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Correlation between right atrial pressure measured via right heart catheterization and venous excess ultrasound, inferior vena cava diameter, and ultrasound-measured jugular venous pressure: a prospective observational study. 右心导管测量右房压与静脉超声过量、下腔静脉直径和超声测量颈静脉压的相关性:一项前瞻性观察研究。
IF 3.4 Q2 Medicine Pub Date : 2024-11-29 DOI: 10.1186/s13089-024-00397-y
Suppawee Klangthamneam, Krissada Meemook, Tananchai Petnak, Anchana Sonkaew, Taweevat Assavapokee

Background: Venous congestion is associated with adverse cardiovascular outcomes, necessitating accurate venous pressure assessment. Current methods, such as right heart catheterization (RHC), have limitations. Non-invasive techniques, including venous excess ultrasound (VExUS), inferior vena cava (IVC) assessment, and ultrasound-measured jugular venous pressure (uJVP), show promise but require validation in diverse populations.

Aims: We aimed to assess the correlation between right atrial pressure (RAP) via RHC and non-invasive methods, including VExUS, IVC diameter with collapsibility index (CI) by American Society of Echocardiography (ASE) classification, and uJVP.

Methods: In a prospective study involving 73 patients undergoing RHC, we evaluated the correlation between RAP and VExUS, IVC CI by ASE classification, and uJVP. We introduced and compared a modified VExUS grading system.

Results: VExUS significantly correlated with RAP (p < 0.001), especially between VExUS grade 0 and grade 3. RAP significantly differed across IVC classifications by ASE (P < 0.001). VExUS grade 0 correlated with IVC class 1, and VExUS grade 3 correlated with IVC class 3. The modified VExUS grading system improved low and high RAP differentiation. uJVP exhibited a robust, highly significant positive correlation with invasively measured RAP (ρ = 0.67, P < 0.001).

Conclusion: This study establishes a strong correlation between non-invasive ultrasound measurements (VExUS, IVC diameter with CI, and uJVP) and invasively measured RAP. These findings underscore the clinical potential of these non-invasive techniques in venous congestion assessment and patient risk stratification.

背景:静脉充血与不良心血管结果相关,因此需要准确的静脉压评估。目前的方法,如右心导管(RHC),有局限性。非侵入性技术,包括静脉超声过量(VExUS)、下腔静脉(IVC)评估和超声测量颈静脉压(uJVP),显示出希望,但需要在不同人群中验证。目的:我们旨在通过RHC评估右房压(RAP)与无创方法的相关性,包括VExUS、美国超声心动图学会(ASE)分类的下腔静脉直径与折陷指数(CI)和uJVP。方法:在一项涉及73例RHC患者的前瞻性研究中,我们评估RAP与VExUS、IVC CI(按ASE分类)和uJVP的相关性。我们介绍并比较了改进后的VExUS分级系统。结论:本研究建立了无创超声测量(VExUS、IVC直径与CI、uJVP)与有创RAP之间的强相关性。这些发现强调了这些非侵入性技术在静脉充血评估和患者风险分层中的临床潜力。
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引用次数: 0
VExUS: common misconceptions, clinical use and future directions. VExUS:常见误解、临床应用和未来方向。
IF 3.4 Q2 Medicine Pub Date : 2024-11-26 DOI: 10.1186/s13089-024-00395-0
Philippe Rola, Korbin Haycock, Rory Spiegel, William Beaubien-Souligny, Andre Denault

There has been a significant interest in venous congestion in recent years, among which the VExUS score has been prominent, both in clinical practice and research efforts. We have noted some recurrent misconceptions among clinicians which are also reflected in certain research efforts. Notably, the misguided attempt to correlate VExUS to volume status, which is only one of the factors influencing it, as well as attempts to re-interpret VExUS in the context of certain pathologies, which reflects a fundamental misunderstanding of its circulatory perspective. In this article we review the physiological basis of the VExUS assessment as a measure and marker of venous congestion from the organs' standpoint and its role as part of the emerging concept of fluid tolerance, in hopes to address these misconceptions for clinicians and for important further studies.

