WFUMB Ultrasound Open最新文献

Objective

Worldwide there is increasing use of musculoskeletal ultrasound (MSUS) in clinical practice, particularly by rheumatologists. Despite reported high levels of interest in the use of MSUS, lack of education and experience are often reported as barriers to rheumatologists performing MSUS in clinical practice. To evaluate current MSUS practices in Australia, we undertook a survey of rheumatologists who are current members of an Australian MSUS special interest group.

Methods

Descriptive and summary statistics of responses to a web-based survey to rheumatologists who had attended a workshop with the Australian Musculoskeletal Imaging Special Interest Group (AMISIG) were undertaken.

Results

Of thirty-six respondents, 97.2 % reported using MSUS as part of clinical care, and more than a quarter also use MSUS for research and teaching. The most frequent indication for MSUS use in 94.4 % of clinicians was for early diagnosis of rheumatic diseases, followed by monitoring response to treatment. Barriers to use of MSUS were identified, including time constraints, costs and lack of training post courses and experience. To support MSUS use in Australia, respondents nominated more “hands-on” supervised training courses and supervision of advanced trainees.

Conclusion

MSUS use by surveyed Australian rheumatologists is most frequently to make an early diagnosis of rheumatic diseases as well as in monitoring response to treatments, in research and in teaching activities. Australian clinicians identified that increased clinical education in MSUS, particularly for rheumatology trainees, was needed.

Purpose

This study aimed to determine the feasibility of using intraoperative contrast-enhanced ultrasound (CEUS) to assess subcortical hemodynamic changes in moyamoya disease patients who had undergone combined revascularization. It also aimed to investigate the correlation between quantitative CEUS parameters and post-operative neural functional recovery.

Methods

This study included seventeen patients diagnosed with moyamoya disease, confirmed through cerebral angiography, who underwent combined revascularization. Intraoperative subcortical hemodynamics were assessed using CEUS before and immediately after cerebrovascular bypass. Hemodynamic parameters were calculated by analyzing the time-intensity curve generated from a defined region of interest in each CEUS video. Post-operative neurological symptoms, computed tomography records, and short-term modified Rankin Scale (mRS) scores were also recorded.

Results

During the post-operative follow-up, 29.4 % of the patients experienced new neurological symptoms, including epilepsy, dyskinesia, and language impairment. Overall, CEUS quantitative parameters suggested that blood supply improved after surgery. And certain hemodynamic parameters exhibited a stronger correlation with the mRS scores, with correlation coefficients ranging up to 0.73 (p < 0.01). However, no statistically significant differences were observed among the different functional groups. The advanced parameter of wash-out intensity ($\delta$ WOI), which signifies the rate of change at the point when blood flow is completely washed out, demonstrated a significant difference between two functional groups (p = 0.02) and exhibited a correlation with mRS scores (correlation coefficients: 0.55, p = 0.02).

Conclusions

This preliminary study suggests that quantitative intraoperative CEUS can measure subcortical hemodynamic changes. It provides a novel non-invasive method that may predict the short-term post-operative neural functional recovery of combined revascularization in moyamoya disease patients.

Carotid atherosclerosis, a subtype of large artery atherosclerosis, is a significant contributor to ischemic stroke events. Considering the pivotal role of ultrasound in assessing carotid artery pathology, this review emphasizes its application in visualizing carotid atherosclerosis, with a particular interest in distinguishing stable from vulnerable carotid plaques. Recent advancements have improved our understanding of the relationship between plaque stability and ischemic stroke. This has motivated a comparative analysis of cutting-edge ultrasound techniques to evaluate extracranial carotid plaque, particularly focusing on areas of intraplaque vulnerability. The B-Mode remains the standard first-line imaging modality for both detecting carotid plaques and their morphology. However, its diagnostic potential is typically realized during the intermediate to advanced stages of atherosclerosis. In contrast, the latest innovations in ultrasound imaging techniques, such as contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE), grayscale median (GSM), and the refined Doppler method (superb microvascular imaging, SMI), offer a detailed quantitative approach to categorize carotid plaques into “stable” or “vulnerable” categories. Their application, however, is not widespread in outpatient settings due to factors such as exorbitant costs, extended imaging duration, and a prevalent lack of technical knowledge among healthcare providers. Beyond conventional echogenicity markers, both CEUS and SMI imaging possess the capability to evaluate intraplaque neovascularization, illuminating deep and microvessels within hypoechoic plaques. This aids in identifying high-risk plaque attributes, such as morphological irregularities and ulcerations, which are paramount for risk stratification and monitoring therapeutic responses. SWE offers insights into tissue rigidity and carotid plaque constituents, such as the fibrous cap and lipid core by gauging shear wave velocity and quantifying shear deformation with a specificity of 66.7 % which is higher than that of CEUS (58.3 %). Therefore, a multiparametric ultrasound approach offers a viable strategy for a holistic evaluation of carotid plaques. The timely identification of susceptible plaques can tailor therapeutic interventions, potentially averting cerebrovascular incidents, including acute ischemic strokes (AIS) and transient ischemic attacks (TIA).

Objective

To investigate the prognostic value of indicators from b-mode ultrasound, color Doppler ultrasound, and strain elastography of the thyroid gland in the diagnosis of Hashimoto's thyroiditis (HT).

