3364

Ultrasound evaluation of tibial periosteal ganglion withintraosseous componentChoi YS, Choi KH, Kim B-S, Kim DH, Chun TJ, Yang S-O, EuljiHospital, Eulji University School of Medicine, Korea

Periosteal ganglion cyst occurring within or beneath the periosteum isa rare condition and has not well recognized. It can easily be misdi-agnosed as other surface bony lesions due to suspicious periostealreaction on plain radiograph. We experienced a periosteal ganglion inthe tibia, which had cortical defect accompanied by intraosseous com-ponent in the metaphysis of distal tibia. We will demonstrate ultrasoundfindings of the periosteal ganglion with MR imaging findings, andreview the literature. Ultrasound can be used to characterize the loca-tion and cystic nature of the mass in evaluating the periosteal ganglion.

3365

Sonography of the knee after traumaRamova ELP, Poposka A, Military Hospital, Macedonia; Orthopedicclinic-Medical faculty-Skopje, Macedonia

Objectives: The knee sonography is significant method for periartic-ular structures and their changes, however, it is not significant forinternal exploration of knee structures. The aim of our study was toshow sonography like a diagnostic method in determination of patho-logical changes before following conservative treatment of soft tossestissue trauma.Methods: Thirty-six patients, male, over age 37.2 years, were withtrauma of knee and surgically treated with immobilization and drugs.They were sent for rehabilitation to our department. The sonographywas made before and after treatment, in standard way.Results: The patients after first sonography were divided in two groupsfor rehabilitation, A: physical procedures and B: physical proceduresand gymnastic. The patients after treatment and second sonographywere divided in tree groups, A: no changes, no clinical changes (45%),B: no changes, functional knee instability (33%), C: changes andclinical indication of MRI (22%).Conclusions: The knee sonography is with limitation in internalchanges of it. MRI is not indication for diagnosis, immediately aftertrauma. We can use knee sonography before and after treatment todetermine the therapy and condition.

3366

Sonographic evaluation of anterior and posterior cruciateligament rupture signs in acutely injured knees: Comparisonwith arthroscopic findingsKim DH, Kim YS, Oh HW, Koh KH, Chosun University Hospital,Korea

Objectives: To determine the accuracy of sonography and to promotethe method as an inexpensive screening method in the diagnosis ofacute rupture of the ACL/PCL in the setting of a knee trauma.Methods: Seventy-two consecutive patients (20 to 25 y) with a kneetrauma were included this study. The equipment used was a MedisonSA-9900 (Medison Co., ROK) with a 5.0–12.0 MHz linear transducer.The standard planes for assessing the ACL/PCL were transverse scanof the popliteal fossa with prone position and with relaxed knee andoblique sagittal scan of the knee parallel to ACL/PCL with supineposition. The sonographic criteria for diagnosing ACL/PCL rupturewere directly visualized rupture and indirect signs: echo-poor space atthe femoral insertion of the ACL, S-shaped course and thickening ofACL/PCL and protrusion of the posterior fibrous capsule. The con-tralateral knee was examined for comparison in all cases.

Results: Indirect sonographic criteria describe a better sensitivity (0.9)and specificity (0.8) than the direct criteria (0.7/0.6) in diagnosing acuterupture of ACL/PCL. Echo-poor space at the femoral insertion, hema-toma shows the best sonographic criterion.Conclusions: Sonography has a well documented and reasonably highsensitivity and a very high specificity for diagnosing acute lesions ofACL/PCL.

3367

Sural nerve imaging with high-resolution ultrasonographyIto T, Kijima M, Sakuta M, Nishiyama K, Department of Neurology,Kyorin University School of Medicine, Japan; Department ofNeurology, National Hospital Organization Chiba Medical Center,Japan

