Pub Date : 2024-03-26eCollection Date: 2024-01-01DOI: 10.1055/a-2275-0702
Ricarda Neubauer, Claus Juergen Bauer, Christoph F Dietrich, Brigitte Strizek, Valentin Sebastian Schäfer, Florian Recker
Despite a large number of studies previously conducted on educational concepts of ultrasound teaching in medical school, various controversial issues remain. Currently, recommendations for ultrasound curricula that aim to standardize ultrasound teaching are frequently based on expert panel advice instead of relying on valid evidence-based literature. In December 2022, a systematic literature review on the subject of undergraduate ultrasound education was conducted. All ultrasound studies listed in the PubMed and Google Scholar medical databases were filtered and analyzed with respect to various aspects of their methodological conduct and curricular implementation. A total of 259 publications were considered in the data synthesis, including 145 teaching studies in the field of undergraduate ultrasound education. The latter encompassed 58 (40%) studies that did not compare their ultrasound training to a control group. Furthermore, 84 (58%) of these studies did not assess knowledge prior to the applied ultrasound training, neglecting this factor's potential influence on study outcomes. Despite a great interest in the development and further implementation of ultrasound education during medical school, this process is still compromised by significant deficiencies in studies that have been conducted in the past. In order to provide a valid basis for curricular decisions, teaching studies should fulfill essential methodological requirements despite the multifactorial framework in which they are conducted. In the future, a guide for the design of ultrasound studies could be a useful aid for ultrasound enthusiasts and promote scientific knowledge gain.
{"title":"Evidence-based Ultrasound Education? - A Systematic Literature Review of Undergraduate Ultrasound Training Studies.","authors":"Ricarda Neubauer, Claus Juergen Bauer, Christoph F Dietrich, Brigitte Strizek, Valentin Sebastian Schäfer, Florian Recker","doi":"10.1055/a-2275-0702","DOIUrl":"https://doi.org/10.1055/a-2275-0702","url":null,"abstract":"<p><p>Despite a large number of studies previously conducted on educational concepts of ultrasound teaching in medical school, various controversial issues remain. Currently, recommendations for ultrasound curricula that aim to standardize ultrasound teaching are frequently based on expert panel advice instead of relying on valid evidence-based literature. In December 2022, a systematic literature review on the subject of undergraduate ultrasound education was conducted. All ultrasound studies listed in the PubMed and Google Scholar medical databases were filtered and analyzed with respect to various aspects of their methodological conduct and curricular implementation. A total of 259 publications were considered in the data synthesis, including 145 teaching studies in the field of undergraduate ultrasound education. The latter encompassed 58 (40%) studies that did not compare their ultrasound training to a control group. Furthermore, 84 (58%) of these studies did not assess knowledge prior to the applied ultrasound training, neglecting this factor's potential influence on study outcomes. Despite a great interest in the development and further implementation of ultrasound education during medical school, this process is still compromised by significant deficiencies in studies that have been conducted in the past. In order to provide a valid basis for curricular decisions, teaching studies should fulfill essential methodological requirements despite the multifactorial framework in which they are conducted. In the future, a guide for the design of ultrasound studies could be a useful aid for ultrasound enthusiasts and promote scientific knowledge gain.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"10 ","pages":"a22750702"},"PeriodicalIF":1.3,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477173","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}
Pub Date : 2024-02-23eCollection Date: 2024-01-01DOI: 10.1055/a-2243-9625
Claudio Baracchini, Elsa Azevedo, Uwe Walter, João Sargento-Freitas, Branko Malojcic
Purpose To provide an overview on education, training, practice requirements, and fields of application of neurosonology in Europe and beyond. Materials and Methods National representatives and experts in neurosonology were surveyed regarding neurosonology requirements and practice in their countries. Descriptive statistics were used to report the data. Results Between February 1 and March 31, 2023, 42/46 (91.3%) national representatives responded to our questionnaire and the completion rate was 100%. Most countries (71.4%) offer a neurosonology training program during neurology residency, but it is part of the undergraduate medical program only in 30.9%. National certification is available in 47.6% of the countries surveyed and most countries (76.2%) require certification to practice. In 50% of the countries, candidates are assessed by a board examination, while in 26.2% they just need to document their practice. There is no formal accreditation of neurosonology centers in 78.6% of the countries surveyed. Only a few require certified personnel and appropriate equipment. Adequate teaching and research activities are only rarely necessary elements for laboratory accreditation. Conclusion Our results indicate that there is a substantial need for transnational harmonization of neurosonological standards to guarantee uniformity and quality of performance. This survey will also provide guidance to promote an international accrediting council and create a quality-controlled laboratory network for implementing neurosonology in clinical trials.
