Australasian Journal of Ultrasound in Medicine最新文献

Purpose

The learning curve of nurse practitioners (NPs) to accurately diagnose paediatric distal forearm fractures using point-of-care ultrasound (POCUS) was investigated.

Methods

Each NP’s learning curve was calculated as cumulative diagnostic accuracy against a number of scans performed. The curve’s plateau represented the attainment of competency. Secondary outcomes were the comparisons before and after this cut-off of diagnostic accuracy, classification of diagnostic errors, pain scores, duration and preference.

Results

Five NPs performed 201 POCUS studies with diagnostic accuracy plateauing at 90%, providing a ‘cut-off’ point at scan 15. Accuracy of POCUS scanning before and after the fifteenth scan was 81% (95% CI 70%–89%) and 90% (95% CI 84%–94%), respectively, demonstrating 9% improvement (P = 0.07). There was a 10% reduction in image interpretation errors. After fifteen scans, POCUS became faster (mean difference (MD) 2.6 min [95% CI 2.0–3.3], P < 0.001), less painful (MD 0.61 points FPSR scale [95% CI 0.04–1.18], P = 0.04) and more preferred by NPs (63% vs 77%, P = 0.03).

Discussion

The learning curve of POCUS-novice NPs independently scanning paediatric distal forearm injuries plateaued with mean diagnostic accuracy of 90% after 15 scans, suggesting competency was attained at this cut-off, supported by higher accuracy, being faster, less painful and more preferred by NPs. Future training packages in forearm POCUS should further address image interpretation and provide ongoing expert feedback.

Conclusions

The findings from this study suggest that competency in paediatric distal forearm POCUS can be attained by novices after a short training course and approximately 15 scans.

Purpose

The aim of this study was to investigate the applicability of four existing fetal growth charts to a local tertiary hospital obstetric population.

Method

Four existing fetal growth charts (the Raine study reference charts, INTERGROWTH-21st charts, World Health Organization (WHO) fetal growth study charts and Australasian Society for Ultrasound in Medicine (ASUM) endorsed Campbell Westerway charts were compared using data from 11651 singleton pregnancy ultrasound scans at King Edward Memorial Hospital (KEMH). The 3rd, 10th, 50th 90th and 97th percentile curves for abdominal circumference (AC) biometry for the KEMH data were calculated and the four primary correlation parameters from fitted 3rd order polynomials (a, b, c and d) were used to generate like-for-like comparisons for all charts.

Results

The overall comparisons showed a significant variation with different growth charts, giving different percentiles for the same fetal AC measurement. INTERGROWTH-21st percentile curves tended to fall below those of other charts for AC measurements. Both the Raine Study charts and ASUM charts were the charts of closest overall fit to the local data.

Conclusion

Our data show the Raine Study charts are the most appropriate for our population compared with the other three charts assessed suggesting the ‘one size fits all’ model may not be appropriate. However, additional analysis of biometry measurements, primarily AC, is needed to address the deficiency of data at 14-18 weeks gestation which exists for the Raine Study data.

A reasonable alternative may be to adopt the WHO charts with local calibration (including the 14 - 18 week gestation period).

Introduction

A systematic review of the value of intra-operative duplex scanning during renal transplantation was undertaken.

Methods

Studies assessing intra-operative renal cortical flow in the arcuate vessels with outcomes of ultrasound directed interventions during the initial procedure, delayed graft function, post-operative resistive indices, graft losses and early returns to theatre for graft hypoperfusion were reviewed. PROSPERO registration: (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203873).

Results

Literature searching identified 2069 articles for screening, with 131 reviewed and 12 selected for analysis comprising 5 individual case reports, one case series of 11 patients and 6 non-randomised controlled trials. Studies with similar methodologies were pooled because of the low number of studies and outcomes. Outcomes of interest were not reported for all patients. Intra-operative interventions comprising graft repositioning in 18 (16%) and vascular revision in 2 (2%) were performed in 115 patients undergoing intra-operative scans. There were no graft losses or returns to theatre for graft hypoperfusion (0 of 108 cases) compared to 7 of 71 (10%) without intraoperative scanning (P = 0.003). Three of 8 (38%) patients with high intra-operative resistive indices (RIs) were returned to theatre for hypoperfusion compared to 1 of 110 (1%) patients with normal resistive indices (P = <0.001). Ten of 13 (77%) patients with high RIs had delayed graft function compared to 10 of 40 (25%) with normal RIs (P = 0.001).

Conclusion

Despite the absence of randomised controlled trials, and heterogeneous small studies, adverse outcomes were reduced with intra-operative scanning. High intraoperative RIs were predictive of both delayed graft function and return to theatre for hypoperfusion.

