Scientific Exhibits Abdomen SE 001 interval for surveillance longer than 6 month may not be effective in the detection of resectable cases. Blood test for tumor markers and LFT are not sensitive for the detection of early CCAs. Surveillance of Cholangiocarcinoma (CCA) in a High Prevalent Area: the Initial Experience Surachate Siripongsakun, Prakongboon Sangkasuban, Terapat Engtrakool, Sirachat Vidhyarkorn, Nisakorn Kijsawad Department of Radiology, Chulabhorn Hospital, Thailand Image-Guided Microwave Ablation with New Generation Equipment in Liver Tumors: Results of a Single Centre Prospective Study Maria Franca Meloni1, Anita Andreano1, Giovanni Turtulici2, Simone Schiaffino2, Maria Proiti3, Alberto Frosi4 1 Department of Radiology, Ospedale Valduce Como, Italy 2 Department of Radiology, Ospedale Evangelico Internazionale Genova, Italy 3 Department of Internal Medicine, Policlinico Vittorio Emanuele Catania, Italy 4 Department of Radiology, IRCCS Multimedica SS.Giovanni, Italy PURPOSE: To prospectively evaluate local tumor control rates and incidence of complications in a consecutively enrolled cohort of patients with liver tumors treated with microwave ablation after a median follow-up of 13 months. MATERIALS AND METHODS: Fifty-four patients (median age 73 yr) were prospectively enrolled to undergo percutaneous MW ablation of liver tumors between March 2009 and November 2011, using a 2.45 GHz device with a 14-gauge antenna. Thirty-six patients had HCC and 18 had liver metastasis. The total number of treated tumors was 60. Patients underwent CEUS and contrast-enhanced CT before, the day after, and one month after treatment and every 4 months thereafter. Pre-ablation mean tumor size at contrast CT was 24В±11 mm. RESULTS: Forty-five tumors (75%) required a single insertion, 11 tumors 2 insertions and 4 tumors 3 insertions. Maximum and minimum diameters of the obtained necrosis assessed the day after treatment, were 47В± 12 mm and 37В±8 mm at CEUS and 48В±12 and 38В±9 cm at CECT, respectively. In 59/60 lesions the treatment was judged to be complete by both CEUS and CT at 24-hours. Two years local recurrence rate per lesion was 19%. The differ- 237 Scientific Exhibits PURPOSE: High incidence rates of cholangiocarcinoma (CCA) have been reported in Eastern Asia, especially in Thailand which reported to have extremely high incidence rates. Early detection may help identify early cases so that curative surgical treatment can be performed and eventually improve survival of the patients. Aim of the study is to develop an effective surveillance program for early CCA detection in a high endemic area of CCA as well as to identify potential information which helps triage the person at risk for CCA. MATERIALS AND METHODS: A 5-year planned prospective cohort study have been started for 2 years in Banluang district, Northern Thailand, included every Thai individuals in the district who aged 30-60 years and have a legitimate record of residence. Clinical interview for common CCA risk factor, liver function test (LFT), tumor markers, stool examination, and ultrasonography every 6 months were performed. Demographic data, follow up rate and annual incidence are recorded. Common risk factors and imaging findings of patients who developed CCA were analyzed. RESULTS: During the first 2 years, there were 4,161 participants included with follow up rates for range 95-97%. Twenty-two CCA were detected (8, 5, 4, 5 patients in each phase, respectively), accounting for 14 intrahepatic, 4 hilar, and 4 extrahepatic CCAs. Eighteen cases were resectable and 4 cases were unresectable. None of CCAs are aged less than 40 years and has a trend of increase incidence by age. Tumor markers and LFT failed to depict some of early CCAs. CONCLUSION: Surveillance of CCA using US helps finding early resectable CCAs and surveillance starting from age 40 seems to be cost effective. The SE 002 KSUM Open 2014 ence between pre and post-ablation mean diameter at CT (ablation margin) was at least 0.5 cm for HCC and 1 cm for metastases. We didnвЂ™t see any significant difference in recurrence for HCC vs. metastasis. There were two major complications (3%). One patient died because of bowel perforation; another patient experienced bleeding from an intercostal artery, requiring surgery. We also experienced three asymptomatic thromboses of intrahepatic venous branches and a biloma requiring no treatment (minor complications, 6%). CONCLUSION: Microwave ablation showed good local control rates both for HCC and metastasis, short ablation times, a low number of required insertions per tumor and a good safety profile. SE 003 10.9), diffuse enlargement 11 (61.1В±11.8), focal enlargement 2 (12.1В±7.9). Pancreas contour: clearly visible 12 (66.7В±11.4, p<0.05). Pancreatic structure: homogeneous 1 (5.6В±5.6), inhomogeneous 17 (94.4 В±5.6, p<0.001). Loculated fluid collection in peripancreatic space was found 11 (61.1В±11.8, p<0.05). Necrotizing type (n=15): normal in size 1 (6.6В±6.6), diffuse enlargement 10 (66.7В±12.6, p<0.05), focal enlargement 4 (16.7В±11.8). Pancreatic contour: clearly visible 2 (13.3 В± 9.1), not clearly visible 13 (86.7В±9.1, p<0.001), structure: homogeneous 3 (20.0В±10.7), inhomogeneous 12 (80.0В±10.7). Loculated fluid collection in peri-pancreatic space was found 9 (60.0 В± 13.1, p<0.05). CONCLUSION: The ultrasound examination plays crucial role in the diagnosis and evaluation the all form of acute pancreatitis, also very helpful for therapeutic selection. Ultrasonographic Assessment of Acute Pancreatitis Buyanjargal Burenjargal1, Badamsed Tserendorj2, Jargalsaikhan Sodnombaljir2, Bayarjargal Nanzad1, Aryasuren Zuunai3, Munkhbaatar Dagvasumberel1 1 Department of Radiology, Health Sciences University of Mongolia, Mongolia 2 Department of Radiology, State Third Central Hospital, Mongolia 3 Department of Radiology, State Second General Hospital, Mongolia PURPOSE: To evaluate specific ultrasound findings of acute pancreatitis. MATERIALS AND METHODS: This study was conducted at State Third Central Hospital in Mongolia from July, 2012 to September, 2013. This study consisted of 81 cases of acute pancreatitis was evaluated by ultrasonography. All our cases was proven by CT, MRI, surgery and biopsy. RESULTS: We have studied 81 patients by ultrasonography. Edematous type (n=48): normal in size 9 (18.75В±5.6), diffuse enlargement 26 (54.17В±7.2), focal enlargement 13 (27.08В±6.4). Pancreas contour: clearly visible 34 (70.83В±6.5, p<0.001), structure: homogeneous 20 (41.67В±7.1), inhomogeneous 28 (58.33В±7.1). Loculated fluid collection in peripancreatic space was found 9 (18.75В±5.6, p<0.001). Hemorrhagic type (n=18): normal in size 5 (27.8В± 238 SE 004 Accuracy of Ultrasound in Diagnosis of Groin Hernia Ka Lok Lee, James Griffith, Wing Hung Ng Department of Radiology, Prince of Wales Hospital, Hong Kong OBJECTIVE: To evaluate the accuracy of ultrasound in diagnosing presence and type of groin hernia. MATERIALS AND METHODS: 172 ultrasound examinations in 151 patients (101 men : 50 women ; mean age : 59 years, range 20 - 89 years), who underwent ultrasound for suspected groin hernia were studied. The presence and type of groin hernia was determined by ultrasound. A total of 119 groin hernias were diagnosed on ultrasound and 107 (90%) of these 119 hernias had surgery. Ultrasound positive cases who did not undergo surgery (n=12) and all ultrasound negative cases (n= 53) underwent either pelvic MRI or CT. The sensitivity, specificity and accuracy of diagnosing the presence of a groin hernia (using operative, MRI or CT findings as a reference) and differentiating the type of groin hernia (using operative findings as a reference) was determined. To investigate the change in ultrasound accuracy with time, sensitivity/specificity and accuracy The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits of ultrasound was compared from January 2002December 2010 (n=54 groins) to January 2011December 2012 (n=118 groins). RESULTS: The overall sensitivity and specificity of diagnosing the presence of groin hernia was 95% and 96% respectively With greater experience, the sensitivity and specificity of hernia improved from 92% and 88% prior to 2011 to 98% and 100% after 2011. Similarly, the accuracy regarding the type of hernia improved from 90% to 97% over this time period. CONCLUSION: Ultrasound is highly accurate at diagnosing the presence and type of groin hernia. This accuracy improves with greater experience. SE 005 The Role of Ultrasonography in the Diagnosis of Acute Phase of Chronic Pancreatitis Bayarjargal Nanzad1, Badamsed Tserendorj2, Jargalsaikhan Sodnombaljir2, Buyanjargal Burenjargal1, Munkhbaatar Dagvasumberel1 1 Department of Radiology, Health Sciences University of Mongolia, Mongolia 2 Department of Radiology, State Third Central Hospital, Mongolia SE 006 Sonographic Appearance of Ascaris and Typical Serpentine Movement Musarrat Hasan Department of Radiology, Thomas Jefferson University Philadelphia PA USA, Pakistan PURPOSE: The aim of this study was to share the experience of serpentine movement of ascaris at different places in the abdomen. MATERIALS AND METHODS: Ascaris worm is very common in Pakistan especially in children and infects the human bowels. In our experiences, we have seen ascaris in bowels, Stomach, CBD, intrahepatic duct and gallbladder on ultrasonography. Some of these ascaris were alive, and they had typical serpentine movement. We recorded these cases on our video which will be shown during the presentation. The patient had various signs and symptoms ranging from acute intestinal obstruction, intermittent jaundice, right hypochondrium discomfort, mimicking to acute appendicitis. RESULTS: We saw ascaris in bowel, stomach, CBD, intrahepatic ducts, and gallbladder, and recorded their serpentine movement on video tape. CONCLUSION: This paper will highlight the sonographic features and will show on video the typical 239 Scientific Exhibits PURPOSE: To estimate ultrasonography features in acute phase of chronic pancreatitis. MATERIALS AND METHODS: We made the study for this study and 66 patients with acute phase of chronic pancreatitis were investigated from July, 2012 to September, 2013. All our causes was proven by CT, MRI, surgery and biopsy. RESULT AND DISCUSSION: This study consisted of 66 patients with acute phase of chronic pancreatitis. We estimated size of pancreas, contour visibility of pancreas, structure of pancreas, pseudocyst, dilatation of main pancreatic duct and extra-pancreatic manifestations and intra-pancreatic manifestations calcification. Size of pancreas was normal 8 (12.1В±4.0), diffuse enlargement pancreas were in 17 (25.8В±5.4), diffusely got smaller in 26 (39.4В±6.0), focal enlargement in 11 (16.7В±4.6), focally got smaller in 4 (6.1В±2.9), pancreas structure were homogeneous in 18 (27.3В±5.5), pancreas structure were inhomogeneous in 48 (72.7В±5.5), pancreas contour: clearly visible in 15 (22.7В±5.2), not clearly visible in 51 (77.3В±5.2), calcification of pancreas detected in 9 (13.6В±4.2), calcification of parenchyma were in 7 (77.8В±14.7), calcification of pancreatic duct in 2 (22.2В±14.7), calcification not detected in 57 (86.4В±4.2), main pancreatic duct dilatation in 19 (28.8В±5.6), ductal not dilatation in 47 (71.2В±5.6). CONCLUSION: This study showed acute phase of chronic pancreatitis were diffuse enlargement of pancreas was in 25.8%, diffuse got smaller was in 39.4%, pancreas structure inhomogeneous was in 72.7%, pancreas contour not clearly was in 77.3%, pancreatic endocrine symptoms characterized predominantly established STD (p<0.001). Knowledge of the ultrasonographic features of chronic pancreatitis will be helpful for differential diagnosis. KSUM Open 2014 serpentine movement. SE 008 SE 007 Role of Color Doppler Study in Living Donor Liver Transplant: Experience of First Two Successful Liver Transplants in Bangladesh The Clinical Disparity of Gallstone Disease in a Chinese Occupational Population in Taipei, Taiwan Wei-Hsiu Chiu1, Jui Wang2, Tao-Hsin Tung2, Shuo-Hui Hung1, Ran-Chou Chen1 1 Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan 2 Faculty of Public Health, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan PURPOSE: The authors sought to explore the disparity of gallstone disease (GSD) in a Chinese occupational population in Taipei, Taiwan. MATERIALS AND METHODS: The study participants were conducted with a total of 8,352 (5,243 males and 3,109 females) healthy elderly subjects voluntarily admitted to a teaching hospital for a physical check-up in 2009. Blood samples and realtime ultrasound-proved sonography results were collected. RESULTS: The results showed that the prevalence of GSD was 3.89% and revealed a statistically significant increase with increasing population age. The prevalence of GSD for females proves to be no substantially greater than it is for males (respectively, 3.99% vs. 3.83%, p-value for c2 test=0.72). Using multiple logistic regression analysis, age (OR=1.06, 95% CI: 1.05-1.07) and the presence of obesity (пїЅ27 vs. 2, OR=1.70, 95% CI: 1.12-2.34) appeared to be statistically significantly related to a GSD. For subjects with normal BMI, nonalcoholic fatty liver disease (NAFLD, OR=1.47, 95% CI: 1.01-2.14) was significantly related to GSD. The condition was not significantly related to GSD in overweight or obesity. CONCLUSION: Occupational populations are symptomatic GSD should be considered with older age, higher BMI, and NAFLD. 240 Nasreen Sultana, Raihan Hussain, Mohitul Alam, Haider Ali Khan, Mohammad Ali Department of Nuclear Medicine, 1. National Institute of Nuclear Medicine and Allied Sciences, BAEC, Bangladesh BACKGROUND: Living donor liver transplantation (LDLT) is the most effective treatment for various end-stage liver diseases. Imaging is an important part of the pre-liver transplantation and identification of post surgical complications. Bangladesh is incorporated as one of the Liver transplanting country of the world. BIRDEM, Dhaka has the pioneered the application of LDLT to patients using right lobe grafts. MATERIALS AND METHODS: With all aseptic precaution, intra-operative Color Doppler ultrasound is done to detect abnormal hepatic hemodynaemics, allowing early intervention to ensure better patient outcome. Grey scale Ultrasound and Color Doppler Ultrasound (CDUS) are also the most important tools in the follow-up of liver transplant patients because they show high sensitivity and specificity in detecting vascular complications. During transplantation, CDUS usually performed twice a day during first week, and once a week in the following two month, and is the key in the suspicion or identification of vascular complications. RESULTS: Two successful liver transplants have done and evaluations by color Doppler US of transplantations also successfully performed in intraoperatively and post-operatively. Higher mean blood flow velocity with successive thick serrated wave was seen in portal vein (range 30-50 cm/sec). Hepatic artery blood flow with peak speed was 4085 cm/sec and resistive index = .50 to .70. Neither thrombus nor any turbulence is seen in hepatic artery and portal vein in both of these cases. CONCLUSION: Color Doppler USG is the most important tools in the follow-up of LT patients intraoperatively and post operatively, because they show high sensitivity and specificity in detecting vascular complications. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits SE 009 Accuracy of Ultrasound to Identify Liver Cirrhosis in End Stage Tsevelmaa Dorj1, Munkh-Od Enkhjargal1, Vaanchigsuren Seesregdorj1, Badamsed Tserendorj2 1 Department of Radiology, Health Sciences University of Mongolia, Mongolia 2 Department of Radiology, 3rd Central Clinical Hospital of Mongolia, Mongolia AIM: To identify and assess studies reporting the diagnostic performance of ultrasound imaging for identifying liver cirrhosis in the last stage. METHODS: A search was performed to identify studies investigating the diagnostic accuracy of ultrasound imaging for liver cirrhosis in the last stage. Diagnostic accuracy was determined for a range of ultrasound techniques across all studies. There were 48 reports of diagnostic accuracy. RESULTS: Majority of patients 34 (71.4%) presented with decreased liver size, liver echogenicity was abnormal in 27 (57.1%), 40 (85.7%) presented with an enlarged spleen, Portal vein was dilated in 39 (80.9%) and ascites was in 43 (90.5%). CONCLUSION: We observed enlarged spleen, shrunken liver, and portal hypertension and ascites in the patients with liver cirrhosis in end stage. SE 010 Computer-aided Classification of Liver Tumors in 3D Ultrasound Images with Combined Active Contour Model Segmentation and Support Vector Machine Myungeun Lee, Jong Hyo Kim Department of Radiology, Seoul National University Hospital, Korea SE 011 Evaluation of the Accuracy of Abdominal Ultrasound Focusing on the Missed Lesions Based on the Abdominal Computed Tomography in Health Screening Noh Hyuck Park, Yong Suk Jang Department of Radiology, Myongji Hospital, Korea PURPOSE: To evaluate the accuracy of abdominal ultrasonography (US), and the incidence, size and types of lesions, easily missed on abdominal US in health screening. MATERIALS AND METHODS: We retrospectively enrolled 311 physical checkup patients (male-tofemale ratio, 156: 155; mean age, 53.1 years), who underwent screening abdominal US and abdominal computed tomography (CT) on same day from July, 2011 to October, 2013. Per-organ and per-lesion analyses and verification of size and location of renal and hepatic lesions which were frequently missed on abdominal US were performed. RESULTS: Overall, 209 additional lesions were found on abdominal CT in 140 physical checkup patients and the missing rate of the lesion was 45%. Renal lesions were most common (105 lesions), followed by hepatic lesions (91 lesions). In renal and hepatic lesions which were missed on abdominal US, most (93.4%, 93.5%) lesions were less than 1.5 cm in longitudinal diameter. Most of missed renal lesions were located in mid portion of left kidney (24.7%). Most of the missed hepatic lesions on US were located in the hepatic dome (segment 7, 8, 2) (66%). CONCLUSION: An awareness of the prevalence 241 Scientific Exhibits In this study, we propose a computer-aided classification scheme of liver tumor in 3D ultrasound by using a combination of deformable model segmentation and support vector machine. For segmentation of tumors in 3D ultrasound images, a novel segmentation model was used which combined edge, region, and contour smoothness energies. Then four features were extracted from the segmented tumor including tumor edge, roundness, contrast, and internal texture. We used a support vector machine for the classification of features. The performance of the developed method was evaluated with a dataset of 79 cases including 20 cysts, 20 hemangiomas, and 39 hepatocellular carcinomas, as determined by the radiologistвЂ™s visual scoring. Evaluation of the results showed that our proposed method produced tumor boundaries that were equal to or better than acceptable in 89.8% of cases, and achieved 93.7% accuracy in classification of cyst and hemangioma. KSUM Open 2014 and location of easily missed lesions on screening abdominal US is helpful to enhance diagnostic performance of abdominal US in physical checkup patients. SE 012 Abdominal Wall Lesions Presenting as Palpable Mass: Identified on Ultrasonography Sung Eun Ahn, Seong Jin Park, Soung Kyung Moon, Joo Won Lim, Dong Ho Lee Department of Radiology, Kyung Hee University Medical Center, Korea PURPOSE: The purpose of this presentation is to review the sonographic appearances of different abdominal wall lesions presenting as palpable mass. MATERIALS AND METHODS: Patients were scanned with high-frequency (5- to 12- MHz) linear transducers. Color Doppler US were recorded often to show the vascularity of the mass. US findings of different abdominal wall lesions were correlated with comparative studies of CT and MRI. RESULTS: The ultrasonographic and clinical differential diagnosis of abdominal wall lesions presenting palpable mass include hernias, localized fluid collections in the abdominal wall (seromas, hematomas, abscesses), inflammation (actinomycosis, inflammatory myofibroblastic tumor), tumors (desmoid tumor, lymphoma), vascular lesions or metastatic masses. CONCLUSION: US is a useful imaging modality in detection of various abdominal wall pathology. Hernias and localized fluid collections in the abdominal wall (hematomas, abscesses) can be well visualized. Infrequently tumors (desmoid tumor, lymphoma) and metastasis can be identified in the abdominal wall. 242 SE 013 Measurement of Hepatic Vascular Arrival Times at Immediate Post-Transplantation Period Using Contrast Enhanced Ultrasonography Ji Hye Min, Woo Kyoung Jeong, Won Jae Lee Department of Radiology, Samsung Medical Center, Korea PURPOSE: To explore a median values of hepatic vascular [hepatic arterial (HA), portal venous (PV), and hepatic venous (HV)] arrival times (HVATs) at the first post-operative day in the patients with following liver transplantation and to investigate the clinical implication of HVATs for estimation of the presence of vascular complication of transplanted liver. MATERIALS AND METHODS: We explored 35 consecutive patients (M:F=32:3; mean age, 52.6 years) who underwent liver transplantation from March to July 2013. Contrast enhanced ultrasonography was performed at the first postoperative day to estimate the vascular complication of liver transplantation using Sonovue and a video clip of contrast US imaging per patient was recorded. For investigation of arrival time, two radiologists reviewed the video clips without information about the patients, and explored the time at which microbubbles reached to hepatic artery, portal vein and hepatic vein. RESULTS: Median hepatic arrival times of the patients without vascular complication were as followings: HA, 11 seconds; PV, 13 seconds; and HV, 17 seconds. Median differences between arrival times were as followings: PV-HA, 2 seconds; HV-PV, 4 seconds; and HV-HA, 6 seconds. In a patient with markedly decreased portal inflow due to a large portocaval shunt, PV-HA was slightly prolonged, and a patient who underwent angioplasty for HV stenosis showed that both PV-HA and HV-HA were prolonged. A patient with hepatic arterial thrombosis showed that PV inflow was detected firstly because HA inflow was not present. CONCLUSION: Median values of HVATs were consistent in the patients without hepatic vascular complications. HVATs may be useful parameters for estimation of the presence of vascular complication fol- The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits lowing liver transplantation. SE 014 Percutaneous Ultrasonography-Guided Radiofrequency Ablation of Hepatocellular Carcinomas: Usefulness of Image Fusion with Three-Dimensional Ultrasonography Hyun Jeong Park1, Min Woo Lee2, Hyunchul Rhim2, Dong Ik Cha2, Sanghyeok Lim2, Tae Wook Kang2, Hyo K Lim2, Kyoung Doo Song2 1 Department of Radiology, Chung-ang University Hospital, Korea 2 Department of Radiology, Samsung Medical Center, Korea SE 015 Doppler Ultrasound in Cirrhosis and Portal Hypertension: Beyond Flow Reversal Joon-Il Choi1, Chandana Lall2, Puneet Bhargava3, Mohammad Helmy2, Sadhna Verma4, Penny Roumanis2, Laura Findeiss2, David Imagawa5 1 Department of Radiology, The Catholic University of Korea, Seoul St. MaryвЂ™s Hospital, Korea 2 Department of Radiology, University of California, Irvine, USA 3 Department of Radiology, University of Washington, USA 4 Department of Radiology, University of Cincinnati, USA 5 Department of Surgery-Hepatobiliary, University of California, Irvine, USA Portal hypertension is one of the common complications of the patients with liver cirrhosis. The objectives of this presentation are 1) understanding nuance of portal venous flow in cirrhosis and portal hypertension, 2) reviewing atypical hepatic venous and hepatic arterial flow patterns in cirrhosis and portal hypertension, 3) understanding the findings implicating portal vein thrombosis and differentiating bland thrombus from neoplastic ones, 4) reviewing the location of TIPS shunts, cavernous transformation, portal varices and the locations of porto-systemic collaterals: implications in surgical planning prior to liver transplantation. Content organization of this presentation includes variant portal venous flow patterns including reversal, turbulence, helical pattern, stasis and shunting. Also, states of hepatic arterial flow in cirrhosis, and changes of splenic artery, portal vein aneurysms and issues related to transplantation will be included in this presentation. 243 Scientific Exhibits PURPOSE: To evaluate the usefulness of fusion imaging with real-time ultrasonography (US) and 3dimensional (3D) US for the guidance of radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs) with 2-5 cm in diameter. MATERIALS AND METHODS: This study was conducted as a retrospective cohort study. This study was approved by the institutional review board and informed consent was waived. Percutaneous RFA was performed for HCCs with 25 cm in diameter. Targeting was performed under conventional fusion imaging guidance whereas monitoring and controlling under fusion with 3D US guidance. Technical success, technique effectiveness, major complication and local tumor progression rate were evaluated. According to tumor size (small: < 3 cm vs. medium: 3-5 cm), roundness indexes of ablation zone and local tumor progression rate were compared. RESULTS: There were 29 small-sized HCCs (2.5 В± 0.3 cm) and 17 medium-sized HCCs (3.4 В± 0.5 cm). All RFA procedures were performed in a single RFA session. Both technical success and technique effectiveness rate were 100%. Hepatic abscess (n=1) occurred in a patient with medium-sized HCC as a major complication. Local tumor progression rate was 8.7% (4/46) with mean follow-up of 18.2 months. All roundness indexes of ablation zone were not significantly different between the small- and medium-sized HCCs. Local tumor progression rate was also not significantly different between the two groups [3.4% (1/29) vs. 17.6% (3/17), (P=0.135)]. CONCLUSION: Image fusion with real-time US and 3D US is useful for guidance of percutaneous RFA of HCCs with 2-5 cm in diameter. KSUM Open 2014 SE 016 SE 017 Gastrointestinal Wall Lesions : Identified on Routine Transabdominal Ultrasonography Normal Right Hemidiaphragmatic Motion Measured with M-Mode Ultrasonography in a Large Healthy Population Han Na Lee1, Sung Eun Ahn1, Sung Kyoung Moon1, Hyun Cheol Kim2, Seong Jin Park1, Dong Ho Lee1 1 Department of Radiology, Kyung Hee University Medical Center, Korea 2 Department of Radiology, Kyung Hee University Hospital at Gangdong, Korea PURPOSE: The purpose of this presentation is to review the sonographic appearances of GI wall lesions and its differential diagnosis, detected during routine transabdominal ultrasonography. MATERIALS AND METHODS: We reviewed the various US findings of GI wall lesions which can occur in patients with abdominal pain and can be detected during routine transabdominal ultrasonography. We differentiated the GI wall lesions based on US findings and the US findings of GI wall lesions are correlated with comparative studies of gastroscopy, colonoscopy, CT and barium studies of the GI tract. RESULTS: The ultrasonographic differential diagnosis of GI wall lesions presenting as wall thickening include gastritis, benign gastric ulcer, malignant gastric ulcer, infectious enterocolitis, inflammatory bowel disease and adenocarcinoma. GI wall masses (AGC, adenoma, GIST, leiomyosarcoma, lymphoma) can be well visualized. Small bowel ileus (due to hernia, intussusceptions or mass) and postoperative complication (afferent loop syndrome, duodenal stump leakage) can be identified. CONCLUSION: US is a useful imaging modality in detection of various bowel wall pathology. Recognition of possible bowel wall pathology based on patientвЂ™s symptoms, specific segment of GI wall and US findings can be more helpful in accurate US diagnosis. 244 Won Hong Park, Jeong Eun Lee, June Sik Cho, Kyung Sook Shin Department of Radiology, Chungnam National University Hospital, Korea PURPOSE: To establish the reference value for normal right hemidiaphragmatic motion measured by M-mode ultrasonography in a large healthy population. MATERIALS AND METHODS: From May 2013 to January 2014, a total of 288 adult subjects (140 men and 148 women) who had regular checkup liver ultrasound scans underwent M-mode ultrasonography for evaluation of right hemidiaphragmatic motion. Examinations were performed three times: during quiet breathing, deep breathing, and voluntary sniffing. Diaphragmatic excursion was determined as median value of the three measurements during each examination. Relationships between diaphragmatic motion and different variables [sex, age groups(в‰¤30, 31-60, в‰Ґ61), and BMI groups (<18.5, 18.5-23, >23)] were assessed. RESULTS: Right hemidiaphragmatic motion was successfully evaluated in all 288 subjects during quiet breathing, deep breathing, and voluntary sniffing. The median values of diaphragmatic excursions of quiet breathing, deep breathing, and voluntary sniffing were 1.9 cm(range, 0.9-4.2; mean В±SD, 2.0 В±0.5), 4.9 cm(range, 1.8-8.6; mean В±SD, 4.9 В± 1.2), and 2.6 cm(range, 1.2-5.5; mean В±SD, 2.7В± 0.8). There was no significant difference in diaphragmatic motion between sex and age groups, respectively, during quiet breathing, deep breathing, and voluntary sniffing (p> .05 in all examinations). In BMI groups, there was no significant difference in diaphragmatic motion during quiet breathing and voluntary sniffing (p=0.626 and 0.137, respectively); however, there was significant difference during deep breathing (P< .05). CONCLUSION: The results of this study suggest a reference value of normal right hemidiaphragmatic motion, which can be used in study of diaphragmatic movement disorders such as diaphragmatic paral- The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits ysis. SE 018 Comparison of Contrast-Enhanced Ultrasonography and CT in Evaluation of Immediate Treatment Response after Radiofrequency Ablation of Malignant Hepatic Tumors Han A Lee, Young-Hwan Lee, See Sung Choi, Hye-Won Kim, Kwon-Ha Yoon Department of Radiology, Wonkwang University Hospital, Korea tumor progression. Evaluation of immediate treatment response of CEUS were concordance with that of CECT, which showed statistically significant (P<0.001). CONCLUSION: The sensitivity, specificity and accuracy of CEUS in assessment of treatment response of radiofrequency ablation therapy in malignant hepatic tumor is not inferior to those of CECT. Evaluation of immediate treatment response of CEUS showed consistent results in comparison with CECT. SE 019 Abdominal Tuberculosis with Hemolytic Anemia Maria Goretti Ametembun Department of Internal Medicine, Private Practice, Indonesia PURPOSE: To describe ultrasound finding of peritoneal tuberculosis with hemolytic anemia case. MATERIALS AND METHODS: This descriptive study was conducted at a private clinic in Bandung, Indonesia. A female, 36y, came with pale, weak, headache since a month. Laboratory: severe anemia (Hb 3.3-5.9 g%), Leucocyte 2200-3500, thrombocyte 96,000-102,000, Lympocyte 42 and Basal Erythrocyte Sedimentation was very high 136.). She was very nervous due to hemoglobin still low although blood transfusion was given several time. Direct and indirect Coomb test were strong positive, Total bilirubin was 5.6-6.64 mg%, and indirect bilirubin was 5.25-4.8 mg% according to hemolytic anemia. She had history of recurrent colic abdomen and mild fever since several months. Physical examination were anemia, icteric, moderate spleen enlargement; doughy abdomen and вЂ�dam board phenomenonвЂ™ according to peritoneal tuberculosis. Abdominal ultrasound using ALOKA SSD was performed, including also both on tympanic (normal & painless area) and on dullness with abdominal pain area according to вЂ�dam board phenomenonвЂ™ of peritoneal tuberculosis dry type on June 2, 2013. RESULTS: Ultrasound examination showed spleen enlargement. Hypo-peristaltic, irregular thickening heterogenic hypo-echoic of the small bowel wall, 245 Scientific Exhibits PURPOSE: The purpose of our study was to compare with diagnostic accuracy of immediate contrastenhanced ultrasonography (CEUS) and 24h contrastenhanced CT (CECT) in early treatment response evaluation of liver tumor after radiofrequency ablation. MATERIALS AND METHODS: From July 2012 to December 2013, we included the patients with malignant hepatic tumors who underwent radiofrequency ablation therapy and thereafter received immediate CEUS and 24h CECT examination in our hospital. CEUS were performed with an LOGIQ E9 ultrasound scanner and ultrasound contrast agent (SonovueпїЅ; Bracco Imaging SpA, Italy) were used. Two radiologist reviewed immediate CEUS and 24h CECT images to evaluate residual hypervascular tumor and proper safety margin of ablation zone in consensus. Sensitivity, specificity and diagnostic accuracy of immediate treatment response evaluation were calculated using the results of follow up CT imaging after 90 days as a reference standard. RESULTS: During a follow-up period of 90-572 days (median, 288 day), total 34 lesions with 27 patients (21 men, 6 women; mean age 63) were included (5 patients had two lesions each other and two of them had additional ablation session for the same lesion). Six patients were confirmed to show local tumor progression on follow up CT imaging. The sensitivity, specificity, diagnostic accuracy of detecting incomplete ablation of CEUS were 33.3%, 100% and 88%, respectively. Those of CECT were 16.7%, 100% and 85%, respectively. Ill defined tumor margin was the predictive factor of local KSUM Open 2014 loss differentiation of the wall layers, irregular margin in addition to several round nodular structures (patchy hyper-echoic non-shadowing with an irregular rim of lower echo-density) within the wall and narrowing of the lumen were examined on the dullness pain area. No ascites. During treatment of methyl prednisolone and anti tuberculosis drug for 9 months she only need once blood transfusion, Hemoglobin as well as Leucocyte and thrombocyte were raised gradually. After treatment: all complaints disappear, spleen became normal, Hemoglobin 13,6, Leucocyte 5100 and Thrombocyte 148.000. CONCLUSION: Ultrasound very usefully to know the whole disease progression and proper treatment as in this peritoneal tuberculosis with hemolytic anemia case. SE 020 Appendiceal Intussusception into Cecum: Case Report Phai Ly Department of Radiology, Medic Medical Center HCMC, Vietnam Appendiceal intussusception is not a common disease and is rarely diagnosed preoperatively. In our case, a 25-year-old male patient living in Ho Chi Minh City came to Medic Medical Center complaining about his epigastric abdominal pain, which lasting for 3 days. His body temperature was not high and he did not have any other symptoms. He recalled similar pain which had gone away without any treatment three months ago. Abdominal ultrasound showed abnormalities in appendix and cecum. During performing colonoscopy, we suspected appendiceal intussusception, and following computed tomography showed the images of enlarged appendix with fluid-filled lumen and signs of intussusception at the appendix base. The patient underwent an operation to remove the appendix and appendiceal intussusception was confirmed. Microscopic result was consistent with chronic appendicitis. 