Ultraschall in Der Medizin最新文献

Purpose: Misplacement of ventricular catheters during shunt surgery occurs in 40% of cases using a freehand technique and therefore represents a risk for early shunt failure. The goal of this retrospective, single-center study is to analyze the impact of real-time ultrasound guidance on ventricular catheter positioning and early outcome of shunt survival.

Materials and methods: We analyzed the charts and images of all patients who underwent shunt surgery from 09/2017 to 12/2022 and compared the position of the ventricular catheter using the freehand technique and real-time ultrasound guidance. Central catheter position was graded as grade I (optimal), II (contact with ventricle structures or contralateral), and III (misplacement).

Results: A ventricular catheter was placed in 244 patients using real-time US guidance and in 506 patients using a freehand technique. The mean age (53.4 and 53.6 years, respectively) and the preoperative frontal occipital horn ratio (FOHR; 0.47 versus 0.44) were almost equal in both groups. In the study group, grade I catheter position was achieved in 64% of cases, grade II in 34%, and grade III in 2%. The control group showed grade I position in 45%, grade II in 32%, and grade III in 23% of cases (p<0.05). An early central catheter failure rate was the highest in grade III (40.5%) compared to 4% in grade I.

Conclusion: Our data demonstrate that real-time US guidance leads to a significant improvement in ventricular catheter placement. Consequently, early shunt revisions decrease significantly. Further prospective, randomized, and controlled studies comparing the standard method to real-time ultrasound catheter placement are required.

Purpose: Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown aetiology, that causes progressive and destructive inflammation in the joints. Superb microvascular imaging (SMI), a new ultrasound technique that allows visualizing slow blood flow in synovitis. This study aimed to report the clinical value and utility of the SMI technique and its grading for monitoring RA by determining the correlation with clinical disease activity scores (DAS 28) and power Doppler ultrasound (PDUS).

Methods: All RA patients with clinically apparent synovitis were assessed using DAS 28. Synovitis were investigated with PDUS and SMI and each joint was graded semiquantitatively. All assessments were carried out at baseline and repeated at least 4-month follow-up. Correlations between scores were investigated using Spearman's correlation.

Results: Sixty RA patients with 552 affected joints were recruited. Clinical and sonographic scores were significantly improved at follow-up (p<0.001). SMI showed significantly more joint count and flow signal scores than clinical examination and PDUS. Moderate correlations were found between SMI score and clinical scores (p<0.001,0.586 for SMI score vs DAS 28-CRP, p=0.001,0.432 for SMI vs DAS 28-ESR). There were also stronger correlations between SMI score and PDUS score at both baseline and follow-up (p<0.001, r = 0.817, 0.842 respectively).

Conclusion: SMI provides greater utility and ability to detect synovial vascularity and monitor disease activity than PDUS. A new activity scoring system based on SMI and clinical objective findings is required to improve reliability and validity.

Ultrasound probe quality assurance is an underserved and underregulated area in medical imaging. While several testing methods exist, their availability and adoption remains varied, and the frequency of testing is often insufficient. Here we aimed to conduct a user-driven simple and rapid probe quality testing approach and to evaluate its rationale.Testing was based on physical examination of probe integrity (all probes) and in-air reverberation check (for curvilinear and linear array probes), findings, as well as probe age were registered. Prior to assessment, probes were divided into a high-risk vs. a low-risk category, based on the perceived risk of probe damage as a result of the typical application (e.g., non-invasive vs. interventional, inpatient vs. point-of-care).17.4% of the low-risk and 31.4% of high-risk probes demonstrated physical wear or damage. Reverberation artifacts were significantly more frequent (68%) in the high-risk category vs. the low-risk one (29.4%). Probes with either physical or reverberation faults were significantly older on average.The simple, rapid investigational technique uncovered an alarming percentage of probe damage or faults. It also identified immediately solvable technical issues (e.g., poor cable contact mimicking dropout). High-risk probe usage resulted in an increased rate of reverberation errors and physical damage. Risk-based, frequent rapid observational testing of ultrasound probes could substantially improve both diagnostic quality and patient safety.

