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Placental Mesenchymal Dysplasia: Ultrasound Characteristics and Diagnostic Pitfalls. 胎盘间充质发育不良:超声特征和诊断缺陷。
IF 3.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2020-06-01 Epub Date: 2020-07-06 DOI: 10.1055/a-1180-9571
Alexandros Psarris, Michail Sindos, Ploutarchos Kourtis, Andreas Pampanos, Panagiotis Antsaklis, Marianna Theodora, Maria Eleni Chondrogianni, Georgios Morphopoulos, Dimitrios Loutradis, Georgios Daskalakis

Placental mesenchymal dysplasia (PMD) is a rare, benign developmental anomaly with a reported prevalence of 0.02% (Arizawa and Nakayama, 2002). It is characterized by placentomegaly with multiple cystic lesions of the stem villi and vascular anomalies (Pawoo and Heller, 2014). Early detection of PMD has been described during routine prenatal ultrasound (Vaisbuch et al., 2009). The sonographic characteristics of PMD include increased placental thickness and multiple cystic areas within the placenta with either an absence of blood flow or with low venous Doppler signals (Vaisbuch et al., 2009). The differential diagnosis of multicystic placental lesions with the presence of a live fetus include partial molar pregnancy, multiple hematomas, chorioangioma Beckwith-Wiedemann syndrome and PMD. Chorioangiomas are well circumscribed masses within the placenta and they are characterized by the presence of a single feeding vessel with the same pulse rate as the umbilical cord (Zalel et al., 2002). Invasive prenatal testing is required for the exclusion of partial molar pregnancy and Beckwith-Wiedemann Syndrome (Vaisbuch et al., 2009). Definitive diagnosis of PMD is based on the pathologic examination of the placenta. Histology reveals aneurysm or dilated blood vessels that may be thrombosed. The stem villi are edematous and enlarged with thick-walled vessels, without trophoblastic proliferation (Pawoo and Heller, 2014). This case report highlights the significance of the early detection of PMD, illustrates the pitfalls in differential diagnosis and provides valuable insights regarding PMD management in a clinical setting.

胎盘间充质发育不良(PMD)是一种罕见的良性发育异常,据报道患病率为0.02% (Arizawa and Nakayama, 2002)。其特征是胎盘肿大,并伴有多个茎绒毛囊性病变和血管异常(Pawoo和Heller, 2014)。在常规产前超声检查中已经发现了PMD的早期检测(Vaisbuch et al., 2009)。PMD的超声特征包括胎盘厚度增加和胎盘内多个囊性区域,血流缺乏或静脉多普勒信号低(Vaisbuch et al., 2009)。存在活胎的多囊胎盘病变的鉴别诊断包括部分磨牙妊娠、多发血肿、绒毛膜血管瘤、贝克威氏综合征和经前症候群。绒毛膜血管瘤是胎盘内界限明确的肿块,其特征是存在一条与脐带相同脉搏率的单一喂养血管(Zalel等,2002)。为了排除部分臼齿妊娠和Beckwith-Wiedemann综合征,需要进行侵入性产前检查(Vaisbuch et al., 2009)。明确的诊断PMD是基于病理检查的胎盘。组织学显示动脉瘤或扩张的血管可能形成血栓。茎绒毛水肿、增大,有厚壁血管,没有滋养层增生(Pawoo和Heller, 2014)。本病例报告强调了PMD早期检测的重要性,说明了鉴别诊断的陷阱,并提供了关于临床PMD管理的宝贵见解。
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引用次数: 3
Ultrasound Curricula of Student Education in Europe: Summary of the Experience. 欧洲学生教育的超声课程:经验总结。
IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2020-06-01 Epub Date: 2020-08-31 DOI: 10.1055/a-1183-3009
Helmut Prosch, Maija Radzina, Christoph F Dietrich, Michael Bachmann Nielsen, Sven Baumann, Caroline Ewertsen, Christian Jenssen, Adnan Kabaalioğlu, Wojciech Kosiak, Wolfgang Kratzer, Adrian Lim, Alina Popescu, Vladimir Mitkov, Cosima Schiavone, Martin Wohlin, Matthias Wüstner, Vito Cantisani

