Ultrasound最新文献

Introduction: Riedel's thyroiditis is a rare inflammatory disease of the thyroid with non-specific and varied presentations. A typical presentation and ultrasound findings are reported in this case.

Case report: A 68-year-old male is referred to Ear, Nose and Throat for a neck lump that varied in size over 2 years. An ultrasound scan identified a suspicious nodule on the left thyroid that was biopsied confirming the diagnosis of Riedel's thyroiditis.

Discussion: The aetiology, presentation and management of Riedel's thyroiditis are explored. The use of ultrasound and the utility of other imaging and biochemical tests are discussed.

Conclusion: Riedel's thyroiditis is a difficult condition to diagnose due to rarity, varied presentation, with non-specific clinical, biochemical and radiographic findings which often mimic thyroid cancers. Definitive diagnosis of Riedel's thyroiditis requires histological analysis, and while fine-needle aspirations are typically insufficient, diagnostic samples can be taken with ultrasound-guided core biopsies.

Musculoskeletal disorders are a significant global health concern, affecting over 1.71 billion individuals worldwide, with a considerable impact on quality of life and economic burden due to healthcare costs and productivity losses. In the United Kingdom, approximately one-third of the population suffers from musculoskeletal disorders, underscoring the need for effective diagnostic and management strategies. Musculoskeletal ultrasound imaging emerges as a preferred diagnostic modality, offering a balance between technical capabilities and cost-effectiveness, owing to its non-invasive nature, portability and lack of radiation exposure. However, the operator-dependent nature of musculoskeletal ultrasound imaging necessitates specialised training for medical and healthcare professionals. The integration of musculoskeletal ultrasound imaging into traditional clinical examinations, known as ultrasound imaging-assisted clinical examination (UIACE), enhances traditional diagnostic processes by providing immediate visual feedback, facilitating a more accurate and comprehensive assessment of musculoskeletal conditions. This approach not only refines diagnosis in cases with ambiguous symptoms or overlapping signs but also significantly improves patient reassurance and management strategies. In addition, incorporating musculoskeletal ultrasound imaging into medical education through ultrasound imaging-assisted clinical examination offers students a dynamic, interactive learning experience, fostering a deeper understanding of clinical anatomy and examination skills. By advocating for its systematic inclusion in the undergraduate medical curriculum, the study highlights the potential to enhance the competence and confidence of future professionals in utilising ultrasound imaging, ultimately improving patient outcomes in musculoskeletal care.

Objectives: Focused cardiac ultrasound (FoCUS) is increasingly applied in many specialities, and adequate education and training of physicians is therefore mandatory. This study aimed to assess the impact of artificial intelligence (AI)-assisted interactive focused cardiac ultrasound (FoCUS) teaching session on undergraduate medical students' confidence level and knowledge in cardiac ultrasound.

Methods: The AI-assisted interactive FoCUS teaching session was held during the 9th National Undergraduate Cardiovascular Conference in London in March 2023 and all undergraduate medical students were invited to attend, and 79 students enrolled and attended the training. Two workshops were conducted each over 3-hour period. Each workshop consisted of a theoretical lecture followed by a supervised hands-on session by experts, first workshop trained 39 students and the second workshop trained 40 students. The students' pre- and post-session knowledge and confidence levels were assessed by Likert-type-scale questionnaires filled in by the students before and immediately after the workshop.

Results: A total of 61 pre-session and 52 post-session questionnaires were completed. Confidence level in ultrasound skills increased significantly for all six domains after the workshop, with the greatest improvement seen in obtaining basic cardiac views (p < 0.001 for all six domains). Students strongly agreed about the effectiveness of the teaching session and supported the integration of ultrasound training into their medical curriculum.

Conclusions: AI-assisted interactive FoCUS training can be an effective and powerful tool to increase ultrasound skills and confidence levels of undergraduate medical students. Integration of such ultrasound courses into the medical curriculum should therefore be considered.

Background: Multiple factors impact kidney perfusion peri-operatively. The aim of this study was to evaluate the effect of patient position and size on renal transplant perfusion.

Methods: Consecutive adult recipients of 123 single renal grafts were studied. Renal artery velocity, renal vein velocity and cortical resistive indices were measured in supine, oblique and decubitus positions on post-operative days 1, 3, 7 and 30, and standing on days 7 and 30.

Results: Positional resistive indices were significantly lower than the supine resistive indices except in the day 1 oblique scan. Greater reductions in resistive indices occurred in grafts with higher supine cortical resistive indices, higher renal vein velocities and greater change in renal vein velocities. Renal artery velocities, renal vein velocities and resistive indices progressively decreased with greater positional change. Although renal vein velocities correlated poorly with resistive indices in individual patients, mean resistive indices correlated well (r ² = 0.73) with mean renal vein velocities for scans in different positions and on different days, and less so with mean renal artery velocities (r ² = 0.37). Supine abdominal girth and change in girth with position were more strongly associated with larger changes in supine resistive indices than recipient weight, body mass index or peri-operative weight gain.

