Victoria J. A. Baumann, Richard Banati, Jillian L. Clarke
Introduction
In both highly industrialised and developing countries, obesity is reaching epidemic proportions and increasingly becoming a critical indicator of general morbidity, cardiovascular disease (CVD) and renal dysfunction. A promising trend in detection and management of obesity is the measurement of perirenal adipose tissue (PRAT), increasingly recognised as a metabolically active endocrine organ in itself. Its measurement by ultrasound is used increasingly to indicate visceral obesity and its clinical management. This review synthesises current techniques for measuring PRAT and its potential use as an indicator of CVD.
Methods
We included clinical studies published between 2010 and 2023, investigating the current practice and use of specific ultrasonographic techniques and assessed the reliability and accuracy of included papers. The risk of bias was assessed using the Downs and Black Checklist, and the methodological quality examined using the Grade of Recommendations, Assessments, Development and Evaluation.
Results
It found, PRAT measures are predictive of CVD risk factors and the accuracy of ultrasound is comparable to CT and MRI, but there is no consistency in ultrasound technique. The lack of any randomised control trials and the use of 20 different non-standardised ultrasound techniques across the 21 studies resulted in inconsistent and imprecise clinical observations and interpretations, which decreased the overall quality of the studies.
Conclusion
This review found the inclusion of ultrasound measures in routine abdominal imaging potentially invaluable but demonstrates the need for standardisation of the perirenal fat ultrasound measuring technique to improve reproducibility and reliability.
{"title":"Ultrasound measurement of perirenal adipose tissue indicates cardiovascular disease, but standardisation is needed: A systematic review","authors":"Victoria J. A. Baumann, Richard Banati, Jillian L. Clarke","doi":"10.1002/ajum.12407","DOIUrl":"10.1002/ajum.12407","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In both highly industrialised and developing countries, obesity is reaching epidemic proportions and increasingly becoming a critical indicator of general morbidity, cardiovascular disease (CVD) and renal dysfunction. A promising trend in detection and management of obesity is the measurement of perirenal adipose tissue (PRAT), increasingly recognised as a metabolically active endocrine organ in itself. Its measurement by ultrasound is used increasingly to indicate visceral obesity and its clinical management. This review synthesises current techniques for measuring PRAT and its potential use as an indicator of CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included clinical studies published between 2010 and 2023, investigating the current practice and use of specific ultrasonographic techniques and assessed the reliability and accuracy of included papers. The risk of bias was assessed using the Downs and Black Checklist, and the methodological quality examined using the Grade of Recommendations, Assessments, Development and Evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>It found, PRAT measures are predictive of CVD risk factors and the accuracy of ultrasound is comparable to CT and MRI, but there is no consistency in ultrasound technique. The lack of any randomised control trials and the use of 20 different non-standardised ultrasound techniques across the 21 studies resulted in inconsistent and imprecise clinical observations and interpretations, which decreased the overall quality of the studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review found the inclusion of ultrasound measures in routine abdominal imaging potentially invaluable but demonstrates the need for standardisation of the perirenal fat ultrasound measuring technique to improve reproducibility and reliability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There are varying international recommendations regarding the minimum level of disinfection required for ultrasound transducers used in percutaneous procedures. While some guidelines recommend high-level disinfection (HLD), others question the additional benefit this delivers over low-level disinfection (LLD).
Methods
This narrative review identifies current guidelines and evaluates the evidence used to support disinfection recommendations for ultrasound transducers used in percutaneous procedures. Thirteen guidelines were identified using a search encompassing PubMed, Embase, Scopus and Google from 1st January 2013 to 31st January 2024.
Results
No guidelines were supported by high-quality evidence, instead, guidelines relied upon: expert opinion through the application of national standards and infection control principles; consideration of recommendations from other published guidelines; and the incidence of infection from retrospective studies. Guidelines were uniformly supportive of using ultrasound transducer covers and sterile ultrasound gel during ultrasound-guided percutaneous procedures. However, the minimum recommended disinfection level was varied with seven guidelines recommending HLD, four LLD and two not specifying a level. Spaulding's classification was commonly used to support disinfection recommendations, however, the resultant wide variation in classification and subsequent recommendations suggest that its utility in accurately determining the minimum level of disinfection in this specific context is low.
