Ultrasound最新文献

Ectopic pregnancy is a gynaecological emergency. While its identification and management are monumental, it also impacts the patient's future fertility. Ectopic pregnancy is one of the leading causes for maternal deaths in the first trimester. The rate of ectopic pregnancy in the United Kingdom is reported to be 11 per 1000 pregnancies, with a maternal mortality of 0.2 per 1000 estimated ectopic pregnancies and two-thirds of these deaths are associated with substandard care. Literature is replete with risk factors leading to ectopic pregnancy, such as tubal disease, previous pelvic surgery, tubal surgery, assisted reproduction, smoking and so on. The paper employs case scenarios of recurrent ectopic pregnancies in two patients with triple recurrent ecotpic pregnacies. It discusses the risk factors and preventive measures to avoid multiple recurrences.

Introduction: Groin discomfort is one of the most common presenting complaints in health care and often requires ultrasound to detect hernias. However, such singular emphasis leads to over diagnosing hernia and other significant aetiologies in and around the groin are overlooked.

Topic description: The article elaborates on the key areas a sonographer needs to focus on and presents a range of conditions responsible for groin pain other than hernia.

Discussion: In addition to evaluating for hernia, a groin ultrasound should evaluate structures in the inguinal canal, the adductor muscles and symphyseal region, the superficial inguinal lymph nodes, the femoral neurovascular bundle, the hip joint with periarticular regions and the structures in the right iliac fossa.

Conclusion: Sonographers must have a methodical approach, a good knowledge of normal anatomy and pathologies and a comprehensive understanding of the various types of groin abnormalities for a thorough examination.

Introduction: This pilot study aims to evaluate the clinical impact of artificial intelligence-based decision support, Koios Decision Support™, on the diagnostic performance of ultrasound assessment of thyroid nodules, and as a result to avoid fine needle aspiration.

Methods: This retrospective pilot study was conducted on ultrasound images of thyroid nodules investigated with fine needle aspiration from January 2022 to December 2022. Orthogonal ultrasound images of thyroid nodules, previously investigated with fine needle aspiration, were compared with the Koios Decision Support™ suggestion to perform fine needle aspiration. Surgical histology was used as ground truth.

Results: A total of 29 patients (76% women) with a mean age of 48 ± 16.5 years were evaluated, n = 15 (52%) were histologically proven benign and n = 14 (48%) were malignant. In the benign group, Koios Decision Support™ suggested avoidable fine needle aspiration in n = 8 (53%). In the malignant group, Koios Decision Support™ suggested follow-up or no fine needle aspiration in n = 2 (14%). Sensitivity is 85.7% (n = 12) (p = 0.027), whereas specificity is 53.3% (n = 8) (p = 0.027). The positive predictive value is 63.2% (n = 12), negative predictive value is 80% (n = 8), false-negative value is 20% (n = 2) and false-positive value is 36.8% (n = 7). Based on artificial intelligence decision, one cancer would have been missed.

Conclusion: Artificial intelligence can improve specificity without significantly compromising sensitivity. There was a suggested reduction in the fine needle aspiration rate, in the histologically proven benign nodules, by 53%. This had no statistical significance, likely due to the small population, however, it is thought to be the largest study to date. Further investigation with wider-ranging studies is suggested.

Background: Pre-operative assessment of non-melanoma skin cancers via advanced ultrasound techniques may potentially provide additional information to tumour margins and morphology compared to current assessment via dermoscopy or optical coherence tomography. In this case series, the findings of multimodal ultrasonography of non-melanoma skin cancer are described, with histological correlation.

Methods: Consecutive patients with clinical suspicion of malignant skin lesions underwent multimodal ultrasonography, comprising B-mode, colour Doppler imaging, superb microvascular imaging, strain elastography, and shear-wave elastography, followed by surgical excision. Images were reviewed by two radiologists.