Background Despite the increasing role of ultrasound, structured ultrasound teaching is only slowly being integrated into the curricula of medical schools and universities all over Europe. Aim To survey the current situation at European universities regarding the integration of ultrasound in student medical education and to report on models of student ultrasound training from selected European universities. Methods A questionnaire survey focusing on the implementation of curricular ultrasound education was sent out to the 28 presidents of the national ultrasound societies of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), who were asked to distribute the questionnaires to the medical universities of their countries. Results Overall, 53 questionnaires were returned from 46 universities in 17 European countries. In most of the universities (40/46 universities, 87%), the theoretical background of ultrasound is taught. However, in only a minority of universities is ultrasound integrated in anatomy courses (8/46 universities, 17%) or basic science courses (16/46 universities, 35%). Practical skills in ultrasound are taught in 56% of the universities (26/46 universities) and tested in a practical exam in seven of the responding universities (15%). The number of hours in which ultrasound was taught ranged from one to 58 (mean, seven). The respondents reported that lack of time and limited faculty funding were major hurdles. Conclusion According to our survey, only a minority of European universities has integrated ultrasound into the preclinical curriculum thus far. Future EFSUMB initiatives will continue to promote the introduction of ultrasound as an integrative part of the core curriculum of student medical education, and the preparation of proper teaching material.

背景 尽管超声波的作用越来越大,但有组织的超声波教学只是缓慢地纳入欧洲各地医学院校和大学的课程中。目的 调查欧洲大学将超声波纳入学生医学教育的现状,并报告部分欧洲大学的学生超声波培训模式。方法 向欧洲医学和生物学超声协会联合会(EFSUMB)的 28 个国家超声协会主席发送了一份问卷调查,重点调查超声课程教育的实施情况,并要求他们将问卷分发给各自国家的医科大学。结果 17 个欧洲国家的 46 所大学共收回 53 份调查问卷。大多数大学(40/46 所大学,87%)都开设了超声波理论背景课程。然而,只有少数大学将超声波纳入解剖学课程(8/46 所大学,17%)或基础科学课程(16/46 所大学,35%)。56%的大学(26/46 所大学)教授超声波实践技能,7 所大学(15%)在实践考试中进行测试。超声波教学的课时从 1 到 58 课时不等(平均为 7 课时)。受访者表示,缺乏时间和有限的教师经费是主要障碍。结论 根据我们的调查,迄今为止只有少数欧洲大学将超声波纳入了临床前课程。今后,欧洲临床超声医学联盟将继续推动将超声作为学生医学教育核心课程的一个组成部分,并编写适当的教学材料。
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引用次数: 0
Editorial. 社论。
IF 3.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2020-06-01 Epub Date: 2020-10-07 DOI: 10.1055/a-1199-4883
Vito Cantisani
Dear Colleagues, It is a pleasure to introduce the present issue of Ultrasound International Open. It contains an updated overview of how handling ultrasound systems, fundamental adjustments, and their optimization in B-mode ultrasound provided by Dr. Zander and colleagues.
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引用次数: 0
Ultrasound-Guided Cryoablation of Renal Grafts Tumors. 超声引导下肾移植肿瘤的冷冻消融。
IF 3.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2020-06-01 Epub Date: 2020-07-22 DOI: 10.1055/a-1196-2244
Janni Lynggård Bo Madsen, Camilla Brinkmann Bak-Ipsen, Tommy Kjærgaard Nielsen, Jan Solvig, Ole Graumann
Tumors in renal grafts are rare with an estimated prevalence of 0.18 % (X. Tillou et al. Transplant Rev. 2015 and FM Drudi et al. J Ultrasound. 2019 [1, 2]). An increased incidence of graft tumors may be observed in the future due to increased donor age and prolonged graft survival. Furthermore, the immunosuppressant state of graft recipients may cause the tumor to behave more aggressively (G. Ploussard et al. BJU Int. 2012: 109: 195–9 [3]). In these complex cases, there is a need for a minimally invasive nephron-sparing treatment option that can keep patients free of dialysis. Here we present two cases of T1a renal cell carcinoma (RCC) in renal grafts that were successfully treated using ultrasound-guided percutaneous cryoablation: a minimally invasive technique where only the tumor is destroyed, and the graft’s function is preserved. Furthermore, when comparing percutaneous cryoablation to laparoscopic cryoablation and partial nephrectomy, the risk of treatment-related complications is decreased (T. Klatte et al. J Urology. 2014: 191: 1209–17 [4]).