近年来,人们对静脉充血问题产生了浓厚的兴趣,其中 VExUS 评分在临床实践和研究工作中都非常突出。我们注意到临床医生中经常出现的一些误解,这些误解也反映在某些研究工作中。值得注意的是,有人错误地试图将 VExUS 与血容量状态相关联,而这只是影响 VExUS 的因素之一,还有人试图在某些病理情况下重新解释 VExUS,这反映了对其循环角度的根本误解。在这篇文章中,我们从器官的角度回顾了 VExUS 评估作为静脉充血测量和标记的生理基础,以及它作为新出现的液体耐受性概念一部分的作用,希望能为临床医生和重要的进一步研究消除这些误解。
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引用次数: 0
Decoding VExUS: a practical guide for excelling in point-of-care ultrasound assessment of venous congestion. 解码 VExUS:卓越的护理点静脉充血超声评估实用指南。
IF 3.4 Q2 Medicine Pub Date : 2024-11-19 DOI: 10.1186/s13089-024-00396-z
Taweevat Assavapokee, Philippe Rola, Nicha Assavapokee, Abhilash Koratala

Venous congestion, often associated with elevated right atrial pressure presents a clinical challenge due to its varied manifestations and potential organ damage. Recognizing the manifestations of venous congestion through bedside physical examination or laboratory tests can be challenging. Point-of-care ultrasound (POCUS) is emerging as a valuable bedside tool for assessing venous congestion, with the Venous Excess Ultrasound (VExUS) technique gaining prominence. VExUS facilitates non-invasive quantification of venous congestion, relying on measurements of the inferior vena cava (IVC) size and Doppler assessments of the hepatic vein (HV), portal vein (PV), and intrarenal vein, thereby providing real-time insights into hemodynamic status and guiding therapeutic interventions. The grading system outlined in VExUS aids in stratifying the severity of congestion. However, achieving proficiency in VExUS requires a comprehensive understanding of Doppler techniques and their clinical applications. This review article provides practical guidance on performing VExUS, encompassing equipment requirements, preparation, machine settings, and examination techniques for assessing the inferior vena cava (IVC), hepatic vein (HV), portal vein (PV), and intrarenal vein. Potential pitfalls and troubleshooting strategies are discussed to ensure accurate interpretation of Doppler waveforms.

静脉充血通常与右心房压力升高有关,由于其表现形式多种多样并可能造成器官损伤,因此给临床带来了挑战。通过床旁体格检查或实验室检查来识别静脉充血的表现具有挑战性。床旁超声(POCUS)正在成为评估静脉充血的重要床旁工具,其中静脉过度超声(VExUS)技术日益受到重视。VExUS 依靠测量下腔静脉 (IVC) 大小和肝静脉 (HV)、门静脉 (PV) 及肾内静脉的多普勒评估,可对静脉充血进行无创量化,从而实时了解血液动力学状态并指导治疗干预。VExUS 中概述的分级系统有助于对充血的严重程度进行分层。然而,要熟练掌握 VExUS 需要对多普勒技术及其临床应用有全面的了解。这篇综述文章为进行 VExUS 提供了实用指导,包括设备要求、准备工作、机器设置以及评估下腔静脉 (IVC)、肝静脉 (HV)、门静脉 (PV) 和肾内静脉的检查技术。还讨论了潜在的误区和故障排除策略,以确保准确解读多普勒波形。
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引用次数: 0
Tele-education in point-of-care ultrasound training. 护理点超声波培训中的远程教育。
IF 3.4 Q2 Medicine Pub Date : 2024-10-28 DOI: 10.1186/s13089-024-00394-1
Reina Suzuki, William J Riley, Matthew S Bushman, Yue Dong, Hiroshi Sekiguchi

Background: Traditionally, ultrasound skills have been taught through a one-on-one approach, where instructors physically guide learners' hands at the bedside or in the workshop. However, this method is frequently challenged by scheduling and cost limitations. Our objective was to create a tele-education model for point-of-care ultrasound training and evaluate its effectiveness and its impact on learners' perceived workload compared to conventional education and self-directed learning methods.