{"title":"Neurosonology Survey in Europe and Beyond.","authors":"Claudio Baracchini, Elsa Azevedo, Uwe Walter, João Sargento-Freitas, Branko Malojcic","doi":"10.1055/a-2243-9625","DOIUrl":"10.1055/a-2243-9625","url":null,"abstract":"<p><p><b>Purpose</b> To provide an overview on education, training, practice requirements, and fields of application of neurosonology in Europe and beyond. <b>Materials and Methods</b> National representatives and experts in neurosonology were surveyed regarding neurosonology requirements and practice in their countries. Descriptive statistics were used to report the data. <b>Results</b> Between February 1 and March 31, 2023, 42/46 (91.3%) national representatives responded to our questionnaire and the completion rate was 100%. Most countries (71.4%) offer a neurosonology training program during neurology residency, but it is part of the undergraduate medical program only in 30.9%. National certification is available in 47.6% of the countries surveyed and most countries (76.2%) require certification to practice. In 50% of the countries, candidates are assessed by a board examination, while in 26.2% they just need to document their practice. There is no formal accreditation of neurosonology centers in 78.6% of the countries surveyed. Only a few require certified personnel and appropriate equipment. Adequate teaching and research activities are only rarely necessary elements for laboratory accreditation. <b>Conclusion</b> Our results indicate that there is a substantial need for transnational harmonization of neurosonological standards to guarantee uniformity and quality of performance. This survey will also provide guidance to promote an international accrediting council and create a quality-controlled laboratory network for implementing neurosonology in clinical trials.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"10 ","pages":"a22439625"},"PeriodicalIF":3.2,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10921371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094790","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}
Francesco Giangregorio, Emilio Mosconi, Maria Grazia Debellis, Eliana Palermo, Stella Provini, Manuela Mendozza, Laura Ricevuti, Ciro Esposito
Purpose Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient's bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money. Materials and Methods 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC). Results HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros. Conclusion BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.
{"title":"Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The \"Bed Med-Us\" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients.","authors":"Francesco Giangregorio, Emilio Mosconi, Maria Grazia Debellis, Eliana Palermo, Stella Provini, Manuela Mendozza, Laura Ricevuti, Ciro Esposito","doi":"10.1055/a-2196-1599","DOIUrl":"https://doi.org/10.1055/a-2196-1599","url":null,"abstract":"<p><p><b>Purpose</b> Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient's bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money. <b>Materials and Methods</b> 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC). <b>Results</b> HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros. <b>Conclusion</b> BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"10 ","pages":"a21961599"},"PeriodicalIF":3.2,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10829908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673248","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}
Pub Date : 2023-10-05eCollection Date: 2023-01-01DOI: 10.1055/a-2173-3966
Benjamin Philipp Ernst, Carla Dörsching, Alessandro Bozzato, Jennis Gabrielpillai, Sven Becker, Matthias Frank Froelich, Benedikt Kramer, Christoph Sproll, Mirco Schapher, Miguel Goncalves, Naglaa Mansour, Benedikt Hofauer, Wieland H Sommer, Felix von Scotti, Johannes Matthias Weimer, Julian Künzel
Purpose Ultrasound examinations are often criticized for having higher examiner dependency compared to other imaging techniques. Compared to free-text reporting, structured reporting (SR) of head and neck sonography (HNS) achieves superior time efficiency as well as report quality. However, there are no findings concerning the influence of SR on the interrater reliability (IRR) of HNS. Materials and Methods Typical pathologies (n=4) in HNS were documented by video/images by two certified head and neck ultrasound instructors. Consequently, structured reports of these videos/images were created by n=9 senior physicians at departments of otolaryngology or maxillofacial surgery with DEGUM instructors on staff. Reports (n=36) were evaluated regarding overall completeness and IRR. Additionally, user satisfaction was assessed by a visual analog scale (VAS). Results SR yielded very high report completeness (91.8%) in all four cases with a substantial IRR (Fleiss' κ 0.73). Interrater agreement was high at 87.2% with very good user satisfaction (VAS 8.6). Conclusion SR has the potential to ensure high-quality examination reports with substantial comparability and very high user satisfaction. Furthermore, big data collection and analysis are facilitated by SR. Therefore, process quality, workflow, and scientific output are potentially enhanced by SR.
