Ultrasound Quarterly最新文献

Abstract: Point-of-care ultrasound (POCUS) curriculum varies among countries. However, the length of training required for physicians is still under debate. We investigated the impact of different training methods: short hands-on courses (STS), long academic training sessions (LTS), or both (mixed training [MTS]), for POCUS daily use and self-reported confidence overall and specific to specific clinical situations. This was a descriptive study conducted over a 3-month period through a Web-based survey designed to assess the influence of different methods of POCUS training among physicians and residents on their daily practice. The survey was sent to 1212 emergency physicians with prior POCUS training; 515 answers (42%) could be analyzed. Participants in the STS group performed POCUS less frequently than physicians in the LTS or MTS group. Daily use in the STS group was 51% versus 82% in the LTS group and 83% in the MTS group ( P < 0.01). The overall self-reported confidence in POCUS was lower in the STS group ( P < 0.01) in all studied clinical situations. There was no significant difference between LTS and MTS groups ( P > 0.05). Method of POCUS training significantly influenced POCUS daily use. Physicians who underwent long training sessions used POCUS more frequently in their routine practice and were significantly more confident in their ability to perform and interpret a POCUS examination.

Abstract: This study aims to assess the application value of transanal normal saline infusion-assisted multipath ultrasonography (TNSI-MU) in the diagnosis of T1/T2 rectal cancer (RC). All patients first received single-path 360-degree transrectal ultrasonography and then received 360-degree transrectal ultrasonography, transabdominal ultrasonography, or transvaginal ultrasonography after TNSI to determine the T stage. With surgical pathology as the criterion standard, the detection rates of T1/T2 RC lesions and the T-staging results of single-path 360-degree transrectal ultrasonography, TNSI-MU, and contrast-enhanced magnetic resonance imaging (MRI) were compared and analyzed. T1/T2 RC was surgically and pathologically confirmed in 52 patients. Single-path 360-degree transrectal ultrasonography had a lesion detection rate of 57.69% (30/52) and a T-staging accuracy of 80.0% (24/30), the sensitivity was 57.69%, and the specificity was 88.46%. Transanal normal saline infusion-assisted multipath ultrasonography had a lesion detection rate of 100%, and its T-staging accuracy was 84.62% (44/52), the sensitivity was 100%, and the specificity was 88.61%. Transanal normal saline infusion-assisted multipath ultrasonography had a significantly higher detection rate of T1/T2 RC lesions than single-path 360-degree transrectal ultrasonography ( P < 0.001), but the 2 methods had similar T-staging accuracy for T1/T2 RC (χ 2 = 0.286, P = 0.593). Contrast-enhanced MRI had a lesion detection rate of 100% and a T-staging accuracy of 40.38% (21/52), the sensitivity was 98.07%, and the specificity was 61.54%. Transanal normal saline infusion-assisted multipath ultrasonography had significantly higher diagnostic accuracy than contrast-enhanced MRI for T staging of T1/T2 RC ( P < 0.001), and the diagnostic results of the 2 methods were not consistent (κ = 0.151). Transanal normal saline infusion-assisted multipath ultrasonography outperformed single-path 360-degree transrectal ultrasonography in the detection rate of T1/T2 RC lesions and contrast-enhanced MRI in the staging accuracy for T1/T2 RC.

Abstract: High-frequency ultrasound is the imaging modality of choice for evaluating penile pathology because of its easy access, low cost, and patient tolerance ( The Penis, Diagnostic Ultrasound, second edtion . Boca Raton: CRC Press; 2007:957-978). This pictorial review will illustrate the sonographic features of emergent and nonemergent penile conditions such as penile fracture, spongial tear, urethral injury, various types of priapism, erectile dysfunction, penile abscess, and Mondor disease.

Abstract: Thyroglossal duct cyst is the most common congenital neck mass, but the incidence of malignancy within a thyroglossal duct cyst is rare, estimated at 1%. Most cancers arising within thyroglossal duct cysts are incidentally detected after surgical excision. We present the preoperative radiologic findings of 8 patients with papillary thyroid cancer arising within a thyroglossal duct cyst, as evaluated on ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scan.

Abstract: Many physicians, particularly those practicing in remote regions, lack training opportunities to develop point-of-care ultrasound (POCUS) skills. This pretest-posttest study quantified the skill improvement of learners after participating in a virtual training program that used real-time, remotely delivered point-of-care tele-ultrasound (tele-POCUS) for teaching and learner feedback provision. Ten physicians practicing in an urban tertiary (Kingston, Ontario, Canada, n = 6) or remote care center (Moose Factory, Ontario, Canada, n = 4) completed a 3-week educational program that consisted of e-learning module review, independent image acquisition practice, and expert-guided tele-POCUS consultations. Pretraining and posttraining assessments were performed to evaluate skill enhancement in image acquisition, image quality, and image interpretation for cardiac and lung/pleura POCUS using a 5-point Likert scale. A total of 76 tele-POCUS consultations were performed during the study period. Significant improvements in image quality were noted following remotely delivered mentorship and guidance (all P < 0.01). In cardiac POCUS, pretraining and posttraining comparisons noted significant improvements in image acquisition (means, 2.69-4.33; P < 0.02), quality (means, 2.40-4.03; P < 0.01), and interpretation (means, 2.50-4.40; P < 0.02). In lung/pleura POCUS, significant improvements in image acquisition (means, 3.00-4.43; P < 0.01), quality (means, 3.23-4.37; P < 0.01), and interpretation (means, 3.00-4.40; P < 0.01) were demonstrated. Introductory ultrasound can be taught to novice users using a virtual, live-streamed training format with tele-POCUS while demonstrating significant enhancement in imaging skills.