Conclusion
Without high-level evidence, using a risk-based assessment will likely remain fundamental to future guideline recommendations in determining the minimum disinfection level for an ultrasound transducer used in percutaneous procedures. This risk assessment must include the highest level of evidence available in addition to acknowledging the contribution of all steps taken to prevent infection during ultrasound-guided percutaneous procedures.
{"title":"Ultrasound transducer disinfection for percutaneous procedures: A review of the evidence supporting guideline recommendations","authors":"Nathan Peters, Frances Williamson, Victoria Eley","doi":"10.1002/ajum.12408","DOIUrl":"10.1002/ajum.12408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction/Purpose</h3>\u0000 \u0000 <p>There are varying international recommendations regarding the minimum level of disinfection required for ultrasound transducers used in percutaneous procedures. While some guidelines recommend high-level disinfection (HLD), others question the additional benefit this delivers over low-level disinfection (LLD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This narrative review identifies current guidelines and evaluates the evidence used to support disinfection recommendations for ultrasound transducers used in percutaneous procedures. Thirteen guidelines were identified using a search encompassing PubMed, Embase, Scopus and Google from 1st January 2013 to 31st January 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No guidelines were supported by high-quality evidence, instead, guidelines relied upon: expert opinion through the application of national standards and infection control principles; consideration of recommendations from other published guidelines; and the incidence of infection from retrospective studies. Guidelines were uniformly supportive of using ultrasound transducer covers and sterile ultrasound gel during ultrasound-guided percutaneous procedures. However, the minimum recommended disinfection level was varied with seven guidelines recommending HLD, four LLD and two not specifying a level. Spaulding's classification was commonly used to support disinfection recommendations, however, the resultant wide variation in classification and subsequent recommendations suggest that its utility in accurately determining the minimum level of disinfection in this specific context is low.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Without high-level evidence, using a risk-based assessment will likely remain fundamental to future guideline recommendations in determining the minimum disinfection level for an ultrasound transducer used in percutaneous procedures. This risk assessment must include the highest level of evidence available in addition to acknowledging the contribution of all steps taken to prevent infection during ultrasound-guided percutaneous procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 4","pages":"242-250"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This case examines the sonographic and clinical challenge of diagnosing a Klebsiella pnumoniae pyogenic liver abscess with systemic metastatic infection.
Case Description
The patient in this case study is an 81-year-old man who presented with intermittent rigors. Following radiological and clinical assessments, a Klebsiella pnumoniae pyogenic liver abscess, with evidence of systemic metastatic infection, was diagnosed. Sonographic features of the liver abscess were atypical for a cystic lesion and instead appeared as a solid mass, raising the possibility of malignancy. Treatment of intravenous ceftriaxone infusions resulted in full resolution of the liver lesion.
Discussion
The discussion criticises the terminology when describing hepatic lesions, which result from a Klebsiella pnumoniae infection. The term hepatic phlegmon is appropriate when a liver lesion caused by bacterial infection demonstrates a solid appearance on radiologic imaging. The term hepatic abscess is appropriate in cases where liver lesions caused by bacterial infection demonstrate a fluid filled core on radiologic imaging. Differentiation of these terms is important when treating the underlying lesion as a phlegmon, in contrast to an abscess, cannot be drained because it contains no pus. The variable sonographic appearances of Klebsiella pnumoniae pyogenic abscesses were also examined. Despite reported sonographic appearances in the literature, none are sufficient to distinguish a pyogenic liver abscess from malignancy without further investigation.
Conclusion
Ultrasound operators should be aware of the variable sonographic appearances of a Klebsiella pnumoniae liver abscess and how these features, combined with non-homogenous terminology, can obfuscate the correct diagnosis.