Objectives: To establish reference values for the sural nerve size, weanalyzed the normal sural nerve characteristics on high-resolutionultrasonography (US).Methods: Forty-four sural nerves in 22 healthy subjects were prospec-tively evaluated using high-resolution US. The transverse and antero-posterior diameters, and cross-sectional area of the nerves were used asUS parameters; and the age, height, weight and body mass index of thepatients, as body parameters. Correlation between US and body param-eters was evaluated.Results: The sural nerve appeared as an ovoid hyperechoic honeycombstructure transversely, while it appeared as a hyperechoic tubular struc-ture with parallel linear internal echoes longitudinally. The measure-ments with mean � standard deviation for transverse diameter, antero-posterior diameter and cross-sectional area were 2.4 � 0.3 mm, 1.6 �0.2 mm, and 3.0 � 0.5 mm2, respectively. There were no significantdifferences of US parameters between gender and between left andright sides (p � 0.05). Correlation between the cross-sectional area andheight was significant (r � 0.32, p � 0.03), and the cross-sectional areawas represented by the equation: cross-sectional area (mm2) � 0.19 �1.77 � height (m).Conclusions: High-resolution US is an useful imaging method forevaluating the sural nerve. The obtained reference values for the suralnerve size should be helpful in the diagnosis of the sural nerve abnor-malities.

3368

A new method for ultrasound evaluation of the iliopsoas tendoninsertionBird SJ, Benson Radiology, Australia

Sonographic evaluation of the iliopsoas insertion is difficult using thetraditional sagittal approach from the anterior aspect of the hip. Thedifficulties arise due to the depth of the tendon and the steep course tothe lesser trochanter resulting in anisotropy. Refraction artifact from theoverlying sartorius, rectus femoris and vastus medialis muscle edges,combined with the femoral neurovascular bundle further degrade theimage. I describe a new sonographic technique that overcomes thesedifficulties and produces images of excellent definition. Abduction andexternal rotation of the hip, combined with an approach angled steeplythrough the pectineus, adductor brevis and adductor longus musclebellies provides an excellent acoustic window and imaging perpendic-ular to the tendon insertion free of anisotropy.

3369

High resolution ultrasonography of carpal tunnel syndrome: Adynamic evaluationLan HH-C, Wang P-Y, Keng C-Y, Su Y-G, Lee T, Lee S-K, TaichungVeterans General Hospital, Taiwan; Yuanshan and Suao VeteransHospital, Taiwan

P252 Ultrasound in Medicine and Biology Volume 32, Number 5S, 2006

Objectives: To assess the median nerve in carpal tunnel with motion ofthe wrists and hands.Methods: Seventy wrists of 50 patients with proved carpal tunnelsyndrome were enrolled (group A). The 30 asymptomatic wrists (groupB) and 50 wrists of 25 volunteers (group C) were scanned for com-parison. Axial high resolution ultrasonography (HRUS) scanning ofwrists through the pre-tunnel, proximal tunnel and distal tunnel withwrists in neutral and extension, and fingers in rest and flexion wasperformed. The shape, cross-sectional area (CSA) and flattening ratio(FR) of median nerve were assessed. The sliding distance of mediannerve with motion of wrists and hands were recorded.Results: With wrists in neutral position and fingers in rest, the meanCSA of the median nerve were significantly enlarged in group A. Themean FR of the median nerve at proximal tunnel level was significantlyincreased in group A. With wrists in extension position and fingersflexion, the mean distance of median nerve sliding was significantlydecreased in group A and group B.Conclusions: The HRUS might be useful for the evaluation of carpaltunnel syndrome. The decrease in mobility of the median nerve in thecarpal tunnel might be a predisposing factor of carpal tunnel syndrome.

3370

High resolution ultrasonography of carpal tunnel: A dynamicevaluation of asymptomatic volunteersLan HH-C, Wang P-Y, Keng C-Y, Su Y-G, Lee T, Lee S-K, TaichungVeterans General Hospital, Taiwan; Yuanshan and Suao VeteransHospital, Taiwan

Objectives: To assess the median nerve in carpal tunnel with motion ofwrists and hands in asymptomatic volunteers.Methods: Fifty asymptomatic wrists of 25 volunteers were scannedwith high resolution ultrasonography (HRUS). Axial scanning of wriststhrough pre-tunnel, proximal tunnel and distal tunnel with wrists inneutral and extension positions, and with fingers in rest and flexion wasperformed. The shape, cross-sectional area (CSA) and flattening ratio(FR) of median nerve were assessed. The sliding distance of mediannerve with wrists and hands were recorded.Results: With wrists in neutral position and fingers in rest, the meanCSA of the median nerve at pre-tunnel, proximal tunnel and distaltunnel levels were 8.7 � 1.2 mm2, 8.0 � 1.1 mm2 and 7.4� 1.4 mm2,respectively. The mean FR of median nerve at proximal tunnel levelwas 2.8 � 0.3 mm. With wrists in extension position and the fingers inflexion, the median nerve slipped laterally. The mean sliding distancewas 2.8 � 1.1 mm. In eight wrists, the nerves slipped laterodorsally andbecome round. In seven wrists, the nerves slipped a shorter distanceand were compressed by the tendons in the tunnel.Conclusions: The HRUS might be useful for evaluation of morphologyand mobility changes of median nerve in the carpal tunnel.