Methods: We conducted a 3-arm randomized trial, comparing tele-education (TE), conventional education (CE) and self-directed learning (SL) methods. All subjects underwent online didactic lectures prior to a hands-on ultrasound workshop. The TE group utilized an ultrasound machine equipped with a speakerphone, a webcam for direct visualization of learner's hand maneuvers, and an analog-to-video converter for the real-time streaming of ultrasound images. This configuration enabled remote instructors to provide immediate verbal feedback to learners. In contrast, the CE group received in-person coaching, while the SL group had no instructors present. Following the coaching session, subjects completed a scenario-based skill test and a survey on the National Aeronautics and Space Administration task load index (NASA-TLX) to measure their ultrasound competency and perceived workload, respectively.

Results: Twenty-seven ultrasound novices were randomly allocated into 3 groups. The median skill test score of TE, CE, and SL was 22 [interquartile range (IQR): 18-28], 24 [IQR: 21-31], and 16 [IQR: 15-18], respectively (p < 0.01). Pairwise comparisons of median test scores of 3 groups demonstrated a statistical significance in comparisons of TE vs. SL (22 vs. 16, p = 0.01) and CE vs. SL (24 vs. 16, p < 0.01), but not in TE vs. CE (22 vs. 24, p = 0.56). There was no statistical significance observed in the median NASA-TLX scores among the 3 groups; 54 [IQR:47-61] in TE, 57 [IQR:22-64] in CE, and 66 [IQR: 66-72] in SL (p = 0.05).

Conclusions: Our tele-education model was more effective than self-directed learning. There was no statistically significant difference in effectiveness between the tele-education and the conventional education groups. Importantly, tele-education did not impose a significantly higher workload on learners compared to conventional education or self-directed learning. Tele-education has a substantial potential as an alternative to conventional ultrasound training.

背景:传统上,超声波技能是通过一对一的方式传授的,即指导员在床边或车间里亲自指导学员操作。然而,这种方法经常受到时间安排和成本的限制。我们的目标是创建一种远程教育模式,用于护理点超声波培训,并评估其效果以及与传统教育和自主学习方法相比对学习者感知工作量的影响:我们进行了一项三臂随机试验,比较了远程教育(TE)、传统教育(CE)和自主学习(SL)方法。所有受试者在参加超声波实践研讨会之前都要接受在线授课。TE组使用的超声波机配备了免提电话、用于直接观察学员手部操作的网络摄像头,以及用于实时流式传输超声波图像的模拟视频转换器。这种配置使远程教师能够向学员提供即时的口头反馈。相比之下,CE 组接受的是面对面的指导,而 SL 组则没有指导人员在场。辅导课结束后,受试者完成了基于场景的技能测试和美国国家航空航天局任务负荷指数(NASA-TLX)调查,以分别测量他们的超声能力和感知工作量:27 名超声波新手被随机分为 3 组。TE、CE和SL的技能测试得分中位数分别为22[四分位间距(IQR):18-28]、24[四分位间距(IQR):21-31]和16[四分位间距(IQR):15-18]:我们的远程教育模式比自主学习更有效。远程教育组和传统教育组在效果上没有明显的统计学差异。重要的是,与传统教育或自主学习相比,远程教育并没有给学习者带来明显更高的工作量。远程教育作为传统超声培训的一种替代方式,具有很大的潜力。
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引用次数: 0
Quantitative lung ultrasound findings correlate with radial alveolar count in experimental bronchopulmonary dysplasia. 肺部定量超声波检查结果与实验性支气管肺发育不良的径向肺泡数相关。
IF 3.4 Q2 Medicine Pub Date : 2024-10-28 DOI: 10.1186/s13089-024-00389-y
Chiara Catozzi, Angelo Modena, Matteo Storti, Francesca Ricci, Gino Villetti, Daniele De Luca

We investigated the relationship between the degree of alveolarization and ultrasound-assessed lung aeration in a validated preterm rabbit model of experimental bronchopulmonary dysplasia (BPD). Lung ultrasound findings were heterogeneously abnormal and consisted of zones with interstitial, interstitial-alveolar or consolidated patterns. The median radial alveolar count was 10.1 [8.4-11.5], 7.8 [6.1-9] and 7.3 [1.8-10.1] in rabbits with interstitial, interstitial-alveolar or consolidated ultrasound pattern, respectively (overall p = 0.036). Alveolar count and lung ultrasound score were significantly correlated (ρ = - 0.044 (95%CI: - 1; - 0.143), p = 0.009; τ-b = - 0.362 (95%CI: - 0.6; - 0.1), p = 0.017).

