Hong-Jen Chiou

Tion, along with a review of existing literature on the anatomy of shoulder and treatment of tendinopathy. Materials and Methods: We retrospectively reviewed the ultrasound studies of 17 patients diagnosed with CHL pathology and associated shoulder pain. All patients received ultrasound-guided interventions, including prolotherapy and platelet-rich plasma injection. The pretreatment and first posttreatment symptoms were reviewed and analyzed according to visual analog scale (VAS) scores. Results: The etiology of CHL pathology in our case series included traumatic injury and tendinosis. Of the 17 patients, the mean pretreatment VAS score was 6.8/10, and the mean posttreatment VAS score was 3.5/10. In total, 10 (58.8%) patients reported >50% improvement after a single treatment session. Conclusion: CHL pathology should be recognized and considered in the diagnosis of shoulder pain. Ultrasound examination is a safe and effective means of obtaining a precise diagnosis and can be used for the treatment of CHL pathology....

Journal of Medical Ultrasound, Chinese Taipei Society of Ultrasound in Medicine Asian Federation of Societies for Ultrasound in Medicine and Biology

Considering the potential chondrotoxic effects of lidocaine, this retrospective study aimed to examine whether ultrasound-guided hydrodilatation without concurrent lidocaine infusion can still provide comparable treatment benefits for patients with adhesive capsulitis (AC). Outpatient data from 104 eligible AC patients who received ultrasound-guided hydrodilatation between May 2016 and April 2021 were reviewed. A total of 59 patients received hydrodilatation with diluted corticosteroid only, while 45 patients received treatment with mixed, diluted corticosteroid and 1% lidocaine. The overall treatment outcome was documented as the percentage of clinical improvement, ranging from 0% to 100% compared to baseline, and it was ranked into poor, moderate and good treatment outcomes. The results show no significant group-wise difference in demographics, overall treatment outcome, and number of hydrodilatations, while most patients showed moderate and good treatment outcomes. Patients with lidocaine infusion did not show greater treatment benefit. Our results suggest that ultrasound-guided hydrodilatation without concurrent lidocaine infusion can still deliver good treatment benefits for AC patients, and the findings are supportive of a modified approach toward careful intra-articular local anesthetic use during management of AC in the primary care setting.

Objectives: Sarcopenia patients require more medical attention and caretaking. As such, early detection of sarcopenia and appropriate interventions are crucial for decreasing medical costs and meeting the challenges of aging populations. The aim of the present study was to develop a reliable and accurate model to estimate muscle mass using ultrasound‐derived parameters from the rectus femoris (RF), referenced by dual‐energy X‐ray absorptiometry.Methods: Cross‐sectional study was performed. The study patients were recruited by Taipei Veterans General Hospital (No. 2016‐07‐013C) between 2016 and 2019. A total of 91 community‐dwelling adults (35 men and 56 women) were enrolled in this study. Ultrasound measurements of RF muscle thickness (MT), cross‐sectional area (CSA), and muscle volume (MV) were performed in B‐mode. Muscle strength and physical performance were also examined. Multivariate linear regression was used to build models for the prediction of appendicular skeletal muscle index (ASMI) based on MT, CSA, and MV values. The accuracy of ultrasound RF measurements for predicting sarcopenia was evaluated by using receiver operating characteristic (ROC) curve analysis.Results: The regression equations used for ASMI prediction (adjusted body mass index, sex, and leg length) had high precision and low error. Moreover, the MV model results were close to those of the CSA model and higher than those of the MT model. The ROC analysis showed that both MV and CSA had excellent discrimination when assessing sarcopenia (AUC = 0.83 and 0.81, respectively), whereas MT showed acceptable discrimination (AUC = 0.73).Conclusions: Ultrasound‐derived RF MV was accurate when predicting ASMI and diagnosing sarcopenia in community‐dwelling adults.

Background: To assess the efficacy and safety of perimysium dissection for posterior shoulder myofascial pain. Methods: This retrospective single-arm study was performed at a medical center between April 2016 and August 2017. Fifty-seven participants with refractory chronic posterior shoulder pain of myofascial origin underwent ultrasound (US)-guided perimysium dissection with hypertonic dextrose solution. Visual analog scale (VAS) scores and complication rate were evaluated before treatment and 4 weeks after treatment. Results: US-guided perimysium dissection with dextrose solution resulted in excellent treatment efficacy and safety. Nineteen participants (33.3%) were free of pain after treatment, and 32 (56.1%) had >50% improvement in pain score. Forty-nine participants had complete VAS records. Overall mean pre- and posttreatment VAS scores were 7.18 ± 1.60 and 1.91 ± 2.04 (mean difference −5.27, 95% CI −5.99 to −4.55, p < 0.0001), respectively, including 7.26 ± 1.44 and 1.84 ± 1.98 (mean difference −5.43, 95% CI −6.33 to −4.52, p < 0.0001) for those with infraspinatus myofascial pain, and 7.00 ± 1.96 and 2.07 ± 2.26 (mean difference −4.93, 95% CI −6.23 to −3.62, p < 0.0001) for those in the teres minor subgroup. No complications were reported in any of the participants. One participant received retreatment for teres minor myofascial pain. Conclusion: US-guided perimysium dissection is an easy, safe, and effective injection method to manage posterior myofascial shoulder pain.