{"title":"Structured Reporting of Head and Neck Sonography Achieves Substantial Interrater Reliability.","authors":"Benjamin Philipp Ernst, Carla Dörsching, Alessandro Bozzato, Jennis Gabrielpillai, Sven Becker, Matthias Frank Froelich, Benedikt Kramer, Christoph Sproll, Mirco Schapher, Miguel Goncalves, Naglaa Mansour, Benedikt Hofauer, Wieland H Sommer, Felix von Scotti, Johannes Matthias Weimer, Julian Künzel","doi":"10.1055/a-2173-3966","DOIUrl":"10.1055/a-2173-3966","url":null,"abstract":"<p><p><b>Purpose</b> Ultrasound examinations are often criticized for having higher examiner dependency compared to other imaging techniques. Compared to free-text reporting, structured reporting (SR) of head and neck sonography (HNS) achieves superior time efficiency as well as report quality. However, there are no findings concerning the influence of SR on the interrater reliability (IRR) of HNS. <b>Materials and Methods</b> Typical pathologies (n=4) in HNS were documented by video/images by two certified head and neck ultrasound instructors. Consequently, structured reports of these videos/images were created by n=9 senior physicians at departments of otolaryngology or maxillofacial surgery with DEGUM instructors on staff. Reports (n=36) were evaluated regarding overall completeness and IRR. Additionally, user satisfaction was assessed by a visual analog scale (VAS). <b>Results</b> SR yielded very high report completeness (91.8%) in all four cases with a substantial IRR (Fleiss' κ 0.73). Interrater agreement was high at 87.2% with very good user satisfaction (VAS 8.6). <b>Conclusion</b> SR has the potential to ensure high-quality examination reports with substantial comparability and very high user satisfaction. Furthermore, big data collection and analysis are facilitated by SR. Therefore, process quality, workflow, and scientific output are potentially enhanced by SR.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"9 1","pages":"E26-E32"},"PeriodicalIF":3.2,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/e5/10-1055-a-2173-3966.PMC10556873.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41146766","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}
Pub Date : 2023-09-18eCollection Date: 2023-01-01DOI: 10.1055/a-2137-8318
Angeliki Rouvalis, Panagiotis Vlastarakos, Georgios Daskalakis, Abraham Pouliakis, Sofoklis Stavrou, Maria Tsiriva, Maria Giourga, Angeliki Gerede, Kalliopi Pappa, Themos Gregoriadis, Dimitrios-Efthymios Vlachos, Alexandros Rodolakis, Ekaterini Domali
Objective: The purpose of the study was to assess the efficacy of local ultrasound-guided methotrexate injection in patients with caesarean section scar pregnancy, to chart the course of beta-human chorionic gonadotropin levels (HCG) after treatment, and to see if HCG levels are correlated with clinical presentation.
Methods: Between May 2018 and January 2021, data were collected retrospectively from the Early Pregnancy Unit of a tertiary hospital.
Results: Our clinic assessed 20 patients; one disputed terminating the pregnancy and was not included in the research. The remaining 19 patients, with a median age of 34 years, received intragestational sac methotrexate injection under ultrasound guidance. 7w3d was the median gestational age. These women had one to four previous caesarean sections, with a mean of 1.60±9. Patients with caesarean scar pregnancy most typically presented with spotting (42.1%), whereas 26.3% were asymptomatic. Except in cases of pain, the symptomatic women's HCG levels were lower than in the non-symptomatic women. The level of HCG in patients with pain was approximately double that of non-pain patients (p=0.2557). In our series, intragestational sac methotrexate injection was effective in 17/19 women, or 89.5% (95%CI: 75.7-100%). HCG levels were undetectable in 97.6±30 days on average (minimum: 42 days, maximum: 147 days).
Conclusion: Caesarean scar pregnancy is a rare possibly fatal condition with no consensus on the optimal treatment. An experienced Early Pregnancy Unit member performing local methotrexate injections under ultrasound guidance is a feasible and successful strategy in clinically stable patients.
