Pub Date : 2023-09-15DOI: 10.1177/1742271x231195723
Moussa Toudou-Daouda, Nicolas Chausson, Didier Smadja, Cosmin Alecu
Background: Intracranial atherosclerotic stenosis is a common cause of ischemic cerebrovascular events and is associated with a high risk of stroke recurrence. This study aimed to assess the diagnostic accuracy of transcranial color-coded duplex sonography for moderate-to-severe middle cerebral artery stenosis in stroke patients. Methods: A retrospective analysis was carried out, including 31 patients aged ⩾18 years hospitalized for ischemic cerebrovascular event in whom middle cerebral artery stenosis ⩾30% was identified on computed tomography angiography. Transcranial color-coded duplex sonography findings were compared to the degree of stenosis blindly identified on the computed tomography angiography used as the reference method. Results: Overall, 27 patients had M1 stenosis and the other 4 had M2 stenosis. To detect M2 stenosis ⩾ 50% and ⩾ 70%, stenotic to pre-stenotic ratio ⩾ 2 and ⩾ 3 had a sensitivity of 100%, respectively. To detect M1 stenosis ⩾ 70%, peak systolic velocity ⩾ 300 cm/s had a sensitivity of 53.8% and specificity of 85.7% with area under the receiver-operating characteristic curve of 0.753 (95% confidence interval: 0.568–0.938; p = 0.026), and stenotic to pre-stenotic ratio ⩾ 3 had a sensitivity of 84.6% and a specificity of 78.6% (area under the curve = 0.854; 95% confidence interval: 0.707–1; p = 0.002). Middle cerebral artery/anterior cerebral artery velocity ratio < 0.7 had a sensitivity of 57.1% and specificity of 90% to detect dampened pre-stenotic flow in middle cerebral artery secondary to downstream M1 stenosis ⩾ 70% (area under the curve = 0.800; 95% confidence interval: 0.584–1; p = 0.040). This study showed that stenotic to pre-stenotic ratio ⩾ 3 was more sensitive than peak systolic velocity ⩾ 300 cm/s to screen M1 stenosis ⩾ 70%. Middle cerebral artery/anterior cerebral artery ratio < 0.7 was a good indirect sign to detect dampened pre-stenotic flow due to M1 stenosis ⩾ 70%.
{"title":"Detection of moderate to severe middle cerebral artery atherosclerotic stenosis in stroke patients: Transcranial color-coded duplex sonography versus computed tomography angiography","authors":"Moussa Toudou-Daouda, Nicolas Chausson, Didier Smadja, Cosmin Alecu","doi":"10.1177/1742271x231195723","DOIUrl":"https://doi.org/10.1177/1742271x231195723","url":null,"abstract":"Background: Intracranial atherosclerotic stenosis is a common cause of ischemic cerebrovascular events and is associated with a high risk of stroke recurrence. This study aimed to assess the diagnostic accuracy of transcranial color-coded duplex sonography for moderate-to-severe middle cerebral artery stenosis in stroke patients. Methods: A retrospective analysis was carried out, including 31 patients aged ⩾18 years hospitalized for ischemic cerebrovascular event in whom middle cerebral artery stenosis ⩾30% was identified on computed tomography angiography. Transcranial color-coded duplex sonography findings were compared to the degree of stenosis blindly identified on the computed tomography angiography used as the reference method. Results: Overall, 27 patients had M1 stenosis and the other 4 had M2 stenosis. To detect M2 stenosis ⩾ 50% and ⩾ 70%, stenotic to pre-stenotic ratio ⩾ 2 and ⩾ 3 had a sensitivity of 100%, respectively. To detect M1 stenosis ⩾ 70%, peak systolic velocity ⩾ 300 cm/s had a sensitivity of 53.8% and specificity of 85.7% with area under the receiver-operating characteristic curve of 0.753 (95% confidence interval: 0.568–0.938; p = 0.026), and stenotic to pre-stenotic ratio ⩾ 3 had a sensitivity of 84.6% and a specificity of 78.6% (area under the curve = 0.854; 95% confidence interval: 0.707–1; p = 0.002). Middle cerebral artery/anterior cerebral artery velocity ratio < 0.7 had a sensitivity of 57.1% and specificity of 90% to detect dampened pre-stenotic flow in middle cerebral artery secondary to downstream M1 stenosis ⩾ 70% (area under the curve = 0.800; 95% confidence interval: 0.584–1; p = 0.040). This study showed that stenotic to pre-stenotic ratio ⩾ 3 was more sensitive than peak systolic velocity ⩾ 300 cm/s to screen M1 stenosis ⩾ 70%. Middle cerebral artery/anterior cerebral artery ratio < 0.7 was a good indirect sign to detect dampened pre-stenotic flow due to M1 stenosis ⩾ 70%.