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Tissue characterisation in a male triathlete with a history of sudden cardiac arrest 有心脏骤停病史的男性铁人三项运动员的组织特征
Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-09-24 DOI: 10.1002/sono.12376
Richard P. Allwood
A Caucasian male triathlete and previous soccer player in his early thirties presented for further evaluation post out-of-hospital cardiac arrest and implantation of a transvenous single-chamber implantable cardioverter-defibrillator (ICD) (Figure 1). He originally presented with chest pain and ventricular ectopy with no family history of sudden cardiac death or inherited cardiac disease. Question: The findings were consistent with pathological characteristics of arrhythmogenic cardiomyopathy (ACM) with biventricular involvement. Diagnosis was made considering the 2010 Task Force criteria and the 2020 International criteria (Padua criteria).1, 2 The 12-lead ECG showed sinus bradycardia (50 bpm), T-wave inversion in the inferior leads (II, III, and aVF) with isoelectric J-points and ST segments and low QRS voltage criteria in the limb leads (Figure 1A). Poor anterior R-wave progression and prolonged terminal activation duration (V2) were also present. The transthoracic echocardiogram (ECHO) demonstrated normal left ventricle (LV) size with low normal systolic function (EF 52%) (Video 1). However, strain imaging was abnormal, with reduced LV epicardial and mid layer-specific global longitudinal peak systolic strain (GLPSS) (−11% and −13.2%) (Figure 1C), prolonged mid-wall LV mechanical dispersion (60 ms) and post-systolic shortening in the basal segments (Figure 2—arrows). The right ventricle (RV) was normal in size with reduced systolic function (RV FAC 34%), with a dyskinetic RV apex (Figure 1B) (Video 2). RV deformation patterns showed early systolic lengthening and post-systolic shortening of the apex (Figure 3—arrows). Prior to ICD implantation, cardiac magnetic resonance (CMR) demonstrated extensive circumferential, intramural and subepicardial late gadolinium enhancement (LGE) of the LV (nonischaemic pattern) (Figure 1D). Genotyping revealed a heterozygous pathogenic (ACMG class 5) missense desmin (DES) gene variant: c.1205T>C, p.(IIe402Thr). Family screening of his asymptomatic sister in her late twenties showed a mildly dilated RV with apical dyskinesis on cardiac imaging. ACM is a genetic disease characterised by progressive fibrofatty tissue replacement of the myocardium, with greater exercise exposure associated with LV involvement and systolic dysfunction.2, 3 CMR imaging is considered the gold standard for the characterisation of tissue, with the detection and quantification of myocardial fibrosis (MF) using gadolinium. MF is associated with increased myocardial stiffness, heart failure, a higher incidence of ventricular arrhythmias (VA), and adverse cardiac outcomes such as sudden cardiac death.4 Tissue characterisation with the use of 2D strain imaging on ECHO and CMR can help in the distinction of different ACM phenotypes and identify subclinical disease.5, 6 Studies have shown that 2D strain imaging including layer-specific GLPSS and LV mechanical dispersion may help identify ACM patients with high-risk arrhythmic features such as
