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Multifaceted uses for musculoskeletal ultrasound 肌肉骨骼超声的多方面用途
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-12-12 DOI: 10.1002/ajum.12372
Fred Joshua

This issue of the Australasian Journal of Ultrasound in Medicine highlights the use of ultrasound in musculoskeletal ultrasound. This area of medicine encompasses approximately 20% of presentations to primary care physicians.1, 2 Determining how to investigate and manage these problems is a major burden to society. This is a very large cost in both evaluation and treatment.3 Ultrasound is increasingly the modality used to investigate musculoskeletal complaints as it is relatively cheaper, safer and more available, increasingly at the bedside.4

Fenech describes the anatomy of the metacarpophalangeal joints and the use of real-time ultrasound to diagnose the injuries in Boxer's knuckle.5 Fenech demonstrates both the normal anatomy and the tears of the sagittal bands of the dorsal hood and associated extensor tendon instability. This is an important article for teaching the clinical use of ultrasound to allow patients to be able identified so that they may move forward to improve from what can result in long-term disability from the loss of hand function. The treatment may require surgical repair.

Following on from this, Renfree et al describe the evaluation of flexor tendon surgical repair with differing ultrasound transducers.6 The superficial nature of the flexor tendons of the hand allows high-frequency probes to be used for evaluation. This study highlights that improvements in transducer technology from 18 to 24 MHz do provide more information and may result in less re-operation. Another important aspect of ultrasound evaluation is how this study was performed using cadavers. Cadaveric evaluation of techniques for both procedures and education is an important aspect of how ultrasound can be used.7, 8

Finally, Magoon et al.9 highlight the safe and accurate evaluation of diagnostic biopsy of soft-tissue lesions in the hand. Importantly, the study demonstrated that even small lesions (<1 cm) are amenable to this, allowing a safer evaluation than open biopsy.9 The article also highlights the high level of experience of all groups involved in the evaluation of the soft-tissue lesions from the ultrasound and radiology staff through to the pathologist involved.

These three articles highlight the scope of ultrasound use in musculoskeletal imaging. This includes the evaluation of injury, biopsy of lesions though to review of results of surgical treatments. Ultrasound has important roles in both the diagnosis and treatment of musculoskeletal conditions, and the increasing availability of the technology will only increase this in future. It is essential that we develop an evidence base, as these authors have done, to document the true benefit, if any of the technology.

本期《澳大利亚超声医学杂志》重点介绍超声在肌肉骨骼超声中的应用。这一医学领域约占初级保健医生接诊病例的 20%。1,2 确定如何调查和处理这些问题是社会的一大负担。4 Fenech 描述了掌指关节的解剖结构，以及使用实时超声波诊断拳击手指关节损伤的方法。5 Fenech 展示了正常的解剖结构、背罩矢状带的撕裂以及相关的伸肌腱不稳定性。这篇文章对于临床使用超声波进行教学非常重要，可帮助患者识别疾病，从而改善因手部功能丧失而导致的长期残疾。6 手部屈肌腱的表浅特性允许使用高频探头进行评估。6 手部屈肌腱的表浅特性允许使用高频探头进行评估。这项研究强调，从 18 到 24 MHz 的探头技术的改进确实能提供更多信息，并可能减少再次手术的次数。超声评估的另一个重要方面是这项研究是如何使用尸体进行的。在尸体上对手术和教育技术进行评估是如何使用超声的一个重要方面。重要的是，该研究表明，即使是小的病变（1 厘米）也可以进行活检，这样的评估比开放性活检更安全。9 文章还强调了参与评估软组织病变的所有小组，从超声和放射科工作人员到病理学家，都具有丰富的经验。这三篇文章强调了超声波在肌肉骨骼成像中的应用范围，包括损伤评估、病变活检以及手术治疗结果的复查。超声波在肌肉骨骼疾病的诊断和治疗中都发挥着重要作用，随着技术的日益普及，未来这一作用只会越来越大。正如这些作者所做的那样，我们必须建立一个证据库，以记录该技术的真正益处（如果有的话）。
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引用次数: 0
Point-of-care ultrasound to diagnose acute cholecystitis in the emergency department: A scoping review 在急诊科使用床旁超声诊断急性胆囊炎：范围审查
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-12-10 DOI: 10.1002/ajum.12371
Alexander Joyce, Peter J Snelling, Tarek Elsayed, Gerben Keijzers