{"title":"Klebsiella liver phlegmon mimicking a solid liver tumour","authors":"Martin Necas, Jereme Mitchell","doi":"10.1002/ajum.12406","DOIUrl":"10.1002/ajum.12406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This case examines the sonographic and clinical challenge of diagnosing a <i>Klebsiella pnumoniae</i> pyogenic liver abscess with systemic metastatic infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Description</h3>\u0000 \u0000 <p>The patient in this case study is an 81-year-old man who presented with intermittent rigors. Following radiological and clinical assessments, a <i>Klebsiella pnumoniae</i> pyogenic liver abscess, with evidence of systemic metastatic infection, was diagnosed. Sonographic features of the liver abscess were atypical for a cystic lesion and instead appeared as a solid mass, raising the possibility of malignancy. Treatment of intravenous ceftriaxone infusions resulted in full resolution of the liver lesion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The discussion criticises the terminology when describing hepatic lesions, which result from a <i>Klebsiella pnumoniae</i> infection. The term hepatic phlegmon is appropriate when a liver lesion caused by bacterial infection demonstrates a solid appearance on radiologic imaging. The term hepatic abscess is appropriate in cases where liver lesions caused by bacterial infection demonstrate a fluid filled core on radiologic imaging. Differentiation of these terms is important when treating the underlying lesion as a phlegmon, in contrast to an abscess, cannot be drained because it contains no pus. The variable sonographic appearances of <i>Klebsiella pnumoniae</i> pyogenic abscesses were also examined. Despite reported sonographic appearances in the literature, none are sufficient to distinguish a pyogenic liver abscess from malignancy without further investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ultrasound operators should be aware of the variable sonographic appearances of a <i>Klebsiella pnumoniae</i> liver abscess and how these features, combined with non-homogenous terminology, can obfuscate the correct diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053398","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}
<p>As a novice researcher, I worked with a cardiology professor who was driven by clinical evidence. Clinical trials were his bread and butter, and leading guideline writing groups became his passion. The most memorable take-home message for me was this: Before you do any test, a clinician should ask themselves, ‘Will this change management? And if so, how?’ A clinician should know what they will do if the test is positive or negative and be able to articulate that. Sadly, this is not always the case. And whilst it might be ‘nice to know’, the cost of confirmatory tests is certainly not insignificant.</p><p>When I trained in ultrasound, we still called it ‘diagnostic ultrasound’ to differentiate it from therapeutic ultrasound, but this also highlighted the immense and unique diagnostic properties of ultrasound. Increasingly, ultrasound is used to not only diagnose, but also to monitor and screen for conditions, as well as to aid in management and prognosis. While all of these are laudable uses, I still think it is helpful when we can link our imaging directly to change in management.</p><p>In this issue of AJUM, Smith and Mistry<span><sup>1</sup></span> present research documenting the impact of formal echocardiography (echo) on patient management in a small clinical audit of formal echos in their intensive care unit (ICU). Although half of the patients had critical findings found on formal echo, only 25% resulted in management change. Perhaps, the remainder of the critical findings were either already suspected, and therefore being treated; or had been anticipated. Indeed, it is possible that a point of care ultrasound (POCUS) had already given them some clinical cues, and thus, the formal echo was simply confirmatory. In a reasonable number of patients, the formal echo helped make the decision to proceed with palliation and this seems an entirely reasonable reason to do an extra imaging test.