Journal of Ultrasonography最新文献

Ultrasound is a reliable imaging modality for diagnosing and assessing musculoskeletal disorders. Recent advancements in ultrasound technology have substantially improved image resolution, enabling the visualization of anatomic structures on a near-microscopic level. However, existing guidelines for standardized shoulder ultrasound primarily rely on earlier machine models and settings that may not harness the full potential of these high-resolution imaging capabilities. This article provides a simple and systematic guide to high-resolution sonography of the shoulder using anatomical and histological images from cadavers for comparison. International standard techniques are considered, and images were obtained using modern equipment. This two-article series systematically shows the examination and normal findings, presenting first the posterior, then frontal, then further anterior, followed by lateral and, optionally, the axillary examination. In this article, the focus is on the posterior and coronal shoulder.

Since the first clinical use of ultrasound in the 1940s, significant advancements have been made in its applications. Color Doppler imaging and power Doppler imaging are considered the first and second generations of flow ultrasound assessment tools, respectively. Subsequently, the introduction of contrastenhanced ultrasound has significantly improved the assessment of arterial and venous vascular patterns in lesions and vessels. 'Blood flow brightness-mode imaging' or 'B-flow', a non-Doppler ultrasound flow assessment mode introduced more recently, provides even more information for ultrasound users in flow assessment. Microvascular imaging, introduced about a decade ago, is the third generation of Doppler non-contrast ultrasound flow modes, and is growing in popularity. Using a special wall filter, microvascular imaging overcomes the limitations of color Doppler imaging and power Doppler imaging in the detection of slow flowing signals. Advanced dynamic flow is a third-generation non-contrast Doppler flow technology that has so far gained popularity in obstetric ultrasound, commonly used to evaluate fetal umbilical vessels and heart chambers. This review article presents some recent updates on the various non-contrast ultrasound flow modalities available in clinical practice. It focuses on the design principles of individual flow modalities, discussing their strengths, limitations, and clinical applications, along with a review of the relevant literature.

Aim: Arteriovenous fistulas are created to serve as a vascular access in hemodialysis patients. Our study assessed the Doppler ultrasound characteristics of upper limb arteriovenous fistulas.

Material and methods: We carried out a cross-sectional, consecutive sampling study at the Yaoundé University Teaching Hospital. We interviewed consenting patients on maintenance dialysis performed for at least one month via an upper limb arteriovenous fistula, which was subsequently scanned. We compared the proportions and means using chi-squared and ANOVA tests, respectively, with a threshold for significance set at a p value ≥0.05.

Results: Between 1 July and 31 August 2022, we recruited a total of 41 participants, of whom 56.1% were males. The mean age of the participants was 48.39 years. Radiocephalic (76%) and brachiocephalic (24%) arteriovenous fistulas were the only types present. The mean flow volume in the arteriovenous fistulas was 680.47 (365.98) ml/min, with 34.1% of the fistulas having a low flow volume. Also, 56.1% of the arteriovenous fistulas were stenosed, with the main site of stenosis being the juxta-anastomotic segment of the efferent vein. Aneurysms (53.7%), reverse flow (51.2%), venous luminal flaps (22%), and thrombus (17.1%) were the most common complications identified in the study population, with 78.05% of the arteriovenous fistulas having at least one complication. Factors associated with arteriovenous fistula stenosis included the patient body mass index and the radiocephalic fistula type. Diabetes, aneurysms, and luminal venous flaps were found to be associated with low flow volume.

Conclusions: The prevalence of vascular modifications and stenosis within functional arteriovenous fistulas was high.

Aim: The study aimed to quantitatively clarify the effects of several weeks of static stretching on the flexibility of the rectus femoris muscle using shear wave elastography.

Material and methods: Fifteen healthy men (age: 26.4 ± 2.2 years) were instructed to perform 5 min of voluntary static stretching of their right rectus femoris muscles five times a week for four weeks. The participants adjusted their stretching inrectus femoris muscle tensity to a point immediately before experiencing discomfort or pain. The Young's modulus of the rectus femoris muscle and the knee-flexion range of motion were measured as indicators of flexibility. The Young's modulus was measured using shear wave elastography. Measurements were performed at baseline, as well as at two and four weeks after the stretching program started. A generalized linear mixed model was used to assess the change in the Young's modulus after the stretching program and the effects of the Young's modulus on the knee-flexion range of motion.

Results: The Young's modulus of the rectus femoris muscle decreased after two and four weeks of stretching compared with the baseline (p = 0.0004 and p <0.0001, respectively). The Young's modulus of the rectus femoris muscle and the four-week duration of stretching affected the knee-flexion range of motion (p = 0.0242 and 0.0016, respectively).

Conclusions: Shear wave elastography quantitatively revealed that several weeks of static stretching increased the flexibility of the rectus femoris muscle in healthy men. A four-week static stretching regimen reduced the Young's modulus of the rectus femoris muscle and increased the knee-flexion range of motion.

Aim: In the study, we aimed to introduce a formula for measuring the oesophageal total wall thickness area, which could be used for developing an artificial intelligence-based algorithm for the detection of patients whose total wall thickness area exceeds the norms.

Material and methods: Mathematical formulas for measuring the square area of the oesophageal total wall thickness area were introduced and applied. Children were grouped according to their weight in clusters. For each cluster, the range (minimal and maximal value) were established. The measurements were done by using the formula for the area of the circular ring according to the formula A = n (B2-b2); the product of n and subtraction square b (smaller radius) and square B (bigger radius). The basic data for our calculations were derived from papers published by Dalby et al., 2010 and Loff et al., 2022.