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引用次数: 0
A Case of Unresectable Pancreatic Cancer with Long-Term Survival in High-Intensity Focused Ultrasound (HIFU) Therapy. 高强度聚焦超声(HIFU)治疗不能切除的胰腺癌长期存活1例。
IF 3.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2019-11-01 Epub Date: 2020-01-08 DOI: 10.1055/a-1061-7790
Atsushi Sofuni, Mitsuru Fujita, Yasutsugu Asai, Takayoshi Tsuchiya, Kentaro Ishii, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjo, Shuntaro Mukai, Kazumasa Nagai, Kenjiro Yamamoto, Yukitoshi Matsunami, Takashi Kurosawa, Hiroyuki Kojima, Takao Itoi
Despite advancements in imaging diagnosis, about 60% of cases of pancreatic cancer (PC) are still unresectable. Chemotherapy and radiochemotherapy are commonly performed as alternative treatments, but satisfaction with the results remains low. High intensity focused ultrasound therapy (HIFU) is expected to be a minimally invasive therapy for these cases. HIFU is an epoch-making therapeutic method and is a local therapy that converges a large number of ultrasonic transmission sources at one point at the target site of the tumor and cauterizes tissues from outside the body 1 2 3 . Case Description A 63-year-old male, who underwent CT examination at another medical center due to epigastric pain, was then diagnosed with a low-density tumor (65mm) infiltrating the celiac artery (CA) and superior mesenteric artery (SMA) in the pancreas body ( Fig. 1a ). It was histologically diagnosed as PC (UICC criteria; stage III) by EUS-FNA. There was no suitable surgery. Therefore, chemoradiotherapy was initiated due to locally advanced PC. Chemotherapy was performed with GS therapy (GEM 1000 mg/m 2 +S-1 100 mg/day), and radiotherapy with 50.4 Gy / 28 fraction. After receiving GS therapy (GEM 1000 mg/m 2 +S-1 100 mg/day) for 2 months, the PC was still diagnosed as progressive disease (PD) based on WHO criteria by CT. The patient presented at our hospital for HIFU therapy. Under sufficient informed consent, HIFU therapy was performed as an additive therapy to systemic chemotherapy. This clinical trial was approved by the ethics committee of our hospital (IRB: 890) and registered with University Hospital Medical Information (UMIN) and was initiated (UMIN000009969). B-mode US showed a hypoechoic mass in the pancreas body ( Fig. 2a ), and contrast-enhanced ultrasound (CE-US) showed isovascularity in previous HIFU therapy ( Fig. 2b ). The FEP-BY 02 HIFU Therapeutic System was used as the HIFU device. (Yuande Bio-Medical Engineering, Beijing, China) ( Fig. 3 ). Open in a separate window Fig. 1 CT imaging: a : CT before HIFU therapy showed a low-density mass (65 mm) infiltrating the CA and SMA in the pancreas body. b : CT imaging 3 months after HIFU therapy showed that the pancreas tumor had shrunk slightly. c : CT imaging after the second HIFU therapy (5 months after the first HIFU therapy) showed that the tumor had shrunk and PR in the therapeutic effect was obtained. d : CT imaging after the 4th HIFU therapy (19 months after the first HIFU therapy) showed the tumor size was unchanged (PR continued). e : CT imaging after the 7th HIFU therapy (39 months after the first HIFU therapy) showed continued PR until the patient passed away.