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"355 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135395632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: CT-scan Severity Score (CT-SS) is the gold standard for the quantification of COVID-19 pneumonia, however CT-scan is not always available. Aims and objectives: Lung ultrasound (LU) is able to identify lung abnormalities, hence we hypothesize that can be used to predict CT-SS. Objectives are to determine whether it is possible to predict CT-SS from the LU score, and whether the change in LU score associates with a change in CT-SS during hospitalization. Methods: This is a retrospective observational study. Hospitalized patients with COVID-19 pneumonia who performed LU within 6 hours from CT-scan were included. Two LU scores, the LU-Mean, calculated by diving the sum of scores of explored chest areas for the total number of areas, and the LU-Sum, calculated as the sum of chest areas with a score ≥ 2, were derived and used to predict CT-SS using linear regression models. The agreement between fitted values and CT-SS was assessed using Bland-Altman plot. The correlation between the change in CT-SS and LU scores was reported using the Pearson correlation index. Results: The median CT-SS was 11 (IQR:6). LU-Mean and LU-Sum were linearly correlated with CT-SS (rLU-Mean=0.78 and rLU-Sum=0.79), with a Beta of 7.34 (P-value<0.001) and 0.94 (P-value<0.001), respectively. Two predictive models, based on LU scores and type of respiratory support, were developed, with an adjusted R-squared of 0.64 and 0.67, respectively. The correlation between the change of CT-SS and LU scores was 0.86 (P-value<0.001) for LU-Mean and 0.87 (P-value<0.001) for LU-Sum. Conclusions: CT-SS can be predicted from LU scores, and its change correlates with that of LU score. LU score can be used to predict CT-SS when CT-scan is not available.
{"title":"Lung ultrasound based prediction of CT-scan Severity Score in COVID-19","authors":"Panaiotis Finamore, Emanuele Gilardi, Moises Muley, Tommaso Grandi, Silvia Navarin, Michela Orrù, Chiara Bucci, Simone Scarlata, Francesco Travaglino, Federica Sambuco","doi":"10.1183/13993003.congress-2023.pa1819","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1819","url":null,"abstract":"<b>Background:</b> CT-scan Severity Score (CT-SS) is the gold standard for the quantification of COVID-19 pneumonia, however CT-scan is not always available. <b>Aims and objectives:</b> Lung ultrasound (LU) is able to identify lung abnormalities, hence we hypothesize that can be used to predict CT-SS. Objectives are to determine whether it is possible to predict CT-SS from the LU score, and whether the change in LU score associates with a change in CT-SS during hospitalization. <b>Methods:</b> This is a retrospective observational study. Hospitalized patients with COVID-19 pneumonia who performed LU within 6 hours from CT-scan were included. Two LU scores, the <i>LU-Mean</i>, calculated by diving the sum of scores of explored chest areas for the total number of areas, and the <i>LU-Sum</i>, calculated as the sum of chest areas with a score ≥ 2, were derived and used to predict CT-SS using linear regression models. The agreement between fitted values and CT-SS was assessed using Bland-Altman plot. The correlation between the change in CT-SS and LU scores was reported using the Pearson correlation index. <b>Results:</b> The median CT-SS was 11 (IQR:6). <i>LU-Mean</i> and <i>LU-Sum</i> were linearly correlated with CT-SS (r<sub>LU-Mean</sub>=0.78 and r<sub>LU-Sum</sub>=0.79), with a Beta of 7.34 (P-value<0.001) and 0.94 (P-value<0.001), respectively. Two predictive models, based on LU scores and type of respiratory support, were developed, with an adjusted R-squared of 0.64 and 0.67, respectively. The correlation between the change of CT-SS and LU scores was 0.86 (P-value<0.001) for <i>LU-Mean</i> and 0.87 (P-value<0.001) for <i>LU-Sum</i>. <b>Conclusions:</b> CT-SS can be predicted from LU scores, and its change correlates with that of LU score. LU score can be used to predict CT-SS when CT-scan is not available.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136193679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Ultrasound is the gold standard for determination of pleural puncture sites. The utility of clinico-radiological examination and its performance with reference to ultrasound has not been studied extensively. Physical signs of pleural effusion have not been studied with respect to ultrasound. Methods: Patients were examined clinicoradiologically by multiple physicians and a pleural puncture site was proposed and was confirmed via ultrasound. Response was characterized as true positive, true negative, false positive, or false negative. Upper and lower limits of pleural effusions were mapped and the distance of the first appearance of physical signs consistent with pleural effusion from the upper limit of pleural effusion was noted as a percentage of the total distance. Results: We enrolled 115 patients and 345 physician observations. Overall accuracy of the clinico-radiological examination was 94.8% with a sensitivity, specificity, PPV, NPV of 96.8 %, 92.4%, 93.8% and of 96% respectively. BMI (OR - 1.19) and lower zone pleural effusions (OR – 4.99) demonstrated significant role when adjusted for age, gender, side of effusion, and experience of examining doctors. Least accuracy was seen in lower zone pleural effusions, loculated pleural effusion and mid-zone pleural effusion. Conclusion: Clinico-radiologic determination of pleural puncture sites have reasonable overall accuracy. BMI and lower zone pleural effusions are significant factors of accuracy. We suggest use of ultrasound in lower zones limited effusions and/or patients with BMI > 23.15 kg/m2.