{"title":"Caesarean Scar Pregnancy: Single Dose of Intrasac Ultrasound-Guided Methotrexate Injection Seems to be a Safe Option for Treatment.","authors":"Angeliki Rouvalis, Panagiotis Vlastarakos, Georgios Daskalakis, Abraham Pouliakis, Sofoklis Stavrou, Maria Tsiriva, Maria Giourga, Angeliki Gerede, Kalliopi Pappa, Themos Gregoriadis, Dimitrios-Efthymios Vlachos, Alexandros Rodolakis, Ekaterini Domali","doi":"10.1055/a-2137-8318","DOIUrl":"10.1055/a-2137-8318","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of the study was to assess the efficacy of local ultrasound-guided methotrexate injection in patients with caesarean section scar pregnancy, to chart the course of beta-human chorionic gonadotropin levels (HCG) after treatment, and to see if HCG levels are correlated with clinical presentation.</p><p><strong>Methods: </strong>Between May 2018 and January 2021, data were collected retrospectively from the Early Pregnancy Unit of a tertiary hospital.</p><p><strong>Results: </strong>Our clinic assessed 20 patients; one disputed terminating the pregnancy and was not included in the research. The remaining 19 patients, with a median age of 34 years, received intragestational sac methotrexate injection under ultrasound guidance. 7w3d was the median gestational age. These women had one to four previous caesarean sections, with a mean of 1.60±9. Patients with caesarean scar pregnancy most typically presented with spotting (42.1%), whereas 26.3% were asymptomatic. Except in cases of pain, the symptomatic women's HCG levels were lower than in the non-symptomatic women. The level of HCG in patients with pain was approximately double that of non-pain patients (p=0.2557). In our series, intragestational sac methotrexate injection was effective in 17/19 women, or 89.5% (95%CI: 75.7-100%). HCG levels were undetectable in 97.6±30 days on average (minimum: 42 days, maximum: 147 days).</p><p><strong>Conclusion: </strong>Caesarean scar pregnancy is a rare possibly fatal condition with no consensus on the optimal treatment. An experienced Early Pregnancy Unit member performing local methotrexate injections under ultrasound guidance is a feasible and successful strategy in clinically stable patients.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"9 1","pages":"E18-E25"},"PeriodicalIF":1.3,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/3b/10-1055-a-2137-8318.PMC10506866.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41137172","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}
Maria Giourga, Abraham Pouliakis, Panagiotis Vlastarakos, Sofoklis Stavrou, Maria Tsiriva, Angeliki Gerede, Georgios Daskalakis, Charalampos Voros, Petros Drakakis, Ekaterini Domali
Objectives The discrimination of ovarian lesions presents a significant problem in everyday clinical practice with ultrasonography appearing to be the most effective diagnostic technique. The aim of our study was to externally evaluate the performance of different diagnostic models when applied by examiners with various levels of experience. Methods This was a diagnostic accuracy study including women who were admitted for adnexal masses, between July 2018 and April 2021, to a Greek tertiary oncology center. Preoperatively sonographic data were evaluated by an expert gynecologist, a 6 th and a 1 st year gynecology resident, who applied the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) and Assessment of Different NEoplasias in the adneXa (ADNEX) model to discriminate between benign and malignant ovarian tumors. The explant pathology report was used as the reference diagnosis. Kappa statistics were used for the investigation of the level of agreement between the examined systems and the raters. Results We included 66 women, 39 with benign and 27 with malignant ovarian tumors. ADNEX (with and without "CA-125") had high sensitivity (96-100%) when applied by all raters but a rather low specificity (36%) when applied by the 1st year resident. SR could not be applied in 6% to 17% of the cases. It had slightly lower sensitivity, higher specificity, and higher overall accuracy, especially when applied by the 1st year resident (61% vs. 92%), compared to ADNEX. Conclusion Both ADNEX and SR can be utilized for screening in non-oncology centers since they offer high sensitivity even when used by less experienced examiners. In the hands of inexperienced examiners, SR appears to be the best model for assessing ovarian lesions.
