Ultrasound Journal最新文献

Background: The efficacy of bedside chest ultrasonography for the detection and diagnosis of pneumothorax is under debate. We aimed to compare Emergency Healthcare Workers performed chest ultrasonography with chest X-ray in the detection and diagnosis of pneumothorax in the emergency department.

Methods: We queried PubMed, Cochrane, ScienceDirect, Web of Science and ClinicalTrials.gov databases from 2000 through January 2024. We included all studies (both retrospective and prospective) that compared the diagnostic performance of chest ultrasonography with chest radiography, using chest computed tomography as the gold standard. Participants are patients consulting in the emergency department and physician that performed the chest ultrasound was an Emergency Healthcare Workers. Studies reporting the sensitivity and specificity for both chest ultrasonography and chest X-ray met inclusion criteria. We applied a random effects meta-analysis methodology. We then performed a meta-regression analysis to search for influencing variables such as technical parameters of echograph, patients and pneumothorax.

Main results: 15 studies totaling 3,171 patients were analyzed. 71% of patients were male with a mean age of 40.2 years. The mean prevalence of pneumothorax was 27.6% (95 CI 20.9 to 34.3). Chest ultrasonography had higher sensitivity (79.4%, 68.2 to 90.7) compared to chest X-ray (48.1%, 36.8 to 59.4), and a greater negative predictive value (chest ultrasonography = 94.3%, 91.2 to 97.3, and chest X-ray = 87.9%, 84.1 to 91.6). There was no statistical difference in specificity between the two modalities: chest ultrasonography 99.5%, 99 to 100 and chest X-ray 99.8%, 99.4 to 100) or in positive predictive value (chest ultrasonography 94.2%, 90.5 to 97.9 vs chest X-ray 96.7%,92 to 100). Characteristics of echograph or pneumothorax and patients sociodemographic did not influence results.

Conclusion: In this systematic review and meta-analysis, chest ultrasonography performed by Emergency Healthcare Workers, had greater sensitivity and negative predictive value than chest radiography for the diagnosis of pneumothorax in emergency department patients.

Background: Tele-ultrasound is known to offer potential benefits such as improved access and cost efficiency, but concerns still exist about image quality, operator skill, and data security. This study aimed to determine whether remotely supervised ultrasound is inferior to traditional in-centre ultrasound with an in-person imaging specialist regarding patient care quality, service quality, and access to care.

Methods: A systematic search for a critical appraisal of relevant peer-reviewed published literature, as well as a jurisdictional scan of relevant regulations and standards in other Canadian jurisdictions, was performed.

Results: Of the original 6051 discrete records identified through the search, 18 studies were selected for inclusion in the review. They originated from 11 countries, and the patient populations spanned infants, children, adults, and pregnant women. The medical applications were echocardiography (including fetal), obstetrical ultrasound, breast ultrasound, thyroid ultrasound, and abdominal ultrasound. The distance between the tele-ultrasound site and the reference site ranged from 23 to 365 km, or a 30 to 45-min drive. In 3 studies, tele-ultrasound images were acquired in one country (India, Peru) and interpreted in another (US or UK). The majority of studies reported good diagnostic accuracy (the proportion of agreement between tele-ultrasound and in-centre ultrasound ranged from 43.4% to 100%, sensitivity ranged from 43% to 97%, and specificity ranged from 77.4% to 100% across studies and tele-ultrasound application). Details are displayed in Supplementary Table 2. There was limited evidence on patients' and providers' perspectives on tele-ultrasound, but in the studies identified, more than half of the patients surveyed felt that tele-ultrasound was acceptable. Additionally, all comments from providers were positive, including their perspectives on the value of tele-ultrasound. The image quality results were mixed. Some studies found that image quality ranged from at least sufficient quality for diagnosis to excellent. However, some other studies reported inadequate image quality in up to 36.8% of cases. It is possible that this range of responses may be due to the varying technical ability/capacity of local tele-ultrasound systems to acquire and transmit images to a remote reader. Cost savings associated with tele-ultrasound were also reported and attributed mainly to travel costs for patients.