{"title":"Assessing the accuracy of pleural puncture sites as determined by clinic-radiological examination versus Lung Ultrasound- a prospective study.","authors":"Naveen Dutt, Shahir Asfahan, Nishant Kumar Chauhan, Ramniwas -, Mahendra Kumar Garg, Pawan Kumar Garg, Gopal Krishna Bohra, Nitin Kumar Bajpai","doi":"10.1183/13993003.congress-2023.pa1829","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1829","url":null,"abstract":"<b>Introduction:</b> Ultrasound is the gold standard for determination of pleural puncture sites. The utility of clinico-radiological examination and its performance with reference to ultrasound has not been studied extensively. Physical signs of pleural effusion have not been studied with respect to ultrasound. <b>Methods:</b> Patients were examined clinicoradiologically by multiple physicians and a pleural puncture site was proposed and was confirmed via ultrasound. Response was characterized as true positive, true negative, false positive, or false negative. Upper and lower limits of pleural effusions were mapped and the distance of the first appearance of physical signs consistent with pleural effusion from the upper limit of pleural effusion was noted as a percentage of the total distance. <b>Results:</b> We enrolled 115 patients and 345 physician observations. Overall accuracy of the clinico-radiological examination was 94.8% with a sensitivity, specificity, PPV, NPV of 96.8 %, 92.4%, 93.8% and of 96% respectively. BMI (OR - 1.19) and lower zone pleural effusions (OR – 4.99) demonstrated significant role when adjusted for age, gender, side of effusion, and experience of examining doctors. Least accuracy was seen in lower zone pleural effusions, loculated pleural effusion and mid-zone pleural effusion. <b>Conclusion:</b> Clinico-radiologic determination of pleural puncture sites have reasonable overall accuracy. BMI and lower zone pleural effusions are significant factors of accuracy. We suggest use of ultrasound in lower zones limited effusions and/or patients with BMI > 23.15 kg/m2.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136194507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1820
Uma Devaraj, Priya Ramachandran, Kavitha Venkatnarayan, Chitra Veluthat, Uma Maheswari K
Background: The utility of Lung ultrasound (LUS) in the diagnosis of respiratory disorders has evolved in the recent past. Aim and objectives: To describe the ultrasound features of newly diagnosed pulmonary tuberculosis infection and compare them to the ultrasound features of pneumonia. To compare the LUS findings with chest Xray findings. Method: Subjects 18 to 65 years of age and recently diagnosed with tuberculosis or pneumonia in a tertiary care hospital underwent ultrasound evaluation after written informed consent. Results: A total of 96 subjects with 64 microbiologically confirmed TB and 32 pneumonia patients were included. The mean age of the study subjects was 46.78± 15.75 years and the majority were males(64.6%). LUS showed focal interstitial pattern, cavity, and irregular pleura in TB patients that were significantly different (p-value= <0.001)from the findings of air bronchogram and/or shred sign seen in patients with pneumonia (Table1). The time taken to complete LUS ranged from 3 to 6 minutes. The overall sensitivity of USG against X-ray was 88.6% and specificity was 0. Discussion: The composite findings of focal interstitial pattern, cavity, and irregular pleura seen in TB patients were significantly different from the findings of air bronchogram and/or shred sign seen in patients with pneumonia. The LUS and CXR findings were concordant in more than 73% of both pneumonia and TB patients. LUS demonstrated abnormalities in 20.3% of TB patients whose CXR had no demonstrable opacities. Conclusion: LUS is a valuable tool to detect both TB and pneumonia and can discriminate between the two conditions.