Introduction/Purpose

Ultrasound is the first-line imaging modality for suspected acute cholecystitis. This can be radiology-performed ultrasound or point-of-care ultrasound (POCUS). POCUS can potentially streamline patient assessment in the emergency department (ED). The primary objective was to evaluate the literature for the diagnostic accuracy of POCUS performed for acute cholecystitis in the ED. Secondary objectives were to assess the effect of POCUS operator training on diagnostic accuracy for acute cholecystitis, utility of POCUS measurement of the common bile duct and POCUS impact on resource utilisation.

Methods

A systematic scoping review of articles was conducted using Medline, Embase, CENTRAL and CINAHL. Original studies of adults with POCUS performed for the diagnosis of acute cholecystitis in the ED were included. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist (PRISMA-ScR).

Results

A total of 1090 publications were identified. Forty-six met the eligibility criteria. Studies were thematically grouped into categories according to specified objectives. Point-of-care ultrasound was of acceptable but variable accuracy, contributed to by the absence of a consistent reference standard and uniform training requirements. It may positively impact ED resource utilisation through reduced ED length of stay and radiology-performed imaging, whilst improving patient experience.

Conclusion

This review highlights the heterogeneity of existing research, emphasising the need for standardisation of training and reference standards in order to precisely define the utility of POCUS for acute cholecystitis in the ED and its benefits on ED resource utilisation.

超声是疑似急性胆囊炎的一线成像方式。这可以是放射科实施的超声检查，也可以是护理点超声检查（POCUS）。POCUS 有可能简化急诊科（ED）对患者的评估。该研究的主要目的是评估急诊科对急性胆囊炎进行 POCUS 诊断的文献准确性。次要目标是评估 POCUS 操作员培训对急性胆囊炎诊断准确性的影响、POCUS 测量胆总管的效用以及 POCUS 对资源利用的影响。纳入了对急诊室成人急性胆囊炎诊断进行 POCUS 的原始研究。研究报告采用系统综述和荟萃分析首选报告项目扩展范围综述核对表（PRISMA-ScR）。其中 46 篇符合资格标准。根据特定目标对研究进行了专题分组。由于缺乏统一的参考标准和统一的培训要求，护理点超声检查的准确性可接受但不稳定。这篇综述强调了现有研究的异质性，强调了培训和参考标准标准化的必要性，以便准确定义急诊室急性胆囊炎 POCUS 的效用及其对急诊室资源利用的益处。
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引用次数: 0
Role of contrast-enhanced ultrasound for differentiation of benign vs. malignant portal vein thrombosis in hepatocellular carcinoma – A systematic review a meta-analysis 造影剂增强超声在区分肝细胞癌良性与恶性门静脉血栓形成中的作用 - 系统综述与荟萃分析
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-12-10 DOI: 10.1002/ajum.12375
Suprabhat Giri, Arun Vaidya, Dhiraj Agrawal, Jijo Varghese, Ranjan Kumar Patel, Taraprasad Tripathy, Ankita Singh, Swati Das

Introduction/Purpose

Patients with cirrhosis and hepatocellular carcinoma (HCC) can develop both benign and malignant portal vein thrombosis (PVT). Characterising the nature of PVT is important for planning an optimal therapeutic strategy. In the absence of typical findings or contraindications to computed tomography (CT) or magnetic resonance imaging (MRI), contrast-enhanced ultrasound (CEUS) could help in this differentiation. The present meta-analysis aimed to evaluate the performance of CEUS for characterising PVT in patients with HCC.