Conclusion: There is no consistent evidence that tele-ultrasound is inferior to in-centre ultrasound, although further high-quality studies are needed.

Background: Increase in body mass index (BMI) is a risk factor for idiopathic intracranial hypertension (IIH). The matter of body weight and intracranial pressure (ICP) in clinically asymptomatic obese patients is unknown. We aimed at studying the relationship of ICP and BMI pre- and post-surgery in obese patients undergoing bariatric surgery.

Methods: Patients with a BMI > 35 kg/m², qualified for bariatric surgery and without clinical signs of IIH were prospectively and consecutively included. The optic nerve sheath diameter (ONSD) and a combined transcranial Doppler-arterial blood pressure (TCD&ABP-ICP) method were used to non-invasively determine the ICP (nICP) pre- and post-surgery (six months after surgery when weight loss had stabilized). ONSD > 5.8 mm and nICP > 25cmH₂O were assumed as pathologically increased. A nICP between > 20 and ≤ 25 cmH2O was assumed as being in the borderline.

Results: 54 patients (43 female; 44 ± 11 years old) were included. Pre-surgery BMI (46 ± 6 kg/m²) significantly declined after surgery (post-surgery BMI: 32 ± 6 kg/m2; paired t-test: p < 0.0001). Initial ONSD was 5.8 ± 0.6 mm (6 pathological values) which declined to 5.4 ± 0.6 mm (5 pathological values) (paired t-test: p < 0.025). TCD&ABP assessed nICP was 19 ± 4.5 cmH₂O (5 with pathological, 16 with borderline values) pre-surgically and declined to 14 ± 4 cmH₂O (no pathological, 1 high-normal value) after surgery (p < 0.0001).

Conclusion: Assuming the low incidence of IIH, the frequency of pathologic and borderline ICP values in obese patients was unexpectedly high. Reduction of ICP with weight loss followed a simple regression line pointing to a mechanistic effect of increased body weight on ICP. The constancy of pathologic ONSD values might be due to a fixed dilatation of the optic nerve sheath due to the duration of obesity.

Background: In patients presenting with atypical symptoms or low plasma β-HCG levels, the presence of an adnexal mass without a yolk sac or embryo on ultrasound often provides insufficient confidence for a definitive diagnosis of ectopic pregnancy(EP). Consequently, most such cases can only be classified as suspected EP. This study aimed to evaluate the diagnostic value of contrast enhanced ultrasound (CEUS) for tubal EP (tEP). We retrospectively analyzed 21 patients with suspected EP who underwent CEUS between August 2017 and August 2024. All patients had plasma β-HCG levels below 3500 mIU/mL. Among them, 20 underwent laparoscopic surgery, and all underwent curettage. The diagnostic performance of CEUS for tEP was assessed.

Results: A total of 21 patients were included: 19 with tEP, 1 with ovarian pregnancy, and 1 with intrauterine pregnancy. The sensitivity, specificity, and accuracy of transvaginal ultrasound (TVUS) for diagnosing tubal dilation were 15.8%, 100%, and 23.8%, respectively. For CEUS, these values were 94.7%, 100%, and 95.2%, respectively. Statistically significant differences were observed between CEUS and TVUS in sensitivity and accuracy (P = 0.000). The enhancement pattern of villous tissue was categorized as either circular or non-circular. Among the tEP cases, 2 exhibited circular enhancement and 17 showed non-circular enhancement. Based on positive β-HCG, absence of an intrauterine gestational sac, and sonographic visualization of a dilated fallopian tube containing either circular or non-circular enhancement internally, CEUS demonstrated high diagnostic accuracy for tEP diagnosis in cases with low β-HCG levels. CEUS correctly diagnosed 18 of 19 tEP cases. One tEP case was diagnosed as a mass of uncertain significance. The intrauterine pregnancy case was misdiagnosed as an EP. The ovarian pregnancy case was diagnosed as EP, though CEUS indicated a relatively high possibility of ovarian origin.

