Ultraschall in Der Medizin最新文献

To describe the ultrasound (US) features of a complication in patients who have undergone surgery for carpal tunnel syndrome (CTS): the incomplete release of the transverse carpal ligament (TCL).Reports from two institutions were searched using the keywords "persistent CTS" and "incomplete TCL release". Post-surgical US examinations were performed using a standardized approach at both institutions, first assessing the muscles supplied by the median nerve (MN) and then conducting a detailed evaluation of the MN course at the wrist. To avoid misinterpreting ligament regrowth, patients with recurrent symptoms two months or later after surgery were excluded. Only cases showing clear compression by the TCL were selected.A total of 46 patients were identified with incomplete release of the TCL, with the average uncut portion of the ligament measuring 6.7 mm. The proximal margin of the TCL was incompletely released in 65% of the cases, while the distal margin was affected in 35%. Symptoms in these patients persisted after surgery, and, in 52%, they were worse than before surgery. A reduction in thenar muscle bulk was observed in 37 patients. Follow-up clinical data were available in eight patients, with three undergoing US evaluation after revision surgery.US can effectively demonstrate the incomplete release of the TCL, visualized as a fibrillar uncut structure compressing the MN and producing an hourglass appearance of the nerve. In addition, US may help detect other factors that contribute to persistent symptoms and help to guide revision surgery.

Thickening of the medial plantar proper digital nerve (MPPDN) along the medial aspect of the big toe is frequently observed incidentally during high-resolution ultrasound examinations in asymptomatic individuals. However, the clinical significance of these findings remains unclear, as no study has definitively linked them to symptoms. Although the localization and visualization of the medial plantar nerve using ultrasound have been documented, its cross-sectional area has not yet been utilized to assess thickening at this specific site. The study aimed to assess the frequency and specific locations of MPPDN thickening in asymptomatic individuals and to identify associated characteristics.In this prospective study, high-resolution ultrasound examination of the MPPDN was performed on asymptomatic volunteers. The cross-sectional areas and their changes along the course of the nerve are evaluated descriptively. Potential contributing demographic factors in participants are captured.56 asymptomatic volunteers, 30 women and 26 men (median age: 28, range: 20-69) participated in this study. 22 individuals (39.3%) showed thickening of the MPPDN at the interphalangeal joint either in one or both feet. More participants above the median population age of 28 showed thickening of the MPPDN (15 [57.7%] versus 7 [23.3%] p = 0.009).Thickening of the MPPDN is frequently observed in asymptomatic individuals, with the likelihood of these findings increasing with age. The pathological significance should however not be overestimated and should be assessed in a clinical context.

Multiparametric ultrasound (MPUS) integrates B-mode, Doppler techniques and microvascular imaging, contrast-enhanced ultrasound (CEUS) and elastography, enhancing diagnostic precision across a wide spectrum of scrotal diseases. Developed under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), these guidelines provide evidence-based recommendations for the clinical use of MPUS in scrotal imaging. Based on the Oxford Centre for Evidence-Based Medicine framework, this document outlines the diagnostic value of MPUS in acute scrotal pain, trauma, infertility, focal and extratesticular lesions, cryptorchidism, and testicular incidentalomas. The recommendations highlight CEUS as the reference method for vascular assessment and elastography as a complementary tool for tissue characterization. These guidelines aim to standardize MPUS practice and promote its integration into routine scrotal imaging.

Purpose: Fibrosing interstitial lung diseases (F-ILD), which include idiopathic pulmonary fibrosis (IPF) and other ILDs conferring risk for progressive pulmonary fibrosis (PPF), are a heterogeneous group of diseases with multiple subtypes. A multidisciplinary team discussion (MDD) incorporating HRCT is considered the gold standard for diagnosing and quantifying pulmonary fibrosis. However, repeated HRCTs are associated with substantial costs and radiation exposure. Thoracic ultrasound (TUS) has emerged as a potential radiation-free method for diagnosing and monitoring disease severity in F-ILD. Yet, consistent knowledge regarding the use of TUS in patients with F-ILD remains limited. This systematic review aimed to evaluate existing literature on the applicability of TUS in patients with F-ILD.

Materials and methods: We performed a systematic review according to PRISMA guidelines. MEDLINE, Embase, CINAHL, and Cochrane library databases were searched. Prospective, cross-sectional, and retrospective studies were considered. Risk of bias was assessed using quality assessment of diagnostic accuracy studies 2 (QUADAS-2).

Results: Six studies met inclusion criteria. All examined patients with IPF, and two included other F-ILD subtypes. The most frequently evaluated TUS findings were B-lines and pleural line irregularities. However, there was marked heterogeneity in TUS methodology and protocols, precluding meta-analysis.

Conclusion: Although the preliminary findings in this review suggest TUS may have potential utility in this patient group, available data on TUS in F-ILD are sparse and heterogeneous, highlighting the need for further research.

Purpose: Despite advances in diagnostic approaches, fetal anemia of unknown etiology continues to be observed in rare cases. This study aimed to assess the incidence of unexplained fetal anemia and to evaluate the associated perinatal outcomes.

Materials and methods: We conducted an observational retrospective cohort study of all fetuses who underwent fetal blood sampling (FBS) due to an MCA PSV>1.5 MoM at a tertiary center between 2007 and 2024. Fetuses were included if they had moderate or severe anemia defined as a hemoglobin (Hgb) deviation of more than 20 g/L below a gestational age adjusted mean, with a negative anemia workup. Prenatal and postnatal outcomes were obtained.

