Ultrasound最新文献

Introduction: A pancreatic neuroendocrine tumour (NET) originates from the neuroendocrine cells responsible for producing and releasing hormones. They are uncommon findings, mainly seen arising from the head of the pancreas and their appearances may vary among different imaging modalities.

Case report: Interesting case of an asymptomatic patient with an incidental finding of a pancreatic lesion and its variable appearances across different modalities and final histology findings.

Discussion: Ultrasound (US) is the most requested examination as an imaging modality due to its easy accessibility, affordability, and real time assessment feature. This case shows that ultrasound examination although deemed poor in assessing pancreas due to its location and overlying bowel gas, however, can play a vital role especially among asymptomatic patients. It discusses the range of differentials diagnoses including pancreatic NET, Gastrointestinal stromal tumour (GIST), adenocarcinoma, mucinous cystic neoplasm, and a pseudo papillary neoplasm due to variable imaging appearances of the pancreatic lesion on US and Magnetic Resonance Imaging (MRI). Results were reviewed in the Upper Gastrointestinal Multidisciplinary teams meeting and Endoscopic ultrasound scan (EUS) with tissue sampling was undertaken to confirm the diagnosis. The patient underwent prophylactic surgery, and the histology report concluded that the lesion to be a pancreatic NET.

Conclusion: To conclude, we felt that sharing this interesting complex case was important as it highlights the difficulty in diagnostic certainty when dealing with a pancreatic lesion due to its variability in presentation on different modalities and the requirement of multidisciplinary team approach.

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.

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.

Background: From previous studies, evaluation of post-anastomosis draining-vein volume flow rate with Doppler ultrasound can be a predictor for arteriovenous fistula maturation. Due to the high variation in measurements by the effect of probe pressure in draining vein, measuring volume flow rate based on post-anastomosis feeding-artery may be an early alternative predictor of arteriovenous fistula maturation. This study aims to investigate the correlation of post-creation brachial artery volume flow rate on maturity of brachiocephalic arteriovenous fistula access in patients with end-stage kidney disease with diabetes mellitus.

Methods: A retrospective cohort study was conducted on end-stage kidney disease patients with diabetes mellitus who underwent brachiocephalic arteriovenous fistula creation at three hospitals from July 2019 to March 2020. Doppler ultrasound examination of the brachial artery and draining vein volume flow rate was conducted at pre-operative, post-creation, 2 weeks, and 6 weeks post-creation. Maturity was evaluated at 6 weeks post-anastomosis.

Results: A total of 71 subjects met the inclusion and exclusion criteria, with 44 (62%) achieving maturation within 6 weeks. There was a correlation between post-anastomosis brachial artery (p < 0.001) and draining vein volume flow rate (p < 0.001) with arteriovenous fistula maturity after 6 weeks post-operatively. Brachial artery volume flow rate of ⩾350 mL/min can predict AVF maturity with a sensitivity of 95.45% (95% confidence interval = 84.86-98.74) and a specificity of 85.19% (95% confidence interval = 67.52-94.08).

Conclusion: Post-anastomosis brachial artery flow volume can be a valuable parameter to predict brachiocephalic arteriovenous fistula maturity. It is a potential alternative to draining vein volume flow, which is technically a difficult examination.