Methods

In 70 euthyroidal patients with HT, demographic characteristics, serum thyroid profile and ultrasound parameters, including thyroid gland size, vascularity and stiffness (elastography strain index) of the parenchyma, and flow indices of the superior and inferior thyroid artery were recorded. The control group consisted of 70 age and weight matched euthyroid individuals with negative anti-thyroid antibodies (anti-TPO and anti-Tg).

Results

A significant difference was observed between the two groups in total thyroid size (ml, median ± standard deviation, SD) 7.86 ± 2.9 in HT vs. 6.35 ± 2.7 ml in controls, p = 0.003) and parenchymal vascularity which was increased in patients with HT (p < 0.001). Tissue strain index was higher in the HT group but without reaching statistical significance In logistic regression, thyroid size (odds ratio 1.20, 95% confidence interval: 1.02–1.41, p = 0.022) demonstrated significant prognostic value for the presence of HT. No differences were found between the two groups, regarding the peak systolic velocity (PSV), end-diastolic volume (EDV), pulsatility index (PI) and resistive index (RI) values of the thyroid arteries. In the ROC analysis (AUC 0.653, p = 0.002), a thyroid size >7.3 ml exhibited sensitivity of 61.43% and specificity of 72.6% for the diagnosis of HT.

Conclusion

Patients with HT exhibit larger thyroid size and increased intrathyroidal vascularity on ultrasound prior to the manifestation of hypothyroidism compared to the healthy population. Flow indices of the superior thyroid artery do not have prognostic value in the diagnosis of HT.

Introduction

Contrast-enhanced ultrasound (CEUS) is a modality of growing interest because of its improved detection rates when evaluating lesions and better success rates when administering interventions, compared to standard ultrasound. Along with its diagnostic value, the possibilities for therapeutic innovation with CEUS are immense. While there is much discussion of CEUS and its potential applications, there is a scarcity of studies characterizing the current state of CEUS research. Bibliometric analysis, a method of gaining an overview of a body of literature, quantitatively analyzes large amounts of information within publications to reveal trends. This study used bibliometric analysis to characterize the state and nature of the 100 most-cited publications on CEUS.

Methods

We identified the 100 most-cited publications on contrast-enhanced ultrasound using the Scopus database. We recorded various bibliometric data points from these publications, with additional data collected for the 25 most-cited publications. Data were analyzed via R, R studio, and VOSviewer.

Results

Our analysis of the top 100 publications revealed that 38 of the listed first authors were from the United States. Eleven articles were in Radiology, six were in Ultraschall in der Medizin, and six were in Ultrasound in Medicine and Biology, with mean citation counts of 269.2, 433.3, and 291.7 per publication, respectively. The University of Virginia Health System produced the most publications in the top 100. Seventeen of the top 25 most-cited articles were clinical practice guidelines. Four of the top five papers were clinical practice guidelines pertaining to hepatocellular carcinoma.

Conclusion

In conclusion, several interesting trends were demonstrated in our bibliometric analysis. The most heavily cited articles from the top 100 were published between 2010 and 2019, which is in contrast to the finding that the previous decade contained more articles published in the top 100. This trend indicates a significant scientific impact from those articles published from 2010 to 2019. The substantial number of articles addressing applications of CEUS in diagnosing and treating liver diseases correlates closely with their global disease burden; therefore, this finding potentially explains the rise in impactful research production within the field. This study is the first to characterize the landscape of CEUS research, and future studies should further this work as the field continues to develop. Thus, our analysis reveals many important findings in the current state of CEUS research and its impact on medical imaging.

Contrast-enhanced Ultrasound (CEUS) is an advanced ultrasound (US) technique that utilizes specific US contrast agents (UCAs) to provide a more detailed evaluation of anatomic structures and parenchymal vasculature. Although the use of CEUS has been well-established in echocardiography and imaging of focal liver lesions, the updated guidelines by WFUMB-EFSUMB from 2018 also talk about the use of CEUS in the urinary bladder under non-hepatic applications of CEUS. The most common application of CEUS in the urinary bladder is the differentiation between bladder cancer and benign lesions such as a hematoma in patients presenting with hematuria. CEUS is also a promising imaging modality that can be used to detect and stage bladder urothelial cancers. CEUS greatly improves the diagnostic accuracy of conventional US techniques in the detection of bladder cancer. It has been shown previously that low- and high-grade bladder cancers tend to behave differently on the time-intensity curves (TIC) of CEUS. Low-grade bladder cancers tend to show a TIC with an early peak enhancement with a slow plateau and a longer time taken for contrast disappearance, whereas high-grade bladder cancers tend to show a rapid and high peak enhancement with rapid contrast disappearance (fast wash-out phase). In patients presenting with hematuria, CEUS accurately differentiates the etiology as either malignant or benign (i.e., hematoma) as hematomas are non-vascular lesions and do not show any enhancement as opposed to bladder cancers which tend to be highly vascular. CEUS holds several advantages such as being widely available, quick, and cost-efficient. CEUS is also suitable for patients who have contraindications to undergo CT, MRI, and/or conventional cystoscopy. Additionally, CEUS can be safely performed in patients with renal failure as UCAs are not nephrotoxic and not deposited in tissues as they are blood pool agents and are metabolized and excreted via pulmonary breathing.