{"title":"Comparison of lung ultrasound findings in patients with pulmonary tuberculosis and lobar pneumonia: a case-control study.","authors":"Uma Devaraj, Priya Ramachandran, Kavitha Venkatnarayan, Chitra Veluthat, Uma Maheswari K","doi":"10.1183/13993003.congress-2023.pa1820","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1820","url":null,"abstract":"<b>Background:</b> The utility of Lung ultrasound (LUS) in the diagnosis of respiratory disorders has evolved in the recent past. <b>Aim and objectives:</b> To describe the ultrasound features of newly diagnosed pulmonary tuberculosis infection and compare them to the ultrasound features of pneumonia. To compare the LUS findings with chest Xray findings. <b>Method:</b> Subjects 18 to 65 years of age and recently diagnosed with tuberculosis or pneumonia in a tertiary care hospital underwent ultrasound evaluation after written informed consent. <b>Results:</b> A total of 96 subjects with 64 microbiologically confirmed TB and 32 pneumonia patients were included. The mean age of the study subjects was 46.78± 15.75 years and the majority were males(64.6%). LUS showed focal interstitial pattern, cavity, and irregular pleura in TB patients that were significantly different (p-value= <0.001)from the findings of air bronchogram and/or shred sign seen in patients with pneumonia (Table1). The time taken to complete LUS ranged from 3 to 6 minutes. The overall sensitivity of USG against X-ray was 88.6% and specificity was 0. <b>Discussion:</b> The composite findings of focal interstitial pattern, cavity, and irregular pleura seen in TB patients were significantly different from the findings of air bronchogram and/or shred sign seen in patients with pneumonia. The LUS and CXR findings were concordant in more than 73% of both pneumonia and TB patients. LUS demonstrated abnormalities in 20.3% of TB patients whose CXR had no demonstrable opacities. <b>Conclusion:</b> LUS is a valuable tool to detect both TB and pneumonia and can discriminate between the two conditions.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"2016 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1832
Ali Firincioglulari, Hakan Ertürk, Mujgan Firincioglulari, Cigdem Biber
Purpose: This study aimed to evaluate atherosclerosis as comorbidity by measuring the carotid (bulb and common carotid artery) tunica intima-media thickness in COPD- diagnosed patients and to evaluate the relationship of atherosclerosis with the prevelance of COPD,hypoxemia and hypercapnia. Methods: This study was conducted out between January 2019-December 2019 consisting of a total of 140 participants (70 COPD-diagnosed patients-70 healthy individuals). The COPD-diagnosed patients have been planne according to the selection and diagnosis criteria as per the GOLD 2019 guide. It is planned to evaluate as per prospective matching case-control study of the carotd thickness, radial gas analysis, spirometric and demographic characteristics of COPD diagnosed patients and healthy individuals. Results: The average CCA tunica intima-media thickness in COPD patients was 0.8746 ± 0.161, and the thickness of the carotid bulb was 1.04±0.150. In the control group, the average CCA tunica intima-media thickness was 0.6650±0.139, and the thickness of the carotid bulb was 0.8250±0.15. For the carotid thickness that has increased in COPD diagnosed patients a significant relationship is determined between hypoxemia and hypercapnia.The CIMT was high in COPD patients with hypoxemia and hypercapnia. Conclusion: Significant difference was determşnes between the severity (grades) of COPD (mild, moderate, severe, very severe) in carotid thickness. Also,CIMT was found to be high in patients who is in the early phases of the prevalence of COPD. In COPD-diagnosed patients, it was determined that severity of COPD, hypoxemia, hypercapnia and age were determining factors of atherosclerosis.
{"title":"Evaluation Of Atherosclerosis As A Risk Factor in COPD Patients By Measuring The Carotis Tunica Intima-Media Thickness.","authors":"Ali Firincioglulari, Hakan Ertürk, Mujgan Firincioglulari, Cigdem Biber","doi":"10.1183/13993003.congress-2023.pa1832","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1832","url":null,"abstract":"<b>Purpose</b>: This study aimed to evaluate atherosclerosis as comorbidity by measuring the carotid (bulb and common carotid artery) tunica intima-media thickness in COPD- diagnosed patients and to evaluate the relationship of atherosclerosis with the prevelance of COPD,hypoxemia and hypercapnia. <b>Methods:</b> This study was conducted out between January 2019-December 2019 consisting of a total of 140 participants (70 COPD-diagnosed patients-70 healthy individuals). The COPD-diagnosed patients have been planne according to the selection and diagnosis criteria as per the GOLD 2019 guide. It is planned to evaluate as per prospective matching case-control study of the carotd thickness, radial gas analysis, spirometric and demographic characteristics of COPD diagnosed patients and healthy individuals. <b>Results:</b> The average CCA tunica intima-media thickness in COPD patients was 0.8746 ± 0.161, and the thickness of the carotid bulb was 1.04±0.150. In the control group, the average CCA tunica intima-media thickness was 0.6650±0.139, and the thickness of the carotid bulb was 0.8250±0.15. For the carotid thickness that has increased in COPD diagnosed patients a significant relationship is determined between hypoxemia and hypercapnia.The CIMT was high in COPD patients with hypoxemia and hypercapnia. <b>Conclusion:</b> Significant difference was determşnes between the severity (grades) of COPD (mild, moderate, severe, very severe) in carotid thickness. Also,CIMT was found to be high in patients who is in the early phases of the prevalence of COPD. In COPD-diagnosed patients, it was determined that severity of COPD, hypoxemia, hypercapnia and age were determining factors of atherosclerosis.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1823