Methods

Electronic databases of PubMed, Embase and Scopus were searched from inception to 31 December 2022 for studies analysing the role of CEUS in the differentiation of benign and malignant PVT in HCC. Using the bivariate random effect model, pooled sensitivity and specificity were calculated, and the summary receiver operating characteristic (sROC) curve was plotted.

Results

A total of 12 studies with data from 712 patients were included in the meta-analysis. The pooled sensitivity and specificity of CEUS for the diagnosis of tumour in vein were 97.0% (95% CI: 93.0–98.7) and 96.8% (95% CI: 92.1–98.7), respectively, without significant heterogeneity. A sROC curve was plotted, and the area under the receiver operating characteristic was 0.99 (95% CI: 0.98–1.00). Despite the presence of publication bias, sensitivity analysis did not show any change in sensitivity and specificity.

Discussion

Our meta-analysis summarises the accuracy data from 12 studies, including >700 subjects. Contrast-enhanced ultrasound had excellent diagnostic accuracy with pooled sensitivity and specificity of 97.5% (95% CI: 93.5–99.1) and 98.2% (95% CI: 91.5–99.6), respectively, without any significant heterogeneity. Additionally, the pooled positive LR, negative LR and DOR were 54.6 (95% CI: 11.1–25.6), 0.02 (0.01–0.07) and 2186.8 (318.3–15022.2), respectively. A positive result increases the pretest probability of malignant PVT from 50% to 98%, whereas a negative result decreases it from 50% to 2%. Most of the studies included in our meta-analysis used identical techniques and 6–12-month follow-up scans to check for thrombus progression or regression. Our analysis showed no significant heterogeneity in the studies, and area under receiver operating characteristic curve (AUROC) with 95% CI was 1.00 (95% CI: 0.99–1.00). This critical meta-analysis thus propels CEUS to the forefront for differentiating benign from tumoural PVT and suggests routinely using CEUS in patients present

肝硬化和肝细胞癌(HCC)患者可发展为良性和恶性门静脉血栓形成(PVT)。表征PVT的性质对于制定最佳治疗策略非常重要。在计算机断层扫描(CT)或磁共振成像(MRI)没有典型表现或禁忌症的情况下，超声造影(CEUS)可以帮助鉴别。本荟萃分析旨在评价超声造影在HCC患者PVT诊断中的作用。检索PubMed、Embase和Scopus的电子数据库，从创建到2022年12月31日，分析超声造影在HCC良性和恶性PVT鉴别中的作用。采用双变量随机效应模型，计算合并敏感性和特异性，绘制总受试者工作特征(sROC)曲线。meta分析共纳入了12项研究，数据来自712名患者。超声造影诊断静脉肿瘤的综合敏感性和特异性分别为97.0% (95% CI: 93.0 ~ 98.7)和96.8% (95% CI: 92.1 ~ 98.7)，无显著异质性。绘制sROC曲线，受试者工作特征下面积为0.99 (95% CI: 0.98-1.00)。尽管存在发表偏倚，敏感性分析未显示敏感性和特异性有任何变化。我们的荟萃分析总结了12项研究的准确性数据，包括超过700名受试者。对比增强超声具有出色的诊断准确性，综合敏感性和特异性分别为97.5% (95% CI: 93.5-99.1)和98.2% (95% CI: 91.5-99.6)，无显著异质性。此外，合并阳性LR、阴性LR和DOR分别为54.6 (95% CI: 11.1-25.6)、0.02(0.01-0.07)和2186.8(318.3-15022.2)。阳性结果将恶性PVT的预测概率从50%增加到98%，而阴性结果将其从50%降低到2%。我们荟萃分析中的大多数研究使用相同的技术和6-12个月的随访扫描来检查血栓的进展或消退。我们的分析显示，研究中没有显著的异质性，受试者工作特征曲线下面积(AUROC) 95% CI为1.00 (95% CI: 0.99-1.00)。因此，这一关键的荟萃分析将超声造影推向了区分良性和肿瘤PVT的前沿，并建议在HCC和灰度超声有血栓证据的患者中常规使用超声造影。对比增强超声是鉴别HCC患者良性和恶性PVT的有效诊断方式，可以作为CT或MRI的替代方式。超声造影作为原发性肝细胞癌PVT特征的初始诊断方法的作用有待进一步研究。
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引用次数: 0
Complete hydatidiform mole with concurrent fetus: Two cases of live, term birth coupled with spontaneous resolution of molar tissue 完全水样痣并发胎儿：两例活产、足月分娩且臼齿组织自发消融的病例
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-12-09 DOI: 10.1002/ajum.12366
Emily M. Warton, Jan E. Dickinson, Scott W. White, Yee Leung, Bligh Berry

