Medical Ultrasonography最新文献

Skin ultrasound (US) is a relatively new imaging technique, for which interest has grown significantly in the last decade. Properties such as mobility, real-time imaging and lack of irradiation or sedation, have made it a useful tool in completing the clinical examination. The use of probes of different frequencies has managed to improve the US technique, offering the possibility of obtaining high quality images. Thus, by using high-frequency and ultra-high frequency US, subclinical information can be obtained with a wide applicability in dermatological pathology. In this paper we aim to discuss the main uses of skin US in non-tumoral pathology (inflammatory and autoimmune pathology).

The posteromedial corner (PMC) is a common location for knee joint pain, and accurate diagnosis is essential for appropriate treatment. The frequent causes of pain in the PMC include pathologies of the posterior part of the medial meniscus, damage to articular cartilage, popliteal cysts and the semimembranosus tendinopathy.Currently, magnetic resonance imaging is the gold standard for assessing knee joint disorders, but its availability and cost can limit its use in some cases. In this pictorial essay, we presented the use of ultrasonography as an alternative method for assessing PMC.We present a series of images to demonstrate the value of ultrasonography and describe the methods used for assessing PMC with a particular focus on semimembranosus tendinopathy.

In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of bacterial infections are discussed. Improved detection and characterization of common focal liver lesions (FLL) are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper on infectious (bacterial) focal liver lesions is on their appearance on B-mode and Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.

Aim: To investigate the feasibility of assessing the ecacy of non-surgical treatment for gastric lymphoma using oral contrast-enhanced ultrasound (OCEUS) and double contrast-enhanced ultrasound (DCEUS).

Material and methods: A total of 27 patients with gastric lymphoma treated nonoperatively were included in this retrospective study. The ecacy was evaluated using OCEUS and CT, respectively, and the results were tested for kappa concordance. Sixteen of the 27 patients underwent multiple DCEUS examinations before and after treatment. Micro-perfusion of the lesion in DCEUS is represented by the Echo Intensity Ratio (EIR), (echo intensity of the lymphoma lesion/echo intensity of the normal gastric wall), and one-way ANOVA was used to compare the differences between groups in EIR values before and after treatment.

Results: OCEUS and CT were highly consistent in assessing the efficacy of gastric lymphoma, with a Kappa value of 0.758. During a median follow-up of 8.8 months, there was no statistical difference between the complete remission rate obtained by OCEUS and that obtained by endoscopic and CT (25.93% vs. 44.44%, p=0.154; 25.93% vs. 33.33%, p=0.766). There was also no statistical difference in the time to achieve complete remission using OCEUS assessment and endoscopy and CT (4.71±1.03 months vs. 6.01±2.14 months, p=0.088; 4.47±1.84 months vs. 6.01±2.14 months p=0.143). The difference in EIR between the groups before treat-ment and after different numbers of treatments was statistically signifficant (p<0.05), and post hoc analysis revealed this dif-ference as early as after the second treatment (p<0.05).

Conclusions: Transabdominal OCEUS and CT are comparable in the assessment of gastric lymphoma treatment ecacy. DCEUS is a noninvasive, cost-effective, and widely available method for gastric lymphoma therapeutic effect evaluation. Therefore, transabdominal OCEUS and DCEUS have the potential to be used for the early assessment of the ecacy of the non-surgical treatment of gastric lymphoma.

Biventricular metastatic heart tumors from gynecological malignancies presented as an acute coronary syndrome with ST segment elevation are an unusual finding. We present a case of stage-4 vulvar carcinoma that metastasized in both the left and right ventricle. The particularity of the case is the echocardiographic aspect in the emergency room: multiple, large, hyperechogenic masses disseminated in the myocardium, with pericardial extension, in context of acute coronary syndrome with ST segment elevation.

Aims: To compare the accuracy of the optic nerve sheath diameter (ONSD) measured by ocular ultrasonography (US) versus magnetic resonance imaging (MRI) for the diagnosis of increased intracranial pressure (ICP).