</p><p>Also, in the ICU setting, Xin <i>et al</i>.<span><sup>2</sup></span> report on the use of Tissue Doppler Imaging (TDI) of the diaphragm to optimise the timing of weaning from mechanical ventilation in ICU patients. Using TDI to measure the low velocity motion of heart muscle is fundamental to echocardiography, so the extension to the diaphragm seems a logical extension of practice. But a good idea still needs to be tested and shown to aid patient management. Innovation needs to be effective.</p><p>Innovation is a key part of medicine, and finding new applications for imaging is part of that. Lau <i>et al</i>.<span><sup>3</sup></span> applied shear wave elastography to patients in a case–control study comparing patients with COVID-19 with controls and found that patients with recent (<6 months) COVID-19 had increased liver stiffness. They were prompted to do the study after observing elevated liver enzymes in these patients. But as the authors point out, these may be transient changes, and data are needed to see whether these abnormalities are asso
作为一名研究新手，我曾与一位以临床证据为动力的心脏病学教授共事。临床试验是他的面包和黄油，而领导指南编写小组则是他的激情所在。他给我留下的最深刻的启示是这样的：在做任何试验之前，临床医生都应该问自己：'这会改变管理吗？如果会，如何改变？临床医生应该知道，如果检测结果呈阳性或阴性，他们会怎么做，并能清楚地表达出来。遗憾的是，情况并非总是如此。在我接受超声波培训时，我们仍称其为 "诊断性超声波"，以区别于治疗性超声波，但这也凸显了超声波巨大而独特的诊断特性。越来越多的超声波不仅用于诊断，还用于监测和筛查疾病，以及辅助管理和预后。在本期的《AJUM》杂志上，Smith 和 Mistry1 介绍了一项研究，该研究记录了正规超声心动图（echo）对重症监护病房（ICU）正规超声检查的影响。虽然半数患者在正式回波检查中发现了危急病症，但只有 25% 的患者改变了治疗方案。也许，其余的重要发现要么是已经被怀疑，因此正在接受治疗；要么是早有预料。事实上，护理点超声检查（POCUS）可能已经给了他们一些临床线索，因此，正式回波检查只是确认而已。在一定数量的患者中，正式回声有助于做出继续姑息治疗的决定，这似乎是进行额外成像检测的一个完全合理的理由。此外，在重症监护病房环境中，Xin 等人2 报告了使用横膈膜组织多普勒成像（TDI）优化重症监护病房患者机械通气断流时机的情况。使用 TDI 测量心肌的低速运动是超声心动图的基础，因此扩展到膈肌似乎是顺理成章的做法。但是，一个好的想法仍然需要经过测试，并证明它能帮助患者进行管理。创新是医学的重要组成部分，而为成像技术寻找新的应用领域也是创新的一部分。刘（Lau）等人3在一项病例对照研究中对COVID-19患者和对照组患者进行了剪切波弹性成像比较，发现近期（6个月）COVID-19患者的肝脏硬度增加。他们是在观察到这些患者肝酶升高后才进行这项研究的。但正如作者所指出的，这些可能只是短暂的变化，还需要数据来确定这些异常是否与持续性肝损伤有关。关于肝脏的超声评估，衰减成像（ATI）是一种相对较新的超声技术，可对衰减进行定量评估，有助于评估肝脂肪变性或脂肪肝。Tan 等人4 介绍了他们对在同一天接受超声检查和肝活检的患者的数据，并得出结论：虽然 ATI 与脂肪变性的组织学分级密切相关，但放射科医生的定性印象实际上是组织学结果的最佳相关性。这是一个 ATI 无助于诊断的例子，同时也引出了一个问题：如果这些患者仍然要做肝活检，那么在超声检查中增加 ATI 真的有意义吗？这个问题的答案就是证据。当我开始超声波之旅的时候，诊断心脏瓣膜疾病的金标准是有创心导管检查。但是，具有前瞻性思维的临床科学家进行的创新研究提供了证据，因此超声心动图现在已成为量化心脏瓣膜疾病的黄金标准。虽然我认为我们为超声波找到了新的临床应用并使用了正在开发的新技术，但正如这些论文所做的那样，我们必须衡量这些技术的临床效果，这一点非常重要。如果新技术不能增加临床价值，我们就必须放弃，事实上，有些技术可能会造成伤害。成像技术为患者带来的额外临床益处应该是显而易见的，成像技术不应该被常规用作另一种确诊或安慰性检查。当然，在某些情况下，后者在临床上是完全合适的。探索新兴超声技术的临床应用具有重要作用；然而，正如这些论文所显示的，研究应包括这些技术作为独立检查的临床有效性，而不仅仅是确认性的保证。
{"title":"The impact of ultrasound imaging on patient management – Let's practice the evidence","authors":"Gillian Whalley","doi":"10.1002/ajum.12412","DOIUrl":"https://doi.org/10.1002/ajum.12412","url":null,"abstract":"<p>As a novice researcher, I worked with a cardiology professor who was driven by clinical evidence. Clinical trials were his bread and butter, and leading guideline writing groups became his passion. The most memorable take-home message for me was this: Before you do any test, a clinician should ask themselves, ‘Will this change management? And if so, how?’ A clinician should know what they will do if the test is positive or negative and be able to articulate that. Sadly, this is not always the case. And whilst it might be ‘nice to know’, the cost of confirmatory tests is certainly not insignificant.</p><p>When I trained in ultrasound, we still called it ‘diagnostic ultrasound’ to differentiate it from therapeutic ultrasound, but this also highlighted the immense and unique diagnostic properties of ultrasound. Increasingly, ultrasound is used to not only diagnose, but also to monitor and screen for conditions, as well as to aid in management and prognosis. While all of these are laudable uses, I still think it is helpful when we can link our imaging directly to change in management.