Ana Belén Llanos Gonzalez, Natalia Arteaga-Marrero, Enrique Villa, Orlando Acosta Fernández, Juan Bautista Ruiz-Alzola, Javier González-Fernández
Introduction: A training system for ultrasound-guided thoracic interventions was developed. The system was designed for a core needle biopsy (CNB) procedure in combination to a custom, pseudo-anthropomorphic lung phantom. Methods: A dedicated phantom was fabricated (Arteaga-Marrero et al. Gels 2023;9:74) to accurately replicate the healthy lung parenchyma as well as pathologies, like abscesses and neoplasms, as solid inclusions. 3D printed ribs were included to provide realism and a higher level of difficulty. The ultrasound (US) training system employed an optical tracking system (OptiTrack V120), a portable US device (Telemed MicrUs EXT-1H L12 Probe),a biopsy needle (Bard 22mm), and other tools required for calibration. The fixtures to allocate the optical trackers were 3D printed. In addition to the 3D models of the system’s components, a virtual and reconstructed model of each phantom was generated. The integration of the system was carried out using Plus Toolkit and the image computing platform 3D Slicer. The training system was complemented with a custom extension implemented in Python. Results: The capabilities of the system were tested by an experienced pulmonologist and medical students training in US-guided interventions. In-plane and out-of-plane needle insertions were performed simulating CNB procedures which are often employed in a clinical setting. Subsequently, the system provided a quantitative report that indicated the level of success of the procedure carried out. Conclusion: Technical considerations and acquired expertise are required to ensure patient safety. Thus, the presented system is dedicated to aid clinical practitioners to be trained in US-guided interventional thoracic procedures.
{"title":"US training system for ultrasound-guided thoracic interventions","authors":"Ana Belén Llanos Gonzalez, Natalia Arteaga-Marrero, Enrique Villa, Orlando Acosta Fernández, Juan Bautista Ruiz-Alzola, Javier González-Fernández","doi":"10.1183/13993003.congress-2023.pa1823","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1823","url":null,"abstract":"<b>Introduction:</b> A training system for ultrasound-guided thoracic interventions was developed. The system was designed for a core needle biopsy (CNB) procedure in combination to a custom, pseudo-anthropomorphic lung phantom. <b>Methods:</b> A dedicated phantom was fabricated (Arteaga-Marrero et al. Gels 2023;9:74) to accurately replicate the healthy lung parenchyma as well as pathologies, like abscesses and neoplasms, as solid inclusions. 3D printed ribs were included to provide realism and a higher level of difficulty. The ultrasound (US) training system employed an optical tracking system (OptiTrack V120), a portable US device (Telemed MicrUs EXT-1H L12 Probe),a biopsy needle (Bard 22mm), and other tools required for calibration. The fixtures to allocate the optical trackers were 3D printed. In addition to the 3D models of the system’s components, a virtual and reconstructed model of each phantom was generated. The integration of the system was carried out using Plus Toolkit and the image computing platform 3D Slicer. The training system was complemented with a custom extension implemented in Python. <b>Results:</b> The capabilities of the system were tested by an experienced pulmonologist and medical students training in US-guided interventions. In-plane and out-of-plane needle insertions were performed simulating CNB procedures which are often employed in a clinical setting. Subsequently, the system provided a quantitative report that indicated the level of success of the procedure carried out. <b>Conclusion:</b> Technical considerations and acquired expertise are required to ensure patient safety. Thus, the presented system is dedicated to aid clinical practitioners to be trained in US-guided interventional thoracic procedures.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136195379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Pleural involvement is well recognised in rheumatoid arthritis. Despite the now established role of physician-led thoracic ultrasound in pleural disease, there remains a paucity of research into characterising the sonographic features of rheumatoid pleuritis. Aim: To examine the sonographic appearance of established rheumatoid effusions. Methods: A retrospective analysis was performed for all rheumatoid arthritis patients who underwent thoracic ultrasound, with or without intervention, at the John Radcliffe Hospital, Oxford, from July 2015 to January 2023. Results: Sixteen patients of median age 65 years underwent 31 episodes of thoracic ultrasound and 25 pleural procedures. Half of the patients were male; 11 (81%) were seropositive, 5 (31%) manifested with rheumatoid-related parenchymal changes. In 16 (52%) instances of thoracic ultrasound, the effusion was moderate in size, measuring 2-3 rib spaces. Median maximal depth of effusion was 7.5 cm. In 28 (90%) instances, the fluid was echogenic. In 18 (58%), there were no septations. Pleural thickening was examined for in 11 (35%) instances and measured in 1 (3%). Fluid analyses yielded exclusive exudates, with median protein 42 g/L, median glucose 3.35 mmol/L and median LDH 1146 IU/L. Conclusion: Most rheumatoid effusions referred to a pleural service were moderately sized, non-septated and echogenic, yielding inflammatory exudates. Pleural thickening was not routinely screened for or measured on ultrasound. This highlights the important need for developing a systematic sonographic approach to characterising rheumatoid pleuritis, and in depth assessments of patients in rheumatoid clinics for earlier signs of pleural disease.