246 SE 021 Fulminant Liver Failure with Pseudocirrhosis from Malignant Metastatic Breast Infiltration Grace Ho, KS Li, HL Lam Department of Radiology, Queen Mary Hospital, Hong Kong Liver is one of the common sites for breast carcinoma to metastasize, after bone, pulmonary, pleura and contralateral lymph nodes metastases. Majority of liver metastases manifests as radiologically detected mass lesions that do not significantly compromise liver function, and have classic target appearance on ultrasound. Occasionally, hepatic metastases from breast carcinoma can simulate cirrhosis morphologically, such as diffuse hepatic macronodular contour and capsular retraction, especially after systemic chemotherapy has been administered. Pseudocirrhosis is the term to describe the hepatic morphological changes that resemble cirrhosis on imaging, in the absence of chronic liver disease, immunological or histopathological evidence of hepatic cirrhosis. Complication of portal hypertension and progression to acute hepatic failure may occur, and is an uncommon pattern of metastatic liver disease during the clinical course. We present a case report with serial ultrasound findings of development of pseudocirrhosis and portal hypertension in three monthsвЂ™ time, subsequent fulminant liver failure, in a patient with hepatic metastases from primary breast carcinoma. Pseudocirrhosis may resemble cirrhosis, however the etiologies are seen in isolation. Recognition of this entity of pseudocirrhosis, especially in cases of acute liver failure, should alert one to review clinical history and prior imaging, consider the possibility of malignant hepatic infiltration and search of extrahepatic sites of disease, to avoid unnecessary workup in misguided diagnosis of cirrhosis. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits SE 022 Aneurysmal Portal-hepatic Venous Fistula: a Case Report Chau Tran Ngan, Hai Phan Thanh Department of Radiology, Medic Medical Center, Vietnam BACKGROUND: Intrahepatic portal-hepatic venous fistula is rare, and considered to be created as congenital or portal hypertension. We report a case that was diagnosed an aneurysmal portal-hepatic venous fistula incidentally by ultrasound (US) and confirmed by computed tomography angiogram (CTA). CASE DESCRIPTION: A 31-yo-man with no medical or trauma history complained about his mild fever and right subcostal abdominal pain for 3 days. No fever, no mass but mild tenderness in the right subcostal on physical examination. Laboratory test results were normal. US findings detected a cystic lesion in the sixth segment, 21Г—21Г—31 mm in size with yin-yang sign, right portal vein flow and right portal vein flow, it communicated with the right portal vein and the right hepatic vein. CTA confirmed an aneurismal portal-hepatic venous fistula. The patient underwent an open abdominal surgery to resect the sac of the aneurysm for preventing the rupture. CONCLUSION: This case illustrates the role of color US in detecting portal-hepetic venous fistula, especially when it makes of an aneurysm. SE 023 Appendiceal and Hepatic Mucormycosis in Adult Immunocompromised Patient Fungal infections occur in patients who are severely immunocompromised with profound and prolonged neutropenia. We report a case of a 41-yearold female with angioinvasive mucormycosis involving appendix and liver in adult immunocompromised patients presenting as abdominal pain. This SE 024 Gastrointestinal Bleeding from Duodenal Metastatic Renal Cell Carcinoma: a Case Report Sujin Ko, Seong Sook Hong, Ji Young Hwang, Hyun Ju Kim, Jung Hwa Hwang Department of Radiology, Soonchunhyang University Hospital, Korea Upper gastrointestinal bleeding due to malignant causes is uncommon and duodenum is rarely involved either by primary or secondary malignancy. We will report a case of a 74-year-old male who presented with melena and anemia, showing no significant finding on the initial gastroduodenoscopy. We will present ultrasonographic findings including contrast enhanced ultrasonography of the duodenal hypervascular mass and the mass in right kidney, which are important clues of diagnosis. We will also describe MR imagings and angiographic images of two hypervascular masses each in right kidney and duodenum. The diagnosis was confirmed by surgical resection which revealed primary renal cell carcinoma (RCC) in right kidney with duodenal metastasis. In conclusion, we diagnosed RCC with rare presentation of isolated duodenal metastasis initially by using various imaging modalities. SE 025 A Case of Terminal Ileal Diverticultis Mimicking the Acute Appendicitis: Ultrasonography and CT Findings Jewon Jeong, Seong Sook Hong, Ji Young Hwang, Hyun Ju Kim, Jung Hwa Hwang Department of Radiology, Soonchunhyang University Hospital, Korea Acquired small bowel diverticulosis is relatively 247 Scientific Exhibits Seo-youn Choi, Hae Kyung Lee, Min Hee Lee, Boem Ha Yi Department of Radiology, Soonchunhyang University Bucheon Hospital, Korea patient was at the end of induction chemotherapy for acute T-lymphoblastic leukemia. To our knowledge, it is the first described imaging findings including sonography of angioinvasive appendiceal and hepatic mucormycosis. The diagnosis and management of mucormycosis are also reviewed. KSUM Open 2014 rare disease, as compared to colonic diverticulosis. Among the small bowel diverticulosis, jejunum is more frequent occurring site than ileum. Small bowel diverticulosis is usually asymptomatic. However, if any complication such as inflammation, perforation or bleeding developed, it could be symptomatic. Particularly in the case of terminal ileal diverticulitis, it could mimic the acute appendicitis, the commonest abdominal surgical emergency. We experienced a case of a 68-year-old female patient with a day of history of right lower quadrant pain and tenderness suggesting acute appendicitis. However, initial bowel ultrasonographic findings revealed multiple inflamed diverticula with severe regional fat infiltration and Doppler ultrasonographic findings presented increased vascularities around the diverticula. And subsequent CT also noted multiple inflamed diverticula. Thus, the final diagnosis was acute diverticulitis in the terminal ileum, which was mimicked acute appendicitis. The patient received only conservative treatment with antibiotics and clinical symptoms were improved. SE 026 A Case of Arteriovenous Malformation of Pancreas Diagnosed by Pylorus-preserving Pancreaticoduodenectomy (PPPD): Doppler Ultrasonography, CT and MRI Findings Borahm Lee1, Jeongeun Lee1, Junsik Jo1, Kyungsuk Sin1, Insang Song2, Kyunghee Kim3 1 Department of Radiology, Chungnam National University Hospital, Korea 2 Department of Surgery, Chungnam National University Hospital, Korea 3 Department of Pathology, Chungnam National University Hospital, Korea Arteriovenous malformation (AVM) of the pancreas is extremely rare and can present with fatal complications. We report a case of AVM of the pancreatic head combined with early gastric cancer (EGC) in a 48-year-old man who presented recurrent GI bleeding and severe anemia. Despite endoscopic submucosal dissection being performed due to EGC found on endoscopy, recurrent GI bleeding continued. He underwent further evaluation and was diag- 248 nosed as a pancreatic AVM based on characteristic findings on Color Doppler Ultrasonography. Finally, he underwent PPPD and no more GI bleeding occurred. We present the findings of US, CT and MRI and their correlation with pathologic features. We also review the literature of pancreatic AVM. Breast SE 027 Should Internal Mammary Lymph Nodes be Included in Breast Ultrasonographic Study for Women with Breast Cancer? Yi-Hong Chou1, Hsiao-Chuan Liu1, Chui-Mei Tiu1, Hong-Jen Chiou1, Hsin-Kai Wang1, Yi-Chen Lai1, Chih-Yi Hsu1, Ling-Ming Tseng2 1 Department of Radiology, Taipei Veterans General Hospital, Taiwan 2 Department of Surgery, Taipei Veterans General Hospital, Taiwan PURPOSE: Patients with internal mammary lymph nodes (IMLN) metastasis had a worse prognosis than those who did not have. Therefore, assessing the IMLN metastasis is important to identify patients who might benefit the most from adjuvant parasternal radiation. MATERIALS AND METHODS: One hundred and twenty women aged from 29 to 91 years were retrospected from Department of Radiology, Taipei Veterans General Hospital. Average age is 54.9 years with 11.2 of the standard deviation (SD). There are 34 (28.6%) women, which aged from 29 to 81 years and average age is 52.4 with 10.35 of SD, presented the malignant tumor mixed positive IMLN. All patients were referred for routine breast ultrasound (US) examinations, and the initial breast US and axillary/IMLN status were reviewed by 2 radiologists, and then fine-needle aspiration (FNA) biopsy, and the histopathologic and immunohistochemical evaluation were performed. Pearson Chi-square test and odds ratio (OR) were utilized to discuss the relationship between women with the breast cancer mixed IMLN or not. RESULTS: The patients who have suffered positive axillary of the breast cancer, positive axillary of the The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits breast cancer mixed invasive ductal carcinoma (IDC), medial location of the breast cancer+positive axillary of the breast cancer+lymphovascular invasion (LVI)+IDC, or positive axillary of the breast cancer+LVI+IDC+triple negative have significant difference in IMLN metastasis with the p-value of <0.001, 0.016, 0.032 and 0.017, respectively. For triple negative, the women with the breast cancer mixed IMLN metastasis had higher incidence of triple negative (11.8%) than those without IMLN metastasis (3.5%) during the ages between 41 and 50 years. CONCLUSION: A positive IMLN indicates a very high likelihood of women with malignant involvement aged ranges between 41-50 years. Therefore, IMLN should be recommend to include in breast ultrasonography study. SE 028 Breast Density Evaluation in Mammography and Ultrasound Examination in Mongolian Women 59 age groups, retrospectively. BI-RADS category IV grade of breast density was found in 8/24, 6/37, 1/45 and 1/23 in 20-29, 30-39, 40-49, 50-59 age groups, retrospectively. The subsequent US revealed 8 cases with rather benign masses in 20-29 age group, from them 2/8, 1/8 and 5/8 in BI-RADS grade II, III and IV, retrospectively. The 30-39 group showed rather benign masses in 1/11,5/11, 3/11 and 2/ 11 in BIRADs grade I, II, III and IV dense breasts. The 4049 group revealed rather benign masses in 1/21,8/11, 11/21 and 1/ 21 in BI-RADs grade I, II, III and IV dense breasts. CONCLUSION: There are no data on dense breast prevalence in Mongolian women. We showed that, with increasing age, the incidence of focal masses in dense breast is increasing, despite the decrease of overall prevalence of dense breast patterns with advancing age. As next, we need to correlate dense breast prevalence with anthropometrics, menstruation and diet in Mongolian women. SE 029 Nergui Bayanzul , Tuvshinjargal Dashjamts , Orkhon Gombosuren1, Bolorsaikhan Baatar1, Ariunbolor Odkhuu1, Tuya Gansukh1, Darkhijav Yanjiv1, Tugsjargal Purevsukh2 1 Department of Radiology, UB Songdo Hospital, Mongolia 2 Department of Radiology, Health Science University of Mongolia, Mongolia Photoacoustic Imaging of Gold Nanoparticle in Chicken Breast Tissue MATERIALS AND METHODS: We retrospectively reviewed US and mammography of women who underwent breast screening at Ulaanbaatar Songdo Hospital in 2013. Data analysis was done on SPSS17.0. RESULTS: Totally we reviewed 137 women 14-74 years age, mean age was 40В±10.68 years. BI-RADS category II grade of breast density was found in 9/24, 18/37, 20/45 and 6/23 in 30-39, 40-49, 50-59 age groups, retrospectively. BI-RADS category III grade of breast density was found in 9/24, 18/37, 20/45 and 6/23 in 20-29, 30-39, 40-49, 50-59 age groups, retrospectively. BI-RADS category III grade of breast density was found in 1/1, 7/24,9/37, 16/45 and 2/23 in below 20 years, 20-29, 30-39, 40-49, 50- Photoacoustic imaging (PAI) is a rapidly emerging non-invasive imaging technology that integrates the merits of high optical contrast with high ultrasound resolution. This study is undertaken to show the feasibility of PAI using gold nanoparticle (AuNRs) and indocyanine green (ICG) at an integrated photoacoustic imaging and ultrasound system. METHOD: ICG and methyl polymer-coated AuNRs (30-50 nm of diameter) were used as optical contrast agents. The chicken breast tissue was used to verify the three-dimensional imaging. Tubes filled with ICG and AuNRs at different concentration were embedded at depth of 2 mm, 5 mm, 8 mm inside chicken breast tissue. Photoacoustic images were obtained using the Vevo LAZR Photoacoustic 1 2 Meihua Zhang1, Hoe Suk Kim1, Yujin Sun1, Ann Yi2, Woo Kyung Moon1 1 Department of Radiology, Seoul National University Hospital, Korea 2 Department of Healthcare System Gangnam Center, Seoul National University Hospital, Korea Scientific Exhibits 249 KSUM Open 2014 Imaging System at a wavelength of 680-900 nm. RESULTS: While the optical penetration was maximized with near-infrared laser pulses of 800-nm wavelength, the optical contrast was enhanced by ICG and AuNRs whose absorption peak matched the laser wavelength. ICG (2 nM) and AuNRs (10 nM) have high photoacoustic contrast as compared to chicken breast tissue ex-vivo. The optimized PAI was able to image ICG and AuNRs embedded at depths of as much as 8 mm in chicken breast muscle. The resolution was found to deteriorate slowly with decreasing concentration of ICG and AuNRs as well as increasing imaging depth. CONCLUSION: We suggest that AuNRs can be visualized in mice in vivo following subcutaneous administration using PAI. With AuNRs as a contrast agent, PAI has important potential applications in the image guided therapy of superficial tumors such as breast cancer, melanoma and Merkel cell carcinoma. In addition, PAI using selective biomarker-conjugated AuNRs can be applied for targeting organspecific metastatic cancer cells in advance. ues for mammography alone were 67%, 73%, 64%, 46% and 85% respectively while for combined mammography and ultrasound were 88%, 80%, 92%, 80% and 92% respectively. Furthermore, 7% of malignant lesions that were diagnosed as benign on mammography alone, were upgraded to malignant on addition of ultrasound and 28% of benign lesions that were falsely categorised as suspicious for malignancy or malignant on mammography alone were downgraded to benign on additional use of ultrasound. CONCLUSION: Ultrasound significantly increased the diagnostic accuracy of mammography for characterization of breast lesions and reduced the number of false positive cases preventing unnecessary histopathological examinations. Therefore, we strongly recommend that all patients with breast pathologies should be evaluated by mammography along with ultrasonography for further characterization of lesions. SE 031 SE 030 Role of Ultrasound as an Adjunct to Mammography in Evaluation of Breast Masses Shelly Sharma Department of Radiology, Jaypee Hospital, India PURPOSE: The purpose of this study was to evaluate the adjunctive role of ultrasound in addition to mammography for characterization of breast masses. MATERIALS AND METHODS: In this prospective study spanning over a two year period, we evaluated 50 female patients with a total of 51 breast masses. The patients were first evaluated by mammography alone and a BIRADS category was assigned based on mammography findings. The patient was then evaluated with ultrasound and a combined BIRADS category was assigned. Both the examinations were performed by two separate radiologists. Definitive diagnosis was obtained from histopathological examination wherever applicable. RESULTS: The diagnostic accuracy, sensitivity, specificity and positive and negative predictive val- 250 Role of Targeted Breast Ultrasound as a Problem Solver, in Cases of Breast Incidentalomas Detected on Whole Body PET/CT in Patients of Non-breast Malignancies Shelly Sharma1, Ankur Pruthi2 1 Department of Radiology, Jaypee Hospital, India 2 Department of Nuclear Medicine, RGCI & RC, India In women undergoing PET/CT for non-breast malignancies, unexpected increased focal 18F-FDG activity within the breast tissue can be detected. However, there are no clear-cut guidelines on further evaluation of these lesions and often pose a diagnostic dilemma about the further course of action. We prospectively evaluated the role of non contrast CT, mammography and targeted breast ultrasound in ten patients with focal incidental uptake in breasts for further characterization of these lesions. The non-contrast CT detected 9/10 of these lesions. On mammography, 8/10 lesions were detected. However, all the lesions (10/10) were identified on targeted ultrasound which was also used as a guide for tissue sampling. Thus, we found targeted The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits ultrasound to be a useful adjunct to PET/CT for localization and sampling of these lesions. SE 033 SE 032 Eun Young Ko, Jung Whan Han, Boo-Kyung Han, Ji Soo Choi Department of Radiology, Samsung Medical Center, Korea Sonomammographic Evaluation of Dense Breast: Inchan Perspective Sangeeta Saxena Department of Radiology, Govt Medical College Kota India, India PURPOSE: To evaluate the accuracy of elasticity scores and the reproducibility according to the lesion size and elasticity. MATERIALS AND METHODS: One breast radiologist (R1) and one radiologic technologist (R2) examined 20 targets of four different levels of stiffness and five different sizes from 2.5 mm to 18 mm in elasticity phantom (Customized 049A Elasticity QA Phantom, CIRS, Norfolk, VA, USA) at a depth of 2 cm. B-mode image, color elastography image, measurement of kPa were obtained twice by each examiner with one week interval. Intra- and inter-observer reproducibility and the accuracy of measured kPa were analyzed. The accuracy and reproducibility were compared between the lesions with same size and different elasticity and between the lesions with same elasticity and different size. RESULTS: Intra-observer reproducibility assessed by ICC was 0.994, 0.929 in R1 and R2. Inter-observer reproducibility was 0.994. According to the level of stiffness, both intra- and inter-observer reproducibility decreased in correlation with the increase of stiffness. The accuracy of measured kPa also decreased in correlation with the increase of stiffness. According to the lesion size, there was no significant difference in accuracy or reproducibility between 5 different sizes of the lesions. But lesions in 11 mm and 7 mm sizes showed more accurate measurement of kPa than larger or smaller lesions. Lesions of low stiffness showed lower measured kPa in large size and higher measured kPa in small size, while the lesions of high stiffness showed higher measured kPa in large size, and lower measured kPa in small size. CONCLUSION: The accuracy of measured kPa and intra-, inter-observer reproducibility were decreased in correlation with increase of lesion stiffness. Medium size lesions (7 mm, 11 mm) showed more 251 Scientific Exhibits PURPOSE: Sonomammography evaluation of more than 300 patients having dense breasts (age 23 to 87 yrs) were done with highly alarming results in Indian subcontinent. There is paradigm shift at the age of appearance of breast cancer from forties to early twenties. The patients have also undergone xray mammography and MR mammography. Cyto and histopathological results were corelated. This can be a landmark study providing efficacy of Sonomammography for evaluation of dense breasts. MATERIALS AND METHODS: Ultrasound machines GE P5, Siemens sonoline 60 Nemio toshiba scanners with linear high frequency transducers with frequency 4 to 12 MHZ were used at Govt medical collage Kota India. patients with dense breasts age 23 to 87 yrs were evaluated for breast carcinoma. RESULTS: Sonomammographic detection of breast cancer were as high as 98% in dense breasts. There is a shift of age of occurrence of cancer from forty plus to early twenties. This alarming state of breast carcinoma at this early age in Indian subcontinent leading the use of ultrasound for screening and diagnosis of breast cancer. CONCLUSION: This study proposes the use of sonomammography as diagnosing as well screening modality of breast especially in dense breasts in developing countries. The results are pretty high in expert hands. Accuracy and Reproducibility of Shear Wave Elastography According to the Size and Elasticity of the Lesions KSUM Open 2014 accurate measure kPa, but the intra- and interobserver reproducibility were not different according to the lesion size. SE 034 US-Guided Preoperative Localizations for Breast Lesions Eun Young Ko, Boo-Kyung Han, Eun Sook Ko, Soo Yeon Hahn, Ji Soo Choi Department of Radiology, Samsung Medical Center, Korea US-guided localizations for nonpalable breast lesions have been widely used before surgical biopsy and breast cancer surgery. We present various methods of US-guided preoperative localizations using metallic wire, surgical thread (Art wire), tattooing, skin marking. In this poster, we briefly explain the methods with pictures and present good indications for each method and possible complications following the procedures. 3. Practical cases that radiologists should know A. Typical cases B. Pitfalls - False positive findings - False negative findings 2. C. Tips to deal with BI-RADS category 4 lesions SUMMARY Automated breast volume scanner (ABVS) is a rapidly emerging imaging modality with increasing adoption in both the screening and diagnostic setting. Although image interpretation is in some ways similar to hand-held ultrasound, there remain vast differences and specific training is required for radiologists. The overview of image acquisition techniques and interpretation methods of ABVS would help radiologists to understand and use of ABVS. To make an accurate diagnosis, tips and pitfalls of ABUS with various false positive and false negative cases will be presented. SE 036 Hyperechoic Breast Lesions at Ultrasonography SE 035 YouвЂ™re in Good Hands with ABVS: Tips and Pitfalls of Automated Breast Volume Scanner Hyun Jung Koo, Joo Hee Cha, Hak Hee Kim, Hee Jung Shin, Eun Young Chae, Woo Jung Choi Department of Radiology, Asan Medical Center, Korea PURPOSE/AIM To familiarize radiologists with a variety of false positive and false negative findings on automated breast volume scanner (ABVS) for making an accurate diagnosis. CONTENT ORGANIZATION 1. Introduction A. Pros and cons of ABVS B. Diagnostic value compared with hand-held US 2. Evaluation methods using ABVS A. Image acquisition - Patient factors - Technical factors 2. B. Image reconstruction C. Interpretation methods - Locate the lesion: directions and diameters 252 Yoon Nae Seo1, Young Mi Park1, Suk Jung Kim2, Hyun Kyung Jung2, Sun Joo Lee1, Hye Jung Choo1, Seok Jin Choi1, Sang Suk Han1 1 Department of Radiology, Inje University Pusan Paik Hospital, Korea 2 Department of Radiology, Inje University Haeundae Paik Hospital, Korea Hyperechoic lesions in the breast are rare, only 0.6%-5.6% of breast masses, and these lesions are generally regarded as benign. However, according to recent reports, 0.2%-4% of malignant lesions are hyperechoic at ultrasonography (US). Therefore, although the vast majority of hyperechoic breast masses are benign, hyperechogenicity at US alone does not allow exclusion of malignancy. The purpose: s of this exhibit are to illustrate various breast diseases presenting as hyperechoic lesions including benign (lipoma, galactocele, fat necrosis, fibroadenoma, hemangioma, hematoma, siliconoma, and hamartoma) and malignant diseases (ductal carcinoma in situ, invasive ductal carcinoma, not otherwise specified, mucinous carcinoma, and invasive lobular The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits carcinoma), and to investigate US and mammographic features that may predict malignancy. SE 037 Fibroadenoma Variants and Fibroadenomaassociated Diseases Young Mi Park1, Yoon Nae Seo1, Suk Jung Kim2, Hyun Kyung Jung2, Sun Joo Lee1, Hye Jung Choo1, Seok Jin Choi1, Sang Suk Han1 1 Department of Radiology, Inje University Pusan Paik Hospital, Korea 2 Department of Radiology, Inje University Haeundae Paik Hospital, Korea Fibroadenoma of the breast is one of the most common benign tumors and is usually diagnosed in younger premenopausal women. Typical sonographic findings of fibroadenoma are oval shape, circumscribed margin, and homogenous hypoechogenicity. There are several variants of fibroadenoma, including juvenile fibroadenoma, complex fibroadenoma, lactating fibroadenoma, and tubular adenoma. Sometimes, fibroadenoma causes secondary change, including hyaline degeneration, and spontaneous infarction. In addition, several benign and malignant diseases may arise from fibroadenoma, such as phyllodes tumor, lobular carcinoma in situ, and ductal carcinoma in situ. We illustrate each case in detail and investigate mammographic and sonographic appearance. SE 038 Benign Proliferative Disease of the Breast Showing Unique Manifestation Bo Bae Choi Department of Radiology, Chungnam National University Hospital, Korea SE 039 Ultrasonographic Features in Breast Malignancies Under 30 Years Old Yeong Yi An1, Bong Joo Kang2, Sung Hun Kim2 1 Department of Radiology, The Catholic University of Korea, St. VincentвЂ™s Hospital, Korea 2 Department of Radiology, The Catholic University of Korea, Seoul St. MaryвЂ™s Hospital, Korea PURPOSE: The purpose of this study was to evaluate ultrasonographic (US) findings and correlation with other imaging modalities in breast malignancies under 30 years old. MATERIALS AND METHODS: We performed a retrospective review of the clinical, radiological and pathological features of women under 30 years old with breast cancer in our institution between March 2009 and October 2013. A total of 33 women were analyzed. US findings were retrospectively evaluated according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The mammographic (MG) and magnetic resonance imaging (MRI) findings were also reviewed according BI-RADS category. Additionally, we reviewed the report of positron emission tomography/computed tomography (PET/CT) and the standardized uptake value (SUV) of tumor. The US findings were correlated with other imaging findings and final surgical pathology. CONCLUSION: Although breast cancer in women under 30 years old is a rare condition, it is important to keep in mind the possibility of malignancy in women with clinical symptom. Ultrasound may be 253 Scientific Exhibits Benign proliferative breast disease is noncancerous condition that may increase the risk of developing breast cancer. This category comprises with ductal hyperplasia, lobular neoplasia, moderate or florid epithelial hyperplasia, sclerosing adenosis, radial scar and papillomas. 50% of women undergoing breast biopsies for breast disease may have prolifera- tive changes. of these, 5-10% will have atypical hyperplasia. Although a few proliferative breast lesions such as radial scar or single papilloma may show specific radiologic finding or may have predilection site, it is difficult to diagnosis or categorize proliferative disease by imaging findings in most cases. In this exhibition, I would like to present benign proliferative disease with unique manifestation; sclerosing adenosis with multiple nodules or even huge mass, complex fibroadenomas, myxoid fibroadnoma in Carney complex, intraductal papillomas combined with DCIS showing multiple segmental masses, and radial scars. KSUM Open 2014 the appropriate initial imaging test for symptomatic young woman. Ultrasonography can provide more accurate information by revealing additional lesions missed on mammography and play an important role in young women with dense breast. mance in patients with nipple discharge, an additional 26.3% of malignant lesions were detected by adding US to mammography. SE 041 SE 040 Adding Ultrasound in the Evaluation of Patients with Nipple Discharge Can Diagnose Additional Breast Cancers Haesung Yoon, Jung Hyun Yoon, Eun-Kyung Kim, Hee Jung Moon, Min Jung Kim Department of Radiology, Severance Hospital, Korea PURPOSE: The aim of this study was to assess the malignancy yield of the BI-RADS classification and diagnostic value of additional ultrasonography in diagnosing breast cancer in patients with pathologic nipple discharge. MATERIALS AND METHODS: From February 2003 to March 2011, among the 267 patients with nipple discharge, 198 patients with pathological confirmation and follow-up data were included. US and mammography were analyzed according to the BIRADS by the American College of Radiology. The malignancy rate of each BI-RADS category and difference in diagnostic performances by adding US to mammography were calculated. RESULTS: Of the 198 enrolled patients, 34 were diagnosed with malignancy. The malignancy rate of each BI-RADS category for adding US to mammography was 0.0% (0 of 27) for category 1, 5.9% (1 of 17) for 2, 9.4% (5 of 53) for 3, 21.5% (20 of 93) for 4, and 100% (8 of 8) for 5. While those for mammography alone were 9.0-14.3% for categories 1-3, 68.5% (13 of 19) for category 4 and 100.0% (5 of 5) for category 5. Adding US to mammography increased diagnostic sensitivity by 14.5% compared to mammography alone with marginal statistical significance (p=0.069); however, other diagnostic performance markers were not improved. Among patients with available mammograms, US detected five other breast cancers (26.3%) in addition to 19 breast cancers found by positive mammograms. CONCLUSION: Although adding US to mammography did not increase the overall diagnostic perfor- 254 Unveiling the Bewildering Papillary Neoplasm of the Breast: Clues That Radiologists Should Know Beforehand Haesung Yoon1, Min Jung Kim1, Ja Seung Koo2 1 Department of Radiology, Severance Hospital, Korea 2 Department of Pathology, Severance Hospital, Korea PURPOSE/AIM To aid the understanding of spectrum of papillary lesions in the breast through sonographic and pathological findings with illustrations, presenting the strategy of diagnosis and management before, at, and after the biopsy. CONTENT ORGANIZATION 1) Introduction - Understanding lesion with wide spectrum of imaging-pathologic findings. - The difficulty and importance of diagnosis associated with breast malignancy. 