Journal of Ultrasonography最新文献

Aim: Response to cardiac resynchronization therapy varies significantly among patients, with one third of them failing to demonstrate left ventricular reverse remodeling after cardiac resynchronization therapy. Left atrial size and function is increasingly recognized as a marker of disease severity in the heart failure population. The aim of this study was to evaluate whether echocardiographic left atrial indices predict left ventricular reverse remodeling after cardiac resynchronization therapy.

Materials and methods: Ninety-nine cardiac resynchronization therapy candidates were prospectively included in the study and underwent echocardiography before and 3-months after cardiac resynchronization therapy implantation. Cardiac resynchronization therapy response was defined as a 15% relative reduction in left ventricular end-systolic volume. Indexed left atrial volume, left atrial reservoir strain, left ventricular end-diastolic volume, and left ventricular ejection fraction along with other known predictors of cardiac resynchronization therapy response (gender, etiology of heart failure, presence of typical left bundle branch block pattern, QRS duration >150 ms) were included in a multivariate logistic regression model to identify predictors for cardiac resynchronization therapy response.

Results: Cardiac resynchronization therapy response occurred in n = 63 (64%) patients. The presence of a typical left bundle branch block (OR 4.2, 95 CI: 1.4-12.1, p = 0.009), QRS duration >150 ms (OR 4.2, 95 CI: 1.4-11.0, p = 0.029), and left atrial volume index (OR: 0.6, 95 CI: 0.4-0.9, p = 0.012) remained the only significant predictors for cardiac resynchronization therapy response after three months. None of the baseline left ventricular parameters showed an independent predictive value.

Conclusion: Left atrial size at baseline is an independent predictor and is inversely proportional to left ventricular volumetric reverse remodeling in cardiac resynchronization therapy candidates.

Aim: The term "branchial cleft cyst" refers to the lesions that can be considered synonymous with cervical lymphoepithelial cysts. Although relatively rare, they constitute the second major cause of head and neck pathologies in childhood. This study aimed to report the clinical presentations, diagnosis, and management of pediatric patients with the pathological diagnosis of branchial cleft cyst.

Material and methods: This study was a retrospective analysis of the records of 33 patients with the diagnosis of branchial cyst, in two different university hospitals, in two different populations.

Results: Thirty-three cases of branchial cleft cysts were seen in 33 patients: 17 females and 16 males. The majority (16 patients) were 2^nd branchial cleft cysts. Accurate diagnosis of branchial cleft malformation was made via imaging in 20 of the 21 (95%) patients that underwent preoperative surgical ultrasonographic imaging.

Conclusion: Branchial cleft cysts are frequently incorrectly diagnosed and ignored in the differential diagnosis. Thus, the diagnosis is often delayed, resulting in the mismanagement of affected patients. A branchial cyst should be suspected in any patient with a swelling in the lateral aspect of the neck, regardless of whether the swelling is solid or cystic, painful or painless. The use of ultrasonography can dramatically help clinicians with distinguishing branchial cleft cysts from other similar lesions of the head and neck.

Aim of the study: We report a case of a blind-ending bifid ureter in a 67-year-old woman with ascites initially diagnosed with B-mode and Color Doppler ultrasonography and afterwards verified with contrast-enhanced abdominal computed tomography. A literature review of the pathogenesis, sonographic appearance with differential diagnoses and clinical significance is also presented and discussed.

Case description: The patient was referred for an abdominal ultrasound due to enlarged abdomen circumference. Ultrasound revealed signs of chronic pancreatitis with cavernous transformation of the portal vein and large ascites resulting in bilateral pelvicalyceal system dilatation. Additionally, we have preliminarily diagnosed right-sided, dilatated blind-ending bifid ureter with associated contralateral complete duplication of the ureter and the collecting system. These findings, initially revealed with ultrasound, were confirmed with contrast-enhanced abdominal computed tomography.

Conclusions: To our knowledge, this is the first detailed description of sonographic appearance of blind-ending bifid ureter.

Objective: The purpose of this study was to use ultrasonographic data to rule out and distinguish diseases that cause acute pelvic pain.