{"title":"A retrospective review of the sonographic features of rheumatoid pleuritis.","authors":"Hui Guo, Zin Sein, Beenish Iqbal, Dinesh Addala, Anand Sundaralingam, Poppy Denniston, Najib Rahman","doi":"10.1183/13993003.congress-2023.pa1827","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1827","url":null,"abstract":"<b>Introduction:</b> Pleural involvement is well recognised in rheumatoid arthritis. Despite the now established role of physician-led thoracic ultrasound in pleural disease, there remains a paucity of research into characterising the sonographic features of rheumatoid pleuritis. <b>Aim:</b> To examine the sonographic appearance of established rheumatoid effusions. <b>Methods:</b> A retrospective analysis was performed for all rheumatoid arthritis patients who underwent thoracic ultrasound, with or without intervention, at the John Radcliffe Hospital, Oxford, from July 2015 to January 2023. <b>Results:</b> Sixteen patients of median age 65 years underwent 31 episodes of thoracic ultrasound and 25 pleural procedures. Half of the patients were male; 11 (81%) were seropositive, 5 (31%) manifested with rheumatoid-related parenchymal changes. In 16 (52%) instances of thoracic ultrasound, the effusion was moderate in size, measuring 2-3 rib spaces. Median maximal depth of effusion was 7.5 cm. In 28 (90%) instances, the fluid was echogenic. In 18 (58%), there were no septations. Pleural thickening was examined for in 11 (35%) instances and measured in 1 (3%). Fluid analyses yielded exclusive exudates, with median protein 42 g/L, median glucose 3.35 mmol/L and median LDH 1146 IU/L. <b>Conclusion:</b> Most rheumatoid effusions referred to a pleural service were moderately sized, non-septated and echogenic, yielding inflammatory exudates. Pleural thickening was not routinely screened for or measured on ultrasound. This highlights the important need for developing a systematic sonographic approach to characterising rheumatoid pleuritis, and in depth assessments of patients in rheumatoid clinics for earlier signs of pleural disease.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1826
Mona Saeed El-Houshy, Essam Gouda Hassanein, Ayman Ibrahim Baess, Rania Ahmad Sweed, Doaa Mokhtar Emara, Ahmed Farag Abouelnour
Objective: To obtain a cut off value strain ratio using strain elastography (SE) to distinguish between benign and malignant peripheral lung lesions. Methods: We recruited 101 patients with peripheral lung lesions in cross-sectional study. Sensitivity, specificity, accuracy of a cut-off value, positive predicted value (PPV), and negative predicted value (NPV) are acquired at the end of the study. Results: We evaluated strain ratios done using strain elastography targeting reference region (Ref) vs region of interest (ROI) in patients who had already been diagnosed by biopsy, histological investigation, microbiological testing, or radiological imaging. In our study, a cut off value regarding strain ratio ≥ 1.75 is considered statistically significant as malignant lesion (p < 0.001). Conclusion: Using strain elastography, a peripheral parenchymal lung lesion can be classified as malignant based on the strain ratio. Table (1):Strain ratios in patients with benign and malignant lesions Table (2):Diagnostic performance for strain ratio to discriminate Malignant (n=59) from Benign (n =42)