2) Before the biopsy: How to suspect breast lesions as papillomas - Illustration for the spectrum of US findings 3) At the biopsy: A. Pathologic diagnosis with H-E and immunohistochemistry staining - Illustration for the spectrum of pathologic diagnosis B. Diagnostic accuracy comparison (14 gauge automated core-needle vs vacuum-assisted biopsy): Pros & Cons 4) After the biopsy: A. How to predict the malignancy at surgery when papillary lesion was diagnosed at 14Gautomated CNB- clinicopathologic factors associated with the upgrade at surgery. B. Should we recommend further excision or follow-up? Based on the literature. SUMMARY - Suspecting papillary lesions on breast ultrasound can be challenging and certain US appearances can be useful. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits - For the pathologic diagnosis, the overall area of a lesion should be evaluated and larger sampling can be useful. - To predict upgrade at surgery, clinicoradiologic factors can be helpful. SE 042 Columnar Cell Lesions and Atypical Ductal Hyperplasia Diagnosed by UltrasoundGuided Core Biopsy: Radiologic Findings Associated with Underestimation of Breast Carcinoma Hye Shin Ahn1, Mijung Jang2, Sun Mi Kim2, Bo La Yun2, Sung-Won Kim3, Eunyoung Kang3, So Yeon Park4 1 Department of Radiology, Chung-ang University Hospital, Korea 2 Department of Radiology, Seoul National University Bundang Hospital, Korea 3 Department of Surgery, Seoul National University Bundang Hospital, Korea 4 Department of Pathology, Seoul National University Bundang Hospital, Korea SE 043 Various Sonographic Findings of Ruptured Duct Ectasia: from Definite Benign to Highly Suspicious Finding Jin Hwa Lee1, Eun Cho1, Kyung Jae Lim1, Ji Young Kang1, Dae Cheol Kim2, Miri Lee3, Se Heon Cho3 1 Department of Radiology, Dong-A Medical Center, Korea 2 Department of Pathology, Dong-A Medical Center, Korea 3 Department of Surgery, Dong-A Medical Center, Korea PURPOSE 1. To review the pathologic definition of the ruptured duct ectasia. 2. To demonstrate various sonographic findings of the lesions from definite benign to highly suspicious finding. 3. To discuss the US findings of ruptured duct ectasia mimicking breast cancer. CONTENTS ORGANIZATION 1. Pathologic definition of ruptured duct ectasia. 2. Sonographic findings of ruptured duct ectasia according to BI-RADS assessment categories. 3. Radiologic-pathologic correlation. SUMMARY Ruptured duct ectasia shows various imaging findings from definite benign to highly suspicious malignancy. Inflammatory changes in the walls of mammary ducts and periductal tissues are a prominent part of the pathologic findings in mammary duct ectasia, therefore, disruption of the ectatic mammary duct can mimics the ductal carcinoma of the 255 Scientific Exhibits OBJECTIVE: To determine the underestimation rate of columnar cell lesions (CCLs) and atypical ductal hyperplasia (ADH) on ultrasound-guided core biopsy, and to identify the radiologic findings associated with underestimation of breast carcinoma. MATERIALS AND METHODS: From May 2003 and May 2013, 33 CCLs without atypia, 17 flat epithelial atypia (FEA), 9 FEA with ADH and 44 ADH(103 cases in total) which diagnosed on ultrasound-guided core biopsy were included. Imaging and lesion classification was as per the American College of Radiology (ACR), BI-RADS lexicon. Excision (n = 85) or imaging follow-up (n = 18) was performed for all patients. The underestimation rate was determined by dividing the number of lesions that proved to be carcinomas at surgical excision. RESULTS: The underestimation rate of FEA, FEA with ADH and ADH were 5.9% (1/17), 44.4% (4/9), 27.3% (12/44). There were no underestimated cases in CCLs without atypia. The presence of calcification on ultrasound displayed the considerable correlation with underestimation (p = 0.010), and shape of the lesions showed statistically equivalent correlation (p = 0.052). However, size, orientation, margin, boundary, echogenicity, posterior acoustic feature, BI-RADS category on ultrasound, and mammographic findings were not associated with underestimation. CONCLUSION: FEA with ADH showed the highest underestimation rate. The presence of calcification of the lesions on ultrasound should be taken into attention when classifying CCLs and ADH of the breast ultrasound guided core biopsy. KSUM Open 2014 breast. Awareness of imaging spectrum of ruptured duct ectasia may be helpful for differential diagnosis of breast lesions. SE 044 A Wide Spectrum of Benign and Malignant Hyperechoic Breast Lesions Hye Won Kim Department of Radiology, Wonkwang University Hospital, Korea Hyperechoinc masses of breast are frequently benign. But some of malignant tumours that present as hyperechoic lesions. Careful review of sonographic finding and correlation with clinical and mammographic findings are important. It is necessary to pay attention to most worrisome sonographic finding and biopsy for histologic confirmation. This presentation illustrate hyperechoic breast masses as following categories. 1. Benign lesions ; hematoma, fat necrosis, hemangioma, abscess, galactocele, lactating adenoma, fibroadenoma, foreign body granuloma 2. Malignant lesions ; invasive ductal carcinoma, invasive lobular carcinoma, leiomyosarcoma, metastasis SE 045 Application of Gel Pad To Automated Breast Ultrasonography Yun Ju Kim1, Sung Hun Kim2, Su Kyung Jeh3, Jae Jeong Choi3, Bong Joo Kang2, Jeong Dan Kim2 1 Department of Radiology, National Cancer Center, Korea 2 Department of Radiology, The Catholic University of Korea, Seoul St. Mary's Hospital, Korea 3 Department of Radiology, Hallym University Sacred Heart Hospital, Korea BACKGROUND: Many patients complain of pain during the Automated Breast Ultrasonography (ABUS). Degradation of the image at the peripheral region due to contact defect is another drawback of the examination. Using a suitable coupling agent would be helpful for pain relief and for improve- 256 ment of contact defect. PURPOSE: The purpose of this study was to show application of gel pad to ABUS in technical aspect and to show its effects in pain relief, scan coverage, and image quality. MATERIALS AND METHODS: Twenty patients underwent two sets of ABUS with and without gel pad application then were asked about the examination-related pain. Scan coverage and image quality were compared quantitatively and qualitatively. RESULTS: The pain degree was significantly decreased after gel pad application. The scan coverage was expanded particularly at the mid portion of the breast. Image quality was satisfactory without significant difference between the two settings. CONCLUSION: Application of gel pad to ABUS is easy and simple with significant pain relief. The scan coverage was expanded while the image quality was maintained. SE 046 Isoehcoic Lesions of the Breast on Ultrasound: is Correlation Mammography Useful? Hye Seon Shin1, Okhee Woo1, Kyu Ran Cho2, Bo Kyoung Seo3 1 Department of Radiology, Korea University Guro Hospital, Korea 2 Department of Radiology, Korea University Anam Hospital, Korea 3 Department of Radiology, Korea University Ansan Hospital, Korea Breast ultrasound (US) is used as a supplemental diagnostic tool in the evaluation of mass detected on mammography or clinical examination or useful screening tool by detecting some breast lesions that are not visible or are difficult to interpret on mammography. For this reason breast US tends to be overused. In daily practice, radiologists often even overlook previewing mammography when performing breast US exams. But to identify an isoechoic lesion surrounded with fat is difficult to detect by using just breast US and sometimes it can result in false negative interpretations. Therefore we have to pay attention to mammographic abnormal lesions. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits During performing breast US exams, correlation mammography with skin marker is useful to confirm whether the lesions or not. This exhibit illustrates the cases that had needed careful mammographic evaluation when performing breast US exams. The purpose of this study is to assess the importance of the correlation mammography and to improve a diagnostic accuracy about isoechoic mass between mammography and breast US. SE 047 Sonographic and Mammographic Features of Nodular Pseudoangiomatous Stromal Hyperplasia in the Breast In Soo Moon1, Young Mi Park1, Yoon Nae Seo1, Sun Joo Lee1, Hye Jung Choo2, Suk Jung Kim1 1 Department of Radiology, Inje University Pusan Paik Hospital, Korea 2 Department of Radiology, Inje University Haeundae Paik Hospital, Korea A New Automated Breast Ultrasound System with Dual Wide Field-of-View Imaging Jaeyoung Son, Jongho Park, Hyunjae Song, Jin Ho Chang, Tai-Kyong Song, Yangmo Yoo Department of Electronic Engineering, Sogang University, Korea Breast ultrasound imaging is useful for observing the mass according to the desired locations and differentiating the shape of consistency of the mass during breast cancer screening, but its performance is dependent on the examinersвЂ™ skill and has a poor reproducibility. Recently-introduced automated breast ultrasound (ABUS) systems have a potential to decrease user dependency due to its automated scanning protocols. However, the current ABUS system suffers from the limited field-of-view (FOV) and the long scanning time. In this paper, a new automated breast ultrasound system with dual wide FOV imaging is proposed. To improve the FOV and the scanning time, in the newly-developed ABUS system, ultrasound volume scanning is conducted while compressing breast between two plates. New ABUS system concurrently supports two 1024-element wide FOV linear array transducers so that two imaging planes can be acquired to reduce the volume scanning time. To enable the dual wide FOV imaging, the custom-built system has four transmit (Tx)/Receive (Rx) boards and two 1024-to-128 highvoltage multiplexing board that support 128-channel Tx/Rx beamforming simultaneously. The beamformed radio-frequency data are sent to an external PC for mid and back-end processing running on high-performance graphic processing units (GPUs) using CUDA, via the PCI express 2.0 interface. Ultrasound B-mode images generated by multi-planar reconstruction during volume scanning after placing raw meat between two plates. The developed ABUS system can acquire a 3D breast volume set with 20 cm (width)Г—25 cm (length)Г—8 cm (length) within 20 seconds. Two image planes are concurrently captured during the scanning with dual wide FOV imaging. The further evaluation of the developed system including pre-clinical studies is under investigation. These results indicate that the proposed dual wide FOV-based ABUS system can 257 The 45th Annual Congress of Korean Society of Ultrasound in Medicine 257 Scientific Exhibits Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign proliferative disease of the breast stroma that is seen more commonly in premenopausal and perimenopausal patients receiving hormonal therapy. The disease spectrum varies from insignificant incidental microscopic changes in the breast to focal mass-like nodules (nodular PASH) to diffuse breast involvement. Nodular PASH is uncommon, only 0.4% of breast biopsies. We present 7 cases of nodular PASH. All of the patients were women (mean, 45 years; range, 40-48 years) and four patients complained of a palpable lump. On sonography, PASH has benign features, commonly a well circumscribed oval mass with parallel orientation and no posterior acoustic features. Three PASH showed hypoechoic mass with cystic component, reflecting histopathological characteristics which are complex anastomosing slit-like pseudovascular spaces. Mammographic findings are nonspecific. SE 048 KSUM Open 2014 enhance the FOV and the volume scanning time for improving clinical productivity of breast ultrasound imaging. SE 049 Sonographically Guided 14-Gauge Core Needle Biopsy: Medical Audit for One Year Su Jeong Hyun, Ga Ram Kim, Se Jin Nam, Jung Hyun Yoon, Hee Jung Moon, Min Jung Kim, Eun-Kyung Kim Department of Radiology, Severance Hospital, Korea PURPOSE: The objective of our study was to determine the diagnostic accuracy, underestimation rate and false negative rate of sonographically guided core needle biopsy for breast lesions. MATERIALS AND METHODS: In this retrospective study, we included a total of 1179 lesions from 1028 patients who had undergone sonographically guided 14-gauge core needle biopsies between March 2012 and February 2013. The sonographic category of breast lesions and the pathologic results of core needle biopsies were reviewed and correlated with that of surgery or vacuum assisted biopsy, or long term (> 1 yr) imaging follow-up. Through this, the positive predictive value for each sonographic category, sensitivity, underestimation rate and false negative rate of core needle biopsy were evaluated. RESULTS: A total of 1179 cases, the pathologic results for the core needle biopsy were benign in 647, high-risk in 157, ductal carcinoma in situ in 54, invasive cancer in 321. The positive predictive values for each sonographic category were as follows: 0.0% in category 2; 3.9% in category 3; 13.4% in category 4a; 63.1% in category 4b; 84.7% in category 4c and 99.0% in category 5. The sensitivity of core needle biopsy was 93.8% (375 of 400). The underestimation rate was 10.2% for high-risk lesion (47.4% of atypical ductal hyperplasia, 5.1% for non-atypical ductal hyperplasia) and 40.7% (22 of 54) for ductal carcinoma in situ. Of 647 benign lesions, 9 lesions were confirmed as malignancy, and the false negative rate was 1.4%. CONCLUSION: Sonographically guided core needle biopsy for 1 year in our hospital was accurate diagnostic tool for evaluating breast lesion. 258 SE 050 Vacuum-Assisted Breast Biopsy Under Sonographic Guidance: Analysis of A 10-year Experience Seung Hyun Lee, Eun-Kyung Kim, Min Jung Kim, Hee Jung Moon, Jung Hyun Yoon Department of Radiology, Severance Hospital, Korea PURPOSE: Vacuum-Assisted Breast Biopsy under Sonographic Guidance: analysis of a 10-year experience. MATERIALS AND METHODS: This was a retrospective analysis of 2920 breast lesions in 2477 consecutive patients who underwent US-guided VABB between February 2002 and December 2011. Indications for US-guided VABB were classified into 9 categories; (a) calcifications, (b) complex and intraductal lesions, (c) discordant benign lesions, (d) growing lesions, (e) high-risk lesions, (f) low-suspicious lesions, (g) non-mass lesions, (h) palpable lesions, and (i) patient's desire to remove the breast lesion. The proportions of each indication for VABB were analyzed as well as the trend of that over time. Histopathologic diagnosis and malignancy rate of the lesions with VABB were analyzed. Comparison of pathologic diagnosis at VABB and gold standard diagnosis revealed the false negative rate, underestimate rate, and the agreement rate. RESULTS: Proportions of each indication for VABB were as follows; palpable lesions (44.4%), low-suspicious lesions (15.7%), high-risk lesions (12.4%), calcifications (10.3%), patient's desire to remove the breast lesion (7.4%), complex and intraductal lesions (3.8%), discordant benign lesions (2.7%), non-mass lesions (2.2%), and growing lesions (1.0%). Malignancy rate of lesions submitted to VABB was 5.4%. Calcifications were the indication with the highest malignancy rate (36.8%) followed by nonmass lesions (18.5%) and discordant benign lesions (12.7%). False negative rate was only 0.1%, while underestimate rate of high-risk lesions and DCIS being 3.1% and 13.8%, respectively, with 98.7% agreement rate. Among 1512 therapeutic VABB cases, 85.3% showed no residual lesion on long term follow-up US. Complications occurred in 1% of the patients without need for a surgical intervention. CONCLUSION: US-guided VABB is an accurate The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits and safe method that can be an alternative for excisional surgery. SE 051 Can We Accurately Differentiate Between Benign and Malignant Lesions in Mastectomy Site Based on Ultrasonographic Features? Sojung Kim, Kyunghee Ko, Hye Kyoung Jung, Hyerin Kim Department of Radiology, Bundang CHA, Korea icantly associated with local recurrence (p<0.05). CONCLUSION: For predicting local recurrence, the ultrasonographic characteristics of suspicious mass was not be helpful. Therefore, even though ultrasonographic features of chest wall lesion would suggest benign,if they have suspicious axillary LN or if original cancer had larger size, LN metastasis or lymphovascular invasion, we should perform biopsy to confirm local recurrence. SE 052 Are Irregular Hypoechoic Breast Masses on Ultrasound Always Malignancies? Youe Ree Kim, Yoogi Cha, Hye-Won Kim Department of Radiology, Wonkwang University Hospital, Korea There were many kinds of benign or borderline breast diseases representing irregular hypoechoic masses that can mimic carcinoma on ultrasonography. In this presentation, we classify benign or borderline breast lesions into 4 groups : Iatrogenic or trauma-related breast lesions (foreign body reaction, fat necrosis, fibrotic scar), Inflammation (abscess, idiopathic granulomatous lobular mastitis, diabetic mastopathy), proliferative disease (sclerosing adenosis, apocrine metaplasia, fibrocystic change), and benign breast tumors (intraductal papilloma, fibroadenoma). These lesions were assessed as BIRADS Category 4a-to-4c suspicious malignancy on ultrasonography, resulting in US-guided biopsy. Some of inflammation and trauma-related breast lesions could be suspected from patient. Scientific Exhibits PURPOSE: The aim of this study is to assess which ultrasonographic feature is more helpful for predicting local recurrence in patients who underwent mastectomy for breast cancer. MATERIALS AND METHODS: Between March 2009 and December 2013, 2928 breast ultrasonographic examinations were performed for follow up after mastectomy in our institution. Our study included 25 patients, who were suspected for local recurrence by ultrasonography following modified radical mastectomy. Among 25 patients, five (20%) had palpable masses on their chest wall. We evaluated ultrasonographic characteristics of the lesions (size, shape, margin, multiplicity, location) and suspicious axillary lymph nodes (LNs). We also retrospectively investigated clinical data about the postoperative duration and the characteristics of original cancer (size, axillary LN metastasis, lymphovascular invasion, histologic grade) to evaluate which factors affected local recurrence. Eighteen (72%) were confirmed by US guided core biopsy and seven (18%) by surgical excision. RESULTS: Among 25 patients, seventeen (68%) were confirmed as local recurrence and eight (32%) confirmed as benign (5, fat necrosis; 3, fibrosis). The mean size of recurred mass was 1.44 cmВ±0.78, and that of benign lesions was 1.42В±0.85 cm (p=0.97). Time interval between surgery and recurrence was longer than that of benign without statistical significance (p=0.192). Among the ultrasonographic features, only ipsilateral suspicious axillary LN showed statistically significant difference between the benign and malignant lesions (p=0.01). Among the characteristics of original cancer, size, axillary LN metastasis and lymphovascular invasion were signif- 259 KSUM Open 2014 SE 053 Pseudoangiomatous Stromal Hyperplasia (PASH): a Series of 4 Cases Soo Jin Kim, Sung Hee Park, Mirinae Seo, Hyeshin Ahn Department of Radiology, Chung-ang University Hospital, Korea Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. We retrospectively reviewed data from 2005 to 2014 of patients diagnosed with PASH by US-guided biopsy. of our 4 cases, mean size was 2.2 cm (0.59-3.1) and mean age was 39.3 (19-50). Three (75%) patients presented with palpable breast masses clinically. On US, 3 masses were hypoechoic and one mass was isoehoic. Three masses showed relatively circumscribed margin but one had angular margin. Coexisting pathology were intraductal papilloma, sclerosing adenosis. Patients were treated with local excision, vacuum-assisted biopsy or observation. After operation or vacuum-asisted biopsy, there was no additional malignant potential. SE 054 Recurrent Breast Sparganosis: Clinical and Radiologic Findings Jiyoon Park1, Ok Hee Woo1, Hye Seon Shin1, Kyu Ran Cho2, Bo Kyung Seo3 1 Department of Radiology, Korea University Guro Hospital, Korea 2 Department of Radiology, Korea University Anam Hospital, Korea 3 Department of Radiology, Korea University Ansan Hospital, Korea Sparganosis is an uncommon parasitic infection due to the plerocercoid (second stage) larva of Spirometra erinacei. The infection is transmitted by ingesting contaminated water, or eating raw or partially cooked fish, snakes, or fogs. This is a case report of recurrent Sparganosis of the breast within 6 month after a surgical removal of a worm from the breast. The patient was referred to our hospital with palpable right breast mass. At admission, breast ultrasonography showed tortuous tubular hypoe- 260 choic lesion with indistinct margin within surrounding hyperehoic area, which strongly suggested Sparganosis. We surgically removed and confirmed Sparganosis. After 6 month, she felt a new mass in her right breast and visited our hospital. Postoperative breast mammography revealed lobulated, circumscribed, isodense mass and subsequent breast ultrasonography showed similar features as 6 month earlier, in different area of the same breast. Once again, we surgically confirmed recurrent Sparganosis. Breast Sparganosis is a rare disease, but it shows characteristic features especially on ultrasonography, which is helpful in patient management. Also, any patient once diagnosed as Sparganosis should be properly followed-up for a certain period of time, since it can recur like in our case. SE 055 Sparganosis of The Breast and Lower Extremities: Sonographic Appearance Sung Hee Park1, Seung Joon Choi2, Min Jung Kim2 1 Department of Radiology, Chung-ang University Hospital, Korea 2 Department of Radiology, Gachon University Gil Hospital, Korea Sparganosis is a rare parasitic infection caused by larvae of the genus Spirometra. It can involve any part of the human body and usually manifests as a mass in various locations. We report a case of recurrent sparganosis in the breast and lower extremities. Our patient had recurrent subcutaneous masses in her breast and lower leg that showed characteristic ultrasonographic imaging findings of serpentine, tubular structures with surrounding increased echogenicity. These imaging findings are well correlated with pathologic findings. Worms were identified in resected specimens confirming sparganosis. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits SE 056 A Solitary Axillary Lymph Node Metastasis Without Breast Involvement from Ovarian Cancer: a Case Report with Brief Literature Review Ji-in Choi, Soo Jin Kim Department of Radiology, Chung-ang University Hospital, Korea Ovarian cancer is the fifth most common cause of cancer death in women, usually presenting with metastasis to other organs. However, ovarian cancer presenting as axillary lymph node metastasis is quite rare, especially without involving breasts. We reported a case of 68-year-old woman, who presented with abdominal distension. There was no remarkable past medical history, except hypertension and diabetes mellitus. Ovarian malignancy was suspected when abdominopelvic computed tomography (CT) and F-18 FDG Torso PET-CT were performed. In addition, a hypermetabolic (SUV(max)=2.1 g/mL) lymph node was detected as a reactive benign lesion. On surgical diagnostic laparoscopy, the serous papillary carcinoma of the right ovary and metastatic papillary carcinoma of the omentum were proven. Mammography and breast sonography showed three benign looking lymph nodes, but ultrasound-guided core needle biopsy revealed metastatic serous papillary carcinoma from ovarian origin. This report illustrates a rare case of a solitary axillary metastasis from ovarian cancer without breast involvement. In conclusion, we need to consider the physical examination and evaluations for breast and axillary regions in patients with history of ovarian cancer. SE 057 Sonographic Findings of Adenoid Cystic Carcinoma of the Breast Adenoid cystic carcinoma of the breast is a rare type of primary breast cancer accounting for less than 0.1% of all breast carcinomas. Adenoid cystic carcinomas of the breast have favorable outcomes SE 058 Multiple Symmetric Lipomatosis (Madelung's Disease) : A Rare Cause of Pseudogynecomastia Woo Jin Yang1, Jung Kyu Ryu1, Sun Jung Rhee1, Jeong Yoon Song2 1 Department of Radiology, Kyung Hee University Hospital at Gangdong, Korea 2 Department of Surgery, Kyung Hee University Hospital at Gangdong, Korea A 66-year-old male presented with bilateral breast bulging. His breasts had slowly enlarged for several years and this led to a conspicuous deformity. He had a history of excisional biopsy of a lipoma in the central upper back region 1 year earlier. The patient reported more than 25 years of alcohol abuse, and he consumed alcohol five times a week. Mammography and breast US demonstrated excessive fat tissue in both breasts without any glandular tissue. His diagnostic chest MR and CT showed a huge amount of subcutaneous fat deposition at both breast regions extending to the posterior neck, shoulder, upper arm and upper trunk. Surgical excision of the breast masses was performed and the pathologic diagnosis was lipoma. He also had a paternal familial history of multiple large disfiguring masses in the 261 Scientific Exhibits Hyo Soon Lim, Seo Yeon Park, Seo In Jeong Department of Radiology, Chonnam National University Hwasun Hospital, Korea compared with other forms of breast cancer and adenoid cystic carcinomas of the salivary glands. This is due to its slower progressive biological course, lower metastases of lymph nodes and uncommon distant metastases. Because of the rarity, there is scant information about the radiologic features of adenoid cystic carcinomas of the breast. This series describes the sonographic findings of 3 cases of adenoid cystic carcinomas of the breast. Sonograms showed masses with an irregular (n=2) or oval (n=1) shape, angular (n=1), indistinct (n=1), or circumscribed (n=1) margins, and mixed echoic (n=2) or hypoechoic (n=1) internal echo texture. Sonographic assessments were classified as BI-RADS category 4 in all 3 cases. Although adenoid cystic carcinoma is a rare breast malignancy, awareness of its sonographic features will be helpful for the diagnosis. KSUM Open 2014 occipital region, neck, shoulder, upper arm, and upper trunk. Clinical history and pathologic result of these lesions enabled us to confirm the final diagnosis as multiple symmetric lipomatosis (Madelung's Disease). Madelung's disease is a very rare lipid metabolism disorder characterized by the accumulation of multiple, symmetric, non-encapsulated lipomatous masses on the face, neck, shoulders, and upper arms. Pseudogynecomastia looks much the same as gynecomastia with the exception of the underlying breast tissue. In this Madelung's disease, the imaging process of mammography, US and MR played an important role in discriminating pseudogynecomastia from gynecomastia. SE 059 Breast Sparganosis and Incidentally Detected Multiple Sparganosis in the Remaining Body: Imaging Characteristics and Pathologic Correlation Eunjee Song, Yu-Mee Sohn Department of Radiology, Kyung Hee University Medical Center, Korea Sparganosis is an infestation caused by the tapeworm in the Spirometra genus. Human infestation is transmitted by ingestion of raw snakes and frogs and drinking contaminated water with infected larva of the tapeworm. We described a surgically confirmed case of sparganosis in the multiple organ system including breast, both the upper and lower extremities, anterior chest wall, inguinal area, psoas and gluteus muscles with various imaging modalities as sonography, CT and MRI. 262 Cardiovascular SE 060 The Features of the Pulmonary Artery Flow Spectrum in Tetralogy of Fallot in Fetus with Main Pulmonary Artery Stenosis Xiao Hong Zhang, Hai Yan Wang, Yu Ling Gong, Chuan Xi Liu Department of Radiology, Qianfushan Hospital Affiliatied Shandong University, China OBJECTIVE: To analyze the features of the pulmonary artery flow spectrum in TOF fetus with main pulmonary artery stenosis, so as to put forward another clue to the diagnosis of TOF in fetus with echocardiography. MATERIALS AND METHODS: 21 cases of fetal TOF with main pulmonary artery stenosis were analyzed retrospectively, and their cardiac malformation and the features of main pulmonary artery flow spectrum were investigated. 