Ultrasound International Open最新文献

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.

Purpose Neurosonography evaluation of neonatal hypoxic-ischemic encephalopathy (HIE) is mainly qualitative. We aimed to quantitatively compare the echogenicity of several brain regions in patients with HIE to healthy controls. Materials and Methods 20 term neonates with clinical/MRI evidence of HIE and 20 term healthy neonates were evaluated. Seven brain regions were assessed [frontal, parietal, occipital, and perirolandic white matter (WM), caudate nucleus head, lentiform nucleus, and thalamus]. The echogenicity of the calvarial bones (bone) and the choroid plexus (CP) was used for ratio calculation. Differences in the ratios were determined between neonates with HIE and controls. Results Ratios were significantly higher for HIE neonates in each region (p<0.05). The differences were greatest for the perirolandic WM, with CP and bone ratios being 0.23 and 0.22 greater, respectively, for the HIE compared to the healthy neonates (p<0.001). The perirolandic WM had a high AUC, at 0.980 for both the CP and bone ratios. The intra-observer reliability for all ratios was high, with the caudate to bone ratio being the lowest at 0.832 and the anterior WM to CP ratio being the highest at 0.992. Conclusion When coupled with internal controls, quantitative neurosonography represents a potential tool to identify early neonatal HIE changes. Larger cohort studies could reveal whether a quantitative approach can discern between degrees of severity of HIE. Future neurosonography protocols should be tailored to evaluate the perirolandic region, which requires posterior coronal scanning.

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.

[This corrects the article DOI: 10.1055/a-1961-9100.].

Purpose The aims of this study were to prospectively assess the diagnostic accuracy of a bespoke multiorgan point-of-care ultrasound approach for suspected pulmonary embolism and evaluate if this model allows reduced referral to further radiation diagnostics while maintaining safety standards. Materials and Methods Patients with suspected pulmonary embolism referred for CT pulmonary angiography or ventilation/perfusion scintigraphy were included as a convenience sample. All patients were subject to blinded ultrasound investigation with cardiac, lung, and deep venous ultrasound. The sensitivity and specificity of applied ultrasound signs and the hypothetical reduction in the need for further diagnostic workup were calculated. Results 75 patients were prospectively enrolled. The Wells score was below 2 in 48 patients, between 2 and 6 in 24 patients, and above 6 in 3 patients. The prevalence of pulmonary embolism was 28%. The most notable ultrasound signs were presence of a deep venous thrombus, at least two hypoechoic pleural-based lesions, the D-sign, the 60/60-sign, and a visible right ventricular thrombus which all had a specificity of 100%. Additionally, a multiorgan ultrasound investigation with no findings compatible with pulmonary embolism yielded a sensitivity of 95.2% (95%CI: 76.2-99.9). CT or scintigraphy could be safely avoided in 70% of cases (95%CI: 63.0-83.1%). Conclusion The findings of our study suggest that implementation of a multiorgan ultrasound assessment in patients with suspected pulmonary embolism may safely reduce the need for CT or scintigraphy by confirming or dismissing the suspicion.

Due to the severity of their disease, palliative care patients often present complex clinical symptoms and complaints like pain, shortness of breath, nausea, loss of appetite, and fatigue. Solely relying on the information available from the history and physical examination often causes uncertainty among palliative care physicians regarding treatment decisions during home visits, potentially leading to unnecessary hospitalizations or transfer to cross-sectional imaging in radiological practices. A rational approach is essential to avoid diagnostic aggressiveness while still providing the imaging information required for optimal palliative care. Bedside use of handheld ultrasound (HHUS) has the potential to expand the diagnostic and therapeutic spectrum in the case of symptom exacerbation but is still underutilized. In this review, we evaluate the potential uses of HHUS in home care settings to provide a more accurate diagnosis of the most common symptoms in palliative patients and to guide bedside interventions such as bladder catheterization, thoracentesis, paracentesis, venous access, and regional anesthesia. Specific training programs for ultrasound in palliative care are currently not available. Adequate documentation is warranted but fraught with technological and privacy issues. Expert supervision and quality assurance are necessary. Despite its limitation and challenges, we suggest that HHUS leads to improved clinical decision-making, expedited symptom relief, and reduced complications without burdening of the patient and costly transfer to hospital or specialty consultations.

