Journal of Ultrasonography最新文献

Aim: The gold standard nerve conduction study for diagnosing carpal tunnel syndrome is often painful and has variable diagnostic accuracy. This study aimed to evaluate the diagnostic performance of shear wave elastography in correlation with nerve conduction study.

Material and methods: A prospective case-control study was conducted on 50 participants (50 wrists), including 25 carpal tunnel syndrome cases diagnosed by nerve conduction study and 25 healthy controls. Shear wave elastography assessed the stiffness of the median nerve at three locations: outside the carpal tunnel, at the inlet, and at the outlet. Cross-sectional area measurements were also obtained using B-mode ultrasound. Receiver operating characteristic curves were used to evaluate diagnostic performance.

Results: Shear wave elastography and cross-sectional area demonstrated high diagnostic accuracy for carpal tunnel syndrome, with a cut-off value of ≥63.5 kPa inside the tunnel (mean of inlet and outlet values) and a cross-sectional area cut-off of ≥0.08 cm² at the inlet of the tunnel offering optimal performance. While cross-sectional area provided high sensitivity, shear wave elastography showed superior specificity; their combination improved overall diagnostic accuracy. Shear wave elastography values did not significantly differ across carpal tunnel syndrome severity grades based on nerve conduction study (p >0.05). However, shear wave elastography at the tunnel inlet differentiated severe carpal tunnel syndrome from non-severe cases (p = 0.045), with a cut-off of ≥126 kPa predicting severe carpal tunnel syndrome with 100% sensitivity, 77% specificity, and an area under the receiver operating characteristic curve of 0.871.

Conclusions: Shear wave elastography is a reliable, non-invasive modality for carpal tunnel syndrome diagnosis, offering excellent specificity, particularly when combined with cross-sectional area. Additionally, shear wave elastography at the tunnel inlet may help identify severe carpal tunnel syndrome, supporting timely clinical decision-making and prioritization of intervention.

Aim: Sarcopenia is a significant predictor of postoperative morbidity and mortality in liver transplant recipients. Traditional assessment tools such as computed tomography (CT) and bioelectrical impedance analysis have limitations in clinical use. This study aimed to evaluate the utility of ultrasonography (USG) in assessing abdominal muscle thickness as a marker of sarcopenia.

Material and methods: This prospective observational study was conducted at a tertiary liver transplant center between September 2023 and May 2024. USG was used to measure the thickness of the external oblique (EO), internal oblique, and transversus abdominis (TA) muscles in 41 liver transplant recipients and 41 healthy donors. Sarcopenia was also assessed using CT-based L3 skeletal muscle index (L3-SMI) and hand grip strength. Correlations with disease severity (Model for End-Stage Liver Disease, Child-Turcotte-Pugh (CTP)), postoperative outcomes, and ascitic fluid volume were analyzed.

Results: Abdominal muscle thickness was significantly lower in recipients compared to donors (EO: 2.9 ± 1.0 mm vs. 4.5 ± 1.8 mm; TA: 2.2 ± 0.7 mm vs. 3.2 ± 1.0 mm; p <0.001). Sarcopenia prevalence was 78% by L3-SMI and 82.9% by hand grip strength. ROC analysis demonstrated that EO <3.6 mm and TA <2.55 mm predicted sarcopenia in males with high sensitivity and specificity. Muscle thinning correlated with higher CTP scores, greater ascitic fluid volume, and prolonged intensive care unit stay.

Conclusions: USG-derived abdominal muscle thickness, especially EO <3.6 mm and TA <2.55 mm in males, is a reliable, non-invasive marker for sarcopenia in liver transplant candidates. It correlates with disease severity and postoperative morbidity, supporting its utility in pre-transplant risk stratification.

Aim: To evaluate the benefit of abdominal ultrasonography performed routinely and thus independently of symptomatology in patients in the intensive care unit, and to assess the value of a portable ultrasound device. Diagnostic yield and documented results with clinical consequences were considered and compared with findings obtained using a high-end ultrasound device.