{"title":"Evaluation of IOTA-ADNEX Model and Simple Rules for Identifying Adnexal Masses by Operators with Varying Levels of Expertise: A Single-Center Diagnostic Accuracy Study.","authors":"Maria Giourga, Abraham Pouliakis, Panagiotis Vlastarakos, Sofoklis Stavrou, Maria Tsiriva, Angeliki Gerede, Georgios Daskalakis, Charalampos Voros, Petros Drakakis, Ekaterini Domali","doi":"10.1055/a-2044-2855","DOIUrl":"https://doi.org/10.1055/a-2044-2855","url":null,"abstract":"<p><p><b>Objectives</b> The discrimination of ovarian lesions presents a significant problem in everyday clinical practice with ultrasonography appearing to be the most effective diagnostic technique. The aim of our study was to externally evaluate the performance of different diagnostic models when applied by examiners with various levels of experience. <b>Methods</b> This was a diagnostic accuracy study including women who were admitted for adnexal masses, between July 2018 and April 2021, to a Greek tertiary oncology center. Preoperatively sonographic data were evaluated by an expert gynecologist, a 6 <sup>th</sup> and a 1 <sup>st</sup> year gynecology resident, who applied the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) and Assessment of Different NEoplasias in the adneXa (ADNEX) model to discriminate between benign and malignant ovarian tumors. The explant pathology report was used as the reference diagnosis. Kappa statistics were used for the investigation of the level of agreement between the examined systems and the raters. <b>Results</b> We included 66 women, 39 with benign and 27 with malignant ovarian tumors. ADNEX (with and without \"CA-125\") had high sensitivity (96-100%) when applied by all raters but a rather low specificity (36%) when applied by the 1st year resident. SR could not be applied in 6% to 17% of the cases. It had slightly lower sensitivity, higher specificity, and higher overall accuracy, especially when applied by the 1st year resident (61% vs. 92%), compared to ADNEX. <b>Conclusion</b> Both ADNEX and SR can be utilized for screening in non-oncology centers since they offer high sensitivity even when used by less experienced examiners. In the hands of inexperienced examiners, SR appears to be the best model for assessing ovarian lesions.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"9 1","pages":"E11-E17"},"PeriodicalIF":3.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/da/10-1055-a-2044-2855.PMC10446913.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073083","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}
Purpose Blood flow dynamics represent a diagnostic criterion for many diseases. However, no established reference standard is available. In clinical practice, ultrasound pulsed-wave Doppler (PW-Doppler) is frequently used to assess visceral blood flow, despite its well-known limitations. A quantitative analysis of conventional color Doppler patterns can be performed using an innovative ultrasound-based algorithm (pixel flow analysis, PFA). This tool already shows promising results in obstetrics, but the technique has not yet been evaluated for portal venous blood flow assessment. Methods This prospective exploratory research study evaluated the applicability of PFA in the portal venous system. Measurements of portal venous flow using PFA and PW-Doppler were compared in healthy volunteers (n=20) and in patients with hepatic steatosis (n=10) and liver cirrhosis (n=10). Results In healthy volunteers (60% female, mean age 23 years, BMI 21.5 kg/m 2 [20.4-23.8]), PFA and PW-Doppler showed a strong positive correlation in fasting conditions (r=0.69; 95% CI 0.36-0.87), recording a median blood flow of 834 ml/min (624-1066) and 718 ml/min (620-811), respectively. PFA was also applicable in patients with chronic liver diseases (55% female, age 65 years (55-72); BMI 27.8 kg/m 2 (25.4-30.8)), but the correlation between PFA and PW-Doppler was poor (r=- 0.09) in the subgroup with steatosis. A better correlation (r=0.61) was observed in patients with liver cirrhosis. Conclusion PFA and PW-Doppler assessment of portal venous vascularization showed high agreement in healthy volunteers and patients with liver cirrhosis. Therefore, PFA represents a possible alternative to conventional PW-Doppler sonography for visceral blood flow diagnostics and merits further evaluation.
{"title":"Quantification of Portal Vein Vascularization Using an Automated Post-Processing Video Analysis Tool.","authors":"Valentin Blank, Maria Heni, Thomas Karlas","doi":"10.1055/a-1999-7818","DOIUrl":"https://doi.org/10.1055/a-1999-7818","url":null,"abstract":"<p><p><b>Purpose</b> Blood flow dynamics represent a diagnostic criterion for many diseases. However, no established reference standard is available. In clinical practice, ultrasound pulsed-wave Doppler (PW-Doppler) is frequently used to assess visceral blood flow, despite its well-known limitations. A quantitative analysis of conventional color Doppler patterns can be performed using an innovative ultrasound-based algorithm (pixel flow analysis, PFA). This tool already shows promising results in obstetrics, but the technique has not yet been evaluated for portal venous blood flow assessment. <b>Methods</b> This prospective exploratory research study evaluated the applicability of PFA in the portal venous system. Measurements of portal venous flow using PFA and PW-Doppler were compared in