Results: Among 376 fetuses that underwent fetal blood sampling for anemia, 361 (96%) had an identified cause, while 15 (4%) had moderate to severe anemia of unknown etiology. Seven fetuses presented with non-immune hydrops and eight with other major structural anomalies not typically associated with anemia. Eleven (73%) of the 15 fetuses with unexplained anemia had thrombocytopenia, with platelets below 100,000/µL in 8 cases and below 50,000/µL in 6 cases. Seven cases (47%) resulted in perinatal death. Rare causes of anemia were elucidated only in 5 cases (33%) postnatally despite extensive investigations.

Conclusion: Unexplained fetal anemia is uncommon and associated with poor neonatal outcomes warranting close pre- and postnatal surveillance.

Purpose: To investigate the role of Ultra Micro Angiography (UMA) in evaluating Crohn's disease (CD) activity in pediatric patients.

Materials and methods:  In this prospective study, pediatric patients diagnosed with CD were included. A Resona A20 ultrasound machine (Mindray Medical Systems, China) was used for all patients. The semi-quantitative scores of color Doppler flow imaging (CDFI) and UMA on the thickest segments of bowel walls were assessed according to Limberg score. The Pediatric Crohn's Disease Activity Index (PCDAI) was the reference standard to evaluate CD activity. ROC analysis was performed to compare the diagnostic efficiency of Limberg scores between CDFI and UMA.

Results:  Sixty pediatric CD patients were included and divided into three groups according to PCDAI: Group 1, inactive CD (n = 37); Group 2, mild CD (n = 13); and Group 3, moderate to severe CD (n = 10). By UMA, significant differences of Limberg scores were found between Groups 1 and 3 (P < 0.001), Groups 2 and 3 (P = 0.044), and Groups 1 and 2 (P = 0.029). The combined AUROC of B-mode ultrasound (BMUS) features and UMA features in pediatric CD activity evaluation was 0.934, with 87.0% sensitivity and 94.6% specificity, which was significantly higher than that of the combined BMUS features and CDFI ( P = 0.048).

Conclusion:  By sensitively depicting the low velocity blood flow signals and displaying microvascular morphologies of the bowel wall, UMA is an effective noninvasive imaging method enabling semi-quantitative evaluation of the activity of CD in pediatric patients.

English abstract: Frontline physicians working in primary care increasingly use diagnostic ultrasound examinations and simple ultrasound-guided procedures as part of their daily practice. Primary care is organized in many ways across Europe and as a result, primary care physicians have different qualifications in terms of using and integrating point-of-care ultrasound in patient care. To ensure high quality and standardized practice across Europe, this position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) describes training recommendations and a generic core curriculum for frontline physicians working in primary care. The core curriculum was developed through a Delphi process and includes basic ultrasound examinations corresponding to the EFSUMB competence level 1 for medical ultrasound practice. The training recommendations are intended to build a common foundation while national adjustments must be made to ensure relevance in the clinical setting and patient population. German abstract: In der Primärversorgung tätige Ärzte setzen zunehmend diagnostische Ultraschalluntersuchungen und einfache ultraschallgesteuerte Verfahren als Teil ihrer täglichen Routine ein. Die Primärversorgung ist in Europa sehr unterschiedlich organisiert, sodass die Qualifikationen der Ärzte, die Point-of-Care-Ultraschall in der primären Patientenversorgung einsetzen und integrieren, sehr unterschiedlich sind. Mit dem Ziel, eine hohe Qualität und standardisierte Ausübungspraxis in ganz Europa zu gewährleisten, stellt dieses Positionspapier der European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Ausbildungsempfehlungen und ein PoCUS Basis-Curriculum für in der Primärversorgung tätige Ärzte vor. Das Basis-Curriculum wurde im Rahmen eines Delphi-Verfahrens entwickelt und umfasst grundlegende Ultraschalluntersuchungen, die dem EFSUMB-Kompetenzniveau 1 für die medizinische Ultraschallpraxis entsprechen. Die Ausbildungsempfehlungen sollen eine gemeinsame Grundlage schaffen, wobei durch nationale Anpassungen die Relevanz für das konkrete klinische Umfeld und die betreuten Patientengruppen sichergestellt werden muss.

Thyroid nodules are common incidental findings but only a small proportion of cases are malignant (4-6.5%) or symptomatic. Numerous follow-up examinations and invasive diagnostic procedures, such as fine-needle aspiration, fine-needle biopsies, and thyroidectomies, are performed, leading to potentially costly and time-consuming diagnostic procedures and overtreatment. Most experts and scientific societies (EFSUMB, WFUMB...) encourage the use of multiparametric ultrasound evaluation to improve the thyroid nodule characterization thanks also to the continuous technological developments with different ultrasound software (Microvascular flow imaging, Elastosonography...), contrast media (CEUS) and artificial intelligence (AI). Therefore, the recognition and proper use of new multiparametric ultrasound features of thyroid nodules are essential to minimize unnecessary interventions and guide appropriate treatments, also stimulating their use in routine clinical practice, which is the aim of our guideline. In addition, we analyze the use of MPUS in some emblematic thyroid scenarios such as cytologically indeterminate nodule, multinodular goiter and extrathyroidal extension of the malignant nodule and the usefulness of MPUS as a guide to thyroid biopsy/aspiration and in the staging of cervical lymph nodes. For each question, recommendations based on the level of evidence of the published literature and on the EFSUMB expert group's consensus are given.