</p><p>In this issue of AJUM, Smith and Mistry<span><sup>1</sup></span> present research documenting the impact of formal echocardiography (echo) on patient management in a small clinical audit of formal echos in their intensive care unit (ICU). Although half of the patients had critical findings found on formal echo, only 25% resulted in management change. Perhaps, the remainder of the critical findings were either already suspected, and therefore being treated; or had been anticipated. Indeed, it is possible that a point of care ultrasound (POCUS) had already given them some clinical cues, and thus, the formal echo was simply confirmatory. In a reasonable number of patients, the formal echo helped make the decision to proceed with palliation and this seems an entirely reasonable reason to do an extra imaging test.</p><p>Also, in the ICU setting, Xin <i>et al</i>.<span><sup>2</sup></span> report on the use of Tissue Doppler Imaging (TDI) of the diaphragm to optimise the timing of weaning from mechanical ventilation in ICU patients. Using TDI to measure the low velocity motion of heart muscle is fundamental to echocardiography, so the extension to the diaphragm seems a logical extension of practice. But a good idea still needs to be tested and shown to aid patient management. Innovation needs to be effective.</p><p>Innovation is a key part of medicine, and finding new applications for imaging is part of that. Lau <i>et al</i>.<span><sup>3</sup></span> applied shear wave elastography to patients in a case–control study comparing patients with COVID-19 with controls and found that patients with recent (<6 months) COVID-19 had increased liver stiffness. They were prompted to do the study after observing elevated liver enzymes in these patients. But as the authors point out, these may be transient changes, and data are needed to see whether these abnormalities are asso","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 3","pages":"139-140"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajum.12412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the effects of bladder fullness and lower uterine contractions ultrasound on transabdominal and transvaginal cervical length measurements at the mid-trimester fetal anomaly scan (FAS).
Methods
Transabdominal and transvaginal cervical length measurements from 925 mid-trimester FAS examinations were retrospectively analysed. Images were assessed for lower uterine contraction and bladder fullness using a novel qualitative assessment. Bland–Altman plots and single-score interclass correlation (ICC) were used to determine correlation between transabdominal and transvaginal measurements. Sensitivity and specificity of transabdominal cut-offs were calculated.
Results
Transabdominal and transvaginal measurements of the cervix correlated poorly (ICC 0.306). An overfilled bladder and lower uterine contractions on average increased the length of transabdominal cervical length measurements. Removing these variables did not significantly improve correlation between transabdominal and transvaginal measurements of the cervix but resulted in an improved sensitivity of transabdominal assessment to detect a clinically relevant short cervix.
Discussion
Resolving the confounding factors of an overfilled bladder and lower uterine contractions can help improve the our ability to detect a short cervix on transabdominal ultrasound. Our data set supported a two-stage approach to cervical length screening which would allow 100% sensitivity when a cut-off of ≤35 mm is used on transabdominal ultrasound and would limit the need for transvaginal scanning to approximately 39% of patients. This cut-off is in line with the findings of other studies. The low prevalence of short cervix in our study did however make it difficult to extrapolate reliable calculations.
Conclusion
Although transabdominal measurements correlate poorly with transvaginal measurements of the cervix, we demonstrated an improved sensitivity for detecting a short cervix using a transabdominal approach when no contractions or overfilled bladder is present. This potential could be explored in a future study with a larger sample size.