Results: There were 8 female and 3 male patients, whose age ranged from 66 to 98 years. A total of 11 malignant skin tumours (basal cell carcinoma, n = 6; squamous cell carcinoma, n = 5) were reviewed. Tumour depth measured via ultrasound assessment ranged from 1.20 to 7.00 mm (mean ± standard deviation: 4.35 ± 1.99 mm). Tumours were located within dermis (n = 1) and abutting subcutaneous layer (n = 10) sonographically. Where corresponding histological reports for tumour depth were available, ultrasound correlated well with histology. Ultrasound also correctly predicted the deepest layer of involvement for all lesions. The sonographic features observed in all malignant skin tumours (11/11:100%) are solid, hypoechoic, with abundant neovascularity on colour Doppler imaging and superb microvascular imaging, and appeared stiff on strain elastography and shear-wave elastography. In some cases, the microvascular network of intra-tumoural flow were better demonstrated on superb microvascular imaging.

Conclusion: Multimodal ultrasound can potentially be a useful and quick adjunctive tool for the pre-operative assessment of skin cancer by delineating the tumour depth and deepest skin layer involvement, ensuring complete excision of tumour.

Introduction: Preterm delivery is a grave and demanding problem that accounts for the major cause of neonatal deaths and long-term morbidities. It remains an unresolved health issue of global dimensions. Cervical elastography is evolving as a useful diagnostic tool for its timely prediction so that individualised management can be done.

Aim: To assess the diagnostic accuracy of transvaginal strain cervical elastography in prediction of preterm delivery.

Methods: This prospective observational study was conducted from June 2021 to August 2022 in a tertiary care institute of North India. A total of 75 low-risk asymptomatic women were included. Transvaginal ultrasound was performed for the cervical length in the second and third trimesters. In addition, we collected strain elastography data such as colour codes from six regions of the cervix, that is, at the anterior and posterior lips of internal os, middle one-third of the cervix and the external os, and the strain ratios from these three cervical levels were also calculated. Then these parameters were compared with cervical length, second and third trimester groups and also with preterm and term delivery groups.

Result: The red colour (soft colour) at the anterior lip of internal os was the best predictor of preterm delivery in our study with a sensitivity and specificity of 63.64% and 96.87%, respectively. The elastography strain ratio of >2 at the internal os and cervical length ⩽2.8 cm were the additional predictors for the same.

Conclusion: Cervical elastography can serve as a potential and reliable predictor for preterm delivery.

Aim: Growth Assessment Protocol is a fetal growth initiative designed to improve antenatal detection of babies who are small-for-gestational-age and reduce stillbirths. However, its direct impact on pregnancy outcome and stillbirth rates is questioned. This service evaluation aimed to assess Growth Assessment Protocol's influence on pregnancy outcomes at a National Health Service hospital.

Method: Anonymous, maternity and ultrasound data, routinely acquired between 2014 and 2022 were extracted from clinical databases (Viewpoint, Euroking). Trends in maternity data and ultrasound scan volume were explored with descriptive statistics. Variables of stillbirth, antenatal small-for-gestational-age detection and scan volume were compared before and after Growth Assessment Protocol implementation. Associations between these variables were evaluated using Spearman's rho.

Results: The percentage of babies born small-for-gestational-age reduced by 0.3% across the evaluation period. Antenatal small-for-gestational-age diagnosis rose from 4.1% to 14.3%. However, the number of false-positive cases of antenatally diagnosed small-for-gestational-age increased fivefold from 2.2% to 11.5%. Although stillbirth rates remained consistent post-Growth Assessment Protocol, complex scan volume (e.g. number of growth scans using Doppler) increased annually. The peak incline coincided with the Growth Assessment Protocol implementation period (2016-2018). Complex scan volume was significantly associated with overall small-for-gestational-age detection (rho = 0.8, p =< 0.001), but not with stillbirth frequency (rho = -0.1, p = 0.4).

Conclusion: Small-for-gestational-age detection increased following Growth Assessment Protocol implementation, although this was associated with a high false-positive rate and no reduction in stillbirths. The potential implications associated with clinical management, parent experiences and departmental workflow, alongside the benefits for stillbirth reduction, should be fully considered prior to the introduction of a new fetal growth initiative to the antenatal care pathway.

Introduction: The inducibility of the cervix for labour induction is usually determined by cervical status evaluation. The Bishop score is historically used to forecast the success of induction of labour, although it is subjective, and not reproducible. However, transvaginal ultrasound measurements of cervical length are rarely used for preinduction cervical assessment. The study compared cervical length measured via transvaginal ultrasound and the modified Bishop score for preinduction cervical assessment at term.

