Ultraschall in Der Medizin最新文献

Ultrasound examination is a vital imaging tool in medicine, yet opportunities for comprehensive theoretical and practical training during medical education are limited. Effective ultrasound education requires both theoretical knowledge and hands-on practice. To address this, we developed SonoGame, a gamified platform designed to teach ultrasound skills to medical students. SonoGame provides a step-by-step introduction to ultrasound imaging and aims to improve skills such as image orientation, spatial visualization, and hand-eye-coordination through mini-games using geometric objects. This study evaluates the impact of SonoGame training on ultrasound skills.In this prospective, single-center study, 56 medical students, the majority of whom had no prior ultrasound experience, were randomly assigned to either a control group or a SonoGame group. The SonoGame group trained with the platform in four 30-minute sessions over 4 weeks, while the control group received no training. Ultrasound skills were assessed in both groups before and after the training period.The SonoGame group showed significant improvement in ultrasound skills, particularly with complex anatomical structures, compared to the control group. Participants in the SonoGame group also reported increased familiarity and confidence with sonography, viewing SonoGame as a valuable tool in their training.SonoGame is an effective supplement to conventional ultrasound education, enhancing the skills necessary for ultrasound examinations in medical students.

This study aimed to assess the agreement between the 5C1 and deep abdominal transducer (DAX) ultrasound probes when measuring ultrasound-derived fat fraction (UDFF) across different body mass index (BMI) categories and to evaluate the intra- and inter-observer reproducibility of liver fat measurements.In this prospective study 63 subjects (32 with BMI < 25 and 31 with BMI ≥ 25) underwent UDFF measurements. Two observers performed five measurements per subject using both probes (5C1 and DAX). Intra- and inter-observer reliability were assessed using intraclass correlation coefficients (ICC). Agreement between probes and observers was evaluated using Spearman correlation and Bland-Altman analysis, stratified by BMI subgroup.The intra- and inter-observer reliability of UDFF measurements were excellent, with no relevant systematic bias between observers or probes. The 5C1 and DAX probes showed strong correlations (r = 0.92 and 0.93). In normal-weight subjects, differences between probes were minimal, with limits of agreement (LoA) of approximately ±2%. In subjects with BMI ≥ 25, the mean differences between probes were low (up to 2.6%), but the limits of agreement were wider (-8% to +13%), comparable to the inter-observer variability.UDFF measurements with both the 5C1 and DAX probes showed consistently high reliability across BMI categories. Although variability increased with a higher BMI and liver fat, no systematic bias was observed, and both probes performed comparably. These findings support their interchangeable use in clinical settings. Validation against a reference standard is warranted to assess accuracy in challenging patient populations.

Vascularization assessment is crucial for the diagnosis of ovarian masses. However, its subjectivity often results in suboptimal interobserver agreement. This study evaluated the impact of the OvAi denoising algorithm on IOTA color score assignment and perceived image quality in adnexal mass ultrasound.In this multicenter prospective study (May 2018-August 2022), color/power Doppler videos of 100 adnexal masses from 100 women were acquired in 2 outpatient clinics. Six experts, 5 moderately experienced, and 8 beginner examiners assessed IOTA color score and image quality before and after applying the denoising algorithm. Interobserver agreement regarding color score assignments was measured using Fleiss' Kappa, and perceived image quality changes were tested via Chi-square.Interobserver agreement regarding color score assignment was fair across all observer groups (κ: 0.296-0.396) and remained unchanged post-denoising. In benign lesions, CS1 increased (+14.9%), while CS2-CS4 decreased. In malignant cases, CS1 and CS2 increased (+76.2% and +30.8%), with a smaller reduction in CS3 (-3.7%) and CS4 (-21.4%). The CS4 decrease was less marked in malignant than in benign lesions (-21.4% vs. -38.3%). A significant improvement in perceived image quality was observed in all observer groups (p < 0.05).The OvAi algorithm improved perceived image quality without significantly impacting interobserver agreement. Continued development may enable more objective and automated color score assignments, potentially reducing interobserver variability and supporting diagnostic reliability.