我们研究了实验性支气管肺发育不良(BPD)早产兔模型中肺泡化程度与超声评估的肺通气性之间的关系。肺部超声波检查结果呈现异质性异常,包括间质区、间质-肺泡区或合并区。间质型、间质-肺泡型或合并型兔子的径向肺泡数中位数分别为 10.1 [8.4-11.5]、7.8 [6.1-9]和 7.3 [1.8-10.1](总 p = 0.036)。肺泡计数与肺部超声评分呈显著相关性(ρ = - 0.044 (95%CI: - 1; - 0.143), p = 0.009; τ-b = - 0.362 (95%CI: - 0.6; - 0.1), p = 0.017)。
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引用次数: 0
Comparison of 6 handheld ultrasound devices by point-of-care ultrasound experts: a cross-sectional study. 护理点超声专家对 6 种手持式超声设备的比较:一项横断面研究。
IF 3.4 Q2 Medicine Pub Date : 2024-10-02 DOI: 10.1186/s13089-024-00392-3
Ariadna Perez-Sanchez, Gordon Johnson, Neysan Pucks, Riya N Soni, Terry J S Lund, Anthony J Andrade, Minh-Phuong T Le, Jessica Solis-McCarthy, Tanping Wong, Arsal Ashraf, Andre D Kumar, Gisela I Banauch, James R Verner, Amik Sodhi, Meghan K Thomas, Charles LoPresti, Hannah Schmitz, Abhilash Koratala, John Hunninghake, Erik Manninen, Carolina Candotti, Taro Minami, Benji K Mathews, Ghassan Bandak, Harald Sauthoff, Henry Mayo-Malasky, Joel Cho, Nick Villalobos, Kevin C Proud, Brandon Boesch, Federico Fenton Portillo, Kreegan Reierson, Manpreet Malik, Firas Abbas, Tim Johnson, Elizabeth K Haro, Michael J Mader, Paul Mayo, Ricardo Franco-Sadud, Nilam J Soni

Background: Point-of-care ultrasound (POCUS) has emerged as an essential bedside tool for clinicians, but lack of access to ultrasound equipment has been a top barrier to POCUS use. Recently, several handheld ultrasound devices ("handhelds") have become available, and clinicians are seeking data to guide purchasing decisions. Few comparative studies of different handhelds have been done. We conducted a cross-sectional study comparing 6 handhelds readily available in the United States (Butterfly iQ +  by Butterfly Network Inc.; Clarius by Clarius Mobile Health; Kosmos by EchoNous; TE Air by Mindray; Vscan Air SL and CL by General Electric; and Lumify by Philips Healthcare). A multi-specialty group of physician POCUS experts (n = 35) acquired three standard ultrasound views (abdominal right upper quadrant, cardiac apical 4-chamber, and superficial neck and lung views) in random order on the same standardized patients and rated the image quality. Afterward, a final survey of the overall ease of use, image quality, and satisfaction of each handheld was completed.

Results: Thirty-five POCUS experts specializing in internal medicine/hospital medicine, critical care, emergency medicine, and nephrology acquired and rated right upper quadrant, apical 4-chamber, and superficial neck and lung views with 6 different handhelds. For image quality, the highest-rated handhelds were Vscan Air for the right upper quadrant view, Mindray TE Air for the cardiac apical 4-chamber view, and Lumify for superficial views of the neck and lung. Overall satisfaction with image quality was highest with Vscan Air, Lumify, and Mindray, while overall satisfaction with ease of use was highest with Vscan Air. The 5 most desirable characteristics of handhelds were image quality, ease of use, portability, probe size, and battery life. Ultimately, all 6 handhelds had notable advantages and disadvantages, with no single device having all desired qualities or features.

Conclusions: The overall satisfaction with image quality was rated highest with Vscan Air, Lumify, and Mindray TE Airwhen acquiring right upper quadrant, apical 4-chamber, and superficial neck and lung views. No single handheld was perceived to be superior in image quality for all views. Vscan Air was rated highest for overall ease of use and was the most preferred handheld for purchase by POCUS experts.