{"title":"Comparing transabdominal and transvaginal cervical length measurements at mid-trimester fetal anomaly scan: The impact of bladder fullness and lower uterine contractions","authors":"Heidi Beaver, Valeria Lanzarone, Gary KK Low","doi":"10.1002/ajum.12409","DOIUrl":"10.1002/ajum.12409","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess the effects of bladder fullness and lower uterine contractions ultrasound on transabdominal and transvaginal cervical length measurements at the mid-trimester fetal anomaly scan (FAS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Transabdominal and transvaginal cervical length measurements from 925 mid-trimester FAS examinations were retrospectively analysed. Images were assessed for lower uterine contraction and bladder fullness using a novel qualitative assessment. Bland–Altman plots and single-score interclass correlation (ICC) were used to determine correlation between transabdominal and transvaginal measurements. Sensitivity and specificity of transabdominal cut-offs were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Transabdominal and transvaginal measurements of the cervix correlated poorly (ICC 0.306). An overfilled bladder and lower uterine contractions on average increased the length of transabdominal cervical length measurements. Removing these variables did not significantly improve correlation between transabdominal and transvaginal measurements of the cervix but resulted in an improved sensitivity of transabdominal assessment to detect a clinically relevant short cervix.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Resolving the confounding factors of an overfilled bladder and lower uterine contractions can help improve the our ability to detect a short cervix on transabdominal ultrasound. Our data set supported a two-stage approach to cervical length screening which would allow 100% sensitivity when a cut-off of ≤35 mm is used on transabdominal ultrasound and would limit the need for transvaginal scanning to approximately 39% of patients. This cut-off is in line with the findings of other studies. The low prevalence of short cervix in our study did however make it difficult to extrapolate reliable calculations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although transabdominal measurements correlate poorly with transvaginal measurements of the cervix, we demonstrated an improved sensitivity for detecting a short cervix using a transabdominal approach when no contractions or overfilled bladder is present. This potential could be explored in a future study with a larger sample size.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 4","pages":"218-228"},"PeriodicalIF":0.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michelle J. Wang, Cassandra R. Duffy, Yinka Oyelese
Introduction
Vasa previa is a complication of pregnancy, which affects approximately 1:1200 pregnancies, and when undiagnosed prenatally, it can be associated with significant perinatal mortality. This condition is thought to be a sporadic entity without known genetic or familial associations and thus considered to carry a negligible recurrence risk.
Key Findings
We present a case of a 42-year-old gravida 3 para 2 diagnosed on transvaginal ultrasound with a vasa previa at 34 weeks associated with vaginal bleeding, which required an urgent caesarean in a prior spontaneous pregnancy. In the current pregnancy conceived with in vitro fertilisation, she was again diagnosed with a vasa previa at 30 weeks’ gestation at transvaginal ultrasound. She ultimately delivered at 37 weeks’ gestation via an uncomplicated repeat caesarean.
Discussion
Patients with vasa previa in one pregnancy may be at risk for recurrence in subsequent pregnancy and thus should be screened in future pregnancies. Further research should be done to explore and identify any risk factors for recurrence of vasa previa.
{"title":"Case report of recurrent vasa previa","authors":"Michelle J. Wang, Cassandra R. Duffy, Yinka Oyelese","doi":"10.1002/ajum.12405","DOIUrl":"10.1002/ajum.12405","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vasa previa is a complication of pregnancy, which affects approximately 1:1200 pregnancies, and when undiagnosed prenatally, it can be associated with significant perinatal mortality. This condition is thought to be a sporadic entity without known genetic or familial associations and thus considered to carry a negligible recurrence risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Findings</h3>\u0000 \u0000 <p>We present a case of a 42-year-old gravida 3 para 2 diagnosed on transvaginal ultrasound with a vasa previa at 34 weeks associated with vaginal bleeding, which required an urgent caesarean in a prior spontaneous pregnancy. In the current pregnancy conceived with in vitro fertilisation, she was again diagnosed with a vasa previa at 30 weeks’ gestation at transvaginal ultrasound. She ultimately delivered at 37 weeks’ gestation via an uncomplicated repeat caesarean.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Patients with vasa previa in one pregnancy may be at risk for recurrence in subsequent pregnancy and thus should be screened in future pregnancies. Further research should be done to explore and identify any risk factors for recurrence of vasa previa.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053360","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}
Acute aortic occlusion (AAO) is a rare vascular emergency with significant associated morbidity and mortality
Methods
This case report discusses a 39-year-old gentleman with methamphetamine-associated cardiomyopathy (MACM) who presented with bilateral lower limb ischaemia. A POCUS was performed to rapidly evaluate the patient on arrival, which demonstrated AAO. A literature review was conducted to identify similar cases where AAO was detected by POCUS.
