Li Liu
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Desheng Sun
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiangmei Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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Flores DV, Murray T, Jacobson JA. Diagnostic and Interventional US of the Wrist and Hand: Quadrant-based Approach. Radiographics 2023; 43:e230046. [PMID: 37498783 DOI: 10.1148/rg.230046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Diagnostic and interventional US of the wrist and hand can be challenging due to the small size and superficial location of structures and various disorders that need to be considered. A quadrant-based approach (volar, ulnar, dorsal, and radial) provides a rational method for performing a focused examination and joint positioning during both diagnostic imaging and intervention. Volar wrist disorders primarily involve the median nerve and the digital flexor system comprised of the flexor tendons and pulleys. The ulnar nerve and extensor carpi ulnaris tendon are chiefly responsible for ulnar-sided wrist pain. The differential diagnosis for dorsal-sided symptoms typically involves the extensor tendon compartments and includes distal intersection syndrome, extensor pollicis longus tear, and digital extensor apparatus injury. The soft-tissue ganglion is the most common abnormality in the dorsal wrist, typically associated with wrist ligaments or joint capsule. Radial-sided pain may be secondary to de Quervain tenosynovitis and must be differentiated from the more proximal intersection syndrome. US is an important tool for assessing the ulnar collateral ligament of the first metacarpophalangeal joint of the thumb and differentiating between displaced and nondisplaced tears, thereby influencing management. Despite the complexity of the anatomy and potential pathologic features within the wrist, a focused quadrant-based examination can permit the sonologist to focus on the structures of relevance. In conjunction with a systematic approach, this can aid in precise and efficient diagnostic scanning and intervention of the wrist and hand. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Timothy Murray
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Jon A Jacobson
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
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Moellhoff N, Throner V, Frank K, Benne A, Adelmann S, Coenen M, Giunta RE, Haas-Lützenberger E. Visualization of the location and level of pain in common wrist pathologies using color-coded heatmaps. Arch Orthop Trauma Surg 2023; 143:1095-1102. [PMID: 35666312 PMCID: PMC9925519 DOI: 10.1007/s00402-022-04479-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/12/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Pain of the hand and wrist affects a large patient population. If the onset is unrelated to recent trauma, the first medical contact is rarely established with a specialized hand surgeon. OBJECTIVE The objective of this investigation was to (1) visualize the localization of hand pain using pain-related heatmaps in common wrist pathologies, (2) to test whether differences between these pathologies exist with regard to sociodemographic and pain-related aspects, and (3) to evaluate the major patient-reported complaints associated with the pathologies. METHODS This observational cross-sectional study included patients suffering from: thumb basal joint arthritis (CMC-1-OA), dorsal wrist ganglions, and TFCC tears. Patients marked the location of maximum pain projection on hand graphics depicting the outline of the palmar and dorsal hand. Color-graded frequency heat maps were generated for the wrist pathologies investigated. Daily life impairments were assessed and clustered into groups of functions/activities. RESULTS 120 patients with a mean age of 44.3 years were investigated. The diagnostic groups showed significant differences regarding the level and location of pain, as well as daily life impairments. Patients with CMC-1-OA presented with increased pain levels compared to patients with dorsal wrist ganglions and TFCC tears. Daily life impairment was rated highest when household chores were adversely affected, and sport activities were symptomatic/painful. All groups showed significant skin surface pain projection, which was visualized in heatmaps. While general trends in pain localization were visible, pain levels were also reported distal/proximal and palmar/dorsal to the pathology. CONCLUSIONS Knowledge of main demographic parameters, pain projection, and degree of impairment in daily activities can help physicians to narrow differential diagnosis of wrist pain during first patient contact. Patients should then be referred to hand surgeons for specialist examination, to further differentiate the origin of the pain.
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Affiliation(s)
- Nicholas Moellhoff
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Veronika Throner
- grid.5252.00000 0004 1936 973XDepartment of Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, LMU Munich, Munich, Germany ,Pettenkofer School of Public Health, Munich, Germany
| | - Konstantin Frank
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Ashley Benne
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Sonja Adelmann
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Michaela Coenen
- grid.5252.00000 0004 1936 973XDepartment of Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, LMU Munich, Munich, Germany ,Pettenkofer School of Public Health, Munich, Germany
| | - Riccardo E. Giunta
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Elisabeth Haas-Lützenberger
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany.
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Jacobson JA, Middleton WD, Allison SJ, Dahiya N, Lee KS, Levine BD, Lucas DR, Murphey MD, Nazarian LN, Siegel GW, Wagner JM. Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2022; 304:18-30. [PMID: 35412355 DOI: 10.1148/radiol.211101] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Society of Radiologists in Ultrasound convened a panel of specialists from radiology, orthopedic surgery, and pathology to arrive at a consensus regarding the management of superficial soft-tissue masses imaged with US. The recommendations in this statement are based on analysis of current literature and common practice strategies. This statement reviews and illustrates the US features of common superficial soft-tissue lesions that may manifest as a soft-tissue mass and suggests guidelines for subsequent management.
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Affiliation(s)
- Jon A Jacobson
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - William D Middleton
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Sandra J Allison
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Nirvikar Dahiya
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Kenneth S Lee
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Benjamin D Levine
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - David R Lucas
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Mark D Murphey
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Levon N Nazarian
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Geoffrey W Siegel
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Jason M Wagner
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
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