背景:床旁超声(POCUS)已成为临床医生必不可少的床旁工具,但无法获得超声设备一直是使用 POCUS 的首要障碍。最近,市场上出现了几种手持式超声设备("手持式"),临床医生正在寻求数据来指导购买决策。关于不同手持设备的比较研究很少。我们进行了一项横断面研究,比较了美国现售的六种手持式设备(Butterfly Network Inc.公司的 Butterfly iQ + ™;Clarius Mobile Health 公司的 Clarius™;EchoNous 公司的 Kosmos™;Mindray 公司的 TE Air™;通用电气公司的 Vscan Air™ SL 和 CL;以及飞利浦医疗保健公司的 Lumify™)。一个由 POCUS 专家组成的多专业医师小组(n = 35)在同一标准化患者身上按随机顺序采集了三个标准超声视图(腹部右上象限、心尖四腔、颈部浅表和肺部视图),并对图像质量进行了评分。随后,对每种手持设备的整体易用性、图像质量和满意度进行了最终调查:结果:35 位内科/医院内科、重症监护、急诊医学和肾脏内科的 POCUS 专家使用 6 种不同的手持设备获取了右上象限、心尖四腔、颈部浅表和肺部视图,并进行了评分。就图像质量而言,评分最高的手持设备是用于右上象限切面的 Vscan Air™、用于心尖四腔切面的 Mindray TE Air™,以及用于颈部和肺部浅表切面的 Lumify™。对 Vscan Air™、Lumify™ 和 Mindray 图像质量的总体满意度最高,而对 Vscan Air™ 易用性的总体满意度最高。手持设备最理想的 5 个特性是图像质量、易用性、便携性、探头大小和电池寿命。最终,所有 6 种手持设备都有明显的优缺点,没有一种设备具备所有理想的质量或功能:结论:在获取右上象限、心尖四腔以及颈部和肺部浅切面时,Vscan Air™、Lumify™ 和 Mindray TE Air™ 的图像质量总体满意度最高。在所有切面中,没有任何一款手持设备的图像质量更优。Vscan Air™ 在整体易用性方面评分最高,是 POCUS 专家最喜欢购买的手持设备。
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引用次数: 0
Student ultrasound education, current view and controversies. Role of Artificial Intelligence, Virtual Reality and telemedicine. 学生超声波教育、当前观点和争议。人工智能、虚拟现实和远程医疗的作用。
IF 3.4 Q2 Medicine Pub Date : 2024-09-27 DOI: 10.1186/s13089-024-00382-5
Nils Daum, Michael Blaivas, Adrian Goudie, Beatrice Hoffmann, Christian Jenssen, Ricarda Neubauer, Florian Recker, Tudor Voicu Moga, Constantinos Zervides, Christoph Frank Dietrich

The digitization of medicine will play an increasingly significant role in future years. In particular, telemedicine, Virtual Reality (VR) and innovative Artificial Intelligence (AI) systems offer tremendous potential in imaging diagnostics and are expected to shape ultrasound diagnostics and teaching significantly. However, it is crucial to consider the advantages and disadvantages of employing these new technologies and how best to teach and manage their use. This paper provides an overview of telemedicine, VR and AI in student ultrasound education, presenting current perspectives and controversies.

未来几年,医学数字化将发挥越来越重要的作用。尤其是远程医疗、虚拟现实(VR)和创新的人工智能(AI)系统为影像诊断提供了巨大的潜力,预计将对超声诊断和教学产生重大影响。然而,考虑采用这些新技术的利弊以及如何最好地教授和管理其使用至关重要。本文概述了远程医疗、VR 和人工智能在学生超声教学中的应用,介绍了当前的观点和争议。
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引用次数: 0
Sonographic findings using the SAFE-A protocol in pre- and post-hemodialysis patients. 使用 SAFE-A 方案对血液透析前后患者进行超声检查的结果。
IF 3.4 Q2 Medicine Pub Date : 2024-08-27 DOI: 10.1186/s13089-024-00390-5
Matheus Rabahi, Maria Goretti Polito, Larissa Louise Cândida Pereira Takaoka, Marcus Barreto Conte, Philippe Figueiredo Braga Colares

Background: Accurate assessment of relative intravascular volume is one of the cornerstones for the proper management of hospitalized patients requiring hemodialysis. Currently, the use of dynamic parameters such as bedside ultrasonography is recommended to support the assessment of the intravascular volume profile. This study aimed to prospectively evaluate findings of sonographic assessment of intravascular volume estimate (SAFE-A) protocol among hemodialysis inpatients with end-stage renal disease, before and after the hemodialysis sessions, and correlate these findings with the net ultrafiltrate (UFNET).