Introduction

This study aimed to determine the additional time needed to perform an endometriosis transvaginal ultrasound (eTVUS) compared to routine transvaginal ultrasound (rTVUS).

Methods

A retrospective case–control study was performed. The study group included 199 eTVUS performed between September 2019 and September 2020. The control group comprised 105 consecutive rTVUS studies performed in the same time period. The time stamps on the ultrasound images of all cases in both groups were reviewed to determine the time taken to perform each study. Mean, median, minimum and maximum scan times for both groups were calculated as was percentage difference between scan times. A two-tailed, unpaired t-test of the normalised data and a Mann–Whitney U test assessing time difference of scans between two groups were performed with P value <0.05 considered statistically significant.

Results

Performing eTVUS took significantly longer than rTVUS with increases in the mean (8.4 vs 13.8 min, 64%), median (7 vs 12 min, 71%), minimum (4 vs 7 min, 75%) and maximum (19 vs 42 min, 121%) scan times. The Mann–Whitney U test indicated a statistically significant difference in the median scan times (5.0, CI 4.0–6.0), P < 0.001. An independent t-test of the normalised data revealed a significantly larger mean scan time for eTVUS than rTVUS, Mean = 9.05 95%CI [13.17–4.94], t(302) = 4.327, P < 0.001. R² = 0.583.

Conclusion

Endometriosis transvaginal ultrasound added an average 5.4 min to rTVUS, which is statistically significant. For ultrasound departments wanting to offer this technique, doubling the scan time allocated to perform a transvaginal ultrasound (TVUS) is suggested.

Introduction

Non-alcoholic fatty liver disease (NAFLD) is a growing public health issue. Non-invasive methods to assess the fibrosis stage are limited, and biopsy remains the gold standard. The objective of our study was to assess whether the portal venous pulsatility index (VPI) can be used as a predictor of high-risk NAFLD at a tertiary referral centre for liver transplantation.

Methods

We retrospectively reviewed patients with biopsy-proved NAFLD who had undergone a liver ultrasound scan within 1 year of biopsy at our centre from 2011 to 2019.

Results

We did not find a significant correlation between the VPI and the NAFLD risk category or correlation between the VPI and degree of steatosis (P > 0.05 for both).

Conclusion

Since VPI can be easily obtained on routine liver ultrasound and since other studies do report a positive association with significant fibrosis, more studies are needed before it can be recommended or not in risk-stratifying NAFLD patients into high- vs. low-risk NAFLD.

Introduction

Fetal dural sinus malformation is a rare but important finding during pregnancy as it has the potential for significant complications.

Methods

Here we present a case of fetal dural sinus malformation and review the current literature relevant to this condition.

Results

We present the case of a 33-year-old woman who had fetal dural sinus malformation containing thrombus diagnosed at morphology ultrasound and confirmed on fetal magnetic resonance imaging (MRI). Serial ultrasounds demonstrated the sinus to reduce significantly in size over the course of the pregnancy. The woman delivered a healthy, term baby and there was no evidence of any neurological compromise in the early neonatal period.

Discussion

This case is in keeping with a recent systematic review, which identified 78 previous cases of fetal dural sinus thrombosis and reported good outcomes in most cases.

Conclusion

It therefore appears reasonable, in most cases of isolated dural sinus malformation, to monitor the progress of the lesion and continue managing the pregnancy as usual.

Objectives

Several studies suggest solitary gallbladder polyps (GBPs) have an increased malignancy risk compared to multi-polyps. Furthermore, some malignant GBPs possessed faster growth rates compared to benign GBPs. To our knowledge, no study has established a relationship between GBP number and growth rates. Hence, this study aims to: (i) determine whether there is a statistical significance in growth rates between solitary GBPs versus multi-polyps; (ii) determine, in a four-year period, the proportion of GBPs in this study’s total cohort that exhibit growth compared to previous studies.

Methods

A retrospective, quantitative, cohort study was implemented utilising 100 consecutive patient records from three private radiology clinics. These were assessed against the eligibility criteria and allocated into the solitary or multi-polyp study group, depending on number of GBPs detected on initial and follow-up ultrasound examinations conducted 6–48 months later. Patient age, GBP sizes, time interval between initial and follow-up ultrasound examinations and GBP growth rates were compared between the study groups utilising Student’s t tests.

Results

No statistically significant difference was found between the study groups according to gender, age, GBP size and time between ultrasound examinations. Furthermore, there was no statistically significant difference between the growth rates of solitary and multi-polyp groups (P = 0.77). Most GBPs [92/100 (92%)] grew <2 mm in maximal diameter, while 8/100 (8%) of GBPs grew ≥2 mm in maximal diameter at follow-up.

Conclusions

The large majority of GBPs maintained size stability at follow-up. On average, solitary GBPs did not grow faster than multi-polyps, although further research is recommended to reinforce this.