{"title":"Difference in strain elastosonography between benign and malignant peripheral lung lesions","authors":"Mona Saeed El-Houshy, Essam Gouda Hassanein, Ayman Ibrahim Baess, Rania Ahmad Sweed, Doaa Mokhtar Emara, Ahmed Farag Abouelnour","doi":"10.1183/13993003.congress-2023.pa1826","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1826","url":null,"abstract":"<b>Objective:</b> To obtain a cut off value strain ratio using strain elastography (SE) to distinguish between benign and malignant peripheral lung lesions. <b>Methods:</b> We recruited 101 patients with peripheral lung lesions in cross-sectional study. Sensitivity, specificity, accuracy of a cut-off value, positive predicted value (PPV), and negative predicted value (NPV) are acquired at the end of the study. <b>Results:</b> We evaluated strain ratios done using strain elastography targeting reference region (Ref) vs region of interest (ROI) in patients who had already been diagnosed by biopsy, histological investigation, microbiological testing, or radiological imaging. In our study, a cut off value regarding strain ratio ≥ 1.75 is considered statistically significant as malignant lesion (p < 0.001). <b>Conclusion:</b> Using strain elastography, a peripheral parenchymal lung lesion can be classified as malignant based on the strain ratio. Table (1):Strain ratios in patients with benign and malignant lesions Table (2):Diagnostic performance for strain ratio to discriminate Malignant (n=59) from Benign (n =42)","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136194813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1816
Isabel Martínez González-Posada, Juan Cascón Hernández, Pablo Lozano Cuesta, Ramón Fernández Alvarez, Lucía García Alfonso, Francisco Julián López González, Miguel Ariza Prota, Inés Ruiz Álvarez, Ina Guerassimova, Ángela Lanza Martínez, Laura Martínez Vega, Juan Nieves Salceda, Laura Abad Chamorro, Eduardo Sanchez Vázquez, Patricia Álvarez Alvarez, Maria Rodil Riera
Introduction: Pulmonary Function Tests (PFT) are commonly used to monitor respiratory function in patients with Amyotrophic Lateral Sclerosis (ALS). However, these may be difficult to perform for patients with bulbar involvement or advanced stages of the disease. Aim: Our aim is to analyze the relationship between Diaphragmatic Ultrasound (DU) and PFT and to assess its utility to detect ventilatory failure and need for NIVM. Methods: We carried out a prospective study from January to November 2022 including ALS patients not under NIMV. They underwent a DU and PFT every 3 months. DU included: diaphragmatic excursion in sniff test (ExST) and deep breathing (ExDB); end-inhalation (IDT) and end-expiration (EDT) diaphragmatic thickness. Diaphragmatic thickness fraction (DTF) was calculated. PFT included: FVC seated and decubitus, maximum inhalatory pressure (MIP) and arterial blood gas analysis (ABG). NIMV indication was also analyzed. Results: Ten patients were included. A strong correlation was found between FVC and both IDT (r= 0,89, p= 0,003) and ExDB (r=0,9, p= 0,014). Also between MIP and both IDT (r=0,95, p=0,004) and EDT (r=0,92, p=0,008). Regarding ABG, strong reverse correlation was found between Base Excess (BE) and HCO3-, and DTF (r=-0,81, p= 0,004), ExDB (r=-0,8, p= 0,016), ExST (r=-0,74, p=0,015) and IDT (r=0,76, p=0,011). HCO3- inversely correlates with ExDB (r=-0,79, p=0,021), IDT (r=-0,77, p=0,009), DTF (r=-0,75, p=0,012) and ExST (r=-0,72, p=0,019). 30% of patients were unable to complete PFT due to bulbar affection. Conclusions: There is a significant correlation between PFT, ABG (FVC, MIP, BE and HCO3-) and DU. DU is useful in patients unable to perform PFT.