Results: A positive correlation was found between the negative variation of 1 point in the score of the SAFE-A protocol with the withdrawal of 426.73 mL of net ultrafiltrate.

Conclusions: There was a strong correlation between the score of the SAFE-A protocol and the net ultrafiltrate. Therefore, this study concludes that the application of the SAFE-A protocol in dialysis patients demonstrates a correlation between the suggested score and volume status, consistent with findings from the original study conducted in a distinct population.

背景:准确评估血管内相对容量是正确管理需要血液透析的住院患者的基石之一。目前,建议使用床旁超声等动态参数来支持血管内容量情况的评估。本研究旨在前瞻性地评估终末期肾病血液透析患者在血液透析前后的血管内容量估算超声评估(SAFE-A)方案的结果,并将这些结果与超滤净量(UFNET)相关联:结果:SAFE-A 方案得分负差 1 分与净超滤量 426.73 毫升之间呈正相关:结论:SAFE-A 方案的得分与净超滤量之间存在很强的相关性。因此,本研究得出结论,在透析患者中应用 SAFE-A 方案显示了建议评分与血容量状态之间的相关性,这与在不同人群中进行的原始研究结果一致。
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引用次数: 0
Utilizing a balloon sheath and miniprobe for diagnostic endoscopic ultrasound in eosinophilic esophagitis: a case series. 利用球囊鞘和微型探针对嗜酸性粒细胞食管炎进行内窥镜超声诊断:一个病例系列。
IF 3.4 Q2 Medicine Pub Date : 2024-08-21 DOI: 10.1186/s13089-024-00380-7
Simon S Rabinowitz, Rheu Candava, Blair Kady, Dalia Arostegui, Evan Grossman

Background: Endoscopic ultrasound (EUS) is a unique example of POCUS, which allows the gastroenterologist to discuss subepithelial pathology immediately after an endoscopy. The challenges that are encountered to create an acoustic interface by adding free water during the endoscopy may be curtailing the full utilization of EUS during endoscopic procedures. Eosinophilic esophagitis (EoE) is a progressive inflammatory condition whose morbidity is related to esophageal wall remodeling. However, in clinical practice, in clinical guidelines, and in many trials, EoE outcomes are based on esophageal eosinophilia and symptoms. Hence, a method to identify and quantitate the thickening of the esophageal wall, could contribute to the management of this disease.

Results: A modification of the approach employed to perform EUS during bronchoscopy was developed. An EUS miniprobe was positioned inside of a water filled balloon sheath. This technique permitted rapid and reproducible images acquisition of the total esophageal wall and its sublayers (mucosa, and submucosa + submucosa, which permitted derivation of the muscle layer). The presented series describes the results from  22 consecutive EoE patients. A full set of measurements from both the mid and distal esophagus were achieved in all EoE patients in an average time of less than 10 minutes.

Conclusions: This pilot study supports further investigations evaluating this economical, convenient, and safe technique to follow EoE patients. In addition, this approach could be potentially employed in all patients who are found to have subepithelial gastrointestinal pathology during routine endoscopic procedures.