The measurement of fetal cardiovascular function parameters is not yet established in prenatal diagnostics. Now that the research field of fetal programming is becoming increasingly important, this might change. Fetal cardiovascular changes have been described above all in early/severe fetal growth restriction (FGR). The aim of this study was to investigate functional echocardiographic parameters in fetuses with late-onset small for gestational age (SGA)/FGR.A prospective cohort of SGA fetuses (including FGR) and a control group with similar distribution of gestational age were studied. Parameters of systolic, diastolic, and global cardiac function, morphometry and measurements of the fetal abdominal aorta were collected.A total of 149 SGA fetuses and 143 control fetuses were included from 32 weeks until term. The total SGA group was further divided into SGA 3rd-10th (fetuses between the 3rd and 10th weight percentile) and FGR subgroups. In the total SGA group, relative right and left ventricular wall thickness, left E/A ratio, isovolumetric contraction time and left myocardial performance index were significantly increased compared to controls after adjustment for gestational age. MAPSE, TAPSE, ejection time, left cardiac output, and abdominal aortic distensibility were significantly lower. The changes were more pronounced in the FGR subgroup.Even in a group of late-onset SGA/FGR, echocardiographic parameters are already altered in utero.

Purpose: Ultrasound (US) is the preferred imaging modality in pediatrics for diagnostic and therapeutic issues. The absence of radiation and the constant on-site accessibility make it the ideal tool for children. However, despite remarkable technical advances in resolution and applicability, many sophisticated medical questions still require profound expertise on the part of the examiner, thus often hampering fast decisions particularly outside regular working hours.

Materials and methods: This single-center study, at a university children's hospital evaluated the use of US during emergency service. A four-week documentation period was followed by a subsequent eight-week supervision period with live supervision availability on demand guided by a remote US expert. The demand for expert support, diagnosis, grading of urgency, duration and success of examination, and satisfaction of both examiners were analyzed.

Results: 108 patients (mean age 9.7 years) were included. In 38% of cases, US was supervised on demand with a definite diagnosis in 92.6% of cases (25/27). Image quality and technical performance were graded sufficient in 100% of cases. Supervised compared to non-supervised US examinations were prolonged (14.4 min vs. 7.1 min, p<0.001), were more prevalent within the first 24 h in the hospital (70% vs. 56.8%, p=0.06), and were classified more frequently as emergency (22.2% vs. 2.3%; p=0.015). All participants classified the availability of US supervision as decisively helpful.

Conclusion: Remote live supervised pediatric US was feasible and effective. It combined timely, high-quality diagnostics even in the case of challenging medical questions with simultaneous US training.

Purpose: This study aims to investigate placental and fetal lung stiffness in pregnant women with and without gestational diabetes, considering the well-established delay in fetal lung maturation associated with gestational diabetes.

Materials and methods: This prospective cohort study was conducted at a tertiary center and included pregnant women who underwent a 75-gram oral glucose tolerance test between 24-28 weeks of gestation. Elastography measurements were performed using point shear wave elastography (pSWE).

Results: The study included 60 pregnant women diagnosed with gestational diabetes and 60 pregnant women in the control group. The SWE velocity of the peripheral placenta, central placenta, and lung was higher in the gestational diabetes group compared to the control group. Furthermore, the SWE velocity of the peripheral placenta, central placenta, and lung was higher in newborns with neonatal respiratory morbidity. Based on the ROC analysis of patients with gestational diabetes, the AUC for lung SWE velocity was 0.88 (cut-off 12.4 kPa, 95% CI: 0.77-0.99, p<0.001) with a sensitivity of 71.4% and specificity of 95.6% for predicting neonatal respiratory morbidity.

Conclusion: Fetal placental and lung stiffness increase in fetuses of pregnant women with diabetes. Moreover, higher fetal lung stiffness during the fetal period is associated with increased neonatal respiratory morbidity.

Purpose: Ultrasonography is increasingly being discussed as an alternative to X-rays in emergency department settings. Systematic comparisons of the two modalities are often based on using computed tomography as a reference. In diagnosing patients with elbow trauma, the physicians at our emergency department experienced that ultrasonography can be more informative than cone beam computed tomography in identifying radial head fractures. Our purpose is to share this experience with the scientific community.

Materials and methods: All patients diagnosed with a radial head fracture in our emergency department between January 2021 and November 2022 were identified. The images of eighteen cases, in which both point-of-care ultrasonography and cone beam computed tomography had been used were reviewed by us. Eight examples were selected illustrating the variation in coincidence or discrepancy between ultrasonography and computed tomography.

Results: The eight examples illustrate that ultrasonography can be more informative than cone beam computed tomography or vice versa.