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引用次数: 4
Editorial. 社论。
IF 3.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2019-11-01 Epub Date: 2020-03-30 DOI: 10.1055/a-1044-7237
Caroline Ewertsen

Dear Colleagues, Europe is severely hit by the virus SARS-CoV-2 and most countries report increasing numbers of people affected by COVID-19. WHO has declared it a pandemic, many countries have introduced severe restrictions on travelling and thousands of people around Europe are in quarantine. Currently, the most severely affected European country is Italy, which also experienced some of the first European cases.

欧洲受到新冠肺炎疫情的严重打击,大多数国家报告感染新冠肺炎的人数不断增加。世卫组织宣布疫情大流行,许多国家对旅行实施了严格限制,欧洲各地数千人被隔离。目前,受影响最严重的欧洲国家是意大利,该国也出现了首批欧洲病例。
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引用次数: 0
Prenatal Diagnosis of Teratoma in a Torqued Undescended Testis Masked as Unclear Intra-Abdominal Mass. 畸形下睾丸畸胎瘤的产前诊断被不清楚的腹内肿块掩盖。
IF 3.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2019-11-01 Epub Date: 2020-02-26 DOI: 10.1055/a-1088-3569
Adeline Walter, Alexander C Engels, Andreas Heydweiller, Annegret Geipel, Ulrich Gembruch
Constantly improving ultrasound technologies facilitate prenatal detection of various fetal diseases, including low-incidence disorders that are typically diagnosed postnatally, such as testicular teratoma. These can appear as an unclear cystic intra-abdominal structure, caused by an undescended torqued testis. In the case of such uncertain cystic intra-abdominal lesions, a cryptorchidism could lead the investigator to narrow the possibilities to the urogenital tract. Herein, we report the second case of a prenatally detected cystic-solid lesion being a testicular teratoma by a torqued undescended testis and the seventh case of a prenatally seen testicular teratoma. In late gestation, a structured evaluation of the testes would be beneficial to detect such malformations.
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引用次数: 1
Prenatal Diagnosis of Adrenal Neuroblastoma - Differential Diagnosis of Suprarenal Masses in the Third Trimester of Pregnancy. 肾上腺神经母细胞瘤的产前诊断-妊娠晚期肾上肿块的鉴别诊断。
IF 3.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2019-11-01 Epub Date: 2020-01-21 DOI: 10.1055/a-1070-8651
Alexandros Psarris, Michail Sindos, Anastasia Dimopoulou, Panagiotis Antsaklis, Antonios Psarakis, Thomas Kataras, Dimitrios Loutradis, Georgios Daskalakis
Neuroblastoma is the most common malignant extracranial solid tumor in infancy with an incidence rate of 58 per million infants younger than one year old. It originates from the neural crest during fetal development and may arise from the sympathetic ganglia or the adrenal medulla (Gurney JG, et al. J Pediatr Hematol Oncol. 1997; 19: 428). Prenatal detection of neuroblastoma was first described in 1983 (Fenart D, et al. Journalde Radiologie 1983; 64: 359). In the majority of antenatally diagnosed cases, neuroblastomas are adrenal in origin and right-sided. Differentiating neuroblastomas from other fetal suprarenal masses such as extralobar pulmonary sequestration, congenital adrenal hyperplasia, renal duplication, urinoma, gastric duplication cyst, and splenic cyst may be very difficult. However, improvements in ultrasound technology have made early detection possible and, combined with fetal MRI, facilitate differential diagnosis. Finally, prenatal diagnosis of a neuroblastoma is associated with a better prognosis, as it can resolve spontaneously either in utero or shortly after birth (Maki E, et al. J Ultrasound Med 2014; 33:895–904). This is a case of a mixed cystic and solid suprarenal tumor that was identified during a routine antenatal visit in the third trimester of pregnancy