Pregnancies with a complete hydatidiform mole and co-existing fetus (CMCF) are rare, but increasingly common due to the rising prevalence of assisted reproductive technology. They are frequently associated with adverse obstetric outcomes, providing women with the challenge of pregnancy termination or continuing the pregnancy at the risk of maternal-fetal morbidity and fetal mortality.

This report demonstrates two cases of CMCF pregnancy with excellent maternal-fetal outcomes, including spontaneous resolution of the molar tissue antenatally. It is helpful in counselling women who are diagnosed with this rare and frequently morbid condition in considering how to proceed with their pregnancy.

妊娠伴有完整葡萄胎和共存胎儿(CMCF)是罕见的，但由于辅助生殖技术的日益普及，这种情况越来越普遍。它们通常与不良的产科结局有关，使妇女面临终止妊娠的挑战，或冒着母胎发病率和胎儿死亡的风险继续妊娠。本报告展示了两例CMCF妊娠的良好母胎结局，包括产前磨牙组织的自发溶解。对于被诊断患有这种罕见且经常病态的疾病的妇女，在考虑如何继续怀孕时提供咨询是有帮助的。
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引用次数: 0
Clinical audit of ultrasonography for detecting sialoliths in the submandibular gland in paediatric patients: A comparison to computed tomography and magnetic resonance imaging 用于检测儿科患者颌下腺霰粒肿的超声波检查临床审核：与计算机断层扫描和磁共振成像的比较
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-12-09 DOI: 10.1002/ajum.12370
Takahiro Hosokawa, Yutaka Tanami, Yumiko Sato, Nodoka Adachi, Hiroshi Asanuma, Eiji Oguma

Objectives

To compare the performance of ultrasonography with magnetic resonance imaging (MRI) and computed tomography (CT) for detecting submandibular sialoliths.

Methods

Thirteen patients with suspected submandibular sialoliths who underwent ultrasonography and CT or MRI were included. Sialoliths were diagnosed using CT (11 cases) or MRI (two cases). The submandibular duct was classified into distal and proximal ducts based on the point around the mylohyoid muscle. Sialoliths located in the proximal duct were difficult to differentiate from those located within the submandibular gland (SMG). Therefore, the location of the sialoliths was classified as follows: within the SMG/proximal duct and within the distal duct. The ultrasound results were compared with CT/MRI results.

Results

Of the 13 patients included, two had sialoliths in both the SMG/proximal duct and the distal duct, three had sialoliths in the SMG/proximal duct, and five had sialoliths in the distal duct on CT or MRI. In this small cohort, all five sialoliths in the SMG/proximal duct were detected by ultrasoonography; however, of the seven cases with sialoliths located in the distal duct, only three could be detected by ultrasonography.

Conclusions

The incidence of sialoliths in the distal duct was higher than that in the SMG/proximal duct. Ultrasonography showed a good performance compared with CT/MRI in the SMG/proximal duct but not in the distal duct.