46 normal fetuses were chosen and the same parameters of pulmonary artery flow spectrum were measured. The parameters of the two groups were compared with each other to find the differentia. RESULTS: 26 cases of fetal TOF were detected with different malformation in right ventricular outflow tract, 1 case with pulmonary atresia, 4 cases with pulmonary valves stenosis, and 21 cases with main pulmonary artery stenosis. The fetus with pulmonary atresia had no flow signal; the 4 fetuses with pulmonary valves stenosis showed obvious increase in peak velocity. The peak velocity of pulmonary artery were not that visibly increased in the 21 TOF fetuses with main pulmonary artery stenosis, but their ACT, DT, ET and VTI of pulmonary artery were shorter than those of the control group, and the differences were significant пј€P < 0.01пј‰ , and the ratio of pulmonary peak velocity to aortic were enlarged compared with the control group; while the peak velocity of aortic artery showed no significant difference between the two groups пј€P=0.22пј‰ . The 21 TOF fetuses with main pulmonary artery stenosis also had narrow pulmonary artery blanch. CONCLUSION: The pulmonary artery flow spectrum of TOF with main pulmonary artery stenosis in The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits fetus have clear different features with different malformation. SE 061 Percutaneous Treatment with Radiofrequency Needles of Residual Crosse Saphenofemoral Stump after Stripping Giovanni Turtulici, Mario Maturanza, Simone Schiaffino, Riccardo Sartoris, Enzo Silvestri Department of Radiology, Ospedale Evangelico Internazionale Genova Castelletto, Italy A New High PRF Fast Color Doppler Imaging Based on Sliding Angle Compounding Hyohee Kim, Sunmi Yeo, Yangmo Yoo Department of Electronic Engineering, Sogang University, Korea Ultrasound color Doppler imaging (CDI) is useful for interactively visualizing hemodynamics in real time. With the recently-proposed ultrafast color Doppler imaging based on plane wave excitation and angle compounding (CDI-AC), its frame rates can be substantially increased. However, the current CDIAC method suffers from the limited pulse-repetition frequency (PRF) as the number of compounding angles increases for enhancing spatial resolution and sensitivity. In this paper, a new color Doppler imaging technique based on sliding angle compounding (CDISAC) is presented for improving both frame rates and PRF. In the proposed CDI-SAC method, unlike CDI-AC, the angle compounding is updated as each new angle compounding is acquired, so that there is no reduction in both PRF and frame rates. Thus, as more sub-angle excitations are compounded together, the spatial resolution and sensitivity in CDI-SAC can be further improved. To evaluate the performance of the proposed CDI-SAD method, the radiofrequency (RF) data were captured by a L7-4 linear array transducer connected to the research ultrasound platform (Vantage, Verasonics Inc., Redmond, WA, USA) from a flow phantom (Gammex 1425A LE, Gammex Middleton, WI, USA). The acquisition PRF of each plane wave excitation was fixed to 2 kHz for the CDI-AC and CDI-SAC methods. In addition, six angle excitations were differently compounded in the CDI-AC and CDI-SAC methods. The CDI-AC method suffers from the aliasing artifact due to the limited PRF (i.e., 333 Hz) due to six angle compounding. On the other hand, the proposed CDI-SAC method clearly depicts the hemodynamics in the vessel-mimic phantom without aliasing since it can keep the PRF of 2 kHz. These results indicate that the proposed new fast color Doppler imaging with sliding angle compounding can increase the PRF and frame rates while improving spatial resolution and sensitivity in ultrafast color 263 Scientific Exhibits PURPOSE: The aim of our study was to evaluate the efficacy of treatment with radiofrequency needles in patients operated with stripping with varicose recurrences that are powered by the exuberant and refluxing crosse saphenofemoral stump. MATERIALS AND METHODS: Ten patients (mean age 53 years old) with post-stripping recurrence for the presence of residual stump were treated by percutaneous ultrasound-guided treatment with radiofrequency needles. Efficacy was assessed by ultrasonography documented obliteration of the saphenous stump, and the objective reduction of varicose veins. The checks were carried out on the same day, at 30 and 60 days after treatment. RESULTS: An obliteration of the crosse saphenousfemoral stump was observed in 8 patients the day of the treatment, and confirmed at 30 and 60 days. In two patients obliteration was not total. In 5 patients with varicose veins of the leg was observed a significant reduction in the tortuosity the day of surgery that has been consolidated at a distance of 30 and 60 days. In the other five, there was a modest reduction of the varicose veins of the leg. CONCLUSION: This treatment is, in our opinion, a possible solution to the problem of recurrent varicose post-stripping, incurred mainly from the reflux of the crosse saphenofemoral stump. SE 062 KSUM Open 2014 Doppler imaging. tant for improving spatial resolution while reducing the blocky artifacts. SE 063 Analysis of Angle Compounding on a Fast Color Doppler Imaging: Phantom Study Hyohee Kim, Sunmi Yeo, Yeokyeong Yoon, Yangmo Yoo Department of Electronic Engineering, Sogang University, Korea Fast color Doppler imaging (CDI) based on plane wave excitation and angle compounding is useful for evaluating vascular diseases with high frame rates. Due to limited spatial resolution from plane wave excitation, the image quality of CDI is substantially degraded. To enhance the spatial resolution, angle compounding, in which several tiled plane waves are excited and coherently summed together during receive beamforming, can be used. However, the effect of angle compounding on fast CDI has not been extensively analyzed. In this paper, the analysis of angle compounding on fast CDI with phantom studies is presented. To evaluate the effect of the angle compounding, in this paper, the recently-proposed sliding angle compounding (SAC) method is adopted. In SAC, the angle compounding is updated as each new angle compounding is acquired. The pulse-repetition frequency of 2 kHz and four different sets of compounding angles (i.e., 3, 6, 8 and 12) were used for generating a color Doppler image. The color Doppler images with plane wave excitation and SAC angle sets are experiment conditions. When 3 angle excitations and corresponding SAC are applied, the blocky artifacts are clearly shown in the vessel region. These artifacts are decreased as the number of angles for plane wave excitation increases. With 12 angle excitation, it is difficult to identify the blocky artifacts. The parabolic flow profiles at the 64th scanline with a parabolic are calculated, which is consistent with the visual assessments in result images. The measured root mean square errors (RMSEs) for three angle sets (3, 6, 8) by assuming the 12 angle set as the reference are 0.0124, 0.0107 and 0.0082, respectively. These results indicate that the proper selection of the number of angles in fast color Doppler imaging is impor- 264 SE 064 Fetal Double Outlet Right Ventricle Associated with Severe Pulmonary Artery Stenois in Gestational Diabetes Mellitus Xuan-Hong Tomai1, Minh-Le Nguyen2 1 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy in Hochiminh City, Vietnam, Vietnam 2 Department of Internal Medicine-Cardiology, Thong-Nhat Hospital, Vietnam Prenatal double outlet right ventricle (DORV) is a rare anomaly of congenital heart defects and an adverse outcome is often prognostic. We presented a case of fetal DORV associated with pulmonary artery stenosis in pregnant woman suffering from gestational diabetes mellitus at 24 weeks' gestation. An elective termination of pregnancy was carried out because of severe fetal heart defect. Prenatal ultrasonography with standard fetal heart checking, such as a four-chamber and long-axis view, plays an important role to diagnose this anomaly. A routine oral glucose tolerance test is necessary to detect earlier gestational diabetes mellitus and understand more risk factor of cardiac structural anomalies. KEYWORDS: Double outlet right ventricle, gestational diabetes mellitus, ultrasonography Genitourinary SE 065 Contrast Ultrasonography in Ovarian Torsion-Confidence Boosting Initial Experience Asif Momin1, Shenaz Momin2, Avinash Gutte2 1 Department of Radiology, Prince Aly Khan Hospital, Mumbai, India 2 Department of Radiology, B.Y.L Nair Hospital and T.N. Medical College, Mumbai, India B-mode ultrasounds along with colour duplex imaging are known to help in diagnosis of suspected The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits ovarian torsion. In appropriate clinical setting the diagnosis is offered with certain degree of suspicion even though identification of twisted pedicle (snail sign and whirlpool sign) with or without absence of intra ovarian color flow are highly useful signs along with unilateral ovarian enlargement and trapped follicles being the commonest features. Pre-existing ovarian solid or cystic lesion could be a precursor in some cases. By using this early laparoscopic intervention should be carried out to save the ovary in time. Adding CEUS as an adjunct just prior to sending patient for surgery gives further quick confidence boosting exercise. We could study three such cases in last six months. This topic is to highlight its effectiveness as well as some technical difficulties. SE 066 Therapeutic Role of Ultrasound in Reposition of Renal Calculi for Better Clearance, a Novel Method Madan Mohan Gupta, Nandini Bahri Department of Radiology, MP Shah Medical College, Jamnagar, India SE 067 Transvaginal Versus Transperineal Ultrasonography: a Blinded Comparison in the Assessment of Cervical Length in Preterm Labor Kaouther Dimassi, Aymen Hammami, Salma Bennani, Amel Triki, Mohamed Faouzi Gara Department of Obstetrics and Gynecology, Obstetrics and Gynecology Unit, Mongi Slim Hospital, La Marsa Tunisia, Tunisia INTRODUCTION: In the management of preterm labor (PL) , transvaginal ultrasound (TVU) remains the gold standard in terms of diagnosis and prognosis. The transperineal utrasound (TPU) can be a reliable alternative. OBJECTIVES: пїЅPresent the use of transperineal ultrasound technique in preterm labor. пїЅCompare results of TVU and TPU on cervical length measurements and visualization of the opening of the internal os. METHODS: It is about a preliminary prospective study, including study patients between 14 and 36 weeks' gestation with a preterm labor. All the patients underwent transperineal and transvaginal cervical length assessment. The Pearson correlation coefficient and Lin concordance coefficient were used. Acceptable concordance was defined as >0.82, with an acceptable correlation of >0.9. RESULTS: 50 patients underwent the protocol. The Pearson correlation coefficient was 0.959, and the Lin concordance coefficient was 0.955, with a 95% confidence lower bound of 0.949. Close agreement between transperineal and transvaginal measurements was observed across the full range of cervical lengths. CONCLUSION: Transperineal ultrasound is as reliable as transvaginal ultrasound. Moreover, this technique is: fast, precise, trivial and providing more comfort for anxious patients. 265 Scientific Exhibits The global burden of renal calculi is increasing now days. Surgical intervention is the management in symptomatic patients in which, nearly half experience complications associated with stone fragments that are not passed and require follow-up surgical intervention. The success of surgical management of lower pole stones is principally dependent on stone fragmentation and residual stone clearance. Focused ultrasound using radiation force to reposition kidney stones and guided by ultrasound imaging is novel method. The device couples a commercial imaging array with a focused annular array transducer. This is in vitro study. During experiment; stones were located by ultrasound imaging and repositioned by delivering short bursts of focused ultrasound. Stone motion was concurrently monitored by fluoroscopy, ultrasound imaging, and video photography, from which displacement and velocity were estimated. Stones were seen to move immediately after delivering focused ultrasound and successfully repositioned from the lower pole to the collecting system. Estimated velocities were on the order of 1 cm/s. The focused ultrasound demonstrates a promising role to facilitate spontaneous clearance of kidney stones and increased clearance of residual stone fragments after surgical management. KSUM Open 2014 SE 068 SE 069 Predicting the Duration of the Latency Period in Preterm Premature Rupture of the Membranes Using Ultrasound Ultrasound Assessment of Twin Anemia Polycythemia Sequence Kaouther Dimassi, Ahmed Halouani, Amel Triki, Mohammed Faouzi Gara Department of Obstetrics and Gynecology, Obstetrics and Gynecology Unit, Mongi Slim Hospital, La Marsa Tunisia, Tunisia OBJECTIVE: To Assess the value of ultrasonographic measurement of cervical length and amniotic index for predicting the duration of the latency period from admission to delivery in women with preterm premature rupture of the membranes (PROM). METHOD: Prospective study in 26 women with preterm PROM before 37 weeks of amenorrhea. The average gestational age at admission was of 33.3 weeks. The clinical management included: no digital examination of the uterine cervix, antenatal corticosteroids if gestational age < 34 weeks, antibiotics (amoxicillin) for 7 days, and hooding back until 37 weeks. Cervical length and quantity of amniotic fluid at admission were determined with ultrasonography. The duration of the latency period was studied in relation with cervical length and the amniotic fluid index. RESULTS: The average latency period was longer in women with a cervical length Ві25 mm (18.8 vs. 8.8 days, p< 0.001). The average latency period was not longer in women with normal quantity of amniotic fluid. In fact average latency period was shorter in women with an amniotic index >8 cm (10.1 vs. 14.3 days, p = 0.5). CONCLUSION: In women with preterm PROM, the latency period from admission to delivery is shorter when cervical length is < 25 mm. However, normal amniotic fluid does not influence this latency period. 266 Mohamed Zghaier, Kaouther Dimassi, Amel Triki, Mohammed Faouzi Gara Department of Obstetrics and Gynecology, Obstetrics and Gynecology Unit, Mongi Slim Hospital, La Marsa Tunisia, Tunisia OBJECTIVE: Twin anemia polycythemia sequence (TAPS) is caused by small placental vascular anastomoses leading to chronic anemia in the donor and polycythemia in the recipient. TAPS can result in severe fetal or neonatal hematologic complications, cerebral injury and perinatal death. The aim of this study is to ascertain the most relevant echographic signs that helps to make an early diagnosis so we can improve the outcome of this sparse complication. METHODS: It's about two observations of patients treated in the department of gynecology and obstetrics of the Mongi Slim hospital Tunis in 2013. RESULTS: The first case is about a 42 years old patient with one miscarriage, one childbirth, blood type O negative, actual pregnancy a spontaneous monochorionic according to the early first trimester echography. addressed at 31 SA for intra uterine death of one the twins and hydrops fetalis of the second. The second patient is aged of 28 years, first pregnancy hospitalized at 29 SA to explore an hydramnios accidently discovered. The ultrasound exam performed in our service showed for the first twin: no bladder and anamnios, for the second twin: a huge bladder with polyhydramnios. In this too cases, the blood flow in the MCA was superior to 1.5 MoM. Furthermore ultrasound allowed the guidance for fetal transfusion. CONCLUSION: TAPS is fetal emergency. Ultrasound is the only mean for the diagnosis and for the fetal therapy. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits SE 070 Ultrasound Management of Ectopic Pregnancy in Uncommon Implantation Sites Moez Attia, Kaouther Dimassi, Amel Triki, Mohammed Faouzi Gara Department of Obstetrics and Gynecology, Obstetrics and Gynecology Unit, Mongi Slim Hospital, La Marsa Tunisia, Tunisia SE 071 Sonographic Appearances and Typing of the Testicular Epidermoid Cysts Qingda Song Department of Radiology, Shandong Provincial Medical Imaging Research Institute, China OBJECTIVE: The purpose of this study was to describe the sonographic appearances of testicular epidermoid cysts and summarize sonographic characteristics and typing. METHODS: The sonographic features of 21 testicular epidermoid cysts confirmed by surgery and pathological were retrospectively analyzed and typed. RESULTS: According to the different features of 21 cases testicular epidermoid cysts, we typed them into five patterns: в‘ The onion ring type (12 cases) with alternating hypoechoic and hyperechoic concentric rings by ultrasound; в‘Ў The perimeter calcification type (also known as egg-shell calcification type) (3 cases) with lamellar circle hyperechogenicity around the lesion homogeneous or heterogeneous hypoechogenicity in the central area; в‘ў The similar solid type (3 cases) with well-defined homogeneous hypoechogenicity masses; в‘Ј The mixed echo type (2 cases) combined with hypoechogenicity, calcification, and microcysts in the mass; в‘¤ The entirely calcified type (1 case), the whole mass was hyperechoic with posterior acoustic shadowing. All 21 case had no flow signal inside the lesion. The diagnostic accuracy of high-frequency ultrasonography was 95.2% (20/21). CONCLUSIONS: The onion ring type and perimeter calcification type were typical appearances of the testicular epidermoid cysts. Preoperative correct identification could prevent unnecessary radical orchiectomy. KEY WORDS: sonography; testicular neoplasm; epidermoid cyst. 267 Scientific Exhibits INTRODUCTION: Ectopic pregnancies of unusual location are encountered much less frequently, but are perhaps more morbid. The treatment of these unusual ectopic gestations may not be as common place as treatment of tubal pregnancies, but with early diagnosis and effective planning, their treatment can be equally as effective. OBJECTIVE: Familiarizing the practitioner with the imaging of unusual location in ectopic pregnancy. Explaining the modalities of the conservative treatment and detailing the clinical biological and ultrasound monitoring. METHOD: ItвЂ™s a retrospective study over a period of 3 years. Were included patients presenting an ectopic pregnancy in uncommon implantation site whose treatment was conservative. The medical treatment consisted on injection of KCl in the gestational yak by ultrasound guidance in the case where the pregnancy was scalable. Then, the treatment was continued by one or more intramuscular Methotraxate injections. RESULTS: During the study period we collected 04 observations of unusual ectopic pregnancies treated medically. There was an interstitial pregnancy in 2 cases, cervical pregnancy in one case and a scar pregnancy in one case. The diagnosis was made by ultrasound in all cases and confirmed by MRI in 2 cases. (details will be shown in the poster) The medium term at diagnosis was 6 weeks of amenorrhea. Pregnancies were evolving with heart activity in 2 cases. The average number of injection of MTX was 1.3. Medical treatment was able to stop pregnancy in all cases with good clinical and biological evolution. CONCLUSION: The use of advanced ultrasonography in combination with ultrasensitive serum b-hCG assays should lead to early diagnosis of such pregnancies. Early diagnosis and use of multiple modali- ties can reduce morbidity and mortality in cases of ectopic pregnancy at unusual location. KSUM Open 2014 SE 072 the important screening process for IPB. Ultrasound Diagnosis in Inverted Papilloma of the Bladder Yongguang Ban, Qinhua Luan, Qingda Song, Jianbo Teng, Hengtao Qi Department of Radiology, Shandong Medical Imaging Research Institute, China OBJECTIVE: To explore the ultrasound findings of inverted papilloma of the bladder (IPB). MATERIALS AND METHODS: To retrospectively analyze the clinical manifestation, cystoscopy examination, intraoperative observation and ultrasonographic imaging of 24 patients with IPB, confirmed by surgery and pathology examination. RESULTS: 24 patients underwent ultrasound examination and 24 tumors were found. The maximum diameter of tumors were from 1.0 cm to 3.4 cm: 1.0 cm-2.0 cm (n=17), 2.0 cm-3.4 cm (n=7). Tumors were papillary (n=17) or cauliflower shape(n=7), 6 cases had pedicles and none in 18 cases, 2 cases swung in the bladder cavity. Tumors were slight hyperecho (n=14) or high-level echo (n=10), and could be divided into three types: homogeneous internal echoes (n=14), inhomogeneous internal echoes with punctiform hyperecho in brim or internal part (n=7), inhomogeneous internalechoes with peripheral hyperecho and hypoecho in internal part (n=3). Color doppler Fflow imaging (CDFI) showed that there were no blood flow signal in 17 cases, punctiform blood flow signal in 4 cases, point and strip blood flow signal or strip blood flow signal in 3 cases. Local bladder walls were continuous and there were no attenuation behind the tumors. The onset position were: triangular area (n=6), left posterior wall (n=5), internal urethral orifice (n=4), right lateral wall (n=3), right posterior wall (n=3), posterior wall (n=2), left lateral wall (n=1). 5 cases were misdiagnosed as bladder carcinoma, and 17 cases wereconsidered as solid tumors, and only 1 case was diagnosed as papilloma, and 1 case was considered as benign lesion. CONCLUSION: The representative ultrasonographic imaging of IPB are mostly single, pedunculated, papillary or cauliflower shape with smooth surface, neck and trigone of bladder are the most risk position. Color Doppler ultrasonography can be used as 268 SE 073 Early Diagnosis of Uncommon Implantation Sites of Ectopic Pregnancies Mohamed Zghaier, Kaouther Dimassi, Moez Attia, Amel Triki, Mohamed Faouzi Gara Department of Obstetrics and Gynecology, Obstetrics and Gynecology Unit Mongi Slim Hospital La Marsa Tunisia, Tunisia PURPOSE: To report ultrasonographic features of unusual ectopic pregnancy. MATERIALS AND METHODS: A retrospective study over a period of 3 years that included patients within uncommon implantation site of ectopic pregnancy diagnosed before 12 WA. RESULTS: During the study period we collected 05 observations of unusual ectopic pregnancies diagnosed before 12WA. There was an interstitial pregnancy in two cases, cervical pregnancy in one case and a scar pregnancy in two cases. The diagnosis was made by ultrasound in all cases in the first trimester (The medium term at diagnosis was 8 WA) and confirmed by MRI in 2 cases. For the cases of interstitial pregnancies, A scan of the uterus revealed that the eccentric gestational sac was located in the right uterotubal junctional area, lying 1 cm outside the most upper lateral edge of the uterine cavity with thick endometrial echoes, making the typical image of theвЂњinterstitial lineвЂќ . In case of cervical pregnancy, we found an empty uterine cavity and the presence of a gestational bag in cervical location. In cesarian section scar pregnancies, Transabdominal and pelvic ultrasounds demonstrated the gestational sac with surrounding decidual reaction within the anterior myometrium at the site of cesarean section scar. Magnetic resonance imaging of the pelvis demonstrated decidual reaction extending into the scar, confirming a cesarean section scar ectopic pregnancy. In all cases, there was a cardiac activity. CONCLUSION: To be able to make the diagnosis of these uncommon ectopic pregnancies we must know how to recognize an intra-uterine pregnancy. An empty uterine cavity is always present, but there The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits is no pelvic mass, we found an eccentric gestational sac whether isthmic or cervical or far from the uterine cavity. This delicate ultrasound semiology needs a well trained and warned operator. Baseline prostate size is important for predicting benign prostate hyperplasia progression. In future, we need to correlate our data with anthropometrics to estimate reference size of prostate with regard to body constitution. SE 074 Prostate Size and Volume in Normal Mongolians as Measured by Ultrasound for Baseline Reference SE 075 Orkhon Gombosuren1, Bolorsaikhan Baatar1, Nergui Bayanzul1, Delgerekh Sainjargal1, Batsaikhan Narankhuu2, Tuya Gansukh1, Darkhantsetseg Battsengel1, Tuvshinjargal Dashjamts3 1 Department of Radiology, UB Songdo Hospital, Mongolia 2 Department of Surgery, Intermed International Hospital, Mongolia 3 Department of Radiology, Health Science University of Mongolia, Mongolia Tai Le, Hai Phan Department of Radiology, MEDIC Medical Center, HCMC, Vietnam The incidence of tuberculosis is increasing worldwide, with more than 20% of cases exhibiting extrapulmonary manifestations. The genitourinary tract is the most common site of extrapulmonary tuberculosis. We would like to present ultrasound finding of three cases of tuberculous epididymo-orchitis, age from 25 to 52. In which, there were one case of miliary tuberculosis of right testis and left tuberculous epididymitis, other case of tuberculosis of right testis and bilateral epididymis, final case of bilateral tuberculous epididymo-orchitis. SE 076 A Study of Diagnostic Yield, Efficacy and Complications of Ultrasound Guided Renal Biopsy in Different Renal Pathologies Dinesh Chataut, Kamal Subedi Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal INTRODUCTION: Renal biopsy is an integral part of modern nephrology practice, being indicated in renal diseases in both native and transplanted kidneys. The purpose of this study was to evaluate diagnostic yield, efficacy and complications of ultrasound guided renal biopsy with automated biopsy gun. MATERIALS AND METHODS: This was a prospective cross sectional study involving 184 patients including renal transplant recipients. These patients with new onset renal symptoms or deteriorating renal function post transplant underwent free hand real time ultrasound guided renal biopsy with 269 Scientific Exhibits BACKGROUND/INTRODUCTION: Baseline prostate size is essential for assessment of benign prostate hyperplasia and a strong indicator for future prostate growth. Determination of baseline prostate size together with PSA level is also important predictor for clinically significant therapy response. In Mongolia, there was only a single publication on normal prostate size which included less than 200 subjects. With increasing average body height and obesity rate in Mongolia, we need to determine reference size for normal prostate at pelvic US examination, which is most safe and common screening method for prostate evaluation. MATERIALS AND METHODS: We reviewed data of clinically unremarkable male patients who underwent screening pelvic US at Ulaanbaatar Songdo Hospital in 2013. The demographics, prostate length, width, thickness and volume were evaluated using Windows Excel. CONCLUSION: Our data showed steady increase of prostate volume with advancing age, which is in line with similar reports in other countries. Nevertheless, the determination of reference range for normal prostate evaluation is necessary in our country, due to absence of representative data. Ultrasound Finding of Tuberculous Epididymo-orchitis in Three Cases KSUM Open 2014 18 gauge automated biopsy gun. The diagnostic yield, pathological and immunohistochemistry diagnosis and complications of the procedure were analyzed. RESULTS: 184 patients underwent the ultrasound guided biopsy, 17 were renal transplant recipients. Male and female ratio was almost equal (51.1% and 48.9%, respectively). Most patients were in age group of 20-40 years. Most cases presented clinically with nephrotic syndrome (38.04%), followed by equal number of lupus nephritic and nonnephrotic range proteinuria. The average number of glomeruli in the biopsy tissue was 11.8 per specimen. The average length of biopsy tissue was 1.15 cm in native kidneys and 0.9 cm in transplant kidneys. Renal biopsy yielded pathological diagnosis in 97.2% cases with adequate sample for diagnosis in 98.9% cases. Major life threatening complication was noted in a single patient. Rest of the patients showed minor or no complications. CONCLUSION: Ultrasound guided percutaneous biopsy with automated biopsy gun is modality of choice for renal biopsy since it has the greatest yield, highest efficacy and least serious complication rates. Keywords: glomeruli, nephrotic syndrome, renal biopsy, ultrasound. SE 077 Initial Study on Correlation of Prostate Volume and Blood PSA Level with Bodymass-index in Mongolian Tugsjargal Purevsukh , Orkhon Gombosuren , Nergui Bayanzul2, Tuya Gansukh2, Darkhijav Yanjiv2, Tuvshinjargal Dashjamts1 1 Department of Radiology, Health Sciences University of Mongolia, Mongolia 2 Department of Radiology, UB Songdo Hospital, Mongolia 1 2 BACKGROUND: We investigate on correlation of body composition with PSA level and prostate volume to determine the baseline reference which is needed to correctly discriminate patients with hyperplasia at first examination. MATERIALS AND METHODS: We reviewed data of clinically unremarkable male patients who under- 270 went screening pelvic US at Ulaanbaatar Songdo Hospital in 2013. The demographics, prostate volume, PSA and Body-mass-index were evaluated using Windows Excel. RESULTS: Among the age 20-29, the average prostate volume (APV) and PSA level were 21.90 cm3 and 1.23 ng/ml; with regard to the BMI, lean subjects with BMI3/0.89 ng/ml; whereas lean subjects had 19.89/0.89, normal weighted-19.44/0.85, obese19.43/0.87, morbidly-27.8/0.69. Between 40-49 aged, APV and PSA volume were 21.74 cm3/0.84 ng/ml; whereas lean subjects had 21.8/0.84, normal weighted-26.72/1.1, obese-22.2/0.76, morbidly-18.75/0.6. Between 50-59 aged, APV and PSA level were 18.51 cm3/0.94 ng/ml; whereas lean had 18.51/0.94, normal weighted-16.1/0.79, obese-22.57, morbidly obese-10.6/1.11. In the 60-69 aged, APV and PSA level were 18.51 cm3/0.94 ng/ml; whereas lean had 18.30/1.01, normal weighted-17.14/0.62, obese19.01/1.78, morbidly obese-12.1/1.55. In subjects over 70, above measurements were 14.32 cm3/ 1.73 ng/ml; whereas lean had 14.34/1.73, normal weighted-13.36/0.89. CONCLUSION: In our study, the maximum prostate volume and PSA volume were found in the group of age 40-49 in normal weighted subjects with BMI 18-25. Obese and morbidly obese subjects are found to have the smaller prostate volume and higher PSA level, relative to the age average. SE 078 Sonographic Parameter in Benign Prostatic Hyperplasia Vaanchigsuren Seesregdorj1, Tsevelmaa Dorj1, Munkh-Od Enkhjargal1, Badamsed Tserendorj2 1 Department of Radiology, Health Sciences University of Mongolia, Mongolia 2 Department of Radiology, 3rd Central Clinical Hospital of Mongolia, Mongolia BACKGROUND: Benign prostatic hyperplasia (BPH) can be detected in 80% of males over the age of 80. Clinical symptoms do not correlate with organ enlargement. Only 10% of patients with BPH need surgical treatment. The decision for surgical treatment is made as a result of objective findings and The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits the symptoms reported by the patient. GOAL: This study was aimed to evaluate the sonographic parameters of benign prostatic hyperplasia. MATERIALS AND METHODS: Fifty seven patients with symptoms and clinical signs of prostatic gland enlargement had transabdominal ultrasonography at Department of Radiology, AchtanElite clinic in Mongolia between 2012 and 2013. The size, echotexture, shape, contour bulging, capsule, volume of the prostate were evaluated by ultrasonography. With the subject lying supine, the transducer was positioned to view the maximum longitudinal section, usually at midline. RESULTS: This study revealed the size of the prostate which normal were 24.6%, and enlargement were 43 (75.4%), abnormality echogenicity were 46 (81.7%), 36 (63.1%) of shape was round, 29 (50.9%) of capsule was thickness. Prostatic volume was significantly increased 45 (78.9%) in benign prostatic enlargement and 16 (28.1%) of prostatic calcification were occurred. CONCLUSION: Prostatic size and volume were significantly increased in benign prostatic enlargement and echogenicity abnormal capsule thickness were very common. SE 079 Ultrasound Findings in Patients with Chronic Prostatitis Munkh-od Enkhjargal1, Tsevelmaa Dorj1, Vaanchigsuren Seesregdorj1, Badamsed Tserendorj2 1 Department of Radiology, Health Sciences University of Mongolia, Mongolia 2 Department of Radiology, 3rd Central Clinical Hospital of Mongolia, Mongolia SE 080 Sonoelastography and Contrast Enhanced Ultrasound of Renal Masses: are They Useful for Detection and Characterization of Benign and Malignant Renal Lesions? Sang Youn Kim, Sungmin Woo, Myong Seok Lee, Jeong Yeon Cho, Seung Hyup Kim Department of Radiology, Seoul National University Hospital, Korea Most of renal masses are incidentally diagnosed by gray scaled ultrasound. The next steps for characterization of detected renal masses are contrast enhanced computed tomography (CECT). Accompanying problems of CECT are significant risks for patients with impaired renal function, allergic reaction and hyperthyroidism due to iodinated contrast agents. Sonoelastography can provide quantitative information on tissue elasticity of an interesting lesion in real time. Contrast enhanced ultrasound (CEUS) which has been introduced for diagnostic imaging in the liver, heart and several organs can also show qualitative and quantitative information on tissue perfusion of an interesting lesion in real time. We performed sonoelastography and CEUS for detection and characterization of various benign and malignant renal lesions. The aim of this exhibition is 271 Scientific Exhibits BACKGROUND: Prostatitis is the most common urologic diagnosis in men younger than 50 years old and the third most common urologic diagnosis in men older than 50 age, representing about 8% of male urology office visits. PURPOSE: This study was conducted to evaluate the sonographic features of chronic prostatitis. MATERIALS AND METHODS: The study population included 38 men examined by the ultrasonogra- phy at the department of Radiology, Achtan-Elite clinic in Mongolia. These men had symptoms of chronic prostatitis. RESULTS: We found the following US characteristics. There were 16 (42.1%) of echotexture was normality and 22 (57.9%) was heterogeneous. The shape were 27 (71.1% of half-moon, 11 (28.9%) was triangle, 24 (63.2%) was round. We determined prostate volume, 23 (60.5%) was increased, 3 (7.9% was decreased and 12 (31.6%) was normality. Twenty five men had significant calcification (65.8%). Contour bulging of 71.1% was regular and 11 (28.9%) was irregular. CONCLUSION: Sonographic features were statistically confirmed that shape was round, echotexture was abnormality and volume seem to have the potential to increase in patients with chronic prostatitis. And also prostatic calcification were common. KSUM Open 2014 to show the image findings and the quantitative data of various renal lesions and to find out the usefulness of them for detection and characterization of benign and malignant renal lesions. dicitis, the possibility of the ectopic appendicolith from perforated appendicitis as a cause of TOA should be considered. SE 082 SE 081 Tubo-Ovarian Abscess Related with Postappendectomy Remained Appendicolith for One Year in a 19-Year-Old Female Jongchul Kim Department of Radiology, Chungnam National University Hospital, Korea BACKGROUND: The proximity of the fallopian tubes (especially right oviduct) to the appendix and the peristaltic nature of the fallopian tube make it reasonable to believe that there would be a risk of tubo-ovarian abscess (TOA) following perforation of the appendix with or without appendicoliths. We report a case of a right TOA developed secondary to remained intrapelvic appendicolith for one year after laparoscopic appendectomy for perforated appendicitis with generalized peritonitis. CASE: A 19-year-old, sexually active female was transferred to the emergency department of our hospital with the clinical impression of acute appendicitis at local clinic. Abdominopelvic computed tomography (CT) performed at local clinic could not show appendicoliths due to contrast-filled bowel loops. She underwent laparoscopic appendectomy, which revealed perforation of the appendix of pelvic type with generalized acute peritonitis. Her postoperative course has been good. After one year, she visited our emergency department again due to abdominal pain, fever, right lower quadrant tenderness & rebound tenderness, nausea, and leukocytosis. Pelvic ultrasonography and abdominopelvic CT showed right adnexal multilocular cystic mass with (enhancing) thick wall (indicative of right TOA) and a remained appendicolith (1 cm in diameter) behind the right TOA and right lateral to the rectum. After marsupialization of right TOA and removal of appendicolith, her symptoms subsided. CONCLUSION: In female patients with persistent postoperative abdominal pain, fever, and leukocytosis following appendectomy for perforated appen- 272 Malignant Melanoma in Vagina Mimicking Cervix Cancer Jongchul Kim Department of Radiology, Chungnam National University Hospital, Korea BACKGROUND: Primary melanoma of the vagina is an extremely rare neoplasm, accounting for no more that 2% of melanomas among women, and 2.4-2.8% of all vaginal cancers. Malignant melanoma of the vagina (either melanotic or amelanotic) is a disease of postmenopausal women, with 75% of women being over 50 years of age. It may arise anywhere in the vagina with a predilection for the lower third. CASE: A 55-year-old, sexually active female was transferred to the gynecologic department of our hospital with the chief complaints of continuous vaginal bleeding for 2 months. On gynecologic examination, vaginal mass was also palpable, and the clinical impression was cervical cancer with vaginal extension. Transvaginal ultrasonography (US) reveals relatively homogeneous irregular vaginal mass with upward extension to the uterine cervix. Pelvic MR imaging showed a large enhancing irregular mass at the upper vagina, vaginal fornices, and uterine cervix. Pathologic report of punch biopsy of uterine cervix said poorly differentiated papillary squamous cell carcinoma. Radical hysterectomy with bilateral salpingo-oophorectomy & pelvic lymph node dissection were done at our hospital with the pathologic diagnosis of poorly differentiated malignant melanoma. After wound debridement with repair for postoperative wound dehiscence, chemotherapy has been done at this woman. CONCLUSION: Although US finding of vaginal melanoma is nonspecific, the melanotic melanoma may show high signal intensity (SI) on T1-weighted images and low SI on T2-weighted images, which is not suppressed by a fat-saturated sequence. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits SE 083 SE 085 Long-term Experience of Transrectal Prostate Fiducial Markers Placement Evaluation for Combined Therapy of RFAblation with Double Anti-angiogenic Protein Using Contrast Enhanced Ultrasound in Murine Renal Carcinoma Model Sung Hwan Bae, Seong Sook Hong, Jiyoung Hwang Department of Radiology, Soonchunhyang University Hospital, Korea Invasive image-guided frameless robotic radiosurgery is widely used for extracranial lesions, such as lesions in intra-abdominal organs, especially prostate cancer. Tracking by the circumstantial insertion of fiducial markers helps plan the CyberKnife treatment. In this exhibit, we will describe the technique of transrectal prostate fiducial markers implication for image-guided radiation therapy such as CyberKnife treatment. And also, we will present the successful rate of the procedure and failure rate including discrimination failure. Minor and major complications associated with transrectal prostate procedure will be discussed; transient hematuria, nausea, transient rectal bleeding, or voiding difficulty. The purpose of this exhibit is to inform the intervention radiologists that this procedure is a feasible and safe technique without changing patients SE 084 Sonographic Findings of Perineal Diseases with Perineal and Transvaginal Ultrasound Boem Ha Yi, Hae Kyung Lee, Min Hee Lee, Seo-youn Choi, Sun Huh Department of Radiology, Soonchunhyang University Bucheon Hospital, Korea PURPOSE: To evaluate the efficacy of combined therapy of double anti-angiogenic protein (DAAP) and radiofrequency ablation (RFA) in renal cell carcinoma (RCC) model in mice. MATERIALS AND METHODS: RCC cell lines was implanted subcutaneously into 8 nude mice. Eight mice were randomly assigned into one of two groups when tumors reached approximately 10 mm in diameter: Four mice received DAAP adenoviral treatment (1Г—109 pfu); four mice received Lac-adenoviral treatment (1Г—109 pfu). Effect of DAAP in murine RCC model were evaluated a vascularity of the inner tumor by contrast-enhanced ultrasound (CEU) using microbubbles (MBs). MBs were prepared by sonic dispersion of decafluorobutane gas in an aqueous medium containing L-A-phosphatidylcholine-distearoyl and PEG 40 stearate in a 77:15:8 molar ratios. CEU images were analyzed using ImageJ software within the tumor and assessed Kruskal-Wallis test. RF ablation was performed by using a 1-cm active tip, with mean temperatures of approximately 70пїЅC for 5 minutes. To assess RFablation, mitochondrial staining was performed by 2% 2,3,5-triphenyltetrazolium chloride, and it was compared between the groups. RESULTS: Combined therapy group of RFA with antiangiogenic agent DAAP showed the significantly increased tumor coagulation compared to control group (P < .001). The contrast enhancement ratio for tumor vascularization on CEU images were significantly reduced in combined therapy group than 273 Scientific Exhibits Ultrasound is easily adaptable, and useful diagnostic tool in most body parts, and various perineal or genitourinary diseases could be detected and diagnosed by ultrasound examination. WeвЂ™d like to present ultrasound findings of disease in perineal area including vulvar neoplasm, uterine or vaginal tumor, urethral diseases, inflammatory diseases and parasitic diseases involving perineal soft tissue with perineal and transvaginal sonographic images. Hong Young Jun1, Jong-Hyun Ryu1, Young Hwan Lee2, Seung Jae Byun3, Kwon-Ha Yoon2 1 Department of Imaging Science based Lung and Bone Disease Research Center, Wonkwang University Hospital, Korea 2 Department of Radiology, Wonkwang University Hospital, Korea 3 Department of Surgery, Wonkwang University Hospital, Korea KSUM Open 2014 that of control group (30.15 В± 9.88% vs. 77.43 В± 17.26%, P < .001). After RF-ablation, area of viable mitochondria within the tumor was 2.13 В± 0.65% and 10.27 В± 4.46%, respectively (P < .001). CONCLUSION: Combined therapy of double antiangiogenic protein and RFA presented significantly increased effect for tumor coagulation necrosis. Our study suggests that combined therapy of RFA with DAAP might be useful for thermal tumor ablation therapy. SE 086 The Role and Clinical Significance of Simultaneous Scrotal Ultrasound (US) and Transrectal Ultrasound (TRUS) Examination in the Patients with Scrotal Pain Sung Kyoung Moon, Joo Won Lim Department of Radiology, Kyung Hee University Medical Center, Korea PURPOSE: To assess the clinical significance of simultaneous scrotal US and TRUS examination in the patients with acute or subacute scrotal pain. MATERIALS AND METHODS: We enrolled 16 patients who underwent scrotal US simultaneously with TRUS because of acute or subacute scrotal pain in this retrospective study. We retrospectively reviewed their demographic data, clinical symptoms (scrotal, LUTS, and systemic), laboratory test (UA, serum PSA level, and urine culture), and pathologic reports. Two experienced genitourinary radiologists reviewed their scrotal US and TRUS images retrospectively with consensus. In scrotal US and TRUS, the involving segments (proximal and distal vas deferens, epididymis, testis, prostate, and seminal vesicle), laterality (right and left), and the presence of echogenicity change, swelling, mass formation, and hyperemia in color Doppler US were assessed. We compared the image findings and clinical data of the patients with positive and negative TRUS findings. RESULTS: All of the 16 patients had epididymitis or epididymo-orchitis in scrotal US. Among them, 8 patients (50%) showed positive TRUS findings. In TRUS, they showed wall thickening and hyperemia of ipsilateral (87.5%) or bilateral (12.5%) proximal vasa deferentia, and seminal vesicles. Five patients 274 (5/8, 62.5%) showed prostate echogenicity change and hyperemia. In scrotal US, 8 patients with positive TRUS findings showed vasitis (100%). On the other hand, 5 patients without TRUS abnormality showed vasitis in scrotal US (62.5%). Patients with TRUS abnormality had significantly severe UA abnormality (75% vs. 25%), elevated serum PSA level (7.907 vs. 1.058), and LUTS (62.5% vs. 12.5%) than patients without TRUS abnormality. Among the patients without TRUS abnormality, 2 cases were diagnosed as tuberculosis and 1 as mumps epididymo-orchitis. CONCLUSION: Simultaneous scrotal US and TRUS examination is useful to assess the extent of urinary tract infection in patients with scrotal pain and severe LUTS. SE 087 Ruptured Rudimentary Horn Pregnancy: Does Previous Normal Vaginal Delivery Safely Excludes It? Nitin Mishra, Nitin Yadav, Darshan Koshiya, Vikas Jhanwar Department of Radiology, SMS Medical College and Hospitals, Jaipur, India Rudimentary horn pregnancy is a rare event with an estimated incidence of 1 in 76,000 to 1 in 140,000 pregnancies. Unicornuate uterus with rudimentary horn has high incidence of obstetric and gynecological complications. Ruptured ectopic pregnancy in the rudimentary horn is one of the most dreaded complication which can have grave consequences for both mother and fetus. In majority of cases it is detected after rupture of the horn, usually during first or second trimester of pregnancy. A pre rupture ultrasonographic diagnosis may prevent this catastrophic outcome. We report a case of G2P1L1 with rupture left rudimentary horn pregnancy at 16 weeks of gestation which was misdiagnosed as pregnancy in left uterine horn of a bicornuate uterus on prenatal ultrasound. Patient presented to our hospital with pain abdomen and per vaginal bleed. A diagnosis of ruptured left rudimentary horn pregnancy was made on the basis of emergency ultrasound and was later confirmed on laparotomy. Left The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits rudimentary horn along with ipsilateral fallopian tube was excised. SE 088 acterization and diagnosis is essential to optimal management while avoiding radical surgery. We hope that this help you differentiate non-neoplastic miscellaneous ovarian lesions that are faced frequently in daily practice. Miscellaneous Tumor-like Lesions of the Ovary: US, CT, and MR Imaging Jung-Hee Yoon, Kyeong-Wha Rhyu, Seung-Ho Kim, Yedaun Lee, Kwang-Hwi Lee, Suk-Jung Kim, Ji-Hwa Ryu, Ok-Hwa Kim, Hong-Dae Kim Department of Radiology, Inje University Haeundae Paik Hospital, Korea Left Renal and Ovarian Venous Aneurysm: Imaging Features and Clinical Presentation Jeongin Yoo, Sung Bin Park, Jong Beum Lee, Hyun Jeong Park, Mack Shin Department of Radiology, Chung-ang University Hospital, Korea Primary venous aneurysms are characterized by the dilatation of a localized segment of a vein in the absence of associated varicose vein and not as common as arterial aneurysms. Venous aneurysms are described in the popliteal, jugular and saphenous veins, but rarely described in other veins including renal and ovarian veins. Although visceral venous aneurysms are rare lesions, they are increasingly described in recent years, probably because of the increasing availability of advanced radiological imaging in clinical practice. Thus radiologists should be familiar with venous aneurysms. We report two rare cases of left renal and ovarian venous aneurysms. The lesions were depicted on gray scale and color Doppler US as anechoic saccular structures with compressibility, increased blood flow those are characteristics of aneurysm. Spectral Doppler US showed venous flow. Enhanced CT scan confirmed these findings and diagnosed as left renal and ovarian venous aneurysms. We also review the clinical presentation or implications of visceral venous aneurysms: mimicking mass or lymph node enlargement and risk or association with pulmonary emboli. Scientific Exhibits LEARNING OBJECTIVES: Miscellaneous tumorlike ovarian lesions are histologically diverse, and are often mistaken for the more common ovarian cancers, leading to aggressive management. Knowledge of characteristic clinical, laboratory and US, CT or MR imaging of these non-neoplastic ovarian entities allows correct diagnoses and permits optimal management. BACKGROUND: In practice, we daily meet various cystic or solid tumor or tumor-like lesions in the ovary or pelvic location from simple functional cyst to cancerous lesion. The therapeutic strategy and clinical courses are very different between each disease that presents as tumor-like lesions of the ovary. So it is important to differentiate with noninvasive diagnostic methods. In this exhibit, each disease entity is introduced with US and CT findings and correlated pathologic findings. Imaging Findings: The contents of ovary lesions are inflammatory and infectious disease (acute oophoritis, xanthogranulomatous oophoritis, tubo-ovarian abscess, ovarian cyst rupture, inflammatory pseudotumor), pregnancy-related ovarian masses (ectopic pregnancy, ovarian hyperstimulation syndrome, polycystic ovarian syndrome, endometrioma) and other miscellaneous ovarian lesions (ovarian torsion, massive ovarian edema). These patients were underwent US, CT or MRI images were reviewed the shape, morphology, presence of septum and solid vegetation, and correlated with pathologic characteristics. CONCLUSION: Miscellaneous ovarian non-neoplastic entities comprise a wide spectrum. Histopathological evaluation is warranted in some cases to establish definitive diagnosis. Accurate char- SE 089 275 KSUM Open 2014 SE 090 Ultrasound Follow-up of Testicular Adrenal Rest Tumors with Congenital Adrenal Hyperplasia: Report of Three Cases Dong Won Kim, Seong Kuk Yoon, Jung Hyun Jo, Hee Jin Kwon, Jin Han Cho, Jong Young Oh, Kyung Jin Nam Department of Radiology, Dong-A Medical Center, Korea Testicular adrenal rest tumor (TART) is a rare intratesticular tumor, but frequently found in patients with congenital adrenal hyperplasia (CAH). The tumors are diagnosed and followed up by ultrasound (US) examination because these tumors are non-palpable and symptomless in most cases and always benign. US imaging features would be changed depending on how CAH would be controlled. We herein report three cases of testicular adrenal rest tumors with different usual and unusual imaging findings and follow-up imagings. Patient 1 was a 14-year-old boy who presented with poor compliance to medication. Patient 2 and patient 3 were 10-year-old boy and 13-year-old boy who presented with precocious puberty and short stature, respectively. US examinations demonstrated oval hypoechoic masses and irregular speculated hyperechoic masses in the testes and different serial imaging findings. SE 091 US and MRI Findings of Spindle Cell Lipoma Arising from the Spermatic Cord Sung Kyoung Moon, Joo Won Lim Department of Radiology, Kyung Hee University Medical Center, Korea A 29-year-old male patient had the palpable mass at right inguinal region. In scrotal and inguinal US, a right spermatic cord mass was shown. It showed well-circumscribed margin, lobulating contour, and slightly heterogeneous and high echogenicity. In CDUS, there was no significantly increased vascularity in the mass. It was considered as a lipoma of spermatic cord on US images. In MR images, it contained gross fat portion, but also had enhancing solid 276 portion with heterogeneously intermediate and low signal intensity on T2WI. It was presumed as welldifferentiated liposarcoma with MR images. Surgically-resected mass was pathologically diagnosed as spindle cell lipoma (pleomorphic lipoma). SE 092 WegenerвЂ™s Granulomatosis with Renal Involvement: Imaging Findings Chong-ho Lee, Young-Hwan Lee, Kwon-Ha Yoon, Seong-hoon Park, Young Jun Sohn, Taeyeong Heo Department of Radiology, Wonkwang University Hospital, Korea WegenerвЂ™s granulomatosis (WG) is a systemic disorder which affects small- and medium-size vessels in many organs. Although the kidneys are the second most commonly involved organ in WG, its manifestation as multiple intrarenal aneurysms is rare, only a few cases were reported in literature. We present here this unusual manifestation of biopsy proven WG as multiple intrarenal aneurysms in a 71-year-old man, who presented to our hospital with generalized weakness. Pre-admission evaluation revealed impaired renal function, which was not improved in spite of prolonged treatment. Chronic renal parenchymal disease was suspected and US guided renal biopsy was done. The histopathologic exam showed findings of WegenerвЂ™s granulomatosis. Chest CT showed reticular opacities and GGO of both lower lobes, which is not a specific finding of WegenerвЂ™s granulomatosis. However, both kidneys showed multiple subcentimeteric hyperenhancing nodular lesions with similar enhancement degrees to renal arteries, which gave suspicion of aneurysms or pseudoaneurysms. Subsequent contrast enhanced US and dynamic MRI showed multiple small aneurysms. Renal arterial angiography further elaborated their detailed appearance. The patient received immunosuppressive treatment with cyclophosphamide and steroids. Two weeks later chest CT was performed to evaluate pneumonia. Both kidneys showed no visible aneurysms, on the contrary to previous chest CT which showed multiple aneurysms. There have been only a few reported cases of WegenerвЂ™s granulomatosis with bilateral The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits multiple intrarenal aneurysms. In this case report, weвЂ™ll present the changes of imaging features along the disease course with various imaging modalities including contrast enhanced ultrasound, CT, MRI, and angiography. SE 094 Usefulness of Standard Deviation of on the Histogram of Ultrasound as a Quantitative Value for Thyroid Parenchymal Echotexture Heung Cheol Kim Department of Radiology, Chuncheon Sacred Heart Hospital, Korea Head & Neck SE 093 Role of Ultrasound and Color Doppler in Differentiation Between Malignant from Benign/reactive Lymph Nodes Madan Mohan Gupta, Nandini Bahri Department of Radiology, MP Shah Medical College, Jamnagar, India Scientific Exhibits PURPOSE: The purpose of this study was to evaluate role of ultrasound and color Doppler for differentiating malignant from benign/reactive lymph nodes. MATERIALS AND METHODS: A total of 50 patients with oral cancer were evaluated with ultrasound and color Doppler examination of neck. Correlation between ultrasound and color Doppler findings and histopathology results was done to evaluate sensitivity, specificity, positive predictive value and negative predictive value of ultrasound and color Doppler in detecting metastatic neck nodes. RESULTS: Study results showed that malignant lymph nodes were round in shape, showed loss of central hilar echogenicity and peripheral vascularity and had high resistive index and pulsatility index values. In our study, nodal shape (round) and RI and PI values on color Doppler were more accurate for differentiating benign from malignant lymph nodes. CONCLUSION: We conclude that ultrasound and color Doppler had relatively high accuracy in differentiating benign from malignant cervical lymph nodes. So, Ultrasound with color Doppler can be used for initial non-invasive workup in patients with oral cancers for cervical lymph nodes. This study examined whether the standard deviation values, which has measured automatically on the histogram in the picture archiving and communication system (PACS) views of an ultrasound (US), can be used as an index to determine the homogeneity or heterogeneity of a thyroid parenchymal echo. The study groups consist of 30 normal control groups and 30 patient groups who had diagnosed with thyroiditis. We performed thyroid US using a 715 MHz linear array transducer (Philips Ultrasound, Bothell, WA) and measured the parenchymal echogenicity in each region-of-interest (ROI) of the both thyroid lobes. The SD values of thyroid parenchymal echo were calculated automatically on the histogram in the ROI of the PACS view. In a patient, two ROIs were selected in mid-level axial scan images from both thyroid lobes and the average value of SDs of 2 ROIs was used as a representative number. The mean SD of normal control group and thyroiditis group were 11.19В±2.12 and 16.24В±3.96, respectively. There were significant difference (p<0.0001) between two groups. The SD values of US examination of thyroid parenchyma are thought to reflect the homogeneity or heterogeneity of the thyroid parenchyma. So, larger SD values are thought to represent coarse parenchymal echotexture and the possibility of thyroiditis. Our study revealed that the SDs of the ROI was useful quantitative diagnostic method in differentiation of coarse and normal echotexture of thyroid lobe. 277 KSUM Open 2014 SE 095 The Assessment of Nasal Septal and Lateral Cartilage by Ultrasonography Heung Cheol Kim Department of Radiology, Chuncheon Sacred Heart Hospital, Korea We studied the usefulness of ultrasonography (US) as a diagnostic tool in the assessment of the nasal cartilage. The study group consists of 92 patients (18 female, 74 male lies within average age of 25 years, ranging from 3 year to 80 years) who had an US and CT scan with nasal trauma. We performed nasal US using a 7-15 MHz linear array transducer and evaluate the ability to identify the nasal septal, upper and lower lateral cartilage. The US examination has identified the septal cartilage in 88 (95.6%), upper lateral cartilage in 89 (96.7%) and lower lateral cartilage in 62 (67.3%) of 92 patients. In US examination, the pathologic findings of interruption of continuity and acute angulation of septal cartilage indicating a septal injury could be recognized in 6 and 10 patients, respectively. In contrast, those findings could not be found on CT exam. Our study revealed that nasal US was very useful diagnostic method in assessment of nasal cartilages. SE 096 A Case of Thyroid Papillary Carcinoma Arising from Ectopic Thyroid Tissue in Cervical Lymph Node: US and CT Findings Bo Yeon Kim, Dae Young Yoon, Young Lan Seo Department of Radiology, Kangdong Sacred Heart Hospital, Korea Ectopic thyroid tissue in cervical lymph node is a very rare entity resulting from developmental defects at early stages of thyroid gland embryogenesis. A 61-years-old female presented with a palpable neck mass. She had undergone total thyroidectomy for nodular hyperplasia 7 years earlier. Ultrasonography (US) demonstrated a 1-cm, well-defined, ovoid mass in the right lateral cervical region (level IV). This mass shows internal heterogeneous echogenicity and multiple microcalcifications. CT was performed subsequently and showed a strongly 278 enhancing mass with well-circumscribed margin. Patient underwent US-guided fine needle aspiration biopsy and surgical excision and the final diagnosis was PTC in lymph node. The repeated histopathologic examination of previous thyroidectomy specimen showed no evidence of primary PTC. We finally concluded that it was PTC arising from ectopic thyroid tissue in cervical lymph node. SE 097 Ultrasound and MRI Findings of the Solitary Subcutaneous Neurofibroma: a Case Report Da Mi Kim Department of Radiology, Chungnam National University Hospital, Korea A neurofibroma is a benign nerve sheath tumor in the peripheral nervous system. Solitary isolated neurofibroma of the subcutaneous layer not associated with neurofibromatosis type I (von Recklinghausen disease) is even more infrequent. The exact cause of solitary neurofibroma remains unknown. It has been postulated that solitary neurofibroma is hyperplastic hamartomatous malformations rather than a neoplasm. We reviewed a 19-year-old man with an uncommon solitary subcutaneous neurogenic tumor. The patient presented with painless palpable mass in the paramedian infranasal area in 3 months. Ultrasonography demonstrated a 1.8Г—0.8Г—1.7 cm, ovoid shaped, heterogeneously hypoechoic lesion in the subcutaneous layer (between dermis and orbicularis oris muscle) of philtrum area. Color Doppler and Power Doppler ultrasound revealed marked hypervascularity. There was no distinct close contact with the peripheral nerve bundle. T2-weighted images showed slightly high signal intensity in the region which was iso signal intensity to adjacent muscle on T1-weighted images. T1-weighted contrast-enhanced fat suppressed images showed strong enhancement of the lesion. Complete surgical excision was done. Histopathology composed of Schwann cells, perineural cells, and fibroblasts consistent with neurofibroma. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits Musculoskeletal SE 098 Evaluation of Medial Patellofemoral Ligament Tears after Acute Lateral Patellar Dislocations: Comparison of High-frequency Ultrasonography and MR Guang Ying Zhang1, Lei Zheng2, Hong Yu Ding1, Hao Shi1 1 Department of Radiology, Qianfoshan Hospital of Shandong University, China 2 Department of Radiology, Shandong Provincial Corps Hospital of Chinese People's Armed Police Force, China SE 099 Evaluation of Articular Cartilage Lesions after Acute Lateral Patellar Dislocations: Comparison of High-frequency Ultrasonography and MR Guang Ying Zhang1, Lei Zheng2, Hong Yu Ding1, Hao Shi1 1 Department of Radiology, Qianfoshan Hospital of Shandong University, China 2 Department of Radiology, Shandong Provincial Corps Hospital of Chinese People's Armed Police Force, China OBJECTIVES: To compare the diagnostic performance of high-frequency ultrasonography with MR in the evaluation of articular cartilage lesions after acute lateral patellar dislocation (LPD). MATERIALS AND METHODS: Ninety-seven consecutive patients with acute LPD who had undergone high-frequency ultrasonography and MR were included in this study. Arthroscopy or arthrotomy performed within 2 weeks of the imaging, was used as reference standard. In each patient, ultrasound, MR images were retrospectively evaluated by two radiologists. Sensitivity, specificity and accuracy of high-frequency ultrasonography and MR were compared by using the Chi-square test. RESULTS: Thirty-four cases of chondral lesion and twenty-seven cases of osteochondral lesion occurred at the medial patellar facet. Fifteen cases of chondral lesion and twenty-one cases of osteochondral lesion occurred at the lateral femoral condyle. The sensitivity, specificity, accuracy regarding chondral and osteochondral lesion of the medial patella were 50%, 77.78%, 64.28% and 74.07%, 77.78%, 76.19% for high-frequency ultrasonography; 70.59%, 88.89%, 80% and 92.59%, 88.89%, 90.48% for MR, respectively. The sensitivity, specificity and accuracy regarding chondral and osteochondral lesion of the 279 Scientific Exhibits OBJECTIVES: To compare the diagnostic performance of high-frequency ultrasonography with MR in evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). MATERIALS AND METHODS: Ninety-seven consecutive patients with acute LPD who had undergone high-frequency ultrasonography and MR were included in this study. Arthroscopy or arthrotomy performed within 2 weeks of the imaging was used as the reference standard. For each patient, ultrasound and MR images were retrospectively evaluated by two radiologists. Sensitivity, specificity and accuracy of high-frequency ultrasonography and MR were compared by using the Chi-square test. RESULTS: Fifty-three cases of complete MPFL tear and 41 cases of partial MPFL tear were identified in operation. At 28.9%, it occurred in more than 1 localization. Among a total of 291 sites, 127 showed proven MPFL tear, including 51 sites of complete tear and 76 sites of partial tear. Overall, 54 sites of MPFL tear located at their femoral attachment, 47 sites of tear at patellar attachment and 26 sites of mid-substance tear. On a site-based analysis, the sensitivity, specificity, accuracy regarding partial and complete MPFL tear were 90.8%, 96.3%, 94.6% and 86.3%, 96.3%, 94% for high-frequency ultrasonography; 81.6%, 95.7%, 91.3% and 80.4%, 95.7%, 92.1% for MR, respectively. There was no statistic difference in sensitivity, specificity and accuracy between high-frequency ultrasonography and MR in the assessment of partial and complete MPFL lesions (P=0.1, 0.777, 0.155) and (P=0.425, 0.777, 0.449). Interobserver agreement was very good for high-frequency ultrasonography and good for MR. CONCLUSION: Data suggest that high-frequency ultrasonography and MR have similar diagnostic performance for the evaluation of MPFL tears after acute LPD. KSUM Open 2014 lateral femoral condyle were 20%, 85.25%, 72.36% and 19.05%, 85.24%, 68.29% for high-frequency ultrasonography; 75.33%, 93.44%, 89.47% and 85.71%, 93.44%, 91.46% for MR, respectively. Compared with US, MR showed higher accuracy in diagnosis of chondral and osteochondral lesion of the medial patella, higher sensitivity and accuracy in diagnosis of chondral and osteochondral lesion of the lateral femoral condyle. Interobserver agreement in the assessment of articular cartilage lesion of the medial patella and lateral femoral condyle were fair and fair for high-frequency ultrasonography; good and very good for MR, respectively. CONCLUSION: MR provided superior diagnostic performance in the evaluation of articular cartilage lesions after acute LPD, including interobserver agreement, compared to high-frequency ultrasonography. SE 100 Musculoskeletal Applications of Supersonic Shear Imaging (SSI): Pictorial Essay Hung Nguyen Department of Radiology, Medic Medical Center, Vietnam PURPOSE: To apply the supersonic shear imaging (SSI) technique to musculoskeletal disorders in the situation of clinical utility is yet to be established. MATERIALS AND METHODS: A pictorial essay presentation using conventional ultrasound and SSI technique with the linear probe (4-15 MHz) of the Supersonic Imagine System, AiXplorer. The range we used was 0-180 kPa. Using a Qbox of 1 cm in diameter, elasticity values were measured. The results were confirmed by MRI and histopathologic correlations later. RESULTS: The present pictorial essay includes rotator cuff tears, supraspinatus, Achilles tendinosis, plantar fasciitis, synovitis, soft tissue lesions (inflammatory myositis, muscle tuberculosis). CONCLUSION: SSI technique can be used for various musculoskeletal applications. SSI is able to provide quantitative and local elastic information in real time. Further multicenter studies with the histopathological correlation need to be performed 280 in order to establish the clinical utility of supersonic shear imaging. REFERENCES: 1/ Minoru Shinohara, Karim Sabra, Jean-Luc Gennisson, Mathias Flink and Mickael Tanter: Real-Time Visualization of Muscle Stiffness Distribution with Ultrasound Shear Wave Imaging During Muscle Contraction, Muscle & Nerve Month 2010. SE 101 Developmental Dysplasia of the Hip of High Risk Neonates in an Outpatient Clinic Chau Tran Ngan, Hung Nguyen Thien, Hai Phan Thanh Department of Radiology, Medic Medical Center, Vietnam OBJECTIVE: The aim of this study is shown the roles of ultrasound in detecting and following-up in the developmental dysplasia of the hip (DDH). MATERIALS AND METHODS: A cross- sectional prospective study of ultrasound on 1,622 hip joints of 811 under-9-month-old babies who have high risk (family history of DDH, breech presentations, club foot deformity or metatarsus adductus on clinical examinationвЂ¦). We use the GrafвЂ™s method (alpha and beta angle) and the TerjesenвЂ™s method (the proportion of femoral head coverage) for investigation the studied population. RESULTS: Of 190/ 1622 (11.71%) was detected DDH, dominant type through females (78/1622 or 4.8% males and 119/ 1622 or 7.33% females) and affected on the left hip joints approximately 3 times more than the right one (71.26% vs. 25.15%). Relying on TerjesenвЂ™s method (the proportion of femoral head coverage < 37%) the proportion of DDH is 160/1622 (9.68%) and Graf's method (the alpha angle < 43 degree) the proportion of DDH is 91/1622 (5.61%) while using both methods it is 61/811 (3.76%). Although the alpha angle > 43 degree, of 60/ 1622 (3.69%) was detected DDH on physical examination and recovered after treatment. CONCLUSION: US plays an important role in detecting and following-up DDH in early days after birth, instead of screening with the standard pelvis X-ray. TerjesenвЂ™s method is easier to apply than The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits GrafвЂ™s method. SE 103 SE 102 Sonographic Evaluation of Plantar Fasciitis and Relation to Body Mass Index and Heel Pad Thickness Sonographic Diagnosis of Occult Talar Fracture Chia-Yu Hsu1, Yi-Pin Chiang2 1 Department of Rehabilitation Medicine, Ten-Chan General Hospital, Taiwan 2 Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taiwan OBJECTIVES: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis using both qualitative and quantitative parameters; and to establish the correlation between plantar fasciitis, body mass index and heel pad thickness. MATERIALS AND METHODS: In this case controlled analytical study, we evaluated sonographically 100 consecutive patients with plantar fasciitis (unilateral: 90, bilateral:10 with mean age 46.92 years) and control group of 60 (120 heels) healthy volunteers with mean age 45.3 years. Plantar fascial thickness, heel pad thickness, decreased echogenecity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. The plantar fascia thickness was measured 5 mm distal to insertion of the calcaneus of plantar aponeurosis. The unloaded heel pad thickness was measured from the skin surface to the nearest calcaneal tuberosity. RESULTS: Mean plantar fascia thickness was greater on the symptomatic side for patients with bilateral and unilateral plantar fasciitis than on the asymptomatic side for patients with unilateral plantar fasciitis, and also control subjects (4.41В±0.59, 4.63В±0.55, 2.83В±0.36, 2.62В±0.37 mm, respectively). The heel pad thickness was also greater on the symptomatic side for patients with bilateral and unilateral plantar fasciitis than on the asymptomatic side for patients with unilateral plantar fasciitis, and also control subjects (17.64В±1.07, 17.28В±1.10, 16.91В±1.06, 16.73В±1.13 mm, respectively) (p<0.0001). Mean BMI values of the case and control groups were 26.14В±1.9 and 24.42В±0.89 kg/m2, respectively (p<0.05). Qualitative parameters of plantar fasciitis were also positively correlated in the plantar fasciitis group. 