Material and methods: A systematic search of studies evaluating US ONSD or MRI ONSD for the diagnosis of increased ICP was performed. Data were extracted independently by two authors. We used the bivariate random-effects model to evaluate the diagnostic feasibility of measuring the ONSD in patients increased ICP. A summary receiver operating characteristic (SROC) graph was adopted to calculate sensitivity and specificity. Subgroup analysis was used to explore potential difference in US ONSD and MRI ONSD.

Results: A total of 31 studies were included, in which there were 1783 patients diagnosed with US ONSD and 730 patients diagnosed with MRI ONSD. Twenty studies reporting US ONSD were included for quantitative synthesis. The US ONSD had a high diagnostic accuracy, involving estimated sensitivity of 0.92 (95%CI 0.87-0.95), estimated specificity of 0.85 (95%CI 0.79-0.89), positive likelihood ratio (PLR) of 6.0 (95%CI 4.3-8.4), negative likelihood ratio (NLR) of 0.10 (95%CI 0.06-0.15) and Diagnostic Odds Ratio (DOR) of 62 (95%CI 33-117). The data of 11 studies adopting MRI ONSD was pooled. The MRI ONSD demonstrated estimated sensitivity of 0.70 (95%CI 0.60-0.78), estimated specificity of 0.85 (95%CI 0.80-0.90), PLR of 4.8 (95%CI 3.4-6.7), NLR of 0.35 (95%CI 0.27-0.47) and DOR of 13 (95%CI 8-22). The subgroup analysis showed that US ONSD demonstrated a higher sensitivity (0.92 versus 0.70; p<0.01) and almost equal specificity (0.85 vs. 0.85; p=0.67) compared with MRI ONSD.

Conclusion: Measurement of ONSD can be a useful tool to predict raised ICP. The US ONSD demonstrated better accuracy than MRI ONSD for the diagnosis of increased ICP.

Arterial pseudoaneurysms (PSAs) typically occur after (iatrogenic) damage (i.e., puncture) to the arterial wall and are the most frequent complication following percutaneous interventions.In this article we report on successful treatments of two iatrogenic PSAs in two patients (87-year-old male; 69-yearold-female) with a brachial (10 x 7 mm; 10 mm-length "neck") and radial (17 x 7 mm; 3 mm-length "neck") artery PSA by US-guided fibrin glue injection (UGFI). Both PSAs were effectively occluded without any complications. To our knowledge this is the first report on successful treatments of upper limb artery PSAs using UGFI, which may represent a valid first-line, minimally invasive treatment option for brachial artery PSA.

Portal Venous Gas (PVG) provides an important differential diagnosis in the diagnose of intrahepatic reflexogenic structures. This review article is intended to provide an overview of the current literature on the detection of PVG, its special forms and important differential diagnoses, it also shows possibilities for the diagnostic procedure in the case of sonographic detection of PVG.

Flexibility and dynamic perspective of ultrasound imaging allow for a targeted/focused examination, yielding extra find-ings. Sonopalpation - also referred as sono-Tinel for nerves - is one of those particular features of ultrasound examination whereby the ultrasound probe is actively 'manipulated'. It is paramount to ascertain the painful structure/pathology during the evaluation of a patient and it is not possible with other imaging techniques other than ultrasonography. In this aspect, the cur-rent review aims to provide an analysis of the literature regarding the use of sonopalpation for clinical and research purposes respectively.

Hepatocellular carcinoma (HCC) has an atypical onset of clinical symptoms and a rapid tumor progression. The majority of patients with HCC are already in the late stages of the disease when they are diagnosed, limiting them to the best available treatments. Contrast-enhanced ultrasound (CEUS) has achieved significant advances in the diagnosis of HCC, including the detection of small lesions, the investigation of more beneficial contrast agents, and the use of CEUS-based radiomics. The purpose of this review is to discuss the relevant research and future challenges of CEUS in the early detection of HCC, to advise more accurate therapy.