目的:比较超声与磁共振成像(MRI)和计算机断层扫描(CT)对颌下腺结石的检测效果。13例疑似颌下腺结石患者均行超声、CT或MRI检查。通过CT(11例)或MRI(2例)诊断唾液结石。根据下颌舌骨肌周围的点将下颌下导管分为远端和近端。位于近端导管的涎石与位于颌下腺(SMG)内的涎石很难区分。因此，涎石的位置分为:SMG/近端导管内和远端导管内。将超声结果与CT/MRI结果进行比较。在纳入的13例患者中，2例在SMG/近端导管和远端导管中均有唾液结石，3例在SMG/近端导管中有唾液结石，5例在CT或MRI上在远端导管中有唾液结石。在这个小队列中，超声检查了SMG/近端导管中的所有5个唾液结石;然而，在7例涎石位于远端导管中，只有3例可以通过超声检测到。远端导管涎石的发生率高于SMG/近端导管。超声检查在SMG/近端导管中表现良好，而在远端导管中表现不佳。
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引用次数: 0
Artificial intelligence as a teaching tool for gynaecological ultrasound: A systematic search and scoping review 人工智能作为妇科超声教学工具：系统检索和范围审查
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-11-20 DOI: 10.1002/ajum.12368
Alison Deslandes, Jodie Avery, Hsiang-Ting Chen, Mathew Leonardi, George Condous, M. Louise Hull

Purpose

The aim of this study was to investigate the current application of artificial intelligence (AI) tools in the teaching of ultrasound skills as they pertain to gynaecological ultrasound.

Methods

A scoping review was performed. Eight databases (MEDLINE, EMBASE, EMCARE, CINAHL, Scopus, Web of Science, IEEE Xplore and ACM digital library) were searched in December 2022 using predefined keywords. All types of publications were eligible for inclusion so long as they reported the use of an AI tool, included reference to or discussion of teaching or the improvement of ultrasound skills and pertained to gynaecological ultrasound. Conference abstracts and non-English language papers which could not be adequately translated into English were excluded.

Results

The initial database search returned 481 articles. After screening against our inclusion and exclusion criteria, two were deemed to meet the inclusion criteria. Neither of the articles included reported original research (one systematic review and one review article). Neither of the included articles explicitly provided details of specific tools developed for the teaching of ultrasound skills for gynaecological imaging but highlighted similar applications within the field of obstetrics which could potentially be expanded.

Conclusion

Artificial intelligence can potentially assist in the training of sonographers and other ultrasound operators, including in the field of gynaecological ultrasound. This scoping review revealed however that to date, no original research has been published reporting the use or development of such a tool specifically for gynaecological ultrasound.

本研究旨在调查目前人工智能（AI）工具在妇科超声技能教学中的应用情况。2022 年 12 月，我们使用预定义的关键词检索了八个数据库（MEDLINE、EMBASE、EMCARE、CINAHL、Scopus、Web of Science、IEEE Xplore 和 ACM 数字图书馆）。所有类型的出版物只要报告了人工智能工具的使用情况，提及或讨论了教学或超声技能的提高，且与妇科超声有关，均可纳入检索范围。会议摘要和无法充分翻译成英语的非英语论文被排除在外。根据我们的纳入和排除标准进行筛选后，有两篇文章被认为符合纳入标准。这两篇文章均未报告原创性研究（一篇系统综述和一篇评论文章）。收录的文章均未明确提供为教授妇科成像超声技能而开发的特定工具的详细信息，但强调了产科领域的类似应用，这些应用有可能得到扩展。然而，此次范围界定审查显示，迄今为止，尚未有任何原创性研究报告专门针对妇科超声使用或开发此类工具。
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引用次数: 0
Novel technique for ultrasound-guided needle tracking: An inexpensive reusable phantom model utilising a closed electrical circuit 超声引导针跟踪新技术：利用闭合电路的廉价可重复使用模型
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-11-20 DOI: 10.1002/ajum.12367
Hillary J. McKinley, Isaak Jones, Madeline LaRochelle, Erik Christensen, Weeden Bauman, Peter Croft

Purpose

Purpose:There are a variety of commercially made ultrasound training phantoms available for educational purposes. A new concept in phantoms is presented that utilises a low-cost method to create a reusable phantom.

Methods

A closed electric circuit was combined with insulating material to create a novel phantom that can be used to practise needle tracking under ultrasound guidance on repeated occasions. A tricolour light-emitting diode (LED) illuminates when the needle (under ultrasound gudiance) contacts one of three metal objects embedded in the phatom material.