281 Scientific Exhibits PURPOSE: To investigate whether comprehensive scanning with high-resolution ultrasound (US) can aid in the diagnosis of occult talus fractures in patients with negative X-ray findings. MATERIALS AND METHODS: We retrospectively searched the musculoskeletal US database of patients with negative X-ray findings and talus fracture in a tertiary hospital of Northern Taiwan from December 1, 2008, to September 30, 2013. Patients who had negative standard anterior-posterior and lateral views of radiographs were included. We then reviewed the image studies and medical records for these patients. From this database, we reviewed the ultrasonographic descriptions of the location of talar fracture and its associated findings, such as ligamentous injury, anterior tibio-talar joint recess effusion, or hematoma. RESULTS: Among 55 patients (32 males) aged 1869 years who has sonographic diagnosis of talus fracture, 38 demonstrated significant fracture. Significant fracture of lateral process had the largest number (44.7%, 17/38), followed by medial process (34.2%, 13/38), talar head (7.9%, 3/38) ranked the third. Insignificant fracture or bony irregularity was noted as followed: medial process (29.4%, 5/17), lateral process (29.4%, 5/17), talar dome (17.6%, 3/17) and head (17.6%, 3/17). CONCLUSION: It is found that comprehensive scanning of talus with high-resolution US can aid in the diagnosis of occult talus fractures in patients with negative X-ray findings. The two most common sites of occult talar fracture are lateral and medial process. Routine coronal sonograms over lateral and medial process of the talus are suggested in scanning ankle joint. Kamal Subedi1, Prashant Khatiwada2 1 Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal 2 Department of Radiology, Kanti Children's Hospital, Kathmandu, Nepal KSUM Open 2014 CONCLUSION: Sonography remains an useful tool in diagnosis of plantar fasciitis. Both qualitative and quantitative parameters can be used to characterize inflamed plantar fascia. SE 104 Comparison of the Capsular Thickening in Patients with Adhesive Capsulitis and Spastic Hemiplegic Shoulder Using Ultrasound Kwang Jae Lee, Yong-Soon Yoon, Ki Pi Yu, Eun Sil Kim Department of Rehabilitation Medicine, Presbyterian Medical Center, Korea PURPOSE: To compare the capsular thickening at the rotator cuff interval between affected and unaffected shoulder in patients with adhesive capsulitis (AC) and spastic hemiplegic shoulder (HS) using ultrasound. MATERIALS AND METHODS: 10 patients with AC and 12 patients with HS having less than poor grade of shoulder muscle power and more than grade 1 of modified Ashworth scale (MAS) at the affected upper limb and more than 1 month duration after stroke were enrolled. The thickness of the rotator cuff interval (RCI) was measured on RCI on the both shoulder. RESULTS: Age was 53 В± 6.2 years in AC and 68 В± 11.8 years in HS, disease duration was 6.5 В± 7.2 months in AC and 2.9 В± 2.3 months in HS. In HS, the average MMT was trace and the average MAS was grade 2. Shoulder passive external rotation, internal rotation and abduction range of motion of the affected side were significantly decreased than those of the unaffected side (P<0.05). The thickness of capsule of affected side at the RCI was markedly increased in AC (2.05 В± 0.41 mm vs. 1.31 В± 0.24 mm) (P<0.05), but no significant change on both side in HS (1.25 В± 0.37 mm vs. 1.28 В± 0.30 mm). CONCLUSION: (1) Capsular thickening can be a main cause of limitation of range of motion (LOM) of the shoulder in AC. (2) LOM of the shoulder was not related to the capsular thickening in HS. (3) Ultrasound can be useful to evaluate the capsular thickening at the RCI. 282 SE 105 Diagnostic Value of the Ultrasound in Patients with Various Causes of Median Neuropathy Around the Wrist Yong-Soon Yoon, Kwang Jae Lee Department of Rehabilitation Medicine, Presbyterian Medical Center, Korea LEARNING OBJECTIVES: To recall the normal and ultrasound (US) anatomy of the median nerve around the wrist. To present the US finding of various causes of the median neuropathy around the wrist. BACKGROUND: Median entrapment neuropathy at the wrist, known as carpal tunnel syndrome, is the most common type of compressive neuropathy, resulting from nerve compression in the carpal tunnel, which causes paresthesia, pain, numbness, and weakness in the distribution of the median nerve. But we can find several different causes of median neuropathy around the wrist during ultrasound examination. Accurate diagnosis can lessen patient discomfort and lead to the correct choice of the appropriate treatment (surgical versus medical). Peripheral nerve evaluation represents probably one of the best applications of musculoskeletal ultrasound (MSUS) since recent high-frequency broadband transducers and US can detect subtle abnormalities of nerve and adjacent structures. Dynamic examination is also available and is a peculiar advantage of MSUS. Median neuropathies due to various causes can be assessed by MSUS if the examiner has a great knowledge of the anatomy, uses a standardized technique of examination and has a clinical knowledge of the main disorders affecting them. IMAGING FINDINGS OR PROCEDURE DETAILS: In the first part, I present the normal and US anatomy of median nerve around the wrist using comprehensible, annotated drawings and sonograms. Then, I illustrate various causes of neuropathy using US images stored in my patient examination files, associated with schematic drawings to increase comprehension of the US images. CONCLUSION: US allows an accurate assessment of various causes of median neuropathy around the wrist. When experienced operator exams them using a high-resolution equipment, MSUS can detect a fine The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits and subtle structural abnormality and also well correlate with electrodiagnostic study. CONCLUSION: US-guided injection therapy may be useful and effective in patients with piriformis syndrome. SE 106 Effects of Ultrasound-Guided Steroid Injection Therapy in Patients of Piriformis Syndrome SE 107 Hee Seok Jeong, Guen Young Lee, Eu Gene Lee, Eu Gene Joe, Joon Woo Lee, Heung Sik Kang Department of Radiology, Seoul National University Bundang Hospital, Korea Jung Eun Lee1, Kyung Nam Ryu1, Ji Seon Park1, So Hee Yoon2, So Young Park2, Wook Jin2 1 Department of Radiology, Kyung Hee University Medical Center, Korea 2 Department of Radiology, Kyung Hee University Hospital at Gangdong, Korea PURPOSE: 1. To review the pathophysiology, etiologic conditions, clinical manifestations, and natural histories of superficial thrombophlebitis. 2. To describe the sonographic findings of superficial thrombophlebitis with some sample cases involving various part of body. CONTENTS ORGANIZATION: 1. Pathophysiology and underlying etiologic conditions 2. Clinical manifestations (with complications) 3. Diagnosis : the role of sonography and its imaging findings - diagnostic confirmation - extent - exclusion of deep vein thrombosis - associated complications - follow-up 4. Sample cases 5. Differential diagnosis 6. Natural history and prognosis 7. Management SUMMARY: The superficial thrombophlebitis has been considered as a benign condition which can be caused by idiopathic as well as secondary to systemic disease or local trauma. It can accompany deep vein thrombosis or pulmonary thromboembolism as a complication. The clinical examinations usually reveal relatively typical appearance of a tender вЂ�wormlikeвЂ™ mass deep to the skin with warmness or redness. The ultrasonography, however, provides very useful additional information, such as the 283 Scientific Exhibits PURPOSE: This study was conducted to retrospectively analyze the effectiveness of ultrasound-guided steroid injection therapy in patients of piriformis syndrome based on the follow-up records up to three years. MATERIALS AND METHODS: The therapeutic effect was assessed with a total of 67 patients having clinical piriformis syndrome who were referred to the Department of Radiology for injection therapy as outpatients at one tertiary care facility from January 2010 to October 2012, using medical records retrospectively. The ultrasound-guided steroid injection therapy was performed by laying a patient on a bed in the prone position, verifying the piriformis muscle, and then puncturing with a 22G-spinal needle with the guidance of an ultrasonic scope to inject triamcinolon 40 mg. The therapeutic effect was defined as improvement, partial improvement, and failure depending on the degree of symptom alleviation within one month. The therapeutic effect was defined as recurrence when the pain was exacerbated. RESULTS: Among the 67 patients, 23 patients (34.3%) had improvement, 18 patients (26.9%) partial improvement and 26 patients (38.8%) failure as an early therapeutic effect. There was no recurrence. The therapy was performed again with four of the patients who showed impartial improvement. When the second therapy was performed within three years from the first therapy, two patients showed improvement but the other two patients did not show any therapeutic effect. According to the medical records, there was no recurrence for the second therapy within three years. Superficial Thrombophlebitis: Sonographic Features and Clinical Implications KSUM Open 2014 lesion extent, associated complicated conditions, or follow-up images of superficial thrombophlebitis as well as diagnostic confirmation. The recognition of the clinical implications and sonographic imaging features of thrombophlebitis involving the various part of the body may helpful to confirmative diagnosis and clinical management of patients. SE 108 Variable Ultrasonographic Findings of Lymphoma in Musculoskeletal System SeongJin Kim1, Sun Joo Lee1, Hye Jung Choo1, Young Mi Park1, Hae Woong Jeong1, Kil Ho Cho2, Sung Moon Lee3, Jae Hyuck Yi4 1 Department of Radiology, Inje University Pusan Paik Hospital, Korea 2 Department of Radiology, Yeungnam University Medical Center, Korea 3 Department of Radiology, Keimyung University Dongsan Medical Center, Korea 4 Department of Radiology, Kyungpook National University Hospital, Korea PURPOSE: Lymphoma arises in lympho-reticular tissue anywhere in the body and can involve any part of musculoskeletal system but it is distinctly uncommon. The purpose of this exhibit is to illustrate variable US features of lymphoma in the musculoskeletal system and to correlate with other imaging modality and pathologic findings. MATERIALS AND METHODS: This study was reviewed retrospectively gray-scale and color Doppler US findings of various musculoskeletal lymphoma involving lymph node, muscle, subcutaneous tissue or peripheral nervous system. And these findings are correlated with other imaging modality such as CT, MR or PET. All cases were confirmed by needle or excisional biopsy. RESULTS: Musculoskeletal lymphoma is a heterogeneous disease and can involve more than one anatomical compartment and not lead to destruction of an anatomic structure. Thus, imaging manifestations vary among the different modalities. In focal muscle involvement of lymphoma, US shows homogenously hypoechoic mass with prominent vascularity. In diffuse muscle involvement of lym- 284 phoma, US shows diffuse swelling and decreased echogenicity with preservation of internal muscle fibers and hypervascularity, which looks like myositis. In subcutaneous panniculitis-like T-cell lymphoma which is rare subtype and often confused with inflammatory panniculitis, US shows poorly defined and homogeneous hyperechogenicity in the subcutaneous fat layer with relative hypervascularity. If patients have persistent symptoms or increased extent of the lesion despite treatment for myositis or panniculitis, biopsy should be performed to rule out lymphoma. In peripheral nerve lymphoma, US shows diffuse thickening of the peripheral nerve and a surrounding hypoechoic mass which encases whole neurovascular bundle with thickening of the enveloping fascia, and reveals hypervascularity. CONCLUSION: Through the review of this exhibit, musculoskeletal lymphoma covers a broad spectrum of imaging manifestations. Familiarity with US and the other imaging manifestations of musculoskeletal lymphoma is important for detecting and characterizing of the lesion and improving diagnostic accuracy. SE 109 How Many Each Portion of DVT Mimicking Disease in Patients Who Were Clinically Suspected DVT? Dong Joo Kang, Sun Joo Lee, Hye Jung Choo, Sang Suk Han, Hae Woong Jeong, Yeong-mi Park Department of Radiology, Inje University Pusan Paik Hospital, Korea PURPOSE: Deep vein thrombosis (DVT) is the formation of a blood clot in deep vein, predominantly in the legs. DVT is presented by clinical sign, such as pain, swelling, redness, and etc. However many other diseases are also presented as clinical signs. The purpose of this article is to evaluate DVT mimicking disease in clinical practice by using ultrasonography. MATERIALS AND METHODS: From January 2004 to February 2014, total 652 patients were taken ultrasound owing to clinically suspected DVT. Ultrasound was done bilaterally or unilaterally according to clinical sings. Total 314 patients were taken bilaterally and 338 patients unilaterally. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits Patients with DVT were evaluated. And other diseases are classified into seven categories: ruptured bakerвЂ™s cyst, infection and inflammation, lymphatic condition, neoplasm, soft-tissue hydrostatic edema secondary to cardiac and renal failure, hematoma, and miscellaneous (vasculitis, Klippel-Trenaunay syndrome, pseudoaneurysm, and etc). RESULTS: Total 109 patients had DVT by bilateral ultrasound. Other patients had ruptured bakerвЂ™s cyst in 26 (23.9%), lymphatic condition in 25 (22.9%), soft-tissue hydrostatic edema in 25 (22.9%), infection and inflammation in 12 (11%), hematoma in 9 (8.3%), neoplasm in 3 (2.8%), and miscellaneous in 9 (8.3%). Total 120 patients were excluded DVT by unilateral ultrasound. Other patients had infection and inflammation in 29 (24.2%), lymphatic condition in 24 (20%), especially lymphedema in 9, hematoma in 20 (16.7%), ruptured baker's cyst in 15 (12.5%), soft-tissue hydrostatic edema in 14 (11.7%), neoplasm in 5 (4.7%), and miscellaneous in 13 (10.8%). CONCLUSION: DVT is suspected by clinical sings. But many other diseases can be mimicking DVT. Therefore, it is important to make every effort to establish a diagnosis when DVT is ruled out. The key to making a precise diagnosis is recognizing the characteristics of various diseases on US images. three times. We evaluated the thickness, morphology and echogenecity of SCM on grayscale images and color patterns on elastography. Also, one rehabilitation doctor investigated the degree of head tilting and limitation of neck rotation through the chart review and graded the clinical improvements. We evaluated the correlations between US findings and clinical findings by statistical analyses. RESULTS: The month interval of US follow-up was at least 6 months in each patient. 16 babies had right SCM torticollis and 9 had left. The difference between right and left SCM thickness was mean 5.7 mm (1.3-8.6 mm) at initial examination and mean 2.8 mm (0.5-5.8 mm). 20 babies had focal or multifocal thickening of SCM and 5 had diffuse thickening at initial examination and only 4 had focal thickening at 2nd follow-up. All babies showed increased echogenecities of thicken SCM compared with normal muscular structures at initial examination and increased echogenecities with variable degrees at 2nd follow-up. The sonoelastography showed mainly blue color in all patients except two at initial examination and increased green color in all except one. CONCLUSION: The color pattern of sonoelastography was significantly correlated with clinical improvement of congenital SCM torticollis SE 110 SE 111 The Efficacy of Sonoelastography in the Evaluation of Congenital Sternocleidomastoid Muscle Torticollis Is Ultrasound Able to Diagnose Chest Wall Malignancy: A Two-case Review You Seon Song , In Sook Lee , Se Kyoung Park 1 Department of Radiology, Pusan National University Hospital, Korea 2 Department of Radiology, Kosin University Gospel Hospital, Korea 1 1 2 CASE 1 CLINICAL: A 43-year-old female with stage T1N1 right breast cancer and underwent modified mastectomy plus axillary dissection in November 2003. Patient had post-surgery chemotherapy lasted 2 years and annual PET-CT for monitoring. Latest PET/CT (in September 2013) showed a hypermetabolic lesion at anterior 4/5 th right rib. Physical exam found a tender, protuberant spot on anterior right chest. ULTRASOUND: A heterogeneous focus in the intercostal muscle, 2.01 Г— 0.9 cm in size. It was ill- 285 Scientific Exhibits PURPOSE: To evaluate the efficacy of sonoelastography in the evaluation of congenital sternocleidomastoid muscle (SCM) torticollis. MATERIALS AND METHODS: From November 2012 to February 2014, 25 baby patients (17 male, 8 female; age range, 1 month - 24 months) with congenital SCM torticollis performed ultrasonographic (US) examinations including elastography. 17 babies had two times follow-up US examinations and 8 had Li Song Department of Radiology, Beijing United Family Hospital, China KSUM Open 2014 defined, irregular with microcalcifiations. CDFI showed scattered color flow signals in the lesion. PATHOLOGY: Surgical biopsy demonstrated invasive breast carcinoma. CASE 2 CLINICAL: A 40-year-old male presented with a hard lump on lateral aspect of left chest for one month. No history of trauma. Physical exam revealed a вЂњhard nodule, not fixed to the overlying skinвЂќ. ULTRASOUND: A hypoechoic nodule in left lateral chest wall. It located in the intercostal muscle, 2.8Г— 1.9Г—1.2 cm in size. It was well defined with homogeneous internal texture and posterior enhancement. PATHOLOGY: Ultrasound guided biopsy demonstrated nodular fasciitis. DISCUSSION: Our limited experience showed that: 1) The general differential rules of ultrasound for breast and thyroid nodules are well known, including: benign lesions are often well-define, homogeneous texture, and with posterior enhancement, where malignant lesions are illdefined, irregular in shape and heterogeneous. These rules apply in evaluating chest wall lesions 2) The importance of patient's medical history can never be underestimated. 3) Metastatic lesion often presents the features of its original tumor - the microcalcifications in lesion (case 1) raised strong suspicion of malignancy though mastectomy was completed 10 years ago. In summary, ultrasound may play an active role in diagnosing chest wall lesion. To conclude confidently, further investigation is expected in larger case volume and boarder spectrum of abnormalities. SE 112 Sonographic Diagnosis of Patellar Clunk Syndrome a Rare Complication after Total Knee Replacement Vince Lau1, PK Chan2 1 Department of Radiology, Queen Mary Hospital, Hong Kong 2 Department of Orthopedic Surgery, Queen Mary Hospital, Hong Kong Patellar clunk syndrome is a rare complication 286 after total knee replacement. It is characterized by painful, jerky movement of the patella upon knee extension from a flexed position. The cause of this symptom is due to the formation of intra-articular fibrous nodule at the junction between the undersurface of quadriceps tendon and superior pole of the patella. This presentation illustrates the role of ultrasound in diagnosing the disease. A 71-year old man had history of bilateral total knee replacement (press-fit condylar prosthesis) for one year. After the operation, he complained of persistent right knee pain with jerky patellar movement on extension at 45 degrees from flexed position. Sonographic assessment revealed an echogenic lesion immediately underneath the distal quadriceps tendon and abutting the proximal pole of the patella. The overall clinical and sonographic appearances are compatible with patellar clunk syndrome. The patient underwent arthroscopy, confirming the diagnosis by discovering a hyperplastic nodule at superomedial part of patella. The nodule was resected and clinically the patient improved. Another case of clinically suggestive patellar clunk syndrome, comparing the diagnosis by MRI and US, would also be included in the presentation. It demonstrated that US gives a better assessment of the size of the fibrous nodule, is more cost-effective, and has the benefit of real-time functional assessment of the clicking movement. SE 113 Giant Cell Tumor of the Femur Detected by Ultrasound: A Case Report Liem Le Thanh, Hai Phan Thanh Department of Radiology, Medic Medical Center, Vietnam INTRODUCTION: Giant cell tumor of the bone is an uncommon tumor. This is usually regarded as benign and detected by radiology. We report the case of a patient with a giant cell tumor in the femur detected by ultrasound. We have not found any published cases describe ultrasound images of this type tumor. CASE PRESENTATION: A 35-year-old male patient, left thigh swelling for 6 months. The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits Conventional ultrasound (B mode and Doppler, Aloka System SSD-5000) detected bone lesions at one third lower left femur, hypoechoic, 10Г—3Г—3.6 cm in size, well-defined, osteonecrosis with hypervascular, thin and bulge cortical bone interspersed with cystic structures, producing images like honeycomb, eccentric, invasive the surrounding soft tissue with two hypoechoic nodules 16 and 27 mm in the muscle and subcutaneous layer. Combined with extended field of view technique, using software iScape, Mindray system DC-6, creating the image of the lesion, similar to radiologic images. Radiographic findings of left femur showed thin and bulge cortical bone, like honeycomb, clearly limits, eccentric, suggested giant cell tumor. However, unclear invasive soft tissue images. Bone scan detecting radiation lesion (Technitium Tc - 99 m) in the one third lower left femur. MDCT showed thighs hurt third lower left femur, made lacking the intra-marrow bone cliques, breaking the bone crust 7Г—8 cm in size and infiltrating the soft tissue, limits unknown. There were calcifications into the bone marrow. Surgical biopsy was done. The result of histopathology was a giant cell tumor type II of the femur. CONCLUSION: This was the first description of ultrasound findings of a giant cell tumor of the femur with trespassing on the soft tissue and ultrasound images have characteristics similar to X ray. REFERENCES: Daniele Vanni, Giant cell tumor of the distal ulna: a case report, Journal of Medical Case Reports 2012;6:143. SE 114 Sparganosis of Upper Extremity in Subcutaneous and Intramuscular Layers SE 115 Arm Muscle Injury Finding Correlation Between US and MR Dal Soo Park Department of Radiology, S-Seoul Hospital, Korea Recently US territory are marked expanded and now a day US use as a primary diagnostic tool in all over the medical field. But US was not usually used in arm muscle evaluation. Recently I have been experienced exciting US finding about arm lesion such as transient compartment syndrome in biceps muscle, triceps muscle, brachialis muscle partial tear and very extensive olecranon abscess forming bursitis. And I would want to show my US imaging correlation with MR imaging findings. My case will be helpful and interesting for every day practice US MSK beginner. Scientific Exhibits Sung Hee Park1, Hyo Min Lee2, Yu Mi Jeong2 1 Department of Radiology, Chung-ang University Hospital, Korea 2 Department of Radiology, Gachon University Gil Hospital, Korea are definitive hosts. The parasite is typically transmitted to humans by three modes: ingestion of contaminated water, contact with raw snake or tadpoles or following the topical application of infested flesh as a poultice. Once humans become infected, the plerocercoid larvae may migrate to a subcutaneous location and produce a painful nodular lesion. Radiological and serological techniques can provide useful diagnostic clues of sparganosis. We report a case of repeating sparganosis initially presenting as a subcutaneous mass but later manifesting as an intramuscular mass in the upper arm. This case showed the characteristic and distinctive ultrasonographic findings of sparganosis. Ultrasonographic features of sparganosis are very characteristic and distinguishable, so ultrasound imaging can be a clue for diagnosis of sparganosis. Sparganosis is an infection caused by sparganum, a plerocercoid larva of a cestode belonging to the genus Spirometra Spargana. Humans are the accidental, second or third intermediate host in the cestode life cycle, while dogs, cats and other mammals 287 KSUM Open 2014 SE 116 Imaging Features of Proliferative Myositis: a Case Report Pediatric Donghyun Kim, Hye Jung Choo, Sun Joo Lee, Young Mi Park, Dong Wook Kim, Yoon Nae Seo, Sang Suk Han Department of Radiology, Inje University Pusan Paik Hospital, Korea SE 118 Proliferative myositis is a rare benign inflammatory myopathy characterized by infiltration with basophilic giant cells and proliferative fibroblasts. It is classified as pseudosarcomatous myofibroblastic proliferation along with proliferative fasciitis and nodular fasciitis. Because of its rapid growth and its cellularity, the condition can be confused with sarcoma leading to unnecessary, aggressive surgical procedures. Although definite diagnosis can be made by the pathologic studies, variable radiologic studies including ultrasonography and magnetic resonance imaging can aid in the diagnosis. We report a case of proliferative myositis involving the elbow with the characteristic imaging features using ultrasonography and magnetic resonance imaging. SE 117 Compared with Ultrasound and MRI in Patient with Achilles Tendon Rupture JoonBum Koo, Sungwon Kim Department of Radiology, Dongguk University Medical Center, Korea Pediatric Cystic Renal Diseases and Tumors: Focus on the Spectrum Taeil Han1, Eunkyeol Han2 1 Department of Radiology, University of North Carolina at Chapel Hill, USA 2 Chapel Hill High School, USA PURPOSE: To demonstrate the cystic renal diseases and tumors focused on the spectrum. CONTENT ORGANIZATION 1. Autosomal Recessive Polycystic Kidney Medullary sponge kidney: complete/ partial medullary involvement with/without cortical involvement 2. UPJ obstruction - Multicystic Dysplatic Kidney 3. Autosomal Recessive Polycystic Kidney Congenital hepatic fibrosis: Ductal plate malformation 4. Cystic Nephroma - Cystic partially differentiated nephroblastoma - Cystic Wilms tumor 5. Multilocular cystic renal tumor - Pleuropulmonary blastoma SUMMARY This exhibit will review: 1. To understand the spectrum of several cystic renal diseases. 2. To review ductal plate malformation. 3. To demonstrate the spectrum of cystic renal tumors. The Achilles tendon, also known as the tendo Achilles, tendo calcaneus or calcaneal tendon, is the longest tendon of the body, formed by the union of the lower aspect of calf muscles. Achilles tendon rupture can occur at any age, but most often occurs in 30-50 year-old recreational athletes. We reviewed complete or partial rupture of Achilles tendon, tendinosis, gastrocnemius muscle tear, retrocalcacaneal bursitis, and xanthoma of Achilles tendon. 