Methods: The study involved 72 pregnant, nulliparous women for induction of labour at term. They were randomised into the transvaginal ultrasound group and the modified Bishop score group. The cervix was said to be 'ripe' when the transvaginal ultrasound cervical length (CL) was < 28 mm or the modified Bishop score was ⩾ 6. The cervix was considered 'unripe' when the Bishop score was < 6 or the transvaginal ultrasound was ⩾ 28 mm. Participants with ripe cervices had induction of labour with an oxytocin infusion, while those with unripe cervices had preinduction cervical ripening with misoprostol. The primary outcome measures were the mode of delivery and the total amount of prostaglandins administered for preinduction cervical ripening.

Results: There was no significant difference between the two groups with regard to the mode of delivery (p = 0.795), the total amount of prostaglandins administered for preinduction cervical ripening (105.0 ± 51.04 µg vs 111.90 ± 52.2 µg; p = 0.0671), the proportion of women who were administered prostaglandins due to an unfavourable cervix (41.7% vs 55.6%; p = 0.812), induction-to-the-active phase of the labour interval (11.00 ± 4.2 hours vs 11.82 ± 4.12 hours; p = 0.407) or the induction-delivery interval (20.15 ± 5.7 hours vs 22.66 ± 4.33 hours; p = 0.06) in both groups, respectively. Compared with those in the Bishop score group (Bishop score ⩾ 6), the induction-to-active phase of labour intervals (6.47 ± 0.77 hours vs 7.33 ± 1.21 hours, p = 0.024) and the induction-to-delivery intervals (14.97 ± 1.0 hours vs 18.39 ± 0.85 hours; p = 0.0001) in the transvaginal ultrasound group (cervical length < 28 mm) were significantly shorter, respectively.

Conclusion: Preinduction cervical assessment using transvaginal ultrasound (cervical length < 28 mm) or the modified Bishop score is a successful predictor of the outcome of labour induction A larger multicentre studies are needed to identify optimal cervical length cutoffs and to determine if this could decrease unnecessary prostaglandin use or decrease caesarean section rate.

Introduction: Mirror artefacts often can be seen in abdominal ultrasound. Their efficacy in detecting sonographically occult lesions has been overlooked.

Case report: We present two cases of abdominal ultrasound examination, where the mirror image artefact was utilised in the diagnosis of sonographically occult lesions in segment VII of the liver.

Discussion: The physical principle behind the mirror image artefacts in these cases has been explored and explained. Suggestion on utilising this artefact is recommended.

Conclusion: These cases demonstrate the key role that mirror artefacts played in detecting occult liver lesions. Sonographers are advised to extend their survey of the right liver and pay close attention to displayed mirror images above the diaphragm especially from potential sonographically occult lesions in segment VII of the liver.

Introduction: To perform a systematic review of the diagnostic accuracy of point-of-care lung ultrasound, compared to chest radiography, in children and young people (0-21 years) who present to ambulatory settings with suspected community-acquired pneumonia.

Methods: Registration: Prospero June 2021 CRD42021260552. Electronic searching performed on Medline, Embase, CINAHL and Science Citation Index from inception to 20 June 2023. Two researchers independently screened titles, abstracts, and full texts for study selection. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analysis of included studies.

Results: The six studies included in this systematic review described point-of-care lung ultrasound performed primarily by paediatric emergency medicine clinicians on a total of 1099 paediatric patients, with a reference standard of chest radiography or chest radiography with clinical findings. The majority of included studies lacked clarity on training for the index test with potential bias around flow and timing of testing. Meta-analysis of the combined results of the included six studies calculated a pooled sensitivity of 90.9% (95% CI [85.5%, 94.4%]) and pooled specificity of 80.7% (95% CI [63.6%, 91.0%]).

Conclusions: Point-of-care lung ultrasound has high sensitivity but lower specificity to diagnose acute pneumonia in children. Further research is needed which overcomes issues around training in point-of-care lung ultrasound, study design and reliability of the reference test (chest radiography) to better evidence the role of point-of-care lung ultrasound in diagnosing pneumonia in children in ambulatory and resource-limited settings.