Conclusion

This prototype model provides a simple solution for trianing ultrasound needle guidance is particularly geared towards programmes with a high volume of users. This protoype provides a starting point for a new concept in educational phantom trainers.

目的：市面上有多种用于教学目的的超声培训模型。闭合电路与绝缘材料相结合，创造出一种新型模型，可用于在超声引导下反复练习追踪针头。当针头（在超声引导下）接触到镶嵌在模型材料中的三个金属物体之一时，一个三色发光二极管（LED）就会发光。这个原型模型为超声针引导的三维练习提供了一个简单的解决方案，特别适合使用人数较多的项目。该原型模型为教育用模型训练器的新概念提供了一个起点。
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引用次数: 0
Prevalence of anomalies on the routine mid-trimester ultrasound: 3172 consecutive cases by a single maternal–fetal medicine specialist 常规中期妊娠超声波检查中异常情况的发生率：一位母胎医学专家连续检查 3172 个病例
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-11-20 DOI: 10.1002/ajum.12369
Colin A. Walsh, Nicole Lees

Introduction/Purpose

The routine mid-trimester fetal anatomy ultrasound (FAS) is offered to every pregnant woman and remains critical in the detection of structural fetal anomalies. Our study aimed to determine the prevalence of abnormalities on routine FAS performed by a single operator, who is an experienced sub-specialist in maternal–fetal medicine.

Methods

A retrospective analysis of all routine FAS performed a tertiary private obstetric ultrasound practice in metropolitan Sydney over a 7-year period, August 2015–July 2022. An advanced ultrasound protocol including detailed cardiac views was used in every case. Second opinion scans for suspected abnormalities were excluded. Fetal anomalies were classified into major and minor, based on the likely need for neonatal intervention.

Results

Among 14,908 obstetric ultrasound examinations, routine FAS were performed on 3172 fetuses by a single operator. More than 99% of women had screened low-risk for fetal aneuploidy. Structural anomalies were identified in 5% (157/3172) of fetuses; the prevalence of major anomalies was 1% (30/3172). Almost 60% of total anomalies were either cardiac or renal. No differences were identified in anomaly rates for singletons compared with twins (5.0% vs. 4.2%; P = 0.75). The prevalence of placenta previa and vasa previa was 10% and 0.1%, respectively.

Discussion

The prevalence of fetal anomalies on routine FAS by a single operator using a standardised protocol was higher in our practice (5%) than in previously published studies. Although most anomalies were minor, the rate of major abnormality was 1%.

Conclusion

The routine mid-trimester FAS remains an integral component of prenatal ultrasound screening.

常规中期胎儿解剖超声检查（FAS）是为每位孕妇提供的检查项目，它对检测胎儿结构异常至关重要。我们的研究旨在确定由一名经验丰富的母胎医学亚专科医生担任操作员的常规胎儿解剖超声检查中异常情况的发生率。每个病例都采用了先进的超声检查方案，包括详细的心脏视图。疑似异常的第二意见扫描被排除在外。在14908例产科超声检查中，由一名操作员对3172个胎儿进行了常规FAS检查。超过 99% 的妇女接受了低风险胎儿非整倍体筛查。5%（157/3172）的胎儿结构异常；重大异常的发生率为 1%（30/3172）。近 60% 的畸形为心脏或肾脏畸形。单胎与双胞胎的异常率没有差异（5.0% 对 4.2%；P = 0.75）。在我们的临床实践中，单个操作者使用标准化方案进行常规FAS检查时，胎儿畸形的发生率（5%）高于之前发表的研究。虽然大多数畸形是轻微的，但重大畸形的发生率为1%。
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引用次数: 0
Comparison of lung ultrasound scoring systems for the prognosis of COVID-19 in the emergency department: An international prospective cohort study 急诊科COVID-19预后的肺部超声评分系统比较：一项国际前瞻性队列研究
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-10-29 DOI: 10.1002/ajum.12364
Peter J Snelling, Philip Jones, Rory Connolly, Tomislav Jelic, Dan Mirsch, Frank Myslik, Luke Phillips, Gabriel Blecher, the COVID LUS Study Group

Purpose

The purpose of this study was to evaluate whether the lung ultrasound (LUS) scores applied to an international cohort of patients presenting to the emergency department (ED) with suspected COVID-19, and subsequently admitted with proven disease, could prognosticate clinical outcomes.