Conclusion: In conclusion, CEUS holds significant diagnostic value for tEP. It is particularly useful in diagnostically unclear cases and provides a more detailed assessment of the internal structure of adnexal masses.

Background: Point-of-care ultrasound (POCUS) has become indispensable in various medical specialties. The integration of artificial intelligence (AI) and machine learning (ML) holds significant promise to enhance POCUS capabilities further. However, a comprehensive understanding of healthcare professionals' perspectives on this integration is lacking.

Objective: This study aimed to investigate the global perceptions, familiarity, and adoption of AI in POCUS among healthcare professionals.

Methods: An international, web-based survey was conducted among healthcare professionals involved in POCUS. The survey instrument included sections on demographics, familiarity with AI, perceived utility, barriers (technological, training, trust, workflow, legal/ethical), and overall perceptions regarding AI-assisted POCUS. The data was analysed by descriptive statistics, frequency distributions, and group comparisons (using chi-square/Fisher's exact test and t-test/Mann-Whitney U test).

Results: This study surveyed 1154 healthcare professionals on perceived barriers to implementing AI in point-of-care ultrasound. Despite general enthusiasm, with 81.1% of respondents expressing agreement or strong agreement, significant barriers were identified. The most frequently cited single greatest barriers were Training & Education (27.1%) and Clinical Validation & Evidence (17.5%). Analysis also revealed that perceptions of specific barriers vary significantly based on demographic factors, including region of practice, medical specialty, and years of healthcare experience.

Conclusion: This novel global survey provides critical insights into the perceptions and adoption of AI in POCUS. Findings highlight considerable enthusiasm alongside crucial challenges, primarily concerning training, validation, guidelines, and support. Addressing these barriers is essential for the responsible and effective implementation of AI in POCUS.

Microcirculation plays a crucial role in maintaining normal physiological functions in the human body by facilitating the exchange of materials between tissues and blood through a network of microvessels with diameters less than 100 μm. It regulates local hemodynamics and participates in important pathophysiological processes, such as inflammatory reactions and immune responses. In recent years, the monitoring of super-resolution ultrasound (SRUS) in microcirculation has significantly enhanced our understanding of microvascular structure and function, while also providing insights into the noninvasive evaluation of organ conditions at the micro-level, thereby promoting the diagnosis and treatment of related diseases. This review summarizes the development and clinical application progress of SRUS, offering valuable insights into future research directions.

Background: The measurement of the optic nerve sheath diameter (ONSD) via ultrasound is a non-invasive technique to estimate intracranial pressure. Brief training has been shown to be effective in accurately teaching the ONSD technique in specialized healthcare providers. This study evaluates the ability of medical and nursing students, Intensive Care Unit (ICU) nurses, and ICU residents to perform ONSD measurements after a brief training.

Methods: Forty participants underwent a 4-h training session consisting of 30 min of lecture focusing on the key principles of the technique for ONSD measurement, followed by at least 20 measurements with an expert tutor. Thereafter, all participants assessed 5 ONSD measurements on healthy volunteers and their assessments were compared to those by the expert tutor.

Results: All participants successfully visualized the optic nerve and recorded similar values among groups (p > 0.05 for all comparisons). ICU nurse residents and medical students demonstrated a good accuracyof measurements, as defined by an upper and lower limits of agreement with the expert tutor not exceeding 0.5 mm in the Bland-Altman analysis. On the opposite, nurse students had the highest error rates and poor accuracy in ONSD assessment.

Conclusions: These findings highlight the feasibility of training medical students, ICU nurses and residents in ONSD measurement, opening the possibility of a wider application of this technique. After dedicated training, ONSD assessment and monitoring could be performed not only by specialists but also by other healthcare providers, including specialized nurses. This may serve as an additional tool for the rapid triage of patients, even in out-of-hospital settings.