Material and methods: A total of 120 patients of an internal medicine intensive care unit were included over 12 months. The investigator had limited experience in sonography (approximately 300 abdominal sonographies performed). The abdomen and basal portions of the thorax were examined.

Results: The most common pathological findings were renal cysts in 34/120 (28.3%), left-sided or right-sided pleural effusions in 33/120 (27.5%) and 29/120 (24.2%) patients, respectively, dilatation of the vena cava in 24/120 (20.0%), and urinary retention in 14/120 (11.7%) patients. In 13/120 (10.8%) patients, the sonographic examination resulted in a diagnostic consequence, while in 38/120 (31.7%) patients in a therapeutic consequence. Among the false-negative findings using the hand-held ultrasound device, no finding was of therapeutic relevance. Four findings that were missed by the hand-held ultrasound device were diagnostically significant: two lesions of the kidney, one lesion of the liver, and one case of urinary stasis kidney.

Conclusions: With the hand-held ultrasound device, only 33 of 52 focal lesions were detected. Thus, a high-end ultrasound device cannot be replaced by a hand-held ultrasound device for this purpose, but certain clinical questions can be answered reliably with a hand-held ultrasound device (such as the presence of a puncture-worthy pleural effusion in patients with dyspnea, or verification of the volume status based on the diameter of the vena cava).

Aim: In patients with multiple myeloma, extramedullary myeloma manifestations can occur alongside bone marrow infiltration and osseous involvement. The aim of this study was to describe extramedullary myeloma manifestations using B-mode ultrasound and contrast-enhanced ultrasound.

Material and methods: Between February 2006 and 2021, a total of 21 patients with multiple myeloma and histologically or clinically proven extramedullary myeloma manifestations (n = 24) were included. All patients underwent B-mode ultrasound and contrast-enhanced ultrasound of extramedullary myeloma manifestations. B-mode ultrasound patterns of location, size border characteristics, and echogenicity (hypoechoic/isoechoic or hyperechoic) as well as contrast-enhanced ultrasound enhancement (hyper-, iso-, or hypoenhancement) were analyzed.

Results: In most cases, extramedullary myeloma manifestations were located in the chest wall (n = 11; 45.8%). In all 24 cases, extramedullary myeloma manifestations were hypoechoic on B-mode ultrasound. N = 16 (66.6%) of extramedullary myeloma manifestations had smooth and n = 8 (33.3%) had irregular borders. The mean lesion size was 5.4 cm. On contrast-enhanced ultrasound, extramedullary myeloma manifestations presented arterial hyper- (n = 20; 83.3%) or isoenhancement (n = 4; 16.7%) followed by parenchymal iso- (n = 1; 4.2%) or hypoenhancement (n = 23; 95.8%). In molecular genetic analysis, every patient with reliable FISH results tested positive for at least one aberration considered "high-risk".

Conclusion: Extramedullary myeloma manifestations were typically hypoechoic on B-mode ultrasound. On contrast-enhanced ultrasound, they presented characteristic arterial hyperenhancement followed by parenchymal washout. All patients studied for the genetic risk status were found to be "high-risk".

Total anomalous pulmonary venous connection is a rare congenital heart defect that can be diagnosed prenatally and might be very important for perinatal management. In addition to other cardiac abnormalities (levocardia, situs inversus, small left ventricle, double outlet right ventricle, parallel great vessels, and hypoplastic aortic arch), total anomalous pulmonary venous connection of a subdiaphragmatic type was diagnosed during a prenatal echocardiography examination in the second half of pregnancy. Fetal echocardiography monitoring showed no signs of congestive heart failure. The neonate was born at 38 weeks of gestation at our tertiary center. Postnatal echocardiography revealed significant progression in neonatal hemodynamics, and early cardiac surgery, involving repair of the pulmonary veins, pulmonary artery banding, and aortic arch reconstruction, was performed with a good outcome. This case is an excellent example of the value of prenatal echocardiography.