Conclusion: The joint application of ultrasonography and computed tomography is advisable if a correct diagnosis of the extent and components of radial head fractures is of uttermost importance. Zusammenfassung Ziel: Sonographie wird zunehmend als Alternative zur Röntgenuntersuchung in der Notaufnahme diskutiert. Systematische Vergleiche der beiden Modalitäten basieren häufig auf der Verwendung der Computertomographie als Referenz. Bei der Diagnose von Patienten mit Ellenbogentrauma haben die Ärzte in unserer Notaufnahme die Erfahrung gemacht, dass der Ultraschall bei der Erkennung von Radiusköpfchenfrakturen informativer sein kann als die Kegelstrahl-Computertomographie. Unser Ziel ist es, diese Erfahrung mit der wissenschaftlichen Gemeinschaft zu teilen.

Material und methoden: Alle Patienten, bei denen in unserer Notaufnahme zwischen Januar 2021 und November 2022 eine Radiusköpfchenfraktur diagnostiziert wurde, wurden ermittelt. Die Bilder von achtzehn Fällen, bei denen sowohl Ultraschall als auch eine Kegelstrahl-Computertomographie angewandt worden waren, wurden von uns nachuntersucht. Acht Beispiele wurden ausgewählt, um die Variation in Übereinstimmung oder Diskrepanz zwischen Ultraschall und Computertomographie zu veranschaulichen. Ergebnisse: Die acht Beispiele zeigen, dass die Ultraschalluntersuchung informativer sein kann als die Kegelstrahl-Computertomographie oder umgekehrt. Schlussfolgerung: Die gemeinsame Anwendung von Ultraschall und Computertomographie ist ratsam, wenn eine korrekte Diagnose des Ausmaßes und der Komponenten von Radiusköpfchenfrakturen von größter Bedeutung ist.

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Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor with high morbidity and mortality. The aim of this study was to evaluate ultrasonographic findings associated with KHE.The clinical and ultrasonographic findings of a cohort of 64 cases with pathologically proven KHE were retrospectively reviewed and analyzed between November 2014 and February 2021. Two subtypes were divided according to the presence or absence of the Kasabach-Merritt phenomenon (KMP). The KMP risk factors in patients with KHE were analyzed statistically.Among the 64 cases of KHE, 43 (67.2%) were accompanied by KMP. There was a positive correlation between the appearance of KMP and tumor size. KHEs had an increased risk of developing KMP if the lesions measured were >6 cm and if they belonged to the deep or mixed subtype. On ultrasonography, all KHE lesions were heterogeneous, and 81.3% were hypoechoic; 93.8% of KHEs exhibited ill-defined margins, 68.7% had strands branching into the adjacent tissue, and 84.4% presented marked hypervascularity. Elastography showed that central hypoechogenic lesion areas were hard, and surrounding hyperechogenic lesion areas were soft.KHEs can occur in different parts of childrens' bodies. On ultrasonography, the main findings are heterogeneous low erosions, indistinct margins, branching strangulation into adjacent tissues, and obvious hypervascularity. Patients with lesions larger than 6 cm or belonging to deep or mixed subtypes (musculoskeletal infiltrates) are at risk for developing KMP, and clinicians should be vigilant.

Purpose: Insulinoma is a rare tumor of the pancreas that can lead to hypoglycemia. To date, the standard therapy is surgical resection. After the first case report of successful endoscopic ultrasound-guided (EUS) ethanol injection 16 years ago, the need for establishing an alternative treatment method remains unchanged given the high morbidity rates of surgery and its unsuitability in some patients.

Materials and methods: Here, we provide retrospective data from 33 insulinoma patients that were treated at our center between 2010 and 2021. Of these, 9 patients were treated with EUS-guided ethanol injection and 24 underwent pancreatic surgery.

Results: The ethanol group was older (ethanol: mean ± SE 67.8±11.2 years vs. surgery: 52.3±15.7, p=0.014) with a higher Charlson Comorbidity Index (3.0 (1.0;4.0) vs. 1.0 (0.0;2.0), p=0.008). The lowest glucose values were similar between groups before (ethanol: 2.09±0.17 mmol/l vs. surgery: 1.81±0.08, p=0.158) and after (4.95±0.74 vs. 5.41±0.28, p=0.581) the respective treatments. Complications occurred more frequently in the surgery group (11 % vs. 54 %, p=0.026). One patient after prior partial pancreatectomy died postoperatively. The hospitalization time was significantly shorter in the ethanol group (4.78±0.78 days vs. 19.88±4.07, p<0.001).

Conclusion: EUS-guided ethanol injection can be similarly effective for the treatment of hyperinsulinemic hypoglycemia compared with pancreatic surgery but seems to be associated with less severe complications. This implies the need for prospective randomized trials in insulinoma patients with a low risk for malignancy.