Methods

This was an international, multicentre, prospective, observational cohort study of patients who received LUS and were followed for the composite primary outcome of intubation, intensive care unit (ICU) admission or death. LUS scores were later applied including two 12-zone protocols (‘de Alencar score’ and ‘CLUE score’), a 12-zone protocol with lung and pleural findings (‘Ji score’) and an 11-zone protocol (‘Tung-Chen score’). The primary analysis comprised logistic regression modelling of the composite primary outcome, with the LUS scores analysed individually as predictor variables.

Results

Between April 2020 to April 2022, 129 patients with COVID-19 had LUS performed according to the protocol and 24 (18.6%) met the composite primary endpoint. No association was seen between the LUS score and the composite primary end point for the de Alencar score [odds ratio (OR) = 1.04; 95% confidence interval (CI): 0.97–1.11; P = 0.29], the CLUE score (OR = 1.03; 95% CI: 0.96–1.10; P = 0.40), the Ji score (OR = 1.02; 95% CI: 0.97–1.07; P = 0.40) or the Tung-Chen score (OR = 1.02; 95% CI: 0.97–1.08).

Discussion

Compared to these earlier studies performed at the start of the pandemic, the negative outcome of our study could reflect the changing scenario of the COVID-19 pandemic, including patient, disease, and system factors. The analysis suggests that the study may have been underpowered to detect a weaker association between a LUS score and the primary outcome.

Conclusion

In an international cohort of adult patients presenting to the ED with suspected COVID-19 disease who had LUS performed and were subsequently admitted to hospital, LUS severity scores did not prognosticate the need for invasive ventilation, ICU admission or death.

目的 本研究旨在评估对急诊科（ED）疑似 COVID-19 患者进行肺部超声检查（LUS）评分是否能预示临床结果。 方法 这是一项国际性、多中心、前瞻性、观察性队列研究，研究对象是接受 LUS 检查的患者，并对插管、入住重症监护室（ICU）或死亡的综合主要结果进行随访。随后采用的 LUS 评分包括两个 12 区方案（"de Alencar 评分 "和 "CLUE 评分"）、一个 12 区方案（肺和胸膜检查结果）（"Ji 评分"）和一个 11 区方案（"Tung-Chen 评分"）。主要分析包括综合主要结果的逻辑回归建模，并将 LUS 评分作为预测变量进行单独分析。 结果 2020年4月至2022年4月期间，129名COVID-19患者按照方案进行了LUS检查，24人（18.6%）达到了复合主要终点。在 de Alencar 评分[比值比（OR）= 1.04；95% 置信区间（CI）：0.97-1.11；P = 0.29]、CLUE 评分（OR = 1.03；95% CI：0.96-1.10；P = 0.40）、Ji 评分（OR = 1.02；95% CI：0.97-1.07；P = 0.40）或 Tung-Chen 评分（OR = 1.02；95% CI：0.97-1.08）。 讨论 与这些早期在大流行开始时进行的研究相比，我们研究的负面结果可能反映了 COVID-19 大流行的变化情况，包括患者、疾病和系统因素。分析表明，该研究的力量可能不足，无法检测到 LUS 评分与主要结果之间较弱的关联。 结论 在一个国际队列中，疑似患有 COVID-19 疾病的成人患者在急诊室就诊并进行了 LUS 检查后入院，LUS 严重程度评分并不能预示患者是否需要进行有创通气、入住重症监护室或死亡。
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引用次数: 0
Hand and finger, ultrasound-guided, percutaneous core needle biopsies: A safe procedure with high diagnostic accuracy 超声引导下的手部和手指经皮穿刺活检：诊断准确性高的安全手术
Q3 Medicine
Australasian Journal of Ultrasound in Medicine
Pub Date : 2023-10-24 DOI: 10.1002/ajum.12365
Stephanie Magoon, Vanessa Peters, Felipe Ferreira de Souza, David Chen, Patrick Owens, Juan Pretell-Mazzini, Natalia Fullerton, Jean Jose, Andrew Rosenberg, Ty K. Subhawong

Introduction/Purpose

To determine the diagnostic accuracy and complication rates of ultrasound-guided, percutaneous core needle biopsies of soft tissue masses in the hand and fingers.