Material and method: The literature was reviewed using a systematic search of the databases Google Scholars and PubMed, as well as through hand searching. We looked through a total of 35 articles, but only 26 were selected after preliminary screening. Furthermore, 14 articles were left out because they required a membership, copyright clearance, or featured non-English references. There were a total of 12 articles included in the final revuew. Among all the study-related articles, only original research studies and one systematic review that sonographically explored the gynecological etiology of acute pelvic pain were selected.

Results: Acute pelvic pain in women might be difficult to identify between gynecologic and non-gynecologic causes based solely on patient history and examination. Advanced imaging, like ultrasound, aids in determining the reason. Pelvic inflammatory disease can be difficult to diagnose, and clinicians should use a low threshold for starting presumptive treatment in order to avoid significant long-term effects such as infertility.

Conclusions: Pelvic pain can be acute, chronic or functional. Imaging investigations such as CT, ultrasonography, and MRI can assist in establishing a diagnosis. Particularly ultrasound scanning makes it possible to arrive at a diagnosis with a high degree of precision.

Aim of the study: The aim of the present paper is to determine the diagnostic features of the rare presentation of osteochondroma in the mandible. The unusual aspect in this case is that the diagnosis was not established with cone beam computer tomography, which is a commonly used radiographic technique in dentistry, but with the use of ultrasonography.

Case description: Ultrasonography is very useful for initial examinations, avoiding patient exposure to additional radiation and setting the diagnosis in debatable soft tissue involvement of various lesions. In the presented case, even though the clinical presentation was indicative, the cone beam computer tomography evaluation could not confirm the diagnosis, so the final diagnosis was made by ultrasonography.

Conclusions: With the latest advances in the applications of ultrasonography in the maxillofacial region, an examination of lesions on the floor of the mouth or in the neck area may set the diagnosis in cases where hard tissue imaging does not provide enough information.

Background: The assessment of elite athletes after SARS-CoV-2 infection gives rise to doubts concerning return-to-play decisions: what period of convalescence is needed and what diagnostic measures are appropriate. While cardiovascular protocols have been widely discussed in the literature, lung parenchyma imaging was only briefly mentioned, and the usefulness of lung ultrasound has been not considered yet.

Materials and methods: A total of 31 elite Caucasian male athletes (mean age: 26.03 ± 5.62), recovered from COVID-19 were assessed after SARS-COV-2 infection. Medical data was collected. Lung ultrasonography and high-resolution computed tomography were performed.

Results: Normal lung parenchyma dominated on CT scans. A total of 25 athletes (80.6%) presented abnormalities on high-resolution computed tomography; changes typical for COVID-19 were detected in five cases (16.1%), and less specific abnormalities were identified in 20 athletes (64.5%). Despite the prevalence of ultrasound abnormalities, A-line pattern was dominant in 23 athletes (74.2%): for 434 ultrasound-scans, it was visible in = 265 (61.1%). In 93.2% of the subjects, it corresponded to a normal lung parenchyma pattern visible on high-resolution computed tomography. The sensitivity of lung ultrasonography in comparison to high-resolution computed tomography was 74.65%, while the specificity was 68.56%.

Conclusion: Lung changes are frequent, but not extensive. Ultrasound A-line pattern was associated with normal lung parenchyma findings revealed on high-resolution computed tomography. The negative predictive value for lung ultrasonography (93.2%) points towards its suitability in return-to-play protocols.

Aim: The aim of the study was to establish reference values for the cross-sectional area of the tibial nerve on high-resolution ultrasonography and to investigate the relationship between the cross-sectional area of the tibial nerve and subject's age, gender, height (in cm), weight (in kg) and body mass index.

Methods: Two hundred subjects of either gender and over 18 years of age with no history of peripheral neuropathy or trauma to the lower limb were evaluated with high-resolution ultrasonography. Mean cross-sectional areas of tibial nerves were measured at two different levels in both lower limbs, first at 1 cm below the bifurcation of the sciatic nerve into tibial and common peroneal nerves (level I) and the second at 1 cm superior and posterior to the medial malleolus (level II).

Results: The mean cross-sectional area measured at level I (0.196 + 0.014 cm²) was larger than the one measured at level II (0.111 ± 0.011 cm²). A positive correlation was found between the mean cross-sectional area and height, weight, and body mass index (p <0.05). Women had smaller cross-sectional areas of the tibial nerves than men at both sites. In addition, no significant relationship was found with the age of the subjects (p >0.05).