Results
POCUS showed a left ventricular thrombus (LVT), an embolus in the distal abdominal aorta and no flow distal to the embolus, which is consistent with AAO. The patient was successfully reperfused and had a good outcome after a timely diagnosis and management.
Discussion
This case report outlines a rare pathology in an uncommon age group where POCUS can expedite diagnosis and management.
Conclusion
POCUS is a valuable tool, which can expedite and facilitate rapid revascularisation of AAO.
{"title":"Acute aortic occlusion: A point-of-care ultrasound case report","authors":"Erin Newman","doi":"10.1002/ajum.12404","DOIUrl":"10.1002/ajum.12404","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Acute aortic occlusion (AAO) is a rare vascular emergency with significant associated morbidity and mortality</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This case report discusses a 39-year-old gentleman with methamphetamine-associated cardiomyopathy (MACM) who presented with bilateral lower limb ischaemia. A POCUS was performed to rapidly evaluate the patient on arrival, which demonstrated AAO. A literature review was conducted to identify similar cases where AAO was detected by POCUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>POCUS showed a left ventricular thrombus (LVT), an embolus in the distal abdominal aorta and no flow distal to the embolus, which is consistent with AAO. The patient was successfully reperfused and had a good outcome after a timely diagnosis and management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This case report outlines a rare pathology in an uncommon age group where POCUS can expedite diagnosis and management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>POCUS is a valuable tool, which can expedite and facilitate rapid revascularisation of AAO.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 4","pages":"254-258"},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903771","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}
Iatrogenic and traumatic injuries to the femoral and saphenous nerves, and their branches are uncommon but can be a cause of clinically pertinent lower limb dysfunction and neuralgia. Despite this, direct sonographic imaging of these nerves is not commonly requested or performed.
Methods
A review of the literature regarding the detailed relative anatomy, sonographic technique to image these nerves and their branches and their normal and abnormal appearances was conducted.
Discussion
These nerves are often in the direct imaging field of many ultrasound examinations including the assessment of the groin and lower limb vasculature and musculoskeletal studies. They can become entrapped at certain points throughout their path, where particular attention should be provided to these nerves.
Conclusion
Improved knowledge regarding the sonographic imaging of the femoral and saphenous nerves and their branches can assist identification and discrimination between normal and abnormal appearances, and subsequent ultrasound-guided nerve blockades or radiofrequency ablations for pain management where required.
{"title":"Ultrasound imaging of the femoral and saphenous nerves","authors":"Michelle Fenech, Bridie Roche, Jerome Boyle","doi":"10.1002/ajum.12403","DOIUrl":"10.1002/ajum.12403","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Iatrogenic and traumatic injuries to the femoral and saphenous nerves, and their branches are uncommon but can be a cause of clinically pertinent lower limb dysfunction and neuralgia. Despite this, direct sonographic imaging of these nerves is not commonly requested or performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A review of the literature regarding the detailed relative anatomy, sonographic technique to image these nerves and their branches and their normal and abnormal appearances was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These nerves are often in the direct imaging field of many ultrasound examinations including the assessment of the groin and lower limb vasculature and musculoskeletal studies. They can become entrapped at certain points throughout their path, where particular attention should be provided to these nerves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Improved knowledge regarding the sonographic imaging of the femoral and saphenous nerves and their branches can assist identification and discrimination between normal and abnormal appearances, and subsequent ultrasound-guided nerve blockades or radiofrequency ablations for pain management where required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 4","pages":"229-241"},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bruno Antonio Zanfini, Agata Katia Patanella, Francesco Vassalli, Stefano Catarci, Marika Pane, Luciano Frassanito, Matteo Biancone, Mariangela Di Muro, Chiara Bravetti, Eugenio Maria Mercuri, Mario Sabatelli, Gaetano Draisci
Introduction/Purpose
Nusinersen, the first treatment approved for all spinal muscular atrophy (SMA) types, is administered intrathecally through lumbar puncture. We used ultrasound assistance or a landmark-based technique to access the lumbar intrathecal space in adult SMA patients. This study aimed to evaluate the technical success and adverse events (AEs) in such patients using either technique over a long observation period.