and was diagnosed as an adrenal neuroblastoma. Case description A 27-year-old pregnant woman presented to the outpatient clinic of Alexandra Maternity Hospital in Athens, Greece during the third trimester of her pregnancy. The woman was Gravida 2 Para 0 (G2P0). The gestational age of the pregnancy was 38 weeks and 2 days. The woman’s past medical history was uneventful. During her pregnancy, she underwent prenatal testing including first trimester scan, anomaly scan, 3 rd trimester Doppler scan without any abnormal findings. During the initial ultrasound scan we detected one fetus in occiput anterior position. All growth parameters (biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight) and the amniotic fluid index were within normal range for the gestational age. During the scan a well circumscribed mass was detected over the left kidney ( Fig. 1 ). The mass appeared to have both cystic and solid areas and appeared to originate from the left adrenal gland ( Fig. 1 ). The anatomy of the left kidney was not altered. The mass measured 4.40 × 4.12 cm ( Fig. 2 ). Doppler evaluation did not reveal increased blood flow towards the mass nor a single feeding vessel ( Fig. 3 ). The right kidney and right adrenal gland appeared normal ( Fig. 4a and b). Extensive ultrasound examination of the fetus revealed no other abnormalities. After careful evaluation of the ultrasound appearance of the tumor, the diagnosis of adrenal neuroblastoma was suggested. Open in a separate window Fig. 1 The mass is well circumscribed with both cystic and solid areas and appears to originate from the left adrenal gland.
{"title":"Prenatal Diagnosis of Adrenal Neuroblastoma - Differential Diagnosis of Suprarenal Masses in the Third Trimester of Pregnancy.","authors":"Alexandros Psarris,&nbsp;Michail Sindos,&nbsp;Anastasia Dimopoulou,&nbsp;Panagiotis Antsaklis,&nbsp;Antonios Psarakis,&nbsp;Thomas Kataras,&nbsp;Dimitrios Loutradis,&nbsp;Georgios Daskalakis","doi":"10.1055/a-1070-8651","DOIUrl":"https://doi.org/10.1055/a-1070-8651","url":null,"abstract":"Neuroblastoma is the most common malignant extracranial solid tumor in infancy with an incidence rate of 58 per million infants younger than one year old. It originates from the neural crest during fetal development and may arise from the sympathetic ganglia or the adrenal medulla (Gurney JG, et al. J Pediatr Hematol Oncol. 1997; 19: 428). \u0000 \u0000Prenatal detection of neuroblastoma was first described in 1983 (Fenart D, et al. Journalde Radiologie 1983; 64: 359). In the majority of antenatally diagnosed cases, neuroblastomas are adrenal in origin and right-sided. Differentiating neuroblastomas from other fetal suprarenal masses such as extralobar pulmonary sequestration, congenital adrenal hyperplasia, renal duplication, urinoma, gastric duplication cyst, and splenic cyst may be very difficult. However, improvements in ultrasound technology have made early detection possible and, combined with fetal MRI, facilitate differential diagnosis. Finally, prenatal diagnosis of a neuroblastoma is associated with a better prognosis, as it can resolve spontaneously either in utero or shortly after birth (Maki E, et al. J Ultrasound Med 2014; 33:895–904). \u0000 \u0000This is a case of a mixed cystic and solid suprarenal tumor that was identified during a routine antenatal visit in the third trimester of pregnancy and was diagnosed as an adrenal neuroblastoma. \u0000 \u0000Case description \u0000A 27-year-old pregnant woman presented to the outpatient clinic of Alexandra Maternity Hospital in Athens, Greece during the third trimester of her pregnancy. The woman was Gravida 2 Para 0 (G2P0). The gestational age of the