Ultrasound最新文献

Introduction: Imaging appearances and clinical presentation of soft tissue sarcoma and soft tissue haematomas are similar. It is imperative that sarcoma is differentiated from benign soft tissue lesions due to the poor outcomes and high morbidity associated with sarcoma.

Topic description: Part 2 of this pictorial review summarises the key ultrasound appearances of soft tissue sarcoma and soft tissue haematomas and some differential diagnoses.

Discussion: Ultrasound is the first line test in the investigation of soft tissue masses. With the overlapping ultrasound appearances of soft tissue sarcoma and soft tissue haematomas, it is essential that practitioners are aware of key ultrasound appearances and understand when to escalate cases for further investigation.

Conclusion: Sound knowledge of the clinical and sonographic features of soft tissue haematomas and soft tissue sarcoma as well as recognising potential differential diagnoses is fundamental to ensuring an accurate diagnosis, timely management and improved patient outcomes.

Introduction: Enthesitis-related arthritis is a specific subtype of juvenile idiopathic arthritis characterised by the co-presence of arthritis and enthesitis or the evidence of one of them coupled with at least two among sacroiliac joint tenderness, inflammatory back pain, presence of human leukocyte antigen-B27, acute symptomatic anterior uveitis, onset in a male child aged 6 years or older or history of spondyloarthropathy in a first-degree relative. Small joints like the sternoclavicular joint are rarely affected, and the prevalence of their involvement in enthesitis-related arthritis has been poorly assessed in the pertinent literature.

Case report: The authors report an atypical case of left sternoclavicular joint arthritis/enthesitis in a 12-year-old male child with juvenile idiopathic arthritis. The B-mode sonographic findings of articular effusion, synovial hypertrophy and capsular bulging, coupled with the microvascular mapping with colour Doppler of the sternoclavicular joint, have been crucial to optimising the pharmacological approach in clinical practice. In this sense, the sonographic examination presented as a natural extension of the physical examination to accurately define the poor control of disease activity using first-line pharmacological agents.

Discussion: The present case report can be considered the first to accurately report the B-mode and the colour Doppler findings of a pathological sternoclavicular joint in a patient enthesitis-related arthritis. Ultrasound imaging demonstrated intra-articular effusion, capsular bulging and synovial hypertrophy clearly defining sternoclavicular joint arthritis. Interestingly, the hypervascularisation involved both the synovial tissue and the capsule-bone interface - that is, the enthesis of the joint capsule - suggesting a potential co-existence of arthritis and enthesitis of the sternoclavicular joint in enthesitis-related arthritis patients.

Conclusion: The high-resolution point-of-care ultrasound seems to be a potential 'game changer' in paediatrics to promptly optimise the pharmacological management in enthesitis-related arthritis patients. Indeed, unlike other imaging modalities such as magnetic resonance imaging, modern high-frequency ultrasound transducers guarantee a superior spatial resolution of superficial joints and allow an accurate mapping of small-size and low-flow vascular elements of synovial and capsular tissues optimising the grading of disease activity and avoiding the use of contrast agent.

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: 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.