Methods
Fifty-one adult patients received 507 consecutive interlaminar nusinersen administrations. Patients presented with both ‘uncomplicated spines’ or ‘complicated spines’; two patients had previous back surgery. Technical success and AEs were recorded using either technique. A generalised linear mixed model was applied to evaluate predictors of technical success and complications.
Results
An overall success rate of 99.6%, with only two procedures failing to reach the intrathecal space, and an overall optimal procedure rate of 90.3% have been reported. A total of 455 procedures (89.7%) were uneventfully performed. One (0.2%) case of severe AE (puncture of a bulky abdominal annexal cyst) was recorded. Twenty-seven episodes (5.3%) of post-dural puncture headache (PDPH) and 24 episodes (4.7%) of radicular or back pain, both successfully treated with medical therapy, have also been reported. Technical success was significantly associated with ‘complicated spines’ (P = 0.022) and the use of ultrasound assistance (P = 0.01), and the use of ultrasound was the only independent predictor of uncomplicated procedures (P = 0.007).
Discussion
In adult patients with SMA both landmark-based and ultrasound-assisted techniques are safe and effective even in the long term. The use of assistance is associated with technical success and can predict uncomplicated procedures.
Conclusion
Our results support the use of ultrasonography in order to improve the success and reduce the burden of nusinersen intrathecal administration.
{"title":"Ultrasound-assisted and landmark-based nusinersen delivery in spinal muscular atrophy adults: A retrospective analysis","authors":"Bruno Antonio Zanfini, Agata Katia Patanella, Francesco Vassalli, Stefano Catarci, Marika Pane, Luciano Frassanito, Matteo Biancone, Mariangela Di Muro, Chiara Bravetti, Eugenio Maria Mercuri, Mario Sabatelli, Gaetano Draisci","doi":"10.1002/ajum.12401","DOIUrl":"10.1002/ajum.12401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction/Purpose</h3>\u0000 \u0000 <p>Nusinersen, the first treatment approved for all spinal muscular atrophy (SMA) types, is administered intrathecally through lumbar puncture. We used ultrasound assistance or a landmark-based technique to access the lumbar intrathecal space in adult SMA patients. This study aimed to evaluate the technical success and adverse events (AEs) in such patients using either technique over a long observation period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty-one adult patients received 507 consecutive interlaminar nusinersen administrations. Patients presented with both ‘uncomplicated spines’ or ‘complicated spines’; two patients had previous back surgery. Technical success and AEs were recorded using either technique. A generalised linear mixed model was applied to evaluate predictors of technical success and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>An overall success rate of 99.6%, with only two procedures failing to reach the intrathecal space, and an overall optimal procedure rate of 90.3% have been reported. A total of 455 procedures (89.7%) were uneventfully performed. One (0.2%) case of severe AE (puncture of a bulky abdominal annexal cyst) was recorded. Twenty-seven episodes (5.3%) of post-dural puncture headache (PDPH) and 24 episodes (4.7%) of radicular or back pain, both successfully treated with medical therapy, have also been reported. Technical success was significantly associated with ‘complicated spines’ (P = 0.022) and the use of ultrasound assistance (P = 0.01), and the use of ultrasound was the only independent predictor of uncomplicated procedures (P = 0.007).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In adult patients with SMA both landmark-based and ultrasound-assisted techniques are safe and effective even in the long term. The use of assistance is associated with technical success and can predict uncomplicated procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results support the use of ultrasonography in order to improve the success and reduce the burden of nusinersen intrathecal administration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 4","pages":"210-217"},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajum.12401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141646794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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