Conclusion: The established reference values of the cross-sectional area of the tibial nerve will aid in early diagnosis of peripheral neuropathy.

Background: Distal radius fractures are the most common pediatric fractures, increasing in number in recent decades. Although simple bi-planar radiographs are sufficient for diagnosis, wrist ultrasonography has been popularized in recent years for fracture detection, mostly because of the concern about children's radiation exposure. Despite its availability and diagnostic accuracy, ultrasound has not gained widespread acceptance and popularity among orthopedic surgeons. We asked about the reasons for its lack of acceptance as a diagnostic tool by orthopedic surgeons, and its failure to be incorporated into diagnostic algorithms.

Material and methods: We reviewed the latest articles concerning the use of ultrasound in the diagnosis of pediatric distal radius fracture. Data extraction was performed from each study with a focus on the following items: the specialty field of the authors, number of patients, number of fractures, mean age of the patients, and the gold standard method of diagnosis.

Results: Nine studies concerning the diagnostic accuracy of ultrasound in detecting distal radius fractures in children were included in the review. The most common field of practice of the authors was emergency medicine. Only two studies had an orthopedic surgeon among their authors. All studies employed X-ray imaging as the gold standard method. All studies were designed as prospective trials without randomization of patients. Generally, there was no independent blinded reviewer for the interpretation of ultrasound and X-ray images.

Conclusions: Most studies were completed by emergency medicine physicians, without involving an orthopedic surgeon. Ultrasound evaluation was undertaken primarily by emergency medicine physicians with little experience. These studies were not randomized controlled trials, and knowledge of the history and clinical presentation of the subjects could have led to information bias. The relatively low number of included patients and lack of follow-up examinations were other limitations. As a result, we believe that ultrasound has not proven to be a suitable substitute for conventional X-ray imaging in the detection of pediatric distal radius fractures. We propose X-ray evaluation as the clinical gold standard method for pediatric wrist fractures.

Aim of the study: We present a case report of enlarged cisterna chyli in a 25-year-old woman. The diagnosis was made during a routine abdominal ultrasound examination and afterwards verified with contrast-enhanced MRI.

Case description: Ultrasound revealed a large, lobulated, anechoic cystic structure with thin, smooth walls, lacking any solid components. The lesion was located in the retroperitoneal space, beneath the head of the pancreas, between the partially compressed inferior vena cava and the aorta, extending almost to the aortic bifurcation. We performed a contrast-enhanced MRI examination which confirmed the sonographic suspicion of enlarged cisterna chyli, showing a non-enhancing cystic lesion in continuity with the thoracic duct.

Conclusions: Anatomy, sonographic and magnetic resonance appearance of cisterna chyli as well as differential diagnosis are discussed.

Thyroid cancer is a tumour with a steadily increasing incidence. It accounts for 7% to 15% of focal lesions detected by ultrasound, depending on age, gender and other factors affecting its occurrence. Fine-needle aspiration biopsy is an essential method to establish the diagnosis but, in view of its limitations, sonoelastography is seen as a non-invasive technique useful in differentiating the nature of lesions and monitoring them after fine-needle aspiration biopsy. This paper presents a literature review on the role of both sonoelastographic techniques (relative strain sonoelastography, shear wave sonoelastography) to assess the deformability of focal thyroid lesions. Ultrasound examination is a relatively subjective method of thyroid imaging, depending on the skills of the examiner, the experience of the centre, and the quality of equipment used. As a consequence, there are inconsistencies between the results obtained by different examiners (inter-observer variability) and by the same examiner (intra-observer variability). In this paper, the authors present a review of the literature on inter-observer and intra-observer variability in the assessment of individual features of ultrasound imaging of focal lesions in the thyroid. In addition, the authors report on an analysis of cut-off thresholds for the size of lesions constituting the basis for fine-needle aspiration biopsy eligibility assessment. The need to diagnose carcinomas up to 10 mm in diameter is highlighted, however a more liberal approach is recommended in terms of indications for biopsy in lesions associated with a low risk of malignancy, where, based on consultations with patients, active ultrasound surveillance might even be considered.