一名30岁出头的白人男性铁人三项运动员和以前的足球运动员在院外心脏骤停和经静脉单室植入式心律转复除颤器(ICD)植入后进行了进一步的评估(图1)。他最初表现为胸痛和心室异位,没有心脏性猝死或遗传性心脏病的家族史。问题:这些发现与双心室累及的心律失常性心肌病(ACM)的病理特征一致。根据2010年工作组标准和2020年国际标准(帕多瓦标准)进行诊断。1,2 12导联心电图显示窦性心动过缓(50bpm),下导联(II、III和aVF) t波反转,j点和ST段等电,肢体导联QRS电压标准低(图1A)。前路r波进展差,终末激活时间(V2)延长。经胸超声心动图(ECHO)显示左心室(LV)大小正常,正常收缩功能低(EF 52%)(视频1)。然而,应变成像异常,左心室心外膜和中层特异性全局纵向收缩应变峰(GLPSS)降低(- 11%和- 13.2%)(图1C),中壁左心室机械离散度延长(60 ms),收缩后基底段缩短(图2箭头)。右心室(RV)大小正常,收缩功能减少(RV FAC 34%),右心室尖部运动障碍(图1B)(视频2)。右心室变形模式显示收缩早期延长和收缩后尖部缩短(图3箭头)。在植入ICD之前,心脏磁共振(CMR)显示左室广泛的周向、壁内和心外膜下晚期钆增强(LGE)(非缺血模式)(图1D)。基因分型发现一个杂合致病性(ACMG 5类)错义desmin (DES)基因变异:C . 1205t >C, p.(IIe402Thr)。他二十多岁无症状的妹妹的家庭筛查显示心脏显像显示轻度心室扩张伴心尖运动障碍。ACM是一种遗传性疾病,以进行性纤维脂肪组织替代心肌为特征,更多的运动暴露与左室受累和收缩功能障碍相关。2,3 CMR成像被认为是组织表征的金标准,使用钆检测和定量心肌纤维化(MF)。MF与心肌僵硬增加、心力衰竭、室性心律失常(VA)发生率增高以及心脏不良结局(如心源性猝死)相关在ECHO和CMR上使用二维应变成像的组织特征可以帮助区分不同的ACM表型并识别亚临床疾病。5,6研究表明,包括层特异性GLPSS和左室机械弥散在内的二维应变成像可能有助于识别具有LGE和va等高危心律失常特征的ACM患者。3,6,7 Valentini等人还强调,ECG上的低QRS电压可能为怀疑MF提供有价值的信息,特别是在孤立的左室或双室变异中ACM已在编码非桥粒蛋白(如DES)的基因中被发现,这可能与分离或双室表型有关在James等人的一项研究中,DES被确定为与ACM有明确或中度证据的8个基因之一(plakophilin-2、desmoplakin、desmoglin -2、desmocolin -2、连接血小板红蛋白、跨膜蛋白43、磷蛋白和DES),这应该是ACM诊断的主要标准DES是人类心脏和骨骼肌中主要的中间丝蛋白,为心肌细胞的细胞结构提供机械稳定和连接。心脏受累(神经病变)出现在超过70%的致病性DES变异中这些与致心律失常、扩张性、肥厚性、限制性或左室非压实性心肌病有关。在CMR和生命的第三个十年中,desminopathy通常表现为LV心外膜下LGE的圆周型,然而疾病的发作可能是高度可变的。5,10主要MF的存在,包括非缺血性和缺血性模式,应促使对潜在心脏病的进一步评估和随访,特别是在年轻运动员中。作者要感谢贝克心脏与糖尿病研究所和墨尔本圣文森特医院的心脏病专家Kegan Moneghetti博士,他为改进手稿提供了宝贵的意见。一个也没有。补充视频1。LV三平面成像。补充视频2。3D RV焦点视图。请注意:出版商不对作者提供的任何支持信息的内容或功能负责。任何查询(内容缺失除外)都应直接联系文章的通讯作者。
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引用次数: 0
Accuracy of first trimester sonographic features in diagnosing caesarean scar pregnancy 妊娠早期超声特征诊断瘢痕妊娠的准确性
IF 0.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-09-05 DOI: 10.1002/sono.12375
Lay Ee Chew, Chern‐Pin Eric Chua, Paul Lombardo, Melinda Goodyear, S. Teo
Caesarean scar pregnancy (CSP), if not managed timely, can result in pre‐term labour, postpartum haemorrhage, hysterectomy or maternal and fetal death. This study aims to compare the diagnostic performances of different sonographic features recommended in various good practice recommendations and literature; then propose an algorithm that could aid in easier identification of CSP using transvaginal ultrasound.A retrospective review of ultrasound images of intrauterine pregnancy (IUP) and CSP between 4.9 and 11.9 weeks gestation was conducted. The diagnostic performance of the Royal College of Obstetricians & Gynaecologists (RCOG) guideline, Timor‐Tritsch et al. (TT) method and combined method were evaluated. An algorithm was then created to calculate a numerical value for diagnosis. The methods were tested for intra‐ and inter‐observer agreement.A total of 66 ultrasound cases (30 IUP and 36 CSP) were included in this study. The sensitivity of the RCOG guideline, TT method and combined method were 58.3%, 94.4% and 100% while the specificity were 96.7%, 90% and 90%, respectively. The TT method and combined method performed significantly better than the RCOG guideline (p = .0016 and .0002, respectively). Using the proposed algorithm, a value larger or equal to 52.2 gave 97.2% sensitivity and 93.3% specificity that CSP is present. Intra‐ and inter‐observer agreement for all methods were moderate to almost perfect.Screening during early first trimester is important to improve the diagnostic accuracy of CSP. The TT method is a good supplement to the RCOG guideline. The proposed algorithm is a useful tool to improve diagnostic accuracy and confidence.