背景:内窥镜超声(EUS)是 POCUS 的一个独特实例,它允许消化内科医生在内窥镜检查后立即讨论上皮下病理。在内镜检查过程中加入自由水以创建声学界面所遇到的挑战可能会限制 EUS 在内镜手术中的充分利用。嗜酸性粒细胞食管炎(EoE)是一种进行性炎症,其发病率与食管壁重塑有关。然而,在临床实践、临床指南和许多试验中,EoE 的结果都是基于食管嗜酸性粒细胞增多和症状。因此,一种能识别和量化食管壁增厚的方法将有助于这种疾病的治疗:结果:对支气管镜检查期间进行 EUS 所采用的方法进行了改进。将 EUS 微型探针置于充水的球囊鞘内。这项技术可以快速、可重复地获取整个食管壁及其亚层(粘膜、粘膜下层+粘膜下层,从而可以提取肌肉层)的图像。本文介绍了 22 例连续性食管水肿患者的研究结果。在平均不到 10 分钟的时间内,对所有食管炎患者的食管中段和远段进行了全套测量:这项试验性研究支持对这一经济、方便、安全的技术进行进一步的调查评估,以便对呃逆患者进行随访。此外,在常规内窥镜手术中发现有胃肠道上皮下病变的所有患者都有可能采用这种方法。
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引用次数: 0
Transorbital B-mode ultrasound for the assessment of posterior globe flattening in idiopathic intracranial hypertension: a pilot study. 经眶B型超声波评估特发性颅内高压患者球后扁平:一项试验研究。
IF 3.4 Q2 Medicine Pub Date : 2024-08-19 DOI: 10.1186/s13089-024-00388-z
Theresia Knoche, Charlotte Pietrock, Konrad Neumann, Mirjam Rossel-Zemkouo, Leon Alexander Danyel

Background: Posterior globe flattening (PGF) is a specific neuroimaging sign in patients with idiopathic intracranial hypertension (IIH), but its detection is based on subjective qualitative neuroradiological assessment. This study sought to evaluate the utility of transorbital ultrasound to detect and quantify PGF in IIH patients using the Posterior Globe Angle (PGA).

Methods: Consecutive IIH patients and healthy controls were enrolled in a prospective case-control study. Transorbital ultrasound was performed to assess the presence of PGF. For quantification of PGF, an angular measurement (PGA) was performed with the vertex centering the optic nerve at a predefined distance from the lamina cribrosa and angle legs tangentially aligned to the borders of the vitreous body. PGA measurements were compared between IIH patients and healthy controls. Additionally, the diagnostic accuracy of PGA measurements in detecting PGF was evaluated using ROC analysis.

Results: Thirty-one IIH patients (37.3 ± 12.3 years, 29 female) and 28 controls (33.3 ± 11.8 years, 21 female) were compared. PGF was present in 39% of IIH patients and absent in the control group. PGA3mm measurements significantly differed between IIH and controls (116.5° ± 5.5 vs. 111.7° ± 2.9; p < 0.001). A PGA3mm cutoff of ≥ 118.5° distinguished IIH patients from controls with 100% specificity, while retaining a sensitivity of 37.5%.

Conclusions: Transorbital ultrasound may be applied to detect and quantify PGF in IIH patients. Prospective, multicenter studies with extended cohorts and blinded design are needed to validate these preliminary findings and confirm the diagnostic utility of transorbital ultrasound for the assessment of PGF in IIH.

背景:球后扁平(PGF)是特发性颅内高压(IIH)患者的一种特殊神经影像学征象,但其检测是基于神经放射学的主观定性评估。本研究旨在评估经眶超声利用球后角(PGA)检测和量化特发性颅内高压(IIH)患者 PGF 的实用性:方法: 一项前瞻性病例对照研究连续招募了 IIH 患者和健康对照者。进行经眶超声检查以评估是否存在 PGF。为量化 PGF,进行了角度测量(PGA),顶点以视神经为中心,与玻璃体边界相切。对 IIH 患者和健康对照组的 PGA 测量结果进行了比较。此外,还使用 ROC 分析评估了 PGA 测量在检测 PGF 方面的诊断准确性:比较了 31 名 IIH 患者(37.3 ± 12.3 岁,29 名女性)和 28 名对照组(33.3 ± 11.8 岁,21 名女性)。39%的IIH患者体内存在PGF,而对照组中则没有。PGA3mm测量值在IIH和对照组之间存在明显差异(116.5°±5.5 vs. 111.7°±2.9;P 3mm临界值≥118.5°可区分IIH患者和对照组,特异性为100%,灵敏度为37.5%):结论:经眶超声可用于检测和量化 IIH 患者的 PGF。结论:经眶超声可用于检测和定量 IIH 患者的 PGF。需要通过扩大队列和盲法设计的前瞻性多中心研究来验证这些初步发现,并确认经眶超声在评估 IIH 患者 PGF 方面的诊断效用。
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Ultrasound Journal
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