288 The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits SE 119 Doppler Sonographic Evaluation of Nutcracker Syndrome in Children: Comparison Between the Right Flank View and Anterior Abdominal View Young Hun Choi, Jung-Eun Cheon, Hyun-Hae Cho, So Mi Lee, Woo Sun Kim, In-One Kim Department of Radiology, Seoul National University Hospital, Korea SE 120 Intraoperative Neurosonography Revisited: an Effective Neuronavigation Jung-Eun Cheon1, In-One Kim1, Young Hun Choi1, So Mi Lee1, Hyun Hye Cho1, Seung- Ki Kim2, Ji Hoon Phi2, Woo Sun Kim1 1 Department of Radiology, Seoul National University Hospital, Korea 2 Department of Neurosurgery, Seoul National University Hospital, Korea Intraoperative real-time ultrasonography of the brain is a practical and highly effective method of imaging that can aid the pediatric neurosurgeon by providing: 1. Guidance for intraventricular catheter placement 2. Localization of juxtacortical lesions 3. Monitoring the surgical field This review demonstrates representative cases of intraoperative neurosonography a neuronavigation for localization of focal cortical dysplasia and juxacortical benign or malignant tumors. We will also demonstrate several cases of intraventricular drainage procedures beyond the lateral ventricle. SE 121 Ultrasonographic Diagnosis of OvaryContaining Hernias of the Canal of Nuck Dal Mo Yang, Hyun Cheol Kim, Sang Won Kim Department of Radiology, Kyung Hee University Hospital at Gangdong, Korea PURPOSE: The purpose of this study is to describe the ultrasonographic findings of ovary-containing hernias of the canal of Nuck. MATERIALS AND METHODS: This was a retrospective analysis of 22 hernia cases of the canal of Nuck. The following gray scale and color Doppler ultrasonographic features were analyzed: the site and the size of hernia, the texture of hernia contents, and the presence or absence of blood flow of hernia contents. RESULTS: All patients had swelling of the right 289 Scientific Exhibits PURPOSE: To evaluate the usefulness of the right flank view in Doppler sonographic examination of children with clinically suspected Nutcracker syndrome. MATERIALS AND METHODS: From June 2013 to March 2014, renal Doppler ultrasonography was performed in 37 children with clinically suspected Nutcracker syndrome. Doppler spectral waveforms of the left renal vein (LRV) at the aortomesenteric portion were repeatedly obtained both by the right flank view (with the transducer placed on the right flank) and the anterior abdominal view (with the transducer placed on the right or left subcostal area). The following values from two views were compared by using a paired t-test; 1) the mean peak velocity (PV), 2) the standard deviation of the PVs of LRV at the aortomesenteric portion, 3) the mean ratio of the PVs between the aortomesenteric and hilar portion, 4) the mean Doppler angle. RESULTS: In six patients, obtaining Doppler spectral waveform of LRV from the right flank view was failed due to bowel gas or large body habitus, while Doppler spectrum acquisition from the anterior abdominal view was failed in two children. The right flank view was associated with the significantly smaller mean PV (111.6В±48.0 vs. 71.7В±27.9 cm/sec), the smaller standard deviation of the PVs (23.4В±16.8 vs. 5.7В±4.9 cm/sec) of LRV at the aortomesenteric portion, the smaller mean PV ratio (5.6 В±3.0 vs. 3.6В±1.6) and the lower mean Doppler angle (65.7В±5.3 vs. 5.2В±4.4Вє, all p<0.0001). CONCLUSION: The right flank view yielded smaller, but more consistent PV values of LRV at the aortomesenteric portion with lower Doppler angles, compared with the classic anterior abdominal view, even though the right flank view has some limitation in children with large body habitus. KSUM Open 2014 inguinal region (n = 10), left inguinal region (n = 8), or both (n = 2). On ultrasonography, the hernias appeared as either solid masses (n = 17) or solid masses containing cysts (n = 5). The mean anteroposterior diameter of the hernia sac of the canal of Nuck was 9.1 mm (range, 5-18 mm). The mean anteroposterior diameters of the hernia sac were 11.6 mm (range, 7.6-18 mm) for hernias containing ovary, and 8.3 mm (range, 5-13 mm) for hernias containing omental fat. During surgery, among the 17 cases with solid appearing hernia contents on ultrasonography, omental fat was identified in the hernia sac in four cases, but no structure was identified in 13 cases. All five cases that appeared as solid masses containing cysts on ultrasonography contained ovary tissue in the hernia sac. Among the four cases of ovary-containing hernias, color Doppler ultrasonography identified blood flow within the ovary in three cases, but no flow signal was seen in one case of incarcerated hernia. CONCLUSION: Ultrasonography may be helpful for the diagnosis of ovary-containing hernias of the canal of Nuck by detecting solid masses containing small cysts. SE 122 Lumps and Bumps in the Groin in Children Hee Mang Yoon, Young Ah Cho, Jin Seong Lee, Hye Kyung Yoon, Ah Young Jung, Chong Hyun Yoon Department of Radiology, Asan Medical Center, Korea Pediatric inguinal swelling occurs mostly from inguinal hernias, especially in boys. However, various lesions can be found in the inguinal or groin in boys as well as girls. Therefore, it is important to consider the different features and characteristics of masses in the inguinal or groin area to exclude other causes, such as congenital anomalies, infections, and neoplasms. Ultrasound is the modality of choice for initial evaluation of inguinal swelling in children. Therefore, it is essential for radiologists to be familiar with imaging features of various inguinal lesions. In this exhibit, we will systematically review diverse causes of inguinal swelling in boys and girls. We will illustrate imaging features according to causes of 290 inguinal swelling. Moreover, we will provide radiologists with a practical approach to inguinal swelling, which differs in boys and girls. Contents/Outline 1. Anatomy of inguinal area 2. Cause of inguinal swelling in boys and girls Inguinal hernia/femoral hernia Inguinal lymphadenopathy or lymphadenitis Spermatic cord hydrocele Testes: retractile, ectopic, or undescended Various tumors: lipoblastoma, lymphangioma, lymphoma 3. Imaging features according to the causes of inguinal swelling 4. Summary SE 123 Abernethy Malformation: One of the Rare Cause of Hepatopulmonary Syndrome Vikas Jhanwar, Nitin Mishra, Sunil Agrawal, Anu Bhandhari, Amrita Maheshwari, Darshan Koshiya, Rengarajan Rajagopal Department of Radiology, SMS Medical College, Jaipur (rajasthan), India Hepatopulmonary syndrome (HPS) is the clinical relationship between hepatic disease and the existence of pulmonary vascular pathology, which can result in a range of arterial oxygenation abnormalities. Abernethy malformation is characterized by congenital diversion of portal blood away from the liver, by either end-to-side or side-to-side extra hepatic porto-systemic shunt. Here, we report a case of 4-year old-girl who had clubbing since 3 years and recently developed dyspnea and did not have any other pulmonary or cardiac signs or symptoms. She had imperforate anus at birth. Colour Doppler USG & CT SCAN showed the presence of extra hepatic portal-venous shunt with absence of intrahepatic portal vein. We concluded that the patient had Hepatopulmonary syndrome caused by Abernethy malformation type Ib. Abernethy malformation must be included as one of the etiologies of hepatopulmonary syndrome which can be associated with imperforate anus. These are rare anomalies and to the best of our knowledge, this is The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits the first case reported with both anomalies associated together. Although Abernethy malformation is a rare anomaly, it must be recognized early to prevent the consequences of metabolic derangements by appropriate surgical treatment. Imaging plays a vital role in the diagnosis, determination of type of shunt and follow up of Abernethy malformation. Robust Flow Detection in Ultrasound Color Flow Imaging: a Real-Time GPU-Based Eigen-Filter Approach Using our framework, real-time CFI generation throughputs were realized when it was executed on a six-GPU array. The throughput results were based on practical frame sizes (with >10000 pixels) and slow-time ensemble lengths (16 samples). The framework was applied to an experimental scenario an elastic flow phantom model of known operational behavior (5 MHz frequency; 20 dB clutter-to-blood signal ratio; 2 mm/s max tissue velocity; 38 cm/s max flow velocity). Using a receiver operating characteristic analysis approach, we found that our framework has achieved high flow detection sensitivity (area under curve was always >0.9) when operating in real-time range. This demonstrates that real-time robust CFI detection in the presence of tissue motion can be practically realized. Adrian J. Y. Chee, Billy Y. S. Yiu, Alfred C.H. Yu Department of Medical Engineering, The University of Hong Kong, Hong Kong SE 125 Physics SE 124 A New Feature-enhanced Speckle Reduction Method Based on Multiscale Analysis and Synthesis for Ultrasound B-mode Imaging Jinbum Kang, Yangmo Yoo Department of Eletronic Engineering, Sogang University, Korea Effective speckle reduction in ultrasound B-mode imaging is important for improving image quality and the accuracy in image analysis. While multiscale analysis-based speckle reduction methods such as Laplacian pyramid nonlinear diffusion (LPND) and nonlinear multiscale wavelet diffusion (NMWD) showed enhanced speckle reduction, they suffer from excessive blurring and artificial appearance. In this paper, a new feature-enhanced speckle reduction (FESR) method based on multiscale analysis and feature enhancement filtering is presented for ultrasound B-mode imaging. To separate true clinical features (e.g., boundaries of lesions) from noise, the sub-band images from a Laplacian pyramid model are firstly generated. Then, a robust anisotropic diffusion process is applied to suppress the identified noise and the extracted features are selectively emphasized by edge, coherence and contrast enhancement filtering from fine to coarse scales. In vivo abdominal images of 30 consecutive frames were captured with a com- 291 Scientific Exhibits In color flow imaging (CFI), eigen-filters with attenuation response adapted to clutter statistics are well regarded as powerful techniques for achieving high flow detection sensitivity even when tissue motion is present. To put this technical benefit into practice, it is important to incorporate eigen-filtering solutions as part of the CFI processing routine on ultrasound scanners. However, this is not straightforward. Here, we have formulated a new technical framework that enables fast execution of eigen-filtering in CFI. It incorporates three principles: (1) pursuing a parallel computing approach that is becoming mature with the advent of GPUs; (2) adopting the single-ensemble (Hankel-SVD) eigen-filter paradigm that is algorithmically compatible with parallel computing; (3) applying mature eigen-computation algorithms. For each CFI pixel, its flow estimates were derived by processing the pixel's slow-time ensemble as follows. First, the SVD of the slow-time ensemble's Hankel matrix was computed using a GPU algorithm that includes the steps of Householder Transform, QR decomposition, and Givens rotation. After that, the power and mean frequency of each eigen-component were estimated in parallel. Adaptive filter order selection was then applied to extract the flow eigen-components. KSUM Open 2014 mercial ultrasound system from the liver area of a volunteer, and the captured images were transferred to an external PC for processing. For quantitative analysis, the performance of the proposed FESR method was compared with the LPND and NMWD methods by measuring speckle signal-to-noise ratio (SSNR) and contrast-to-noise ratio (CNR). With the FESR method, the mean SSNR value and the mean CNR value are significantly higher compared to the LPND and NMWD methods, i.e., 8.06В±0.74 vs. 5.69В±0.48, 7.14В±0.93 and 6.89В±0.68 vs. 5.08В±0.33, 6.01В±0.53, respectively. Under visual assessments, the proposed FESR method clearly depicts boundaries of lesions while substantially reducing speckle, compared to other two methods. These preliminary results demonstrate that the proposed FESR method can improve the image quality of ultrasound B-mode imaging by enhancing the visualization of borders and boundaries of lesions while effectively suppressing speckle. SE 126 Performance Evaluation of PVDF Single Element Transducers with Different Backing Materials Jun Su Lee, Jin Ho Chang Department of Electronic Engineering, Sogang University, Korea As a molecular imaging modality, photoacoustic microscopy (PAM) imaging uses acoustic waves generated inside the absorbers of incident laser energy. An ultrasound transducer detects the laser-induced acoustic waves, i.e., photoacoustic signals. The spatial resolution of photoacoustic microscopy (PAM) images is typically determined by the ultrasound transducer. Therefore, we selected a polyvinylidene fluoride (PVDF) single element transducer. PVDF has a relatively high receiving constant (g33), low acoustic impedance, and low dielectric constant. In fabrication of a PVDF transducer, a matter of great importance is the selection of backing material. If backing material has acoustic impedance larger than PVDF, it presented the downshift of center frequency and the lowering of bandwidth. In this paper, the 292 suitable the backing layer material properties are experimentally investigated to solve the problems. The PAM transducer is preferred to have the center frequency, the -6 dB bandwidth, and the receive sensitivity as high as possible. For this, we selected three backing layer materials (EPO-TEK 301, E-SOLDER 3022, and RTV). The pulse-echo characteristics of the PAM transducers were measured in order to evaluate their performance. A commercial pulse/receiver system (UT340, UTEX Scientific Instruments Inc) excited the transducer and received ultrasound reflected signals from the focal point. The received signal was stored using an oscilloscope (TDS5054, Tektronics Inc). RTV material property was due to the rubber that is weak role of the backing layer. RTV backing layer has lower attenuation coefficient in the materials. So, the center frequency and -6 dB bandwidth were higher than other transducers. However, the pulseecho signal magnitude of the RTV backing layer transducer was the smallest one. Consequently, EPO-TEK 301 backing layer is the best material for a PAM transducer that is a key element to improve a pulse-echo signal magnitude, center frequency, -6 dB bandwidth characteristics. SE 127 Quantitative Image Quality Evaluation of Ultrasound Imaging Systems Hyeongmin Jin, Jong Hyo Kim, Myung Eun Lee Department of Radiology, Seoul National University Hospital, Korea Ultrasound imaging is known to be a powerful tool with non-invasive and non-ionizing radiation in diagnosis, but objective criteria have not yet been fully developed in image quality assessment. This study presents a quantitative metric for assessing the image quality and compares the results in three different ultrasound imaging systems. A Gammex 403GS LE multi-purpose: phantom (Gammex RMI, Middleton, WI) was scanned with three different ultrasound systems (iU22 xMATRIX, Philips, Aplio XG, Toshiba, E-CUBE 15, Alpinion) at base band mode and harmonic mode. The Fourier metrics of modulation transfer function (MTF) and noise power The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits spectrum (NPS), indicating spatial resolution and noise, respectively, were used for the image quality evaluation. 2D MTF, which represents axial and lateral resolutions, was measured on the beads located in the axial direction. 2D NPS was computed from the 2D Fourier transform on two background ROIs, one is for near field and the other is for far field, to determine the different noise patterns depending on depth. For vendor A, the spatial resolution was preserved at the far field as well as near field in harmonic mode. For other two systems, the 2D MTF graphs were degraded in high frequency, especially lateral resolution, at the far field. For vendor B, the band of NPS was the narrowest in the 3 vendors and the noise magnitude showed lower up to 70% in base band mode. Our study represents the feasibility for an objective metric on clinical evaluation of ultrasound image quality and compares the results of three different ultrasound imaging systems. The objective metrics could improve the accuracy of image quality prediction in ultrasound imaging. SE 128 A New Smart Probe System for a Tablet PC-based Point-of-Care Ultrasound Imaging System: Feasibility Study Yeongnam Lee1, Jeeun Gang1, Sunmi Yeo1, Jaejin Lee1, Gi-Duck Kim2, Yangmo Yoo1, Tai-Kyong Song1 1 Department of Electronic Engineering, Sogang University, Korea 2 Sogang Institute of Advanced Technology, Sogang University Research Foundation, Korea SE 129 Selective Thermal Therapeutic of Deep-lying Tissue by Combining Laser and Ultrasound Energies Heamin Kim1, Jin Ho Chang2 1 Interdisciplinary Program of Integrated Biotechnology, Sogang University, Korea 2 Sogang Institute of Advanced Technology, Sogang University, Korea Photothermal therapy is performed by converting laser radiation into heat owing to the absorption of the photons in tissue chromophores. While laser radiation passes through a medium, the laser energy decreases due to the absorption and scattering of the laser in tissue. This causes the limitation of penetration depth and ineffective thermal therapy. To over- 293 Scientific Exhibits There is a growing interest in a smart ultrasound probe system wirelessly connected to a mobile device (e.g., smartphone and tablet PC) for point-ofcare ultrasound imaging due to its enhanced accessibility. In this paper, the feasibility of a smart ultrasound probe system, in which transmit and receive modules along with a digital receive beamformer are embedded, is demonstrated. In the smart probe, two eight-channel high-voltage pulsers with transmit/ receive switch (MAX14808, Maxim Integrated, San Jose, CA, USA) and two analog-to-digital converter (AFE5808, Texas Instruments, Dallas, TX, USA) are embedded. The transmit/receive beamforming and mid processing blocks are implemented on a single low-cost field programmable gate array chip (Spartan 6 LX150, Xilinx Inc., San Jose, CA, USA). The complex base-band data after quadrature demodulation are transferred to the commercial tablet PC (ATIV Smart PC, Samsung Electronics, Seoul, Korea) via the USB 3.0 interface. The tablet PC handles ultrasound back-end processing (i.e., envelope detection, log compression, image filtering, and digital scanline conversion) and image display with graphical user interface (GUI). To evaluate the performance of the proposed smart probe system, the phantom study with a commercial linear array probe (L5-13IS, Samsung Medison, Seoul, Korea) and a phantom (ATS539. ATS Laboratories, Inc., Bridgeport, CT, USA), was conducted. The developed smart probe system with the size of 150 mmГ— 50 mmГ— 10 mm, the weight of 100 g and total power consumption of 7 W can support 32-channel dynamic receive beamforming with an extended aperture technique while providing the frame rates of 11 Hz for the 4-cm imaging depth with 128 scanlines. These results indicate that the developed smart probe system connected to a general tablet PC can support point-of-care ultrasound imaging. The further evaluation of the developed system, e.g., wireless communication, is under investigation. KSUM Open 2014 come the limitation, we propose a dual thermal therapeutic method in which both laser and ultrasound (US) energies are simultaneously transmitted for selective treatment of deep-lying tissue. In the proposed method, the US energy plays a role in increasing the local temperature of the treatment area, but the temperature rise is limited to the threshold level for tissue damage. Under this condition, laser energy is delivered into the treatment area, thus causing the temperature to surpass the threshold for coagulation necrosis only within the tissue chromophores. Effects of dual thermal therapy were ascertained using a tissue mimicking phantom consisting of scattering and absorbing sections. US energy was produced using an 1.1 MHz single element transducer with 62.5 mm focal depth and 20 mm central opening. Laser energy was delivered by Nd:YAG laser system: 1064 nm wavelength, 10 nm pulse length, and 10 Hz PRF. Through this study, it was verified that the depth of lesion formation was increased by 1.6 mm in the case of simultaneous delivery of both laser energy of 73.5 mJ/cm2 and US energy of 200 W/cm2, compared with the laser energy alone. Also, it was ascertained that the US energy allowed more laser influence to pass through the phantom. The results demonstrate that, because two energies are complementary in elevation of tissue temperature, the therapeutic depth by the laser energy increases under US exposure. Its penetration depth also increases in conjunction with US, which is beneficial for photodynamic therapy using photosensitizers. the 3D Cartesian coordinate system. These 3D SC methods can visualize an arbitrary plane for 3D ultrasound volume data. However, they suffer from blurring and blocking artifacts due to resampling during SC. In this paper, a new multi-planar reconstruction method based on voxel based beamforming (VBF) is proposed for reducing blurring and blocking artifacts. In VBF, unlike direct and separable 3D SC, each voxel on an arbitrary imaging plane is directly reconstructed by applying the focusing delay to radio-frequency (RF) data. To evaluate the proposed VBF method, pre-beamformed RF data were captured by a 7.5-MHz linear array transducer connected to the commercial ultrasound system from a tissue mimicking phantom (Model 050, CIRS Inc., Norfolk, VA, USA). The linear transducer was linearly translated by the motion-controlled motion stage. The direct 3D SC and VBF methods were implemented on GPU by using CUDA programming. The proposed VBF method shows the higher contrast and less blurring compared to the separable and direct 3D SC methods. This result is consistent with the measured information entropy contrast (IEC) values, i.e., 98.9 vs. 42.0 vs. 47.9, respectively. The execution times for the VBF and direct 3D SC methods are 1633.3 ms and 1631.4 ms, which are I/O bounded. These results indicate that the proposed VBF method can improve image quality of 3D ultrasound B-mode imaging by removing blurring and blocking artifacts associated with 3D scan conversion. SE 131 SE 130 A New Multi-planar Reconstruction Method Using Voxel Based Beamforming for 3D Ultrasound Imaging Hyun Seok Ju1, Jae Hee Song2, Yangmo Yoo1 1 Department of Electronic, Sogang University, Korea 2 2Medical Solutions Institute, Sogang Advanced Institute Technology, Korea For multi-planar reconstruction in 3D ultrasound imaging, direct and separable 3D scan conversion (SC) have been used for transforming the ultrasound data acquired in the 3D polar coordinate system to 294 Color Twinkling Enhanced by a Controlled External Mechanical Excitation Jeonghwa Yang1, Gwansuk Kang2, Minjoo Choi2 1 Department of Radiotechnology, Cheju Halla University, Korea 2 Department of Biomedical Engineering, Jeju National University, Korea Color twinkling, a rapidly changing mixture of red and blue colors, often appear in the color Doppler mode of ultrasonography, for a hyper-echogenic target, even if it is stationary. It has been revealed that the color twinkling has clinical potential in confirming various pathological sites associated with calculi, The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits calcifications, cacinoses and fibroses which are inconclusive in conventional grayscale sonograms. This study proposes a technique to enhance the contrast of the color twinkling. The technique involves the capture of a serious of images throughout an external minor impact to a target. In this study, color Doppler images were obtained for a stationary echogenic circular contrast (+15dB, +6, and +3dB) targets (LCS, Model 551 Small parts phantom, ATS Lab. Inc., USA), with a clinical ultrasonic scanner (GE Voluson-e with 12L linear probe, GE Medical, USA). The color twinkling was observed to be sparse before the target was excited by an impact hammer (2302-100, Meggitt sensing system, USA) attached with an accelerometer (3109 front-end, B & K, Denmark). However, the image was entirely occupied by colors twinkling at the moment of impact, and was gradually recovered back. The color disappearance was much faster on the background than the target +15dB. There is a time for observation at which the contrast in twinkling colors for the target is maximized is subject to the mechanical excitation. This finding suggests that well controlled mechanical excitation to either a target or an ultrasonic probe and freezing image at an observation time may significantly enhance the contrast twinkling colors, when color twinkling is clinically informative. SE 132 running on a smart mobile device with high-performance mobile central processing units (CPUs) and graphics processing units (GPUs) is demonstrated for point-of-care ultrasound imaging where automation of user control is critical. For real-time realization of the ADRA method on a high-end smartphone, the OpenGL ES cross-platform graphics application processing interface was used. To accelerate the performance of the mobile GPU embedded in the mobile device, ultrasound core mid and backend processing tasks, including ADRA, are divided into multiple software pipelines and the load operation for accessing the frame buffer by the mobile CPU is minimized. 200 frames of in vivo abdominal data were acquired with a 3.5-MHz convex array transducer from with a commercial ultrasound scanner equipped with a research package (Accuvix V10, Samsung Medison, Seoul, Korea). The performance of the real-time ADRA method on the smart phone was evaluated by measuring the contrast-to-noise ratio (CNR) and frame rates. The ADRA method showed the improved image quality compared to the conventional method (CON) with a fixed 60 dB DR value. The CNR values of the CON and ADRA methods were 3.35В±0.89 vs. 3.89В±0.71, respectively. In addition, the frame rates of the CON and ADRA methods were 74.12В±24.7 Hz vs. 60.51 В±11.51 Hz, respectively. These results indicate that the ADRA method can be incorporated in the smartphone-based point-of-care ultrasound imaging system while providing enhanced image quality and lowered user dependency. A Real-time Realization of an Automatic Dynamic Range Adjustment Method on a Smart Mobile Device for Point-of-Care Ultrasound Imaging SE 133 Jeehoo Kim, Yeonhwa Lee, Yangmo Yoo Department of Electronic Engineering, Sogang University, Korea Phantom and In Vivo Evaluation of Sound Speed Estimation Methods: Preliminary Results Sound speed is the essential parameter that affects image quality in ultrasound B-mode imaging. The constant sound speed corresponding to soft tissues (e.g., 1540 m/s) is typically used, but its performance degrades because of the disparity in sound speed 295 Scientific Exhibits In ultrasound imaging, dynamic range (DR) is the essential parameter that affects image quality and feature representation. Previously, the automatic DR adjustment (ADRA) method, in which DR value is adaptively adjusts based on the analysis of reference and input image, was proposed for improved clinical productivity and lowered user dependency. In this paper, the feasibility of a real-time ADRA method Sooah Cho, Jeeun Kang, Yangmo Yoo Department of Electronic Engineering, Sogang University, Korea KSUM Open 2014 between soft tissue and fatty layers. Various sound speed estimation (SSE) methods were proposed, but these methods have not been extensively evaluated. In this paper, five different SSE methods were evaluated with tissue mimicking phantom and in vivo breast studies. The five SSE methods, i.e., coherent factor (CF), minimum average phase variance (MAPV), minimum average sum of the absolute difference (MASAD), focus quality spectra (FQS) and edge conspicuity using modified nonlinear anisotropic diffusion (MNAD), were implemented on MATLAB (Mathworks Inc., Natick, MA, USA). For quantitative evaluation, pre-beamformed radiofrequency data were acquired from a tissue mimicking phantom (ATS549, ATS Laboratories Inc., Bridgeport, CT, USA) with the mean sound speed of 1450 m/s and from a patient with breast lesions by a 7.5-MHz linear array transducer connected to the ultrasound research platform (SonixTouch, Ultrasonix, Vancouver, BC, Canada). The five SSE methods show the comparable performance with the tissue mimicking phantom (i.e., 1450 В± 25 m/s). The CF and FQS methods also show the lower errors with the in vivo breast data, but, the MAPV, MASAD and MNAD methods have difficulty in estimating the optimal sound speed in image quality (i.e., 1530 m/s) i.e., 25.0 В± 12.9 and 20.0 В± 8.2 vs. 72.5 В± 45.0, 72.5 В± 41.9, 52.5 В± 28.7, respectively. These results indicate that the previously-proposed CF and FQS methods can robustly determine the optimal sound speed for the phantom and heterogeneous tissues (e.g., breast). The further evaluation with breast in vivo data is under investigation. transducers, however, an unrealistic for HIFU transducers because it needs at least thousands of elements due to the large aperture size. Therefore a random sparse array (RSA) is widely used as a HIFU transducer. Although RSAs have shown good performance in GL suppression, it has limitations in element size and inter-element separation due to random distribution of elements. In this paper, we proposed a 2D circular sparse array (CSA) in which elements are distributed on the center of a circular aperture and concentric circles with radii which equally divide the radius of an aperture into equal distances. On each circle, the first element is placed randomly and other elements are distributed around the center of a circular aperture in concentric circles with radii which divide the radius of aperture with equal distance. The sidelobe and grating lobe of beams produced with CSA can be separately controlled to have desired levels by adjusting the radial and circular element spacings (i.e., RES and CES). For the performance evaluation, three kinds of 2D transducers (i.e., uniform array, RSA and CSA) with same number of elements (566) and aperture size (40 mm diameter) were designed and then their field patterns and resultant temperature distributions were compared through simulation. Undesirable heating by GLs are observed when UA is used. On the contrary in CSA as well as RSA, only target area was heated over 60в„ѓ since GLs were effectively suppressed. From results, it was shown that GL suppression of CSA was comparable to RSA. Moreover, element size and inter-element distance of CSA can be controlled more freely than those of RSA, leading to an optimized beam profile. SE 134 A 2-D Circular Sparse Array for HIFU Transducer Jae Hee Song1, Tai-Kyong Song2 1 Medical Solutions Institute, Sogang Institute of Advanced Technology, Korea 2 Department of Electronic Engineering, Sogang University, Korea The half wavelength element spacing requirement must be satisfied to be free of high grating lobes (GLs). This criterion can be met easily for imaging 296 The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits SE 135 A New Phase Rotation Beamforming (PRBF) Based on a Polyphase Delay Filter: Preliminary Results Gunho Lee1, Jongho Park1, Jeeun Kang1, Jaejin Lee1, Yangmo Yoo2, Tai-kyong Song1 1 Department of Electronic Engineering, Signal Processing & System Lab, Medical Solutions Institute, Sogang University, Korea 2 Interdicsiplinary Program of Integrated Biotechnology, Medical Solutions Institute, Sogang University, Korea SE 136 Adaptive Sound Speed Correction for Medical Ultrasound Imaging: Preliminary Results Sewoong Ahn1, Jeeun Kang1, Tai-Kyong Song1, Yangmo Yoo2 1 Department of Electronic Engineering, Sogang University, Korea 2 Department of Interdisciplinary Program of Integrated Biotechnology, Sogang University, Korea In examining obese patients, spatial and contrast resolutions of ultrasound imaging are severely deteriorated when a constant sound speed corresponding to soft tissues (1540 m/s) is applied due to phase aberration. To overcome phase aberration, for a single region-of-interest (ROI), various sound-speed-correction (SSC) methods have been proposed. However, the improvement in image quality from the SSC methods with a single ROI is still limited. In this paper, a new adaptive-SSC (ASSC) method with a bilayer-tissue model is presented for transabdominal imaging of obese patients. In the ASSC method, two ROIs in the lower layer are pre-determined, and the two sound speeds are estimated by an iterative approach. The optimal speed in the lower layer is determined by considering the sound speeds and distance ratio between ROIs. Then, the sound speed in the upper layer is independently estimated with a single ROI. The upper and lower images are reconstructed with the estimated sound speed and these images are blended. For quantitative evaluation, radio-frequency data were obtained by a commercial US-research package (SonixRouch, Ultrasonix Corp., Canada) and a linear probe (L14-5/38) from a gel-pad (Parker Lab. Inc., USA)-stacked, tissue-mimicking phantom (ATS Laboratories Inc., USA). The sound speeds of the gel pad and the phantom are 1610 m/s and 1450 m/s, 297 Scientific Exhibits Dynamic receive beamforming (DRBF) is important for improving spatial resolution and SNR in US imaging. To enhance time delay accuracy in DRBF, interpolation and phase rotation are widely used (IBF and PRBF, respectively). Compared to IBF, the PRBF has a potential to substantially reduce the hardware complexity by lowering the data rate close to f0. However, it suffers from the degraded spatial resolution due to the wide bandwidth of the received signals. In this paper, a new PRBF method based on a polyphase-delay-filter (PRBF-PDF) is presented for ultrasound imaging. The proposed PRBF-PDF method utilizes the polyphase-delay-filter to increase the accuracy in focusing delay computation by 4 f0, compared to f0 in PRBF-CON without increasing the data rate. Also, with phase rotation, the total delay accuracy becomes 16 f0. To evaluate the proposed PRDF-PDF method, the Field II simulation was conducted with an 8.0-MHz linear transducer. The complex baseband data (i.e., inphase and quadrature components) were generated with the sampling frequency of 40 MHz and the 128 channels. The point spread functions are obtained by the IBF, PRBF-CON and PRBFPDF methods for the wire target located at 25 mm of five wire targets were positioned from 15 mm to 55 mm. For quantitative evaluation, -6-dB lateral resolutions for the PRBF-CON and PRBF-PDF methods were compared with the reference, i.e., IBF. This result indicate that the proposed PRBF-PDF method shows the comparable image quality with the IBF method. On the other hand, the PRBF-CON method suffers from the degraded spatial resolution. Unlike PRBF-CON, the proposed PRBF-PDF method pro- vided the comparable lateral resolution to the IBF method after the transmit focal point at 25 mm. These results indicate that the proposed PRBF-PDF method can provide comparable image quality to the IBF method while substantially reducing the hardware complexity. KSUM Open 2014 respectively. Under visual assessments, the ASSC method shows the improvement in image quality for all three wire targets. It is consistent with the measured lateral resolutions. For example, the lateral resolution from the ASSC method is 0.60 mm compared to the conventional and SSC methods, i.e., 0.75 mm and 0.86 mm, respectively, for the wire target at 12 mm. These results indicate that the ASSC method can improve image quality in a bilayer-tissue model. The further evaluation of the ASSC method is still under investigation with in vivo abdominal data. SE 137 ZBF-LI, ZBF-NLI) while varying the allowance error from 0.25 to 1.0. the proposed ZBF-NLI method provides the fewer zones for each allowance error than that of the ZBF-LI method (e.g., 136 vs. 2048 zones for 0.25). The proposed ZBF-NLI method shows the more comparable image quality with the CON method than ZBF-LI method, which is consistent with the PSNR (i.e., 13.7 dB vs. 21.4 dB for ZBF-LI and ZBF-NLI). Also, the proposed ZBF-NLI method only requires 6.9% of memory needed in the ZBF-LI method. These results indicate that the proposed ZBF-NLI method can improve image quality in the zone-based method while substantially lowering the hardware complexity (i.e., memory size) for point-ofcare ultrasound imaging. A New Nonlinear Zone-based Beamforming Method for Point-of-Care Ultrasound Imaging Pilsu Kim1, Jeeun Kang1, Jaejin Lee1, Gi-Duck Kim2, Yangmo Yoo1, Tai-kyong Song1 1 Department of Electronic Engineering, Sogang University, Korea 2 Sogang Institute of Advanced Technology, Korea It is important for reducing the hardware complexity of an ultrasound dynamic receive beamformer for point-of-care ultrasound imaging systems. While the previously-proposed linear zone-based beamforming (ZBF-LI) method that piecewisely interpolates receive delays between predetermined zones can substantially lower the complexity, it degrades image quality in the near field. In this paper, a new nonlinear zone-based beamforming (ZBF-NLI) method, which can decrease delay errors in the near field while reducing the hardware complexity, is proposed. In the proposed ZBF-NLI method, the optimal length of each zone is dynamically determined to limit the delay error below the allowance error (i.e., 0.25 for 16 f0 delay resolution at 4 f0 sampling). The ZBF-NLI method was implemented on the lowcost FPGA (Spartan 6, Xilinx Inc.). To evaluate the proposed ZBF-NLI method, the Field II simulation was conducted by considering the system specification of the portable US imaging system (i.e., 7.5MHz linear array with 40-MHz sampling). The peak signal-to-noise ratio (PSNR) was measured for the conventional dynamic receive focusing (CON) and the linear and nonlinear zone-based methods (i.e., 298 Thyroid SE 138 Infiltrative Pathologies of Thyroid Gland: Hard to Ignore-difficult to Diagnose Shenaz Momin1, Asif Momin2, Roshni Chinoy3, Avinash Gutte4 1 Department of Radiology, Nair Hospital and T N Medical College, India 2 Department of Radiology, Prince Aly Khan Hospital, India 3 Department of Pathology, Prince Aly Khan Hospital, India 4 Department of Radiology, Grant Medical College and J J Group of Hospitals, India The purpose of this study is to familiarize with unusual specific infiltrative thyroid abnormalities which could be mistaken for routine subacute nonspecific thyroiditis or its sequalae. In a head and neck imaging unit ultrasound of thyroid and adjacent neck nodes was done; multiple unusual thyroid infiltrative abnormalities were identified which posed as an initial diagnostic challenge. These were evaluated using biopsy, FNAC and other corroborative imaging studies like CT, MR or radiographs as and when required to understand the extent and distant associated abnormalities. Various specific abnormalities were histologically proven as Langerhans cell histiocytosis, Non The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits Hodgkin's lymphoma of thyroid, Riedel's thyroiditis, thyroid abscess following extension of Ludwig's angina in a known diabetic and intrinsic and extrinsic tuberculous thyroid involvement. All these cases in retrospect have specific imaging clues but were difficult to diagnose without histological help. Hence to conclude thyroid imaging is incomplete without considering specific uncommon infiltrative and infective abnormalities which could be mistaken and treated as nonspecific form of thyroiditis. Ultrasound guided biopsy and FNA play definitive diagnostic role. roid nodules. CONCLUSION: ARFI can be performed in thyroid nodule with reliable results. The combination of VTQ and VTI might give a better differentiation of benign and malignant thyroid nodules. Larger studies are awaited. SE 140 Benign Lesions That Mimic Thyroid Malignancy on Ultrasound Dong Wook Kim Department of Radiology, Inje University Pusan Paik Hospital, Korea SE 139 Acoustic Radiation Force Impulse Imaging of Thyroid Nodules at Medic Medical Center, Ho Chi Minh City Khanh Vo, Hung Nguyen Department of Radiology, Medic Medical Center, Vietnam SE 141 Ultrasound-based T Staging in Preoperative Papillary Thyroid Microcarcinoma Patients Dong Wook Kim, Sun Jeong Moon Department of Radiology, Inje University Pusan Paik Hospital, Korea PURPOSE: This study aimed to assess the diagnostic accuracy of ultrasound (US)-based T staging of papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS: From January 2013 to June 2013, a total of 185 patients underwent preoperative thyroid US for the treatment of thyroid malignancy. A single radiologist immediately determined sonographic T staging for PTMC under realtime US examination. The diagnostic accuracy of sonographic T staging for PTMC and the difference in the frequency of level VI node metastasis accord- 299 Scientific Exhibits PURPOSE: The aim of the present study was to evaluate the VTQ of normal thyroid tissues, benign and malignant thyroid nodules. Besides, VTI (Virtual Touch Tissue Imaging) of ARFI-Imaging was assessed in these objects as well. MATERIALS AND METHODS: One hundred and thirty nodules underwent conventional ultrasound, including Color Doppler ultrasound using a 7.5 MHz linear transducer. Next, nodule stiffness were measured and assessed by VTQ and VTI of ARFIImaging (Acuson Siemens S2000). FNAC (Fine needle aspiration cytology) under ultrasound guide was used as reference method for the diagnosis of benign and malignant thyroid nodules. RESULTS: 103 benign and 27 malignant thyroid nodules. The median velocity of ARFI-imaging in the normal tissue as well as in benign and malignant nodules was 1.51 m/s (range 0.84-3.00 m/s), 2.15 m/s (range 0.8-4.04 m/s), 3.21m/s (range 0.9-9.22 m/s), respectively. At the cut-off of 2.16 m/s, the sensibility and specificity in differentiation of benign and malignant thyroid nodules were 79.4% and 53.7% (AUROC =0.731, p<0.0001). Chi-square statistic showed there was a relationship between VTI and the differentiation of benign and malignant thy- Ultrasound (US)-guided fine-needle aspiration (USFNA) is widely used for the diagnosis of thyroid nodules. However, US-FNA and other biopsies are unnecessary or should be avoided in some cases. These lesions that can mimic malignancies on US can be classified into the following categories: (1) inflammatory thyroid abnormalities, (2) non-pathologic thyroid or perithyroidal abnormalities, (3) fibrotic collapse of benign cystic or solid thyroid nodules, and (4) abnormal perithyroidal structures. Awareness about these lesions, facilitates the choice of the most appropriate diagnostic tool. KSUM Open 2014 ing to the T stage of PTMC were evaluated. RESULTS: Among 185 patients, 105 cases of PTMC (57.1%) were found. The preoperative sonographic diagnoses of the 105 PTMC cases included intraglandular location (n=35), subcapsular location (n=30), mild capsule abutment (n=7), moderate capsule abutment (n=19), and perithyroidal invasion without adjacent strap muscle invasion (n=14). The histopathological results of all PTMC cases revealed intraglandular confinement (n=66), only capsule invasion (n=13), and extrathyroidal fat invasion (n=26). When the sonographic T stages were compared with histopathological results, all the sonographic categories showed a high specificity and low sensitivity. There was no significant relationship between level VI node metastasis and histopathological T stage (p = 0.2631). CONCLUSION: The present sonographic T staging may be useful for preoperative evaluation in PTMC patients. SE 142 Shear Wave Elastography of Thyroid Nodules in a Large Scale Study: Is it a Predictor of Thyroid Malignancy? Ah Young Park , Eun Ju Son , Kyunghwa Han , Ji Hyun Youk1, Jeong-Ah Kim1, Cheong Soo Park3 1 Department of Radiology, Gangnam Severance Hospital, Korea 2 2Biostatistics Collaboration Unit, Gangnam Medical Research Center, Gangnam Severance Hospital, Korea 3 Department of Surgery, Gangnam Severance Hospital, Korea 1 1 2 PURPOSE: To validate the usefulness of shear wave elastography (SWE) in predicting thyroid malignancy with a large-scale quantitative SWE data. MATERIALS AND METHODS: This was an institutional review board-approved retrospective study with waiver of informed consent. 476 thyroid nodules in 453 patients who underwent gray-scale US and SWE before US-guided fine-needle aspiration biopsy (US-FNA) or surgical excision were included. Gray-scale findings and SWE elasticity indices (EIs) were retrospectively reviewed and compared between benign and malignant thyroid nodules. The 300 optimal cut-off values of EIs for predicting malignancy were determined. The diagnostic performances of gray-scale US and SWE for predicting malignancy were analyzed and compared between the gray-scale US findings only and the combined use of gray-scale US findings with SWEs. RESULTS: All EIs of malignant thyroid nodules were significantly higher than those of benign (P в‰¤ .001). The optimal cut-off values of each EI for predicting malignancy were Emean: 85.2 kPa, Emax: 94.0 kPa, Emin: 54.0 kPa. Emean (OR3.071, P=.005) or Emax (OR3.015, P=.003) were the independent predictors of thyroid malignancy. Combined use of gray-scale US findings and each EI showed elevated sensitivity (95.0% to 95.5% vs. 92.9%, Pв‰¤.005) and AUC (0.820 to 0.834 vs. 0.769, Pв‰¤.005) for predicting malignancy, compared with the use of gray-scale US findings only. CONCLUSION: Quantitative parameters of SWE were predictive factors of thyroid malignancy and SWE evaluation combined with gray-scale US was adjunctive to the diagnostic performance of grayscale US for predicting thyroid malignancy. SE 143 US Findings of Thyroid Metastasis in a Patient with Hepatocellular Carcinoma Mimicking Liver Abscess: a Case Report Noh Hyuck Park1, Tae Youn Rho2 1 Department of Radiology, Myongji Hospital, Korea 2 Department of Radiology, Inha international Medical Center, Korea 53-year-old man who was diagnosed as a liver abscess 3 years ago, presented tumor thrombosis in the right hepatic vein and intrahepatic segment of IVC by direct invasion of mass which was considered as a liver abscess. On physical examination, multiple palpable masses were found in anterior and left lateral neck along internal jugular chain. Ultrasonography which was performed to evaluate neck masses, revealed multiple variable sized hypoechoic solid masses in thyroid gland and enlarged lymph nodes along the left internal jugular chain. The masses in the thyroid gland showed echo fea- The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits tures with heterogeneous hypoechoic solid echogenecity without necrosis or calcification. The lymph nodes showed same nature with thyroid masses. No significant increase of intratumoral or intranodal vascularity was found on color Doppler study. We underwent US guided 18G core needle biopsy for the left thyroid mass and a pathologic lymph node at the left level 3 and these were confirmed as metastasis from hepatocelluar carcinoma. SE 144 Ultrasound Elastography Using Carotid Artery Pulsation in Differential Diagnosis of Sonographically Indeterminate Thyroid Nodules Woo Jung Choi1, Jeong Seon Park2, Hye Ryoung Koo2, Soo-Yeon Kim3, Min Sung Chung4, Kyung Tae5 1 Department of Radiology, Asan Medical Center, Korea 2 Department of Radiology, Hanyang University Medical Center, Korea 3 Department of Radiology, Hanyang University Guri Hospital, Korea 4 Department of Surgery, Hanyang University Medical Center, Korea 5 Department of Otorhinolaryngology, Hanyang University Medical Center, Korea SE 145 Hyalinizing Trabecular Tumor of the Thyroid Gland: Ultrasonography Features and the Role of Core-needle Biopsy Woo Jung Choi1, Jung Hwan Baek1, Eun Ju Ha2, Young Jun Choi1, Dong Eun Song3, Jin Yong Sung4, Hyun Ju Yoo5, So Lyung Jung6, Ha Young Lee7, Jeong Hyun Lee1 1 Department of Radiology, Asan Medical Center, Korea 2 Department of Radiology, Ajou University Medical Center, Korea 3 Department of Pathology, Asan Medical Center, Korea 4 Department of Radiology, Daerim St. Marys Hospital, Korea 5 Department of Pathology, Daerim St. Marys Hospital, Korea 6 Department of Radiology, The Catholic University of Korea, Seoul St. Mary's Hospital, Korea 7 Department of Radiology, Inha University Hospital, Korea OBJECTIVES: The purpose of this study was to evaluate the ultrasonography (US) findings and the role of core-needle biopsy (CNB) for hyalinizing trabecular tumor (HTT). 301 Scientific Exhibits PURPOSE: The purpose of this study was to evaluate the diagnostic performance of gray-scale ultrasound (US) and a new method of thyroid US elastography using carotid artery pulsation in the differential diagnosis of sonographically indeterminate thyroid nodules. MATERIALS AND METHODS: A total of 102 thyroid nodules with indeterminate gray-scale US features from 102 patients (20 men and 82 women; age range, 16-74 years, mean age: 51 years) were included. Gray-scale US images were reviewed and scored from 1 (low) to 5 (high) according to the possibility of malignancy. US elastography was performed using carotid pulsation as a compression source. The elasticity contrast index (ECI), which quantifies local strain contrast within a nodule, was automatically calculated. The radiologist reassessed scores after concurrently reviewing gray-scale US and elastography. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performances of each data set and to compare the Az values of grayscale scoring, ECI, and combined assessment scoring. RESULTS: Malignant thyroid nodules were more hypoechoic than benign nodules. The ECI was significantly higher in malignant nodules than in benign thyroid nodules. The Az values of each data set were 0.755 (95% CI, 0.660-0.835) for gray-scale, 0.835 (95% CI, 0.748-0.901) for ECI, and 0.853 (95% CI, 0.769-0.915) for combined assessment. The Az value for the combined assessment of gray-scale and ECI was significantly higher than for gray-scale alone (p = 0.022). CONCLUSION: Combined assessment with grayscale US and elastography using carotid artery pulsation is helpful for differentiating sonographically indeterminate thyroid nodules. KSUM Open 2014 MATERIALS AND METHODS: We retrospectively analyzed 24 patients (3 males and 21 females; age range, 23-58 years, mean age: 52 years) between January 2000 and May 2013 who had histopathological diagnosis of HTT. The US findings were categorized according to shape, margin, orientation, echogenicity, composition, calcification, and vascularity. The cytohistology of fine-needle aspiration (FNA) and CNB, and histopathology of surgery were reviewed. RESULTS: The US features were oval-to-round shape (24/24), smooth margin (21/24), hypoechoic or marked hypoechogenicity (18/24), solid (22/24) and peri- and/or intranodular vascularity (17/17). Of these, seven patients had malignant US tumor features such as marked hypoechogenicity (n=7) and a spiculated margin (n=3). 19 patients underwent FNA and all were misdiagnosed, including 12 malignancies and five atypia of undetermined significance. Four patients underwent CNB and all were correctly diagnosed as HTT. Histological results of CNB specimens suggested HTT, which was confirmed by immunostaining of MIB-1. Final confirmation was done by surgery in 22 patients and by CNB in two. CONCLUSION: HTTs can be suggested when the cytological diagnosis is PTC on FNA and without malignant US features. CNB showed the possibility of a correct diagnosis of HTTs in this study. SE 147 SE 146 Ultrasonography-Guided Ethanol Ablation of Cystic and Predominantly Cystic Nodules: Factors Related with Outcome Diagnosis of Thyroid Follicular Neoplasm: Fine-needle Aspiration Versus Core-needle Biopsy Ra Gyoung Yoon1, Jung Hwan Baek1, Jeong Hyun Lee1, Young Jun Choi1, Dong Eun Song1, Jae Kyun Kim2 1 Department of Radiology, Asan Medical Center, Korea 2 Department of Radiology, Chung-ang University Hospital, Korea PURPOSE: To evaluate the diagnostic role of coreneedle biopsy (CNB) for thyroid nodules with follicular neoplasm (FN), compared with fine-needle aspiration (FNA). MATERIALS AND METHODS: From October 302 2008 to December 2013, 107 patients (24 men, 83 women; mean age, 47.4 years) from 231 FNAs and 107 patients (29 men, 78 women; mean age, 46.3 years) from 180 CNBs with FN readings, all of whom underwent surgery, were retrospectively analyzed. The false positive rate, unnecessary surgery rate, and malignancy rate of FNA and CNB, according to the final diagnosis following surgery, were evaluated. RESULTS: CNB showed a significantly lower falsepositive and unnecessary surgery rate than FNA (4.7% versus 30.8%, 3.7% versus 26.2%, P< 0.001, respectively). In the FNA group, 33 patients (30.8%) had non-neoplasms, including nodular hyperplasia (n=32) and chronic lymphocytic thyroiditis (n=1). In the CNB group, five patients (4.7%) had non-neoplasms, including nodular hyperplasia (n=5). Moreover, CNB showed a significantly higher malignancy rate than FNA (57.9% versus 28%, P< 0.001). CONCLUSION: Our study demonstrated that CNB showed a significantly lower falsepositive rate and a higher malignancy rate than those of FNA for diagnosing FN. Therefore, CNB could minimize unnecessary surgery as well as leading to surgery performed with diagnostic confidence in patients with FN. Mirinae Seo, Soo Jin Kim, Sung Hee Park, Hye Shin Ahn Department of Radiology, Chung-ang University Hospital, Korea PURPOSE: The aim of our study was to evaluate the outcome in ultrasonography (US) guided ethanol ablation (EA) of cystic and predominantly cystic nodules and to assess the factors that predict outcome. MATERIALS AND METHODS: Between March 2010 and October 2013, 28 cystic and predominantly cystic nodules in 26 patients were enrolled. EA outcome in treating cystic and predominantly cystic nodules was compared; and factors related with out- The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits come, including lesion location, initial nodule volume, aspirated fluid volume, aspirated fluid nature, cystic component, vascularity, and echogenicity of solid component, were evaluated. RESULTS: Mean nodule volume decreased from 13.5В±13.4 ml to 2.1В±5.3 ml (mean volume reduction, 88.5В±13.0%) and the therapeutic success rate was 100% on last follow-up US. Seventeen nodules showed an excellent response (90% or greater decrease in volume) and 11 nodules showed a good response (50-90% decrease in volume). Mean initial nodule volume of the excellent response group was smaller than the good response group without statistical significance (12.1В±10.8 vs. 15.7В±17.2, p>0.05). Nodules with viscous cystic content tended to be associated with the good response group (p=0.05). There is no significant difference between the excellent response group and the good response group in lesion location, initial nodule volume, aspirated fluid volume, cystic component, vascularity, and echogenicity of solid component. CONCLUSION: The success rate of EA of cystic and predominantly cystic nodules was 100%, and aspirated fluid nature was useful in predicting the outcome of EA. SE 148 Thyroid Nodules with Initially Nondiagnostic, Fine-needle Aspiration Results: Comparison of Core-needle Biopsy and Repeated Fine-needle Aspiration 1 PURPOSE: To evaluate the role of core-needle biopsy (CNB) by comparing the results of CNB and repeated fine-needle aspiration (FNA) for thyroid SE 149 Virtual Touch Tissue Quantification (VTQ) in the Differential Diagnosis of Benign and Malignant Thyroid Nodules Seung Mi Ha, Seong Whi Cho, Sam Soo Kim Department of Radiology, Kangwon National University Hospital, Korea PURPOSE: The aim of this study was to evaluate the diagnostic ability of Virtual Touch tissue quantification (VTQ) technology for differentiating between benign and malignant thyroid nodules. MATERIALS AND METHODS: A total of 198 nodules (168 benign nodules and 30 malignant nodules) in 186 patients (169 females and 29 males) with available share wave velocity (SWV) results and pathologic diagnosis were included in this study. 303 Scientific Exhibits Sang Hyun Choi , Jung Hwan Baek , Jeong Hyun Lee1, Young Jun Choi1, Min Ji Hong1, Dong Eun Song2, Jae Kyun Kim3, Jong Ho Yoon4, Won Bae Kim5 1 Department of Radiology, Asan Medical Center, Korea 2 Department of Pathology, Asan Medical Center, Korea 3 Department of Radiology, Chung-ang University Hospital, Korea 4 Department of Surgery, Asan Medical Center, Korea 5 Department of Internal Medicine-Endocrine, Asan Medical Center, Korea 1 nodules with initially non-diagnostic FNA results. MATERIALS AND METHODS: From October 2008 to December 2011, 360 nodules, consecutive 180 repeated FNAs and 180 CNBs, from 360 patients (83 men, 277 women; mean age, 54.4 years) with initially non-diagnostic FNA results, were analyzed retrospectively. The incidences of non-diagnostic results, inconclusive results, diagnostic surgery, and diagnostic performance of repeated FNA and CNB were assessed. The factors affecting second nondiagnostic results were evaluated. RESULTS: CNB achieved a significantly lower nondiagnostic and inconclusive rate than repeated FNA (1.1% versus 40.0%, P<0.001; 7.2% versus 72.0%, P<0.001). All diagnostic performances with CNB were higher than repeated FNA. The diagnostic surgery rate was lower with CNB than with repeated FNA (3.6% versus 16.7%, P=0.047). Multivariate logistic regression analysis showed that repeated FNA was the most important factor for second nondiagnostic results (OR=56.06, P<0.001) and followed by nodules with rim calcification (OR = 7.46, P = 0.003). CONCLUSION: CNB is more useful than repeated FNA for reducing non-diagnostic and inconclusive results and preventing unnecessary diagnostic surgery for thyroid nodules with initially non-diagnostic FNA results. KSUM Open 2014 SWV of nodules and adjacent thyroid tissue were examined by using Acuson S2000 ultrasound system (Siemens Medical Solutions) and statistically analyzed by Student's t-test. RESULTS: Malignant nodules had significantly higher SWV values (3.057 В± 1.0350 m/s) than those of benign nodules (2.404 В± 0.8458 m/s) (P=0.002). SWV values of adjacent thyroid parenchyma showed no significant difference between malignant and benign groups. The best cutoff point was 2.380 m/s for accurate differentiation between benign and malignant thyroid nodules. The sensitivity, specificity, positive predictive value, negative predictive value were 86.7%, 49.4%, 13.4%, and 82.6%, respectively. The area under the receiver operating characteristic curve was 0.716. CONCLUSION: VTQ provides quantitative information about tissue hardness, which is helpful in the differentiation of malignant and benign thyroid nodules. Diagnostic accuracy of VTQ is relatively fair. VTQ can be used as a supplement diagnostic tool with high negative predictive value. dicting nondiagnostic result (NDR). Of 753 nodules, 526 nodules, proven histologic result by operation or unchanged for two years, were included for assessing diagnostic performance of three methods. Receiver operator characteristic (ROC) curves were calculated for each preparation methods. RESULTS: NDR was higher in inexperienced performers, <1 cm, solid, and calcified nodules (P <0.05) in all methods. Mixed composition was more prevent in NDR using CC than LC (P =0.004). Nondiagnostic rate was 26.9%, 18.2% and 15.8% in CC, LC and combination, respectively. Sensitivity (92.3% vs. 91.5% vs. 92.3%), specificity (60.2% vs. 66.4% vs. 70.1%), positive predictive value (46.1% vs. 50.1% vs. 53.2%) and negative predictive value (95.5% vs. 95.5% vs. 96.1%) were similar. Area under curve (AUC) was 0.762, 0.790 and 0.821, respectively. CONCLUSION: LC is more effective in reducing repeat FNA with better diagnostic performance than CC. LC may be preferred in a mixed thyroid nodule for reducing NDR than CC. SE 150 SE 151 Comparisons of Liquid-based Cytology and Conventional Cytology on Thyroid Nodules: Prospective Study with Imaging-cytologic Correlations According to Bethesda System Head Rotation Technique in Thyroid Ultrasonography: Focusing on Case Reviews Chang Un Lee1, Soo Jin Kim1, Sung Hee Park1, Semin Chong1, Mirinae Seo1, Hye Shin Ahn1, Han Suk Ryu2 1 Department of Radiology, Chung-ang University Hospital, Korea 2 Department of Pathology, Seoul National University Hospital, Korea PURPOSE: We compared sonographic (US) features predicting nondiagnostic result and diagnostic performance between LC and CC on thyroid nodule. MATERIALS AND METHODS: From September to December 2011, this prospective study included 753 nodules in consecutive 601 patients underwent US-guided FNAB prepared into LC and CC simultaneously. A pathologist reviewed each method (CC, LC and combination) with a month interval. We evaluated US differences between LC and CC in pre- 304 Chanyeong Park, Kwanseop Lee, Kyoon Soon Jung, Jin Hee Moon, Ju Yeon Jung Department of Radiology, Hallym University Sacred Heart Hospital, Korea In this exhibition, a simple head rotation technique using SCM as a sonic window to improve image quality in thyroid ultrasonography (USG) is introduced. The advantages of head rotation technique during thyroid USG are as follows: 1. Avoidance of muscle interface shadowing Muscle interface shadowing is a problem because it often mimics an ill-defined hypoechoic lesion, leading to unnecessary fine needle aspiration (FNA). Therefore, SCM muscle has been considered to be an obstacle on thyroid USG by making muscle interface shadowing. However, better visualization and accurate evaluation is possible by rotating the head and making muscle interface away from suspected lesion, providing an opportunity to hold unnecessary The 45th Annual Congress of Korean Society of Ultrasound in Medicine Scientific Exhibits FNA. 2. Eliminating side lobe artifacts Side lobe artifact is one of well-known artifacts, especially on gallbladder as a mimicker of sludge material. Anechoic cyst can be affected by this artifact also on the thyroid, masquerading as a solid nodule. In the displayed case, we were able to reveal its true internal anechoic nature by taking SCM in front of the nodule. This was probably due to absorption of side lobe with low-amplitude by SCM. 3. Movement difference between superficial and deep portion of the thyroid According to the author's observation, the superficial portion of one thyroid lobe moves as ipsilateral SCM moves medially, while the deep portion of it moves less. This results in slight twisting of the thyroid lobe in anteroposterior plane. This might be useful in certain circumstances. This concept is supported by a displayed case, which is about a previously undetected thyroid nodule due to posterior acoustic shadowing generated by another calcified one. In conclusion, head rotation for using SCM as a sonic window may be a useful technique for improving image quality of thyroid USG. SE 152 Antenatal Diagnosis of Fetal Goiter Due to Hypothyroidism - A Rare Cause of Polyhydramnios Vikas Jhanwar, Nitin Mishra, Sunil Kumar Agrawal, Amrita Maheshwari, Meenu Bagarhatta, Darshan Koshiya, Rengarajan Rajagopal Department of Radiology, SMS Medical College, Jaipur (rajasthan), India SE 153 Thyroid Hemangiomas Diagnosed on Sonography Sung Hee Park1, Soo Jin Kim1, Hyun Kyung Jung2, Hye Shin Ahn1, Mirinae Seo1 1 Department of Radiology, Chung-ang University Hospital, Korea 2 Department of Radiology, Inje University Haeundae Paik Hospital, Korea Primary thyroid hemangiomas are extremely rare, and only a few cases have been previously reported. Primary hemangiomas are developmental anomalies resulting from the inability of the angioblastic mesenchyme to form canals. Thyroid hemangiomas are generally considered difficult to diagnose preoperatively because of their low incidence and nonspecific imaging findings. Here we report two cases of thyroid hemangiomas that were diagnosed correctly on preoperative sonography. Our cases showed similar sonographic findings, such as well-circumscribed hypoechoic lesions with internal channel-like linear lines, and bloody content was aspirated during fineneedle aspirations. Our report shows that thyroid hemangiomas can be diagnosed correctly by sonography with or without confirmation of bloody content in the lesions by fine-needle aspiration. 305 Scientific Exhibits Fetal goiter is a rare but potentially serious disorder that occurs in 0.2% of pregnancies, usually associated with maternal thyroid disease. Antenatal diagnosis of fetal goiter and its cause (hypothyroidism or hyperthyroidism) is crucial for the immediate postpartum management of these neonates. Previously cordocentesis which is an invasive method was solely used to differentiate between hyper and hypothyroidism, but now ultrasonography(USG) can noninvasively diagnose fetal goiter and its cause (hypothyroidism or hyperthyroidism) on the basis of USG scoring system which includes gland vascularity, fetal heart rate, bone maturation and fetal movements. We are presenting a case report of a 23 year old pregnant female patient who presented with complaints of polyhydramnios and abdominal discomfort. On antenatal ultrasound examination, we found an anterior neck mass in 32 weeks fetus. On the basis of imaging characteristics and USG scoring system we gave the probable diagnosis of fetal goiter due to hypothyroidism which was exerting pressure over oesophagus and causing polyhydramnios. Appropriate measures were taken on the basis of diagnosis and no prenatal and postnatal complication occurred. On postnatal clinical examination, diagnosis of fetal goiter was confirmed and biochemical examination showed hormonal assessment in favour of hypothyroidism.