剖宫产瘢痕妊娠(CSP)如不及时处理,可导致早产、产后出血、子宫切除术或母婴死亡。本研究旨在比较各种良好实践建议和文献中推荐的不同超声特征的诊断性能;然后提出一种算法,可以帮助更容易地识别CSP使用经阴道超声。对妊娠4.9 ~ 11.9周的宫内妊娠(IUP)和CSP超声图像进行回顾性分析。评估英国皇家妇产科学院(RCOG)指南、Timor - Tritsch等(TT)方法和联合方法的诊断性能。然后创建了一个算法来计算用于诊断的数值。测试了这些方法在观察者内部和观察者之间的一致性。本研究共纳入66例超声检查,其中IUP 30例,CSP 36例。RCOG指南、TT法和联合法的敏感性分别为58.3%、94.4%和100%,特异性分别为96.7%、90%和90%。TT法和联合方法的疗效显著优于RCOG指南(p =。0016和0.0002)。使用该算法,大于或等于52.2的值表示CSP存在的敏感性为97.2%,特异性为93.3%。所有方法的观察者内部和观察者之间的一致性是中等到几乎完美的。妊娠早期筛查对提高CSP的诊断准确性非常重要。TT方法是RCOG指南的一个很好的补充。该算法是提高诊断准确率和置信度的有效工具。
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引用次数: 0
Transient perivascular inflammation of the carotid artery: Ultrasonography and magnetic resonance imaging findings 颈动脉短暂性血管周围炎症:超声和磁共振成像的表现
IF 0.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-09-01 DOI: 10.1002/sono.12374
Irfan Atik, Mehmet Atalar
Transient perivascular inflammation of the carotid artery (TIPIC) syndrome is a rare cause of atypical neck pain. The etiology of TIPIC is not fully known and is characterized by transient inflammation around the carotid artery. Ultrasonography (US) and especially magnetic resonance imaging (MRI) are the most important evaluation methods in the diagnosis and follow‐up of the disease. In this article, we report a 25‐year‐old male patient who presented with unilateral neck pain and was diagnosed with TIPIC in the light of his clinical and radiological findings.
短暂性颈动脉血管周围炎症(TIPIC)综合征是一种罕见的非典型颈部疼痛的原因。TIPIC的病因尚不完全清楚,其特征是颈动脉周围的短暂炎症。超声检查(US)尤其是磁共振成像(MRI)是该病诊断和随访中最重要的评估方法。在这篇文章中,我们报告了一位25岁的男性患者,他表现为单侧颈部疼痛,根据他的临床和放射学表现被诊断为TIPIC。
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引用次数: 0
Sonographic imaging and assessment of the sural nerve 腓肠神经的超声成像和评估
IF 0.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-08-30 DOI: 10.1002/sono.12372
Michelle Fenech
The sural nerve is a sensory nerve which innervates the posterolateral distal calf and lateral foot. It can be demonstrated using high resolution ultrasound and travels near the small saphenous vein throughout most of its course. There are variations in its origin and relative position through the posterior distal calf, lateral ankle, and foot. To allow this nerve and any potential pathology or injury to be sonographically demonstrated, a good understanding of the sonographic relative anatomy, course, and common anatomical variations, as well as the sonographic normal appearances throughout need to be appreciated and these are reviewed in this paper.
