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GU: Female Pelvis/Endocrine

E3156. Twenty Cases in Which Ultrasound Imaging Trumped CT

Frometa Y,  Imanzadeh A,  Spektor M,  Revzin M. Yale School of Medicine, New Haven, United States

Address correspondence to Y. Frometa (yarisma.i.frometa@gmail.com)

Background Information: Ultrasound (US) imaging is a low-cost imaging tool that is useful for the diagnosis of a wide variety of pathology. In many circumstances CT has been recognized as a superior imaging modality when compared to US, but for many diseases US has also demonstrated its clear superiority to CT. We aim to demonstrate 20 particular cases in which the use of US proved invaluable to the diagnostic workup and added to the findings on CT imaging in order to fully characterize a disease and establish a diagnosis. Some examples include the identification of abnormal calcifications, determining the etiology of fluid collections, and the characterization of abdominal and pelvic solid masses.

Educational Goals/Teaching Points: The purpose of this case-based format exhibit is to familiarize the radiologist with different abdominopelvic pathologies in which a diagnosis was made based on ultrasound findings rather than CT. This will increase the radiologist’s awareness of various pathologies that can be better diagnosed with ultrasound, which in turn will decrease patient radiation exposure and healthcare costs. Different pathologies will be presented in a case-based format. CT images will be shown first along with a description of the findings and possible differential diagnoses that could be entertained, followed by a description of the ultrasound findings that resulted in an accurate diagnosis or a significantly narrowed differential list. Management alternatives will also be provided (if applicable).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: There are certain disease processes that are better assessed by US as opposed to CT imaging. For instance, the characterization and diagnosis of cystic neoplasms and different types of fluid collections can sometimes be challenging by CT imaging. When a fluid collection is identified on a CT scan, the differential diagnosis of what it may represent can be extensive, including but not limited to abscess, hematoma or seroma. Radiologists have a difficult time attempting to distinguish these entities, however with US imaging the diagnosis is often straightforward. Depending on their composition, the detection of calcifications on CT can be challenging as well. Ultrasound may be able to detect and characterize calcifications more readily, and would spare the patients from having to receive high doses of ionizing radiation. The diagnosis and characterization of pelvic and adnexal solid masses with CT imaging may on occasion be particularly challenging, which is why ultrasound is crucial in evaluation of the pelvis. We will review classic ultrasound-specific imaging findings of 20 interesting cases, emphasizing the role that US played in establishing the correct diagnosis.

Conclusion: Although ultrasound imaging is often perceived as a lesser tool for diagnostic purposes, there are clear instances in which it has proven invaluable in the diagnosis of certain abdominopelvic pathology. For this reason, we are determined to call attention to the value of US imaging and review examples of classic US imaging findings that will guide the radiologist toward the correct diagnosis. Furthermore, this approach will save the healthcare system a tremendous amount of money while providing patients the benefit of a radiation-free imaging technique.