healthy volunteers (n=20) and in patients with hepatic steatosis (n=10) and liver cirrhosis (n=10). <b>Results</b> In healthy volunteers (60% female, mean age 23 years, BMI 21.5 kg/m <sup>2</sup> [20.4-23.8]), PFA and PW-Doppler showed a strong positive correlation in fasting conditions (r=0.69; 95% CI 0.36-0.87), recording a median blood flow of 834 ml/min (624-1066) and 718 ml/min (620-811), respectively. PFA was also applicable in patients with chronic liver diseases (55% female, age 65 years (55-72); BMI 27.8 kg/m <sup>2</sup> (25.4-30.8)), but the correlation between PFA and PW-Doppler was poor (r=- 0.09) in the subgroup with steatosis. A better correlation (r=0.61) was observed in patients with liver cirrhosis. <b>Conclusion</b> PFA and PW-Doppler assessment of portal venous vascularization showed high agreement in healthy volunteers and patients with liver cirrhosis. Therefore, PFA represents a possible alternative to conventional PW-Doppler sonography for visceral blood flow diagnostics and merits further evaluation.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"9 1","pages":"E2-E10"},"PeriodicalIF":3.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/9c/10-1055-a-1999-7818.PMC10027440.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299564","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}
Martijn V Verhagen, Ruben H J de Kleine, Hubert P J van der Doef, Thomas C Kwee, Robbert J de Haas
Purpose Doppler ultrasound (DUS) is widely used to detect vascular complications after pediatric liver transplantation (LT). This study aimed to assess the moment of first detection of vascular complications with DUS, and to determine the positive predictive value (PPV) of DUS. Materials and Methods Patients aged 0-18 years who underwent LT between 2015 and 2019 were retrospectively included. 92 LTs in 83 patients were included (median age: 3.9 years, interquartile range: 0.7-10.5). Patients underwent perioperative (intra-operative and immediately postoperative) and daily DUS surveillance during the first postoperative week, and at 1, 3, and 12 months. Vascular complications were categorized for the hepatic artery, portal vein, and hepatic veins. DUS findings were compared to surgical or radiological findings during the 1-year follow-up. Results 52 vascular complications were diagnosed by DUS in 35/92 LTs (38%). 15 out of 52 (28.8%) were diagnosed perioperatively, 29/52 (55.8%) were diagnosed on postoperative days 1-7, and 8/52 (15.4%) after day 7. The PPV for all vascular complications diagnosed with DUS was 92.3%. During the 1-year follow-up, 18/19 (94.7%) hepatic artery complications, 19/26 (73.1%) portal vein complications, and 7/7 (100%) hepatic vein complications were diagnosed perioperatively or during the first week. Conclusion The majority of vascular complications during the first year after pediatric LT were diagnosed by DUS perioperatively or during the first week, with a high PPV. Our findings provide important information regarding when to expect different types of vascular complications on DUS, which might improve DUS post-LT surveillance protocols.
{"title":"Doppler Ultrasound of Vascular Complications After Pediatric Liver Transplantation: Incidence, Time of Detection, and Positive Predictive Value.","authors":"Martijn V Verhagen, Ruben H J de Kleine, Hubert P J van der Doef, Thomas C Kwee, Robbert J de Haas","doi":"10.1055/a-1961-9100","DOIUrl":"https://doi.org/10.1055/a-1961-9100","url":null,"abstract":"<p><p><b>Purpose</b> Doppler ultrasound (DUS) is widely used to detect vascular complications after pediatric liver transplantation (LT). This study aimed to assess the moment of first detection of vascular complications with DUS, and to determine the positive predictive value (PPV) of DUS. <b>Materials and Methods</b> Patients aged 0-18 years who underwent LT between 2015 and 2019 were retrospectively included. 92 LTs in 83 patients were included (median age: 3.9 years, interquartile range: 0.7-10.5). Patients underwent perioperative (intra-operative and immediately postoperative) and daily DUS surveillance during the first postoperative week, and at 1, 3, and 12 months. Vascular complications were categorized for the hepatic artery, portal vein, and hepatic veins. DUS findings were compared to surgical or radiological findings during the 1-year follow-up. <b>Results</b> 52 vascular complications were diagnosed by DUS in 35/92 LTs (38%). 15 out of 52 (28.8%) were diagnosed perioperatively, 29/52 (55.8%) were diagnosed on postoperative days 1-7, and 8/52 (15.4%) after day 7. The PPV for all vascular complications diagnosed with DUS was 92.3%. During the 1-year follow-up, 18/19 (94.7%) hepatic artery complications, 19/26 (73.1%) portal vein complications, and 7/7 (100%) hepatic vein complications were diagnosed perioperatively or during the first week. <b>Conclusion</b> The majority of vascular complications during the first year after pediatric LT were diagnosed by DUS perioperatively or during the first week, with a high PPV. Our findings provide important information regarding when to expect different types of vascular complications on DUS, which might improve DUS post-LT surveillance protocols.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"8 2","pages":"E36-E42"},"PeriodicalIF":3.2,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9306925","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}