Methods

Reports from all ultrasound-guided procedures between 21 May 2014 and 17 March 2022 were queried for keywords including “hand”, OR “finger”, AND “biopsy”. Patient demographics, lesion size and location, biopsy needle gauge and the number of cores obtained were recorded. The final pathology of the mass excision was then compared with the core needle biopsy (CNB) for each patient.

Results

Sixty-six records were reviewed, and 37 patients met inclusion criteria. Maximum lesion diameter averaged 1.45 cm with a range between 0.4 and 4.3 cm. The frequency of needle gauges used was 14G (14%), 16G (24%), 18G (38%), 20G (11%) and ‘not reported’ (14%). The mean number of tissue cores obtained was 2.9 (SD 1.2; range 1 to 6), excluding nine cases that reported ‘multiple’. The frequency of CNB diagnoses included tenosynovial giant cell tumour (TGCT) at 30%, ganglion cyst at 11% and epidermal inclusion cyst at 5%. CNB was 100% sensitive in detecting the three (8%) malignancies. Of the 37 tumours biopsied, 16 were surgically excised. One angiomyoma was originally diagnosed as a haemangioma on CNB, but all other histologic results were concordant for a diagnostic accuracy of 97%.

Discussion

Small soft tissue masses in the hands and fingers, even those less than 1 cm, are often amenable to ultrasound-guided CNB. Performance under image guidance facilitates retrieval of core specimens adquate for histologic diagnosis with relatively few passes using higher gauge needles.

Conclusion

Overall, ultrasound-guided CNB of the hand and fingers is safe and highly accurate in diagnosing soft tissue tumours. The accuracy is unrelated to the needle's gauge, the number of passes and the size of the lesions.

引言/目的 确定手部和手指软组织肿块在超声引导下经皮穿刺核心针活检的诊断准确性和并发症发生率。 方法 查询 2014 年 5 月 21 日至 2022 年 3 月 17 日期间所有超声引导手术的报告，关键词包括 "手 "或 "手指 "和 "活检"。记录了患者的人口统计学特征、病变大小和位置、活检针的规格和取芯数量。然后将每位患者的肿块切除术最终病理结果与核心针活检（CNB）结果进行比较。 结果 共查阅了 66 份病历，37 名患者符合纳入标准。病灶最大直径平均为 1.45 厘米，范围在 0.4 至 4.3 厘米之间。使用针号的频率分别为 14G（14%）、16G（24%）、18G（38%）、20G（11%）和 "未报告"（14%）。获得的组织核的平均数量为 2.9（标度 1.2；范围 1 至 6），不包括报告 "多个 "的 9 个病例。CNB 诊断的病例中，腱鞘巨细胞瘤（TGCT）占 30%，神经节囊肿占 11%，表皮包涵囊肿占 5%。CNB 对三种（8%）恶性肿瘤的检测灵敏度为 100%。在 37 例活检肿瘤中，16 例经手术切除。有一个血管瘤最初被 CNB 诊断为血管瘤，但所有其他组织学结果都一致，诊断准确率为 97%。 讨论 手部和手指的小软组织肿块，甚至是小于 1 厘米的肿块，通常都适合在超声引导下进行 CNB。在图像引导下进行操作，只需使用较高规格的针头，通过相对较少的穿刺次数，就能取出适合组织学诊断的核心标本。 结论 总的来说，超声引导下手部和手指的 CNB 在诊断软组织肿瘤方面是安全和高度准确的。其准确性与针的规格、穿刺次数和病变的大小无关。
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