Background: Due to the lack of an evidence-based consensus, managing refractory myofascial pain syndrome is challenging for clinicians. Dextrose injection (dextrose prolotherapy) emerged as a promising, cost-effective treatment. This study evaluated the efficacy of targeted ultrasound-guided dextrose injection for localized myofascial pain syndrome. Methods: We retrospectively reviewed the clinical outcomes of 45 patients with myofascial pain syndrome refractory to alternative treatments with targeted ultrasound-guided dextrose injection. Pretreatment symptom severity and symptomatic response 1 month after treatment were statistically analyzed using a visual analog scale (VAS)-based scoring system. Results: Of 45 patients, 8 (24.4%) reported complete resolution of symptoms at the treated site. In total, 36 (80.0%) patients reported greater than 50% improvement in their symptoms. The mean pretreatment and posttreatment VAS scores were 7.0 and 2.44 (p < 0.001), indicating an overall 65.0% reduction in symptom severity. Conclusion: Targeted ultrasound-guided dextrose injection was remarkably effective for refractory localized myofascial pain syndrome, significantly reducing symptom intensities in the majority of treated patients within 1 month after a single injection.

Osteosarcoma (OS) is the most common bone tumor in children and teenagers. The multidrug resistant property of OS produces a major obstacle to chemotherapy, since the effective drug dose cannot be achieved via conventional drug delivery routes without serious systemic cytotoxicity. Microbubbles in conjunction with ultrasound (US) has recently been shown to spatially and temporally permeabilize the cellular membrane, promoting drug penetration into tumors. Here, we investigated whether drug (doxorubicin, DOX)-loaded bubbles (DOX-bubbles) can serve as drug-loaded carriers in combination with US in order to facilitate tumor drug delivery. The proposed bubbles have a high payload capacity (efficiency of 69.4 ± 9.1%, payload of 1.4 mg/mL) for DOX. In vitro data revealed that when used in combination with US (1-MHz), these DOX-bubbles facilitate DOX entering into tumor cells. In tumor-bearing animals, DOX-bubbles + US could provide 3.7-fold suppression of tumor growth compared with the group without insonation (1.8 ± 0.9 cm³ vs. 8.5 ± 2.2 cm³) because of the acceleration of DOX-induced tumor necrosis. In the meantime, the tumor perfusion and volume can be monitored by DOX-bubbles with contrast-enhanced ultrasound imaging. Our data provide useful information in support of translating the use of theranostic US-responsive bubbles for regulated tumor drug delivery into clinical use.

Contrast-enhanced ultrasound (CEUS) has been used to diagnose gallbladder (GB) diseases for recent years because it is sensitive to visualize vascularity. Herein, we report a case who had a 1.7 cm × 1.2 cm polypoid lesion located in the gallbladder fundus with a feeding artery located in the stalk. On CEUS, the lesion showed early arterial phase enhancement (time to peak enhancement 18 s), persisting throughout the venous and delay phases. This enhancing pattern suggested that the lesion was a GB adenoma rather than a GB carcinoma. Cholecystectomy was performed, and pathology of the tissue revealed tubular adenoma of the GB.

The purpose of this study is to test the possibility of obtained cell-like resolution in soft tissue tumors on the basis of ultrasound echotexture. This is a prospective study consisting of 57 patients (29 females and 28 males, age range: 9-83 years, average age: 44.5 years) with palpable soft tissue mass, referred from the Departments of Orthopedics and Oncology for ultrasound (US)-guided biopsy. The study was approved by the institutional review board (IRB) of our hospital. Ultrasonographic images were recorded by still imaging in the biopsy tract in each biopsy session. Equipment included curvilinear and linear array probes. After biopsy, a radiologist and a pathologist correlated the US image and the observations regarding the histology of the tissue specimen in low-power (40 × magnification) and high-power (100-400 × magnification) fields. The histologic results included 22 benign and 35 malignant lesions. The echotexture of the soft tissue tumors correlated well with the cellular distribution and arrangement: the greater the number of cells and the more regular their arrangement as seen histologically, the greater is the hypoechogenicity on the ultrasound. The echogenicity of the soft tissue tumor also correlated well with the presence of fat cells, hemorrhage, cartilage, and osteoid tissue, all of which cause an increase in echogenicity. This study showed that the echotexture of soft tissue tumors can predict some details of cellular histology.