Aim of the study: This study seeks to evaluate the effectiveness of ultrasound measurements of the ulnar nerve cross-sectional area in comparison to electrodiagnostic tests for identifying ulnar nerve entrapment at the elbow in rheumatoid arthritis.

Patients and methods: This study was designed as a cross-sectional observational analysis involving 90 individuals, divided into three groups: Group A consisted of 30 individuals diagnosed with rheumatoid arthritis without clinical signs of ulnar neuropathy at the elbow; Group B included 30 individuals with rheumatoid arthritis exhibiting clinical indicators of ulnar neuropathy at the elbow; and Group C comprised 30 healthy controls. Each participant underwent a thorough medical history assessment, along with both clinical and neurological evaluations. Additionally, ultrasound and electrophysiological assessments of the ulnar nerve were performed.

Results: There was no significant demographic difference between the groups, except for age, which was notably lower in Group A compared to Group B. Additionally, abnormalities in nerve conduction studies and cross-sectional area were found to be significantly greater in Group B (p <0.0001). The cross-sectional area demonstrated diagnostic accuracy rates of 52.22%, 62.22%, and 78.89% for identifying ulnar neuropathy at Guyon's canal, the medial epicondyle, and based on the elbow-to-wrist ratio, respectively.

Conclusion: Ultrasonography exhibits high diagnostic accuracy, especially with the cross-sectional area at the medial epicondyle and the elbow-to-wrist cross-sectional area ratio serving as important indicators for ulnar nerve entrapment in patients with rheumatoid arthritis.

To acquire ultrasound skills, students need access to educational resources for both theoretical and practical knowledge. Effective training depends on the availability of educational content, training opportunities, and facilities - all of which are often scarce. E-learning platforms, simulation, and ultrasound skills labs are potential solutions to complement supervised real-life bedside training on patients and improve ultrasound education. This review discusses the advantages and disadvantages of e-learning, simulation, and ultrasound skills labs in the specific context of student education. E-learning platforms and teaching videos support students by offering flexible, accessible learning, allowing them to engage with material at their own pace. These digital resources complement practical lessons by providing essential theoretical knowledge that can be applied during hands-on sessions. Simulation creates a controlled environment for skill development and enhances patient safety, especially during interventional procedures. However, simulation equipment's high cost and technical complexity strain budgets and require specialized staff and training. Simulators often fail to replicate real-life variability, limiting skill transfer to patient care. The establishment of ultrasound skills labs offers a solid, long-term opportunity for skill retention but requires sufficient and sustainable funding. In conclusion, e-learning, simulation, and ultrasound skills labs can be valuable components of student ultrasound education if used deliberately. They should be included in a blended medical curriculum incorporating real-world clinical experiences to ensure effective transfer of learning to clinical practice.

Aim: The aim of the study was to obtain two-dimensional shear wave elastography measurements of the liver, spleen and kidneys in healthy full-term newborns, as well as to assess its feasibility in this age group.

Materials and methods: We performed two-dimensional shear wave elastography of the liver, spleen and kidneys using a linear transducer at least 60 minutes after food intake in a group of 58 healthy, full-term, spontaneously breathing newborns. A series of 5 measurements using 5-mm-diameter regions of interest were performed, with the results expressed in m/s and kPa. Exam feasibility was assessed using the IQR/Median ratio as ≤30% for kPa, and ≤15% for m/s. Descriptive statistics, Shapiro-Wilk W, Levene's, Mann-Whitney U tests and Spearman correlation analysis were used for statistical assessment.