Ultrasound plays a central role in the diagnosis, monitoring, and management of liver diseases. Assessing hepatic fibrosis is essential in chronic liver disease, and several diagnostic modalities are available. The gold standard remains percutaneous liver biopsy, an invasive method using a 16-18-gauge needle. A breakthrough came in 2003 with transient elastography (TE), a non-invasive technique that measures liver stiffness (kPa) via elastic wave propagation. Later, shear wave elastography (SWE), integrated into modern ultrasound systems, was developed to assess tissue elasticity. SWE generates shear waves (SWs) through acoustic radiation force, assuming tissues to be linearly elastic and homogeneous, and provides quantitative stiffness data. Recent evidence shows hepatic tissue is viscoelastic, with wave propagation varying by frequency. Quantifying viscosity remains a challenge. Fibrosis affects viscoelastic properties and shear wave speed (SWS), while necroinflammation predominantly alters the viscous component, influencing the shear wave dispersion slope (SWDS). This review provides an overview of ultrasound elastography methods, including stiffness and viscosity assessment, their physical principles, and clinical applications in hepatology.

Arteria lusoria (AL), a rare vascular variant (prevalence of 0.5-3.2%), is linked to a right non-recurrent laryngeal nerve (RNRLN), thereby increasing nerve injury risk during thyroid and parathyroid surgery. This study evaluates ultrasonography (US) for preoperative AL detection.Retrospective analysis of 1406 hyperparathyroidism patients undergoing 18F-fluorocholine PET/CT with subgroup analysis in 270 patients with "expert US" performed on-site. An experienced senior radiologist assessed the US Y-image (brachiocephalic artery division), with low-dose CT as the standard of truth for AL confirmation.18F-fluorocholine PET/CT analysis found 22 cases of AL (prevalence: 1.57%). US identified 259 Y-images, excluding AL, confirmed by CT. Five absent Y-images indicated AL, all were confirmed by CT. Six non-assessable Y-images were AL-negative on CT. US performance: sensitivity 100% (95% CI: 0.463-1), specificity 98% (95% CI: 0.95-0.99), negative predictive value (NPV) 100%, accuracy 98%.US Y-image assessment reliably excludes AL with an NPV of 100%, offering a non-invasive tool to reduce RNRLN injury risk in thyroid and parathyroid surgery.

Purpose Gastrointestinal ultrasound is a well-established method for diagnosing and following Crohn's disease (CD). The aim of this study was to investigate whether wall layer data measured on gastrointestinal ultrasound could predict endoscopic activity in CD. Materials and methods 64 CD patients underwent a gastrointestinal ultrasound examination and endoscopy ± 2 weeks apart in a single-centre prospective study. Bowel wall thickness and the thickness of individual wall layers corresponding to mucosa, submucosa and the proper muscle wall were measured and compared with simple endoscopic score of Crohn's disease (SES-CD) in the worst affected bowel segment where SES-CD >2 was defined as activity. Results There was increased absolute thickness of mucosa (1.8 versus 1.1mm, p =0.001), submucosa (2.8 versus 1.2mm, p <0.001) and proper muscle (1.6 versus 1.1mm, p =0.006) in patients with endoscopic activity. After a ROC analysis Youden's index suggested a 1.8 mm cut off for submucosal thickness and disease activity giving 90% sensitivity, 78.3% specificity and 84.9% accuracy. In contrast, a bowel wall thickness of 3 mm had a 97.3 % sensitivity, 52.0 % specificity and 79.0% accuracy. The submucosa was also relatively thicker (0.45 versus 0.36, p=0.008) while the proper muscle was relatively thinner (0.25 versus 0.34, p=0.001) in endoscopic activity. Conclusion Patients with Crohn's disease and endoscopic activity had increased thickness of all bowel wall layers in affected areas. Measurements of the submucosa may be used to assess disease activity with similar results as bowel wall thickness.

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.