Conclusions: Peri-operative renal transplant resistive indices, renal artery velocities and renal vein velocities improve with patient positional change due to reduced compression of the graft and renal vein, with implications for post-operative ultrasound scanning protocols, documentation and reporting. Peri-operative patient position, especially for at-risk grafts, is a modifiable risk factor for poorer graft outcomes. Patients should be nursed in the decubitus position rather than supine. Abdominal girth is more relevant to pre-operative patient assessment than weight or body mass index.

Introduction: Increasing demand for ultrasound services is reducing learners' access to medical ultrasound clinical experience. High-fidelity simulation equipment, such as the BodyWorks Eve®, enhances the learners' experience and scanning ability. This has the potential to improve patient safety as the learners' ability to detect, identify and accurately report a known pathology can be assessed, which is not possible in clinical practice.

Methods: Participants performed one pathological ultrasound examination on the BodyWorks Eve® and the participants' performance level was assessed by the primary investigator using a formative clinical assessment form already used by the Diagnostic Imaging programme at the University of Leeds. The outcome was analysed using narrative statistics, and participants' feedback was evaluated using thematic analysis.

Results: A total of 16 participants were recruited. Eight (50%) reached the required level, but eight (50%) failed to reach the required level in at least one of the seven criteria that indicate professionally incompetent or dangerous practice. Thematic analysis of all the participants' comments identified four main themes and two sub-themes which highlighted the benefits of the simulated assessment for prompting reflection, replicating clinical practice and gaining confidence in the assessment process, while also identifying negative aspects such as technical limitations when using the BodyWorks Eve®.

Conclusion: Most participants evaluated the BodyWorks Eve® favourably. Using BodyWorks Eve® for formative clinical assessments is feasible and acceptable to participants. Further correlation to outcomes in clinical practice would be useful.

Background: A large percentage of women fear benign breast lesion surgery, and it is a burden to the healthcare system. Ultrasound-guided vacuum-assisted excision (VAE) is as effective as surgery but does not require general anaesthesia, leaves no scars, and improves patient satisfaction.

Methods: A retrospective analysis of a prospective cohort research carried out on recorded data of a single breast surgeon. VAE was performed on 611 patients with ACR BIRADS 3 or 4a lesions utilising EnCor Enspire equipment and a 7G probe. The average follow-up time was 30.25 ± 9.12 months.

Results: A total of 772 VAEs were performed on lesions with an average diameter of 18.81 ± 8.63 mm. Pathology results revealed fibroadenoma in 70.85% of cases and papilloma in 19.43%. The overall removal rate was 99.2%, and the upgrade rate was <1%. Fibroadenoma was significantly more common in younger people, had a larger width, and was located farther away from the nipple than papilloma. Individuals with a lesion size of 13.5 mm or less and an age of 36.5 years or older were more likely to have papilloma than fibroadenoma. The reported issues consisted of temporary localised discomfort and haematoma. There were no serious complications, no hospitalisation or operation as a result of a complication, and no infection or antibiotic use was reported.

Conclusion: VAE is a safe and effective alternative to open surgery for those with benign breast lesions. VAE can be utilised for both diagnostic and therapeutic purposes, making it a more cost-effective choice while also increasing patient satisfaction.

Introduction: Shear wave elastography is a new modality for the evaluation of erectile dysfunction by assessing the stiffness of corpora cavernosal tissue. We evaluated the shear wave elastography values in erectile dysfunction participants and compared shear wave elastography values between vasculogenic and non-vasculogenic erectile dysfunction participants.

Methods: Overall, 40 participants with clinically diagnosed erectile dysfunction filled out an abridged five-item version of the international index of erectile dysfunction-5 questionnaire and underwent shear wave elastography as well as pharmacologically induced penile erection test after intracavernosal papaverine injection. Shear wave elastography values were obtained serially at 5-minute interval at two locations: Central (cavernosal artery centered circular region) and Peripheral (near the tunica albuginea). Shear wave elastography values were compared with the erectile dysfunction subtypes.