pregnancy was 38 weeks and 2 days. The woman’s past medical history was uneventful. \u0000 \u0000During her pregnancy, she underwent prenatal testing including first trimester scan, anomaly scan, 3 rd trimester Doppler scan without any abnormal findings. During the initial ultrasound scan we detected one fetus in occiput anterior position. All growth parameters (biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight) and the amniotic fluid index were within normal range for the gestational age. During the scan a well circumscribed mass was detected over the left kidney ( Fig. 1 ). The mass appeared to have both cystic and solid areas and appeared to originate from the left adrenal gland ( Fig. 1 ). The anatomy of the left kidney was not altered. The mass measured 4.40 × 4.12 cm ( Fig. 2 ). Doppler evaluation did not reveal increased blood flow towards the mass nor a single feeding vessel ( Fig. 3 ). The right kidney and right adrenal gland appeared normal ( Fig. 4a and b). Extensive ultrasound examination of the fetus revealed no other abnormalities. After careful evaluation of the ultrasound appearance of the tumor, the diagnosis of adrenal neuroblastoma was suggested. \u0000 \u0000 \u0000 \u0000 \u0000Open in a separate window \u0000 \u0000 \u0000Fig. 1 \u0000 \u0000 \u0000The mass is well circumscribed with both cystic and solid areas and appears to originate from the left adrenal gland.","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":"5 3","pages":"E93-E95"},"PeriodicalIF":3.2,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/a-1070-8651","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37570105","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}
引用次数: 5
Student Perceptions of Instructional Ultrasound Videos as Preparation for a Practical Assessment 学生对超声教学视频的认知,为实际评估做准备
IF 3.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2019-11-01 DOI: 10.1055/a-1024-4573
M. Altersberger, P. Pavelka, A. Sachs, Michael Weber, M. Wagner-Menghin, H. Prosch
Abstract Background Learning ultrasound early in the medical school curriculum helps students to understand anatomy and pathology and to perform defined ultrasound standard views. Instructional videos are a potentially valuable tool for improving the process of learning ultrasound skills. It was the aim of the present study to investigate how students perceived instructional videos as a learning aid, compared to other learning opportunities, in preparation for an Objective Structured Clinical Examination (OSCE). Materials and Methods Eleven concise ultrasound videos were created and implemented in the 4th year at the Medical University of Vienna. The videos illustrate the predefined examination process, image optimization, and nine standardized ultrasound views. The videos were available to be used in preparation for the practical ultrasound examination, which was part of the objective structured clinical examination. The students’ perceptions of the instructional videos and other learning methods were surveyed using an online questionnaire. Results In total, 445 of 640 students (69.5% of the cohort) used the instructional videos. Of those students, 134 (30%) answered the questionnaire. Of this group, 88.9% rated the instructional videos as very helpful (49.6% as extremely helpful). An ANOVA revealed a significant difference between various learning materials in terms of helpfulness. Post hoc analysis showed that instructional videos were perceived as the second most helpful learning material after “self-execution and feedback.” Conclusion The study revealed that students use instructional videos frequently and appreciate them as an extra tool for effective studying.
