The Application of Biomedical Engineering Techniques to the Diagnosis and Management of Tropical Diseases: A Review <s> Ultrasound Imaging of Hepatosplenic-Schistosomiasis <s> We reviewed the ultrasound (US) and computed tomography (CT) examinations of the liver in 21 patients with hepatic schistosomiasis japonicum (HSJ), to assess the role of imaging in its diagnosis. Thirteen patients had histopathological evidence of hepatic ova deposition. A 'network' pattern was present in 14 of 17 (82%) patients on US, and 'turtle-back' calcification in 11 of 13 (85%) patients on non-contrast CT (NCCT). The combination of US and NCCT was positive for HSJ in all nine patients subjected to both investigations. These findings are specific for HSJ and we discuss how they differ from the imaging findings reported in hepatic Schistosoma mansoni (HSM). We conclude that the sequelae of HSJ infection create an imaging diagnosis. Although an uncommon incidental finding at liver imaging, the combined US and CT appearances are so characteristic that in the majority of patients biopsy can potentially be avoided. <s> BIB001 </s> The Application of Biomedical Engineering Techniques to the Diagnosis and Management of Tropical Diseases: A Review <s> Ultrasound Imaging of Hepatosplenic-Schistosomiasis <s> For detecting lesions-related schistosomiasis japonica, X-rays, scintillation scanning, ultrasonography (US), computed tomography (CT), magnetic resonance (MR) and endoscopic examinations with biopsies have been used in Japan. Liver fibrosis and calcified changes are detected by US and CT. Most of the lesions that are detected by endoscopic examinations are due to deposited ova of Schistosoma japonicum. Portal hypertension is detected by US, CT and gastroscopic examination. Because schistosome infection decreased rapidly in Japan, most of the studies on imaging diagnosis were performed on chronic lesions or sequelae of schistosomiasis. Most of the techniques were used on admitted patients in well-equipped hospitals. US was introduced in the 1970s as a safe, rapid, non-invasive and inexpensive technique and has been used for diagnosis in hospitals and screening in the fields. As a typical US image of the liver, septal formation by high echogenic bands like mosaic was described, and this network pattern was reported in the other endemic countries; China and Philippines. As an appropriate technique, US has been broadly used in developing countries. Not only for diagnosis in a hospital, but also for monitoring changes of morbidity, US is used in the community level. Network pattern related to the severity of S. japonicum infection, has not been described in S. mansoni or S. haematobium infection. Appearance of network pattern depends on pathological changes such as periportal fibrosis, postnecrotic fibrosis and calcified ova. For advanced studies on morbidity of schistosomiasis japonica, further research on pathological basis of network pattern and standardization of US diagnosis are necessary. <s> BIB002 </s> The Application of Biomedical Engineering Techniques to the Diagnosis and Management of Tropical Diseases: A Review <s> Ultrasound Imaging of Hepatosplenic-Schistosomiasis <s> Over the last 20 years a great advance has been observed in many aspects of medicine, and the advent of novel imaging techniques is certainly amongst the most important. In schistosomiasis these new methods caused a revolution in the definition of the clinical forms of the disease and in the evaluation of its complications, such as, liver fibrosis, pulmonary hypertension and neuroschistosomiasis, as never before. Herein we present an overview of the image methods used to diagnose schistosomiasis mansoni nowadays. <s> BIB003
Ultrasound (US) is known to be one of the most effective methods for investigating liver and spleen abnormalities caused by schistosomamansoni. Portal hypertension induced by the periportal fibrosis is shown to be one of the main characteristics of the hepatosplenic form of schistosomiasis, it can be demonstrated by ultrasound imaging through measurement of the diameter of the portal vein and its main tributaries (splenic vein and superior mesenteric vein). Hepatosplenic schistosomiasis can induce formation of collateral vessels in the gastrointestinal tract leading to acute bleeding or possibly death. This phenomenon can be demonstrated by ultrasound imaging indicating an increased risk of bleeding ( Figure 9 ). Ultrasound can also be applied as a diagnostic tool in the assessment of treatment efficacy and regression of fibrosis in schistosomiasis BIB003 BIB001 . Diagnosis of hepatosplenic Schistomiasis can be obtained by observing characteristic changes of the attenuation in the computerized tomography (CT) or signal intensity and enhancement pattern of the magnetic resonance images (MRI) BIB003 BIB002 . The CT and MRI findings are usually compared and are in agreement with the ultrasound findings. In CT, low-density periportal zones are demonstrated as periportal thickening when compared with echogenic layers in ultrasound images. These low-intensity zones extend uniformly throughout the liver lobes and are enhanced after an intravenous injection of contrast agents to become either homogenous with or denser than the surrounding hepatic tissue. In MRI, on the other hand, periportal bands are demonstrated as areas of hyperintensity on T1-weighted sequences and hyperintensity on T2-weighted sequences after the intravenous injection. Studies of acute cases applying MRI demonstrated that regions of periportal fibrosis were hyperintense on T2-weighted images in all patients ( Figure 10 ). MRI has been known as a highly responsive imaging technique for many diffused liver pathologies. Unlike ultrasound imaging, MRI is not a dynamic method and also it is not dependent on the examiner. In Japan, ultrasound, CT and MRI techniques and endoscopic examinations with biopsies have been used to detect lesions related to schistosmiases japonica BIB002 . Portal hypertension is detected by CT, Ultrsound and gastroscopic examination. The MRI imaging diagnoses were performed on chronic lesions and/or sequelae of schistosemiasis and in well-equipped hospitals because of its high cost and longer time of examination. 