3371

High-resolution sonography of the wrist and hand: Pictorialreview of ultrasonic anatomy and pathologyChoi YS, Adler RS, Sofka CM, Choi KH, Park SW, An JK, Kim SH,Woo JJ, Kim H-S, Han CY, Eulji Hospital, Eulji University Schoolof Medicine, Korea; Hospital For Special Surgery, Weill MedicalCollege of Cornell University, United States of America

The purpose of this essay is to demonstrate the ultrasonic anatomy andpathology of the wrist and hand. The development of high-resolutiontransducer has allowed the assessment of superficial structures. Itbecomes possible to evaluate tendon, ligament, pulley, soft tissuetumor, triangular fibrocartilage complex, compressive neuropathy andarthritis in the wrist and hand. We believe high-resolution ultrasonog-raphy may be helpful to establish the accurate diagnosis in the normal

and diseased wrist and hand, and will be considered as one of thefirst-line imaging modalities, performing after plain radiography.

3372

Interscapular area muscle thickness measurement byultrasonographyTsai W-C, Yang S-HC, Chen H-C, Chang Gung Memorial Hospital,Taiwan; Buddist Tzu Chi General Hospital, Taiwan

Objectives: To measure the interscapular area thickness near themedial border of scapula including skin, fat and muscle (trapezius,rhomboid and serratus posterior muscles) thickness and to determinethe correlation between the total thickness with the anthropometricindices.Methods: High-resolution (12 MHz) linear assay ultrasound was usedto measure the skin, fat and muscle thickness near the medial border ofscapula of 21 male volunteers (aged 18 to 34 years old).Results: The thickness of skin, fat, trapezius muscle, rhomboid muscleand serratus posterior muscle are 1.80 plusmn; .33, 4.00 plusmn; .40,5.04 plusmn; .08, 5.81 plusmn; .29 and 3.74 plusmn; .45 mm, respec-tively. Total thickness of the interscapular area was 20.39 plusmn; 4.39mm. No difference was found between dominant and nondominantsides. Correlations between the total thickness and the anthropometricindices including body weight, body mass index, chest circumference,waist circumference and hip circumference were statistically significant(p � 0.05).Conclusions: Ultrasonography is a useful tool to measure musclethickness. The results could provide a reference to the physician whileperforming needle electromyography examination, acupuncture or lo-cal injection therapy to the interscapular area.

3373

Diagnostic value of high-resolution ultrasonography for imagingof the knee, elbow and wrist joints in rheumatoid arthritisXiao Y, Zhang G, Zuo X, Xiangya Hospital of Central SouthUniversity, China; Department of Internal Medicine, XiangyaHospital, Central South University, China; Department of InternalMedicine, Xiangya hospital, Central South University, China

Objectives: In order to value high resolution ultrasound (HRUS)including two-dimensional ultrasound (2D), color Doppler (CDFI),power Doppler (PDI), and spectrum Doppler (SD), n early diagnosis ofrheumatoid arthritis (RA).Methods: Two hundred forty joints, including knee, elbow and wrist ofthe patients with RA and 120 joints of control persons were checked byGE LogiQ-9 unit with 10.0 MHz transducer. The joints were firstscanned in 2D. Then the blood flow signals were observed with CDFI,PDI and SD.Results: By 2D hydrarthrodial effusion was found in 191 joint spaces(79.50%), and synovial thickening in 174 joints (72.50%) in RApatients. PDI and CDFI identified vascularization as blood signal withspot, cudgel or streak and pannus formation in 165 joints (68.75%). Theflow profile of the arteries measured with SD showed low resistanceindex.Conclusions: HRUS can clearly depict hydrarthrodial effusion, syno-vial thickening and vascularization in RA patients and is a sensitivemethod for early diagnosis of RA.

3374

Preliminary experience of musculoskeletal ultrasound in atertiary rheumatology centerCheng YK, Kong KO, Tan Tock Seng Hospital, Singapore

Abstracts P253