背景在医学院的早期课程中学习超声有助于学生理解解剖学和病理学,并执行明确的超声标准视图。教学视频是一种潜在的有价值的工具,可以提高学习超声技术的过程。本研究的目的是调查学生在准备客观结构化临床检查(OSCE)时,与其他学习机会相比,如何将教学视频视为学习辅助工具。材料与方法在维也纳医科大学第四年制作并实施了11个简明超声视频。视频演示了预定义的检查过程、图像优化和九种标准化超声视图。视频可用于实际超声检查的准备,这是客观结构化临床检查的一部分。使用在线问卷调查学生对教学视频和其他学习方法的看法。结果640名学生中有445名(占队列的69.5%)使用了教学视频。其中134人(30%)回答了问卷。在这个群体中,88.9%的人认为教学视频非常有帮助(49.6%的人认为非常有帮助)。方差分析显示,不同学习材料在帮助性方面存在显著差异。事后分析表明,教学视频被认为是仅次于“自我执行和反馈”的第二有用的学习材料。研究表明,学生经常使用教学视频,并将其视为有效学习的额外工具。
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引用次数: 4
Isolated Echogenic Cardiac Focus: Assessing Association with Trisomy 21 by Combining Results from a Prenatal Center with a Bayesian Meta-Analysis. 孤立的超声心脏病灶:结合产前中心的结果和贝叶斯荟萃分析评估与21三体的关系。
IF 3.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2019-11-01 Epub Date: 2020-03-09 DOI: 10.1055/a-1118-3974
Elisabeth Wrede, Alexander Johannes Knippel, Pablo Emilio Verde, Ruediger Hammer, Peter Kozlowski

Objective To investigate the clinical relevance of an isolated echogenic cardiac focus (iECF) as a marker for trisomy 21 using a large second-trimester collective including a low-risk subgroup. Materials and Methods We retrospectively evaluated 1 25 211 pregnancies from 2000-2016 and analyzed all iECF cases with regard to chromosomal anomalies. It consisted of an early second-trimester collective from 14+0-17+6 weeks (n=34 791) and a second-trimester anomaly scan collective from 18+0-21+6 weeks. Two a priori risk subgroups (high and low risk) of the latter were built based on maternal age and previous screening test results using a cut-off of 1:300. Likelihood ratios (LR) of iECF for the detection of trisomy 21, trisomy 13, trisomy 18 and structural chromosomal anomalies were estimated. Results In total, 1 04 001 patients were included. An iECF was found in 4416 of 1 02 847 euploid fetuses (4.29%) and in 64 of 557 cases with trisomy 21 (11.49%) giving a positive LR of 2.68 (CI: 2.12-3.2). The sensitivity was 11.5% at a false-positive rate of 4.29% (CI:4.17-4.42) with p≤0.01%. In the high-and low-risk subgroups, the prevalence of iECF was comparable: 5.08% vs. 5.05%. The frequency of trisomy 21 was 0.39%, 98/24 979 vs 0.16%, 69/44 103. LR+was 3.86 (2.43-5.14) and 2.59 (1.05-4). For both subgroups the association of iECF with trisomy 21 was statistically significant. The prevalence of structural chromosomal anomalies in the second-trimester anomaly scan collective was 0.08% (52/68 967), of which 2 showed an iECF. Conclusion The detection of an iECF at the time of 14+0-21+6 weeks significantly increases the risk for trisomy 21 in the high-risk and in the low-risk subgroups and does not statistically change the risks for trisomy 13/18 or structural abnormalitie.

目的通过包括低危亚组在内的孕中期大集体调查,探讨孤立超声心脏病灶(iECF)作为21三体标志物的临床意义。材料与方法回顾性分析2000-2016年1 25 211例妊娠,并分析所有iECF病例的染色体异常情况。它包括14+0-17+6周的早期妊娠中期集体(n= 34791)和18+0-21+6周的中期妊娠异常扫描集体。后者的两个先验风险亚组(高风险和低风险)是基于母亲的年龄和以前的筛查测试结果,使用1:30 00的截止。估计iECF检测21三体、13三体、18三体和结构染色体异常的似然比(LR)。结果共纳入104.001例患者。1 02 847例整倍体胎儿中有4416例(4.29%)发现iECF, 557例21三体胎儿中有64例(11.49%)发现iECF,阳性LR为2.68 (CI: 2.12-3.2)。敏感性为11.5%,假阳性率为4.29% (CI:4.17 ~ 4.42), p≤0.01%。在高风险和低风险亚组中,iECF的患病率是相当的:5.08%对5.05%。21三体的发病率分别为0.39%(98/24 979)和0.16%(69/44 103)。LR+分别为3.86(2.43 ~ 5.14)和2.59(1.05 ~ 4)。在两个亚组中,iECF与21三体的相关性具有统计学意义。中期妊娠异常扫描群中,结构性染色体异常发生率为0.08%(52/68 967),其中2例为iECF。结论14+0 ~ 21+6周时检测iECF可显著增加高危亚组和低危亚组发生21三体的风险,对13/18三体和结构异常的风险无统计学意义。
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引用次数: 1
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Ultrasound International Open
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