Results: Median international index of erectile dysfunction-5 score was 11 (interquartile range: 9-14). Median central shear wave elastography values were significantly lower in the erectile state as compared to flaccid state in both vasculogenic (8.27 kPa (interquartile range: 6.3-12.5) vs 23.27 kPa (interquartile range: 15.9-28.6) p = 0.000) and non-vasculogenic (5.50 kPa (interquartile range: 4.4-6.7) vs 23.85 kPa (interquartile range: 17.8-33.6) p = 0.000) erectile dysfunction participants. Vasculogenic erectile dysfunction participants had significantly higher central shear wave elastography value in erectile state than non-vasculogenic erectile dysfunction participants (8.27 kPa (interquartile range: 6.3-12.5) vs 5.50 kPa (interquartile range: 4.4-6.7) p = 0.001). Receiver operating characteristics curve analysis revealed that the cut-off value for central shear wave elastography was 5.65 kPa in erectile state with the sensitivity, and specificity for predicting vasculogenic erectile dysfunction being 90.9% and 61.1%, respectively (area under the curve -0.816; standard error of 0.071 (p = 0.001)).

Conclusion: Central cavernosal shear wave elastography is a good modality to objectively quantify the penile rigidity and can be used to distinguish the subtype of ED.

Introduction: This study aimed to explore the needs of newly qualified sonographers with respect to the requirements of preceptorship. This paper describes the first stage of research, with data obtained from a cohort of experienced preceptors. A second stage of research with data from newly qualified sonographers is pending synthesis with this work. The aim is to produce an evidenced-based tool to support departments in developing and implementing effective and robust preceptorship.

Methods: Twelve experienced participants from eight trusts, with a range of clinical backgrounds and experience were recruited. Two focus groups were held with questions structured around known themes highlighted in current evidence regarding newly qualified sonographers. The interviews were recorded and transcribed, and the qualitative data were analysed using thematic analysis.

Results: Four main themes with subthemes emerged. These were: (1) the gaps between qualification and proficiency, (2) the need for managerial investment and formalisation, (3) the preceptor and (4) tools to support the transition and prevent burnout. Frequency data and quotes are given as exemplars.

Conclusion: Participants report that newly qualified sonographers require support in report writing, clinical reasoning and confidence, and this should be addressed within preceptorship while acknowledging individual needs. Managerial investment is essential in ensuring adequate support and protected time is available for important preceptorship activities, such as meeting for feedback and feedforward with opportunity to clearly document progression. Inadequate support may be damaging for the wellbeing of preceptor and preceptee and ultimately impact the standard of our ultrasound services and patient care.

Objective: The study aims to evaluate the role of the posterior hard palate angle in the prenatal diagnosis of cleft palate.

Study design: Stored images of the axial transverse view of the fetal secondary palate, obtained at three-level obstetric ultrasounds, were used to evaluate the posterior border of the hard palate. The study population comprised 63 consecutive pregnancies of unaffected cases and 17 pregnancies suspected for a cleft palate without cleft lip, including 7 cases of cleft palate, 4 cases of high-arched palate, and 6 false-positive cases.

Results: The posterior angle of the hard palate was significantly larger in the cleft palate group than in the healthy controls and false-positive cases: 227° (±51°) vs 160° (±16°), p < 0.0001; and 173° ± 18°, p < 0.0001, respectively. Regression analysis revealed that reflex angle remained an independent risk factor for cleft palate (odds ratio, 58.67 (95% confidence interval 10-341)). The sensitivity and specificity of the posterior angle assessment were 73% and 96%, respectively.

Conclusions: The posterior hard palate angle could be an ultrasound marker of cleft palate without a cleft lip.

Background: Thyroglossal duct cysts (TGDCs) within the tongue base represent a challenge for the surgeon and are often the cause of recurrence.

Purpose: This study aimed to evaluate diagnostic performance of high-resolution ultrasound in TGDCs within the tongue base, compared to intraoperative findings. Furthermore, accuracy with which the detection of thyroid tissue in parts of the thyroglossal duct cyst was possible was investigated.

Methods: A total of 50 patients with TGDCs were examined by high-resolution ultrasound. Every thyroglossal cystic lesion was examined for the presence of solid thyroid tissue with colour-coded duplex sonography and evaluated according to American Thyroid Association (ATA) guidelines. Ultimately, 45 of the 50 patients underwent surgery (Sistrunk procedure).

Results: In 38/50 patients (76%), TGDCs were seen in their typical distal location inferior to the hyoid. Four patients (8%) had the thyroglossal duct cyst superior and inferior to the hyoid. The TGDC remnants only in the tongue base were recognised in 16% of cases (8 patients). Histological specimens revealed thyroid tissue within the TGDCs in 23 of the 45 patients (49%). Thyroid tissue was diagnosed preoperatively in 15 patients (65%) X ²(1, N = 23) = 2.13, p = 0.144. One patient exhibited suspicious features for thyroid cancer, which was confirmed histologically as papillary thyroid carcinoma.

Conclusion: High-resolution ultrasound represents quick, safe and reliable imaging for TGDCs on both sides of the hyoid bone (inferior and superior) with an impact on surgical planning. Furthermore, thyroid tissue within TGDCs can be revealed preoperatively and assessed for suspicious features.