{"title":"Use of Diaphragmatic Ultrasound to evaluate respiratory function in patients with Amyotrophic Lateral Sclerosis","authors":"Isabel Martínez González-Posada, Juan Cascón Hernández, Pablo Lozano Cuesta, Ramón Fernández Alvarez, Lucía García Alfonso, Francisco Julián López González, Miguel Ariza Prota, Inés Ruiz Álvarez, Ina Guerassimova, Ángela Lanza Martínez, Laura Martínez Vega, Juan Nieves Salceda, Laura Abad Chamorro, Eduardo Sanchez Vázquez, Patricia Álvarez Alvarez, Maria Rodil Riera","doi":"10.1183/13993003.congress-2023.pa1816","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1816","url":null,"abstract":"<b>Introduction:</b> Pulmonary Function Tests (PFT) are commonly used to monitor respiratory function in patients with Amyotrophic Lateral Sclerosis (ALS). However, these may be difficult to perform for patients with bulbar involvement or advanced stages of the disease. <b>Aim:</b> Our aim is to analyze the relationship between Diaphragmatic Ultrasound (DU) and PFT and to assess its utility to detect ventilatory failure and need for NIVM. <b>Methods:</b> We carried out a prospective study from January to November 2022 including ALS patients not under NIMV. They underwent a DU and PFT every 3 months. DU included: diaphragmatic excursion in sniff test (ExST) and deep breathing (ExDB); end-inhalation (IDT) and end-expiration (EDT) diaphragmatic thickness. Diaphragmatic thickness fraction (DTF) was calculated. PFT included: FVC seated and decubitus, maximum inhalatory pressure (MIP) and arterial blood gas analysis (ABG). NIMV indication was also analyzed. <b>Results:</b> Ten patients were included. A strong correlation was found between FVC and both IDT (r= 0,89, p= 0,003) and ExDB (r=0,9, p= 0,014). Also between MIP and both IDT (r=0,95, p=0,004) and EDT (r=0,92, p=0,008). Regarding ABG, strong reverse correlation was found between Base Excess (BE) and HCO3-, and DTF (r=-0,81, p= 0,004), ExDB (r=-0,8, p= 0,016), ExST (r=-0,74, p=0,015) and IDT (r=0,76, p=0,011). HCO3- inversely correlates with ExDB (r=-0,79, p=0,021), IDT (r=-0,77, p=0,009), DTF (r=-0,75, p=0,012) and ExST (r=-0,72, p=0,019). 30% of patients were unable to complete PFT due to bulbar affection. <b>Conclusions:</b> There is a significant correlation between PFT, ABG (FVC, MIP, BE and HCO3-) and DU. DU is useful in patients unable to perform PFT.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1828
Søren Helbo Skaarup, Peter Juhl-Olsen, Brian Bridal Løgstrup
Introduction: The diaphragm is the most important respiratory muscle and dysfunction ultimately leads to respiratory failure. Numerous conditions may affect its function. Evaluation of diaphragm function is cumbersome. Fluoroscopy has been used in many years to measure excursion. Ultrasound can visualize diaphragm excursion and holds many advantages due to is portability and accessibility. However, correlation between fluoroscopy and ultrasound has never been studied. Aims: We aimed to compare fluoroscopy and ultrasound measures of diaphragm excursion to study if ultrasound can replace fluoroscopy. Methods: In patients with COPD or heart failure and in volunteers ultrasound and fluoroscopy was done simultaneously during sniff inspiration and in inspiratory capacity. Cranio-caudal excursion was measured om fluoroscopy recordings and compared directly to M-mode excursion, B-mode excursion, area change, resting thickness, thickening fraction and contraction velocity measured by ultrasound. Results: Forty-two participants were recruited. Pearson´s correlation between M-mode and fluoroscopy excursion was 0.61. The slope was 0.9 (90%CI 0.76 – 1.04) in a regression analysis. Using Bland-Altman method the bias was -0.39 cm (95%CI -1.04 – 0.26), p=0.24 with an error estimate on 3.8%. The correlations were lower during sniff inspiration the in inspiratory capacity breathing. Conclusion: Ultrasound has acceptable and low bias compared to fluoroscopy and can replace it as the primary tool to evaluate diaphragm excursion.
{"title":"Replacing fluoroscopy with ultrasound to evaluate diaphragm excursion? A method comparative study.","authors":"Søren Helbo Skaarup, Peter Juhl-Olsen, Brian Bridal Løgstrup","doi":"10.1183/13993003.congress-2023.pa1828","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1828","url":null,"abstract":"<b>Introduction:</b> The diaphragm is the most important respiratory muscle and dysfunction ultimately leads to respiratory failure. Numerous conditions may affect its function. Evaluation of diaphragm function is cumbersome. Fluoroscopy has been used in many years to measure excursion. Ultrasound can visualize diaphragm excursion and holds many advantages due to is portability and accessibility. However, correlation between fluoroscopy and ultrasound has never been studied. <b>Aims:</b> We aimed to compare fluoroscopy and ultrasound measures of diaphragm excursion to study if ultrasound can replace fluoroscopy. <b>Methods:</b> In patients with COPD or heart failure and in volunteers ultrasound and fluoroscopy was done simultaneously during sniff inspiration and in inspiratory capacity. Cranio-caudal excursion was measured om fluoroscopy recordings and compared directly to M-mode excursion, B-mode excursion, area change, resting thickness, thickening fraction and contraction velocity measured by ultrasound. <b>Results:</b> Forty-two participants were recruited. Pearson´s correlation between M-mode and fluoroscopy excursion was 0.61. The slope was 0.9 (90%CI 0.76 – 1.04) in a regression analysis. Using Bland-Altman method the bias was -0.39 cm (95%CI -1.04 – 0.26), p=0.24 with an error estimate on 3.8%. The correlations were lower during sniff inspiration the in inspiratory capacity breathing. <b>Conclusion:</b> Ultrasound has acceptable and low bias compared to fluoroscopy and can replace it as the primary tool to evaluate diaphragm excursion.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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