腓肠神经是支配小腿远端后外侧和足外侧的感觉神经。它可以通过高分辨率超声显示,并在其大部分过程中在小隐静脉附近传播。通过小腿后侧远端、踝关节外侧和足部,其起源和相对位置各不相同。为了让这条神经和任何潜在的病理或损伤在超声检查中得到证实,需要很好地理解超声的相关解剖、过程和常见的解剖变异,以及超声的正常表现,本文对此进行了回顾。
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引用次数: 0
Utility of diaphragmatic ultrasonography for detection of patient‐ventilator asynchrony 应用横膈膜超声检测患者-呼吸机不同步
IF 0.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-08-18 DOI: 10.1002/sono.12373
Núñez Silveira Juan M., Ezcurra Paulina, Roux Nicolás, Ríos Fernando, Gallardo Adrián
Asynchrony is a frequent problem in critical care units, being underdiagnosed by the treating team and often requiring advanced monitoring equipment for its detection. Ultrasonography of the diaphragm allows direct observation, in real time, of muscle displacement and its synchronization with the ventilator waveforms, which results in a promising tool for interpreting difficult to diagnose asynchronies.
在重症监护病房中,异步是一个常见的问题,治疗团队对其诊断不足,通常需要先进的监测设备来检测。横膈膜超声检查可以直接实时观察肌肉位移及其与呼吸机波形的同步,这是一种很有前途的工具,可以解释难以诊断的异步。
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引用次数: 0
Atrioventricular septal defect: An extended approach to prenatal sonographic imaging of the atrioventricular valves 房室间隔缺损:扩展方法的产前超声成像的房室瓣膜
IF 0.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-06-27 DOI: 10.1002/sono.12370
A. Quinton, N. Kennedy, A. Gooi
An atrioventricular septal defect (AVSD) is diagnosed with prenatal sonography using the 4‐chamber view (4CV) of the fetal heart. Prenatal 2D sonographic imaging of normal and AVSD short axis (SAX) atrioventricular (AV) valve views have not been well described. The aim is to describe the 2D sonographic 4‐chamber and SAX view of the AV valves when an AVSD is present compared to normal AV valves. The 4CV AVSD heart demonstrates no offset of AV valves due to the abnormal valve structure. Complete and intermediate AVSD has a septum primum defect and inlet ventricular septal defect (VSD). The partial AVSDs have either a septum primum defect or just an inlet VSD with an intact primum septum. The SAX view of AVSD demonstrates the common AV junction and the bridging leaflets. In ventricular diastole valves have a “figure 8” and “dumbbell” shape in partial and complete AVSD, respectively. These appearances are not seen in the normal heart in SAX as both tricuspid and mitral valve are separate valves. The SAX view can be obtained by locating a sagittal aortic arch view and then scanning slightly towards the left side of the fetus, near the base of the heart and the AV valves. An in‐depth interrogation of the abnormal fetal heart is obtained without specialised 4D capable ultrasound machines providing information to assist in counselling during the pregnancy and for postnatal surgical planning. Future research to assess the feasibility of incorporating the SAX view into routine practice and by general sonographers is suggested.
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引用次数: 0
Ultrasound of the eye – Part 1: Normal anatomy, technical parameters and scanning technique 眼睛超声。第1部分:正常解剖、技术参数和扫描技术
IF 0.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-06-22 DOI: 10.1002/sono.12371
D. Napier
A request for an ultrasound of the eye can be a relatively infrequent occurrence for a sonographer, but ultrasound can play a pivotal role in the detection of vision threatening conditions. In those instances where sonographers are required to perform the occasional ocular ultrasound, a sound knowledge of normal anatomy, scanning techniques, technical parameters and pitfalls is pertinent to ensure pathology is not overlooked. Ultrasound of the eye is commonly performed following trauma or visual disturbance. As such it is a useful diagnostic tool when fundoscopic examination of the eye is limited. The fact that it lacks the use of ionizing radiation, is non‐invasive and readily accessible are just some of its many advantages. However, the greatest advantage is its ability to provide a dynamic assessment of the eye. Ocular structures have a higher sensitivity to ultrasound exposure, which necessitates the correct use of technical parameters so as to not induce any vision affecting biological effects. The purpose of this article is to introduce sonographers to normal ocular anatomy, optimal scanning techniques for enhanced pathology detection, and most importantly the safe use of physical parameters to minimize damage to sensitive ocular structures.