Results: The feasibility of the exam was 68.97% for the right liver lobe, 67.24% for the left lobe, 91.07% for the spleen, 89.29% for the right kidney, 85.71% for the left kidney. Mean results: right liver lobe: 1.43 m/s, SD ±0.11, 6.04 kPa, SD ±0.97, left liver lobe: 1.41 m/s, SD ±0.12, 5.86 kPa, SD ±1.02, spleen: 2.36 m/s, SD ±0.21, 16.99 kPa, SD ±3.21, right kidney: 1.92 m/s, SD ±0.18, 11.34 kPa, SD ±3.21, left kidney: 1.88 m/s, SD ±0.16, 10.81 kPa, SD ±1.80. The splenic-hepatic elastography index for m/s and kPa results was as follows: mean 1.65, SD ±0.20, mean 2.82, SD ±0.73, respectively. No differences were found between the right vs left lobe of the liver, or the right vs left kidney; there was no correlation between the measurements and gender or food intake interval >60 minutes. A positive correlation was found between the results for the right and left lobe of the liver and age, and the results for the left lobe of the liver and body weight.

Conclusions: Two-dimensional shear wave elastography of the liver, spleen and kidneys can be successfully performed in healthy neonates. We obtained reliable mean shear wave elastography values for the examined organs.

Aim: Hypoplastic left heart syndrome is a severe congenital heart defect that may be accompanied by tricuspid and mitral valve regurgitation. The aim of this paper is to identify a new ultrasound marker for evaluating the outcomes of fetuses with hypoplastic left heart syndrome.

Material and methods: This was a single-center analysis of a group of fetuses who underwent fetal ultrasound examinations at our tertiary center between 2016 and 2023. This study included 80 fetuses with hypoplastic left heart syndrome. The gestational age of the studied fetuses ranged from 16.3 to 39.5 weeks. All anomalies and irregularities accompanying hypoplastic left heart syndrome were detected during the second and third trimesters of pregnancy.

Results: Among fetuses with hypoplastic left heart syndrome with tricuspid regurgitation, the mortality rate was 0% (0/16) and the survival rate was 100% (16/16). In contrast, in fetuses with hypoplastic left heart syndrome with both tricuspid and mitral regurgitation, the mortality rate was 75% (3/4) and the survival rate was 25% (1/4). The incidence of death was significantly higher in the group of fetuses with hypoplastic left heart syndrome with both tricuspid and mitral regurgitation compared to the group with tricuspid regurgitation (Yates's chi-squared test: p = 0.003; Fisher's test: p = 0.0035).

Conclusions: The coexistence of hypoplastic left heart syndrome with tricuspid and mitral regurgitation is significantly associated with the death of newborns even when treatment and/or surgery is performed. Therefore, the presence of mitral regurgitation in fetuses with hypoplastic left heart syndrome may serve as an additional ultrasound marker for poor neonatal outcome.

Aim: Undergraduate medical education in point-of-care ultrasound remains limited. Common barriers to implementation include limited curricular space, financial constraints, and lack of instructors. This pilot study aims to assess the efficacy of a one-day symposium on medical students' point-of-care ultrasound skills, knowledge, and confidence.

Material and methods: The Philadelphia Ultrafest was a single-day educational symposium held in April 2023 for students attending one of seven Philadelphia-area medical schools. Utilizing pre- and post-conference assessments, instructors evaluated background attitudes towards ultrasound, experience level, self-reported confidence, and knowledge of ultrasonography. Pre- and post-test results were compared using McNemar's or Symmetry Chi Squared analysis.

Results: Sixty-six students completed the pre- and post- conference surveys. Before the conference, 62% of students correctly localized abdominal free fluid compared to 89% following the conference (p = 0.02). In identifying transducer type, the correct response rate increased from 78% to 98% (p = 0.004). Before the instruction, students had an average confidence rating of 5.4 out of 10 in their ability to identify organs on exam, compared to 7.7 after Ultrafest (p <0.001). Confidence levels in performing the focused assessment with sonography for trauma examination (3.3 pre vs. 6.7 post; p <0.001) and ultrasound-guided peripheral intravenous catheterization (3.4 pre vs. 6.5 post; p <0.001) also increased after Ultrafest as well.

Conclusions: The results demonstrate enhanced sonographic knowledge and confidence following this one-day point-of-care ultrasound symposium. Future studies should evaluate the long-term outcomes of similar educational formats.