Abstract: Obstetric volume sweep imaging (OB VSI) is a simple set of transducer movements guided by external body landmarks that can be taught to ultrasound-naive non-experts. This approach can increase access to ultrasound in rural/low-resources settings lacking trained sonographers. This study presents and evaluates a training program for OB VSI. Six trainees without previous formal ultrasound experience received a training program on the OB VSI protocol containing focused didactics and supervised live hands-on ultrasound scanning practice. Trainees then independently performed 194 OB VSI examinations on pregnancies >14 weeks with known prenatal ultrasound abnormalities. Images were reviewed by maternal-fetal medicine specialists for the primary outcome (protocol deviation rates) and secondary outcomes (examination quality and image quality). Protocol deviation was present in 25.8% of cases, but only 7.7% of these errors affected the diagnostic potential of the ultrasound. Error rate differences between trainees ranged from 8.6% to 53.8% ( P < 0.0001). Image quality was excellent or acceptable in 88.2%, and 96.4% had image quality capable of yielding a diagnostic interpretation. The frequency of protocol deviations decreased over time in the majority of trainees, demonstrating retention of training program over time. This brief OB VSI training program for ultrasound-naive non-experts yielded operators capable of producing high-quality images capable of diagnostic interpretation after 3 hours of training. This training program could be adapted for use by local community members in low-resource/rural settings to increase access to obstetric ultrasound.

Abstract: In lower-extremity deep vein thrombosis (DVT), thrombus age is essential for successful treatment. The aim of our study was to compare the shear wave elastography (SWE) values measured before treatment and achieved lumen patency after treatment in lower-extremity DVT patients with total occlusion. Patients diagnosed with DVT in the acute-subacute stage (<4 week) with total thrombosis in lower extremity were included in this prospective study. Shear wave elastography measurements were performed where the thrombus was most prominent and homogeneous. To evaluate patient response to treatment, lumen patency (partial [>25%] or total recanalization) was examined using color Doppler imaging in the first and third months posttreatment. Shear wave elastography values with and without patency were compared using an independent t test. Among 75 patients in this study, at the first-month color Doppler imaging examination, the SWE values were 1.77 ± 0.49 (1.09-3.03) m/s in patients who achieved lumen patency (n = 42) and 2.21 ± 0.54 (1.24-3.36) m/s in those who did not show lumen patency (n = 33). The difference between the groups' mean elastography value was statistically significant ( P < 0.001). At the third-month examination, the SWE values were 1.76 ± 0.46 (1.09-3.03) m/s in patients with lumen patency (n = 55) and 2.52 ± 0.48 (1.74-3.36) in patients without lumen patency (n = 20). The difference between the 2 groups' mean elastography value was statistically significant ( P < 0.001). We concluded that it is more difficult to achieve lumen patency in veins occluded by thrombus with higher elasto values, and endovascular interventional procedures should be considered during the initial treatment of high SWE value thrombosis.

Abstract: The aims of this study were to evaluate the kidneys of patients with familial Mediterranean fever (FMF) noninvasively and quantitatively using 2-D shear wave elastography (SWE) and to reveal the diagnostic efficacy of SWE in FMF-induced renal involvement. Healthy controls, FMF patients, and FMF patients with proteinuria were included in the study, and differences in renal stiffness values between the groups were examined. In addition, a relationship between age, sex, height, weight, body mass index, serum erythrocyte sedimentation rate, C-reactive protein, glomerular filtration rate, and renal stiffness values was evaluated. A total of 120 subjects, including 60 controls, 41 FMF patients without proteinuria, and 19 FMF patients with proteinuria, were enrolled in the study. Renal stiffness values were found to be significantly higher in the group with FMF compared with the control group. In addition, the values in the proteinuria group were higher than both the control group and FMF patients without proteinuria ( P < 0.001). A significant positive correlation was found between the renal stiffness value and C-reactive protein. According to receiver operating characteristic analysis, the mean renal stiffness value was 7.905 kPa or greater to determine FMF-induced proteinuria. The current study shows that renal stiffness values were higher in FMF patients compared with the normal population and the values showed further increase in the presence of proteinuria, which indicates a more advanced stage of renal involvement of the disease. These findings reveal that SWE can be used as a noninvasive diagnostic tool in the diagnosis, follow-up, and evaluating the severity of FMF.

Abstract: This study is an analysis of fetal lung stiffness by virtual touch tissue quantification (VTTQ) elastography to predict fetal lung maturation. Evaluation of fetal lungs was first performed in B mode, and fetal lungs were analyzed at 3 different periods at third trimester in each pregnant woman, at 28 to 31, 32 to 36, and 37 to 41 weeks. Fetal lung elastography was performed at regions with the least acoustic shadow and far from ribs and heart. Each fetal lung assessment were done by taking mean lung stiffness obtained by measuring stiffness of both left and right fetal lungs. T test analysis showed no significant difference in fetal lung stiffness between male and female fetuses among 3 gestational periods. Analysis of variance was performed to evaluate fetal lung stiffness of the fetuses at 3 different gestational periods (28-31, 32-36, and 37-41 weeks). This analysis showed significant difference ( P < 0.01). Duncan multiple comparison analysis did not show significant difference in fetal lung stiffness between 28 and 31 weeks and 32 and 36 weeks, whereas fetal lung stiffness of fetuses at 37 to 41 weeks were significantly greater ( P < 0.01). This study is first step to analyze fetal lung maturation noninvasively using VTTQ elastography technique by measuring fetal lung stiffness.