Results: The square area (in mm²) of the oesophageal wall was calculated and proposed to be introduced for further analysis. This value set could be used for creating an algorithm for computer-aided analysis of patients diagnosed with sonographic examination and isolating patients for surveillance. Our newly introduced approach could be implemented in sonographic, computer tomography, and magnetic resonance examinations in eosinophilic oesophagitis and other oesophageal diseases.

Conclusions: Total wall thickness area could be used for monitoring children with eosinophilic oesophagitis and other oesophageal diseases. The method could also be applied for adults. Therefore, it can be a foundation for further progress with applying artificial intelligence algorithms.

Purpose: Distal forearm fractures are one of the commonest injuries in children due to falling on an outstretched hand. Plain X-ray is the gold standard test for diagnosing fractures of long bones but it exposes patients to radiation with its associated health hazards. The use of ultrasonography has been proposed as a safer diagnostic test. This review aimed to summarize the evidence regarding the diagnostic accuracy of bedside ultrasonography for identifying distal forearm fractures in pediatric patients.

Methods: Electronic search of MEDLINE, EMBASE, Cochrane Library, Google Scholar, and Best Bets databases was conducted for studies published from inception to May 2017. The search terms used included "forearm" and "fractures" and "children."

Results: Seven studies were included in the review. The overall accuracy of ultrasonography ranged from 78.6% to 99.5%. The sensitivity and specificity ranged from 85% to 100%, and from 73% to 100%, respectively. The area under the curve for ultrasonography ranged from 0.79 to 1.00.

Conclusion: Ultrasound is a reliable diagnostic tool for the diagnosis of distal forearm fractures in children when performed by well-trained emergency doctors and through using an appropriate viewing method. Conducting larger prospective blinded studies on long bone injuries would be recommended.

We present a pictorial essay based on the case of a 52-year-old man suffering from chronic gout, who was followed up for seven years. During this period of time, radiographs, ultrasonography, and dualenergy computed tomography were performed several times, revealing severe progression of gout. This was most likely due to the lack of patient compliance. Inflammatory and destructive lesions were observed in the wrists, in the metacarpophalangeal and proximal interphalangeal joints. Ultrasonography showed tenosynovitis, synovitis with small calcifications in the synovial membrane. Radiographs obtained in later stages showed tophi and bone erosions. Dual-energy computed tomography showed deposits of monosodium urate crystals in different locations, which increased in volume over time. This modality can be used to confirm a clinical diagnosis of gout, especially in early stages of the disease, and to follow up the treatment.

Aim: Shoulder pain is the third most prevalent musculoskeletal condition that impairs function. Subacromial impingement syndrome is among the most typical causes of shoulder pain. The aim of this study was to evaluate inter-machine reliability of acromiohumeral distance measurements performed with standard ultrasound and wireless ultrasound devices in patients with subacromial impingement syndrome.

Material and methods: A total of 61 participants diagnosed with subacromial impingement syndrome were included. Acromiohumeral distance was measured with wireless and standard ultrasound devices in a neutral position and at 60-degree abduction, respectively. The inter-machine intraclass correlation coefficient, standard error of measurements, and minimum detectable changes were calculated.

Results: Inter-machine reliability measured in the neutral position was excellent (ICC = 0.97, 95% CI = 0.95-0.98); the standard error of measurement was 0.23 mm, and the minimum detectable change was 0.63 mm. Inter-machine reliability measured at 60 degrees abduction was excellent as well (ICC = 0.96; 95% CI; 0.93-0.97). The standard error of measurements was 0.20 mm, and the minimum detectable change was 0.55 mm. The mean difference between the two machines was 0.04 mm for the neutral position and 0.02 mm for the 60-degree abduction position.

Conclusions: The study showed that wireless ultrasound devices were similar to standard ultrasound devices in measuring the acromiohumeral distance in patients with subacromial impingement syndrome. The findings could contribute to a significant improvement in the clinical use of wireless ultrasound devices.

Aim: Determination of blood flow parameters in the ophthalmic artery and central retinal artery using Doppler ultrasound in patients with type 1 diabetes mellitus without fundus signs of diabetic retinopathy and with mild non-proliferative retinopathy.

Material and methods: To eliminate the impact of other systemic factors on vascular flow, the study enrolled a total of 80 patients with type 1 diabetes mellitus, aged between 18 and 45 years. The study participants did not have any diabetic complications or other systemic or ocular comorbidities. The control group comprised 81 healthy individuals within a similar age range. Color Doppler ultrasound examinations of the ophthalmic artery and central retinal artery were performed to evaluate selected blood flow parameters including peak systolic velocity, end-diastolic velocity, and resistance index.

Results: Patients with type 1 diabetes mellitus exhibited statistically significant decrease in both systolic and end-diastolic velocities in the central retinal artery, accompanied by an elevation in resistance index, compared to the control group. The study revealed differences in blood flow parameters between the patients without fundus changes and those exhibiting mild non-proliferative retinopathy. Specifically, patients with retinopathy showed a significant decrease in both systolic velocity and end-diastolic velocity in the central retinal artery. No differences were observed for the same parameters in the ophthalmic artery. When analyzing the patients' blood flow parameters in relation to the degree of diabetes control, as determined by glycated hemoglobin levels, a statistically significant reduction in systolic velocity was identified in both the ophthalmic and central retinal arteries in the group with poorly controlled diabetes.

Conclusions: Examination of the orbital vessels using Doppler ultrasound in patients with type 1 diabetes mellitus holds promise as an effective method for early detection of vascular abnormalities.