In this study we propose a model for building a holographic ultrasound microscope. In this model two mobile phones are first connected by waves and techniques like the WhatsApp waves. If the mobile phones are close to each other, their inductors and speakers become entangled, they exchange electromagnetic and sound waves, and they vibrate many times with each other. Objects placed between two mobile phones change the sound waves and electromagnetic waves and appear as holographic images within the inductors and also on the plastic of the speakers. To see these images, a hologram machine is built from a room of plastic, one or two magnets, iron particles, and sound producers. Holographic waves change the magnetic field within the hologram machine and move the plastic and iron particles. These objects take the shape of waves and produce holographic images. To see microbes, one can send a weak current to a container of microbes and then connect it to an amplifier. The weak current takes the shape of the microbes and is amplified by one strong amplifier. Then this current goes to the mobile phone and sound card and, after passing some stages, is sent to the second mobile phone. In the second mobile phone, the sound wave is amplified by speakers and transmitted to the hologram machine. Consequently, particles within this machine move and produce big holographic images of the microbes.

Different surgical and medical specialists increasingly use head and neck ultrasound and ultrasound-guided interventions as part of their clinical practice. We need to ensure high quality and standardized practice across specialties, and this position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) describes the training requirements for head and neck ultrasound. Traditionally, a minimum number of ultrasound examinations indicates competence, but this is unreliable, and a general shift towards competence-based training is ongoing. For each EFSUMB level, we will outline the theoretical knowledge and skills needed for clinical practice. The recommendations follow the three EFSUMB competency levels for medical ultrasound practice. Level 1 describes the skills required to perform essential head and neck ultrasound examinations independently, level 2 includes ultrasound-guided interventions, while level 3 involves the practice of high-level neck ultrasound and use of advanced technologies. Our goal is to ensure high quality and standardized head and neck ultrasound practice performed by different clinical specialists with these recommendations.

Purpose Transabdominal ultrasound (US) and magnetic resonance enterography (MRE) are used to assess disease activity and extent in IBD, but their impact on therapeutic decisions is unclear. Therefore, our study has two goals: to compare the usefulness of US and MRE in assessing disease extent and activity in the small and large bowel, and to determine the relevance for clinical decisions in IBD. Materials and Methods We included 54 IBD patients who had undergone both MRE and US within three months. We used the construct reference standard model to compare MRE and US for detecting inflammation and examined the impact on clinical decisions in IBD patients. Results In 54 IBD patients (44 patients Crohn's disease (CD), 5 ulcerative colitis (UC), 5 indeterminate colitis (IC)), 42 patients (77.8%) showed inflammation either in the small or large bowel. Small bowel disease was present in 34 patients (77.3%). Complications were found in 19 patients (35.2%). MRE and US both showed high sensitivity (90.5 and 88.1%) and moderate specificity (50% in MRE and US) for detecting inflammation. MRE revealed higher sensitivity than US for detecting conglomerate tumors without statistical significance (85.7 vs. 71.4%, p=1.0) and equal specificity (97.9 vs 97.7, p=1.0). Therapeutic decisions included steroids in 20 patients (47.6%) and surgery/percutaneous drainage in six patients (14.3%), these decisions were triggered by results of US or MRE in equal distribution. Conclusion US and MRE have comparable sensitivity and specificity for detecting intestinal inflammation and complications in IBD patients. Therefore, both methods are sufficient for making clinical decisions.

Purpose Gastrointestinal ultrasound (GIUS) is a noninvasive imaging technique that may be used to study physiological changes in the small bowel. The aim of the study was to investigate the feasibility of measuring blood flow (BF) in the superior mesenteric artery (SMA) and regional motility in the small bowel with GIUS before and after a test meal and to compare ultrasound parameters to demographic factors such as age, sex, height, weight, and smoking habits. Materials and Methods 122 healthy volunteers aged 20 to 80 were examined after an overnight fast. Small bowel motility was registered in the upper left and lower right quadrants (ULQ and LRQ) with TUS and BF in the SMA with pulsed wave Doppler. The first 23 volunteers also received a 300 Kcal test meal and were re-examined 30 min postprandial. Results The feasibility of measuring BF was 97% in fasting patients while motility could be detected in 52% and 62% in the ULQ and LRQ, respectively. Females had a lower resistive index (RI) and a higher mean velocity than males, while the overall BF correlated with height. The RI had a negative correlation with age. Healthy volunteers with motility in the ileum were on average younger than those without motility. After the test meal, motility could be detected in the ULQ and LRQ in 95% and 90%, respectively, and the mean number of contractions in the ULQ increased significantly. As expected, there was a clear increase in all BF-parameters postprandially. Conclusion Regional motility in the small bowel was easier to detect after a test meal. There were some associations between demographic parameters and ultrasound parameters but overall the effects were relatively small.