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引用次数: 0
The incidence of acute lower limb thrombosis, in symptomatic patients detected with ultrasound, with consideration of recent COVID‐19 vaccination or infection 超声检查有症状患者的急性下肢血栓发生率,并考虑近期接种COVID - 19疫苗或感染
IF 0.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-06-21 DOI: 10.1002/sono.12369
Emma Jardine, G. McLean
After the COVID‐19 vaccination roll out began in March 2021 patients began presenting to a Victorian Emergency Department with lower limb pain following their vaccination. As a result, radiology requests for ultrasound examinations, to exclude post vaccination deep vein thrombosis (DVT) began appearing.
{"title":"The incidence of acute lower limb thrombosis, in symptomatic patients detected with ultrasound, with consideration of recent COVID‐19 vaccination or infection","authors":"Emma Jardine, G. McLean","doi":"10.1002/sono.12369","DOIUrl":"https://doi.org/10.1002/sono.12369","url":null,"abstract":"After the COVID‐19 vaccination roll out began in March 2021 patients began presenting to a Victorian Emergency Department with lower limb pain following their vaccination. As a result, radiology requests for ultrasound examinations, to exclude post vaccination deep vein thrombosis (DVT) began appearing.","PeriodicalId":29898,"journal":{"name":"Sonography","volume":"37 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81172077","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}
引用次数: 0
Mucinous breast carcinoma: A case series and literature review 黏液性乳腺癌:病例系列及文献回顾
IF 0.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-06-12 DOI: 10.1002/sono.12364
Nguyen Thuy Linh, Nguyen Thi Hao, Nguyen Thi Mai Phuong, N. Kien, Vu Le Minh, Ngo le Lam
{"title":"Mucinous breast carcinoma: A case series and literature review","authors":"Nguyen Thuy Linh, Nguyen Thi Hao, Nguyen Thi Mai Phuong, N. Kien, Vu Le Minh, Ngo le Lam","doi":"10.1002/sono.12364","DOIUrl":"https://doi.org/10.1002/sono.12364","url":null,"abstract":"","PeriodicalId":29898,"journal":{"name":"Sonography","volume":"48 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77563151","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}
引用次数: 0
A case of pneumonia with dynamic air bronchogram diagnosed by lung ultrasound 肺超声诊断肺炎伴动态支气管空气征1例
IF 0.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-05-16 DOI: 10.1002/sono.12362
Issac Cheong
Lung ultrasound has proven to be a useful tool as an extension of the physical examination for the diagnosis of consolidation. However, it is often challenging to differentiate whether the consolidation corresponds to pneumonia or atelectasis using this method. We present the case of a patient in whom pneumonia was diagnosed using lung ultrasound due to the presence of a dynamic air bronchogram.
肺超声已被证明是一个有用的工具,作为物理检查的延伸诊断实变。然而,用这种方法区分实变是否与肺炎或肺不张相对应往往具有挑战性。我们提出的情况下,患者肺炎是诊断使用肺部超声由于动态空气支气管造影的存在。
{"title":"A case of pneumonia with dynamic air bronchogram diagnosed by lung ultrasound","authors":"Issac Cheong","doi":"10.1002/sono.12362","DOIUrl":"https://doi.org/10.1002/sono.12362","url":null,"abstract":"Lung ultrasound has proven to be a useful tool as an extension of the physical examination for the diagnosis of consolidation. However, it is often challenging to differentiate whether the consolidation corresponds to pneumonia or atelectasis using this method. We present the case of a patient in whom pneumonia was diagnosed using lung ultrasound due to the presence of a dynamic air bronchogram.","PeriodicalId":29898,"journal":{"name":"Sonography","volume":"5 1","pages":"136 - 137"},"PeriodicalIF":0.4,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88595135","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}
引用次数: 0
期刊
Sonography
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