Ultraschall in Der Medizin最新文献

This position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on professional standards in thoracic ultrasound is a supplement to EFSUMB's previously published professional standards in medical ultrasound - general aspects. The paper represents a position across the different medical professions within EFSUMB regarding optimal standards for the performing and reporting of thoracic ultrasound examinations by any professional ultrasound practitioner. It describes aspects that ensure procedure quality, effectiveness, efficiency, and sustainability in the application of thoracic ultrasound. The paper provides recommendations regarding safety and the indication for thoracic ultrasound examinations, requirements for examination rooms, structured examinations, systematic reporting of results, and the management, communication, and archiving of ultrasound data.

Arterial thoracic outlet syndrome (aTOS) is a rare condition, but if undiagnosed, it can have serious consequences for affected patients, up to and including limb loss. Ultrasound could be used here as a widely available method for screening, but it is said to have very high investigator dependence. The fact that ultrasound can be used safely for diagnostic purposes has already been demonstrated. The aim of this study was to evaluate the repeatability of a standardized examination for the diagnosis of aTOS.We recruited inpatients with high-grade suspected arterial thoracic outlet syndrome who were evaluated for invasive therapy at our TOS center. Routine diagnostics were performed according to clinic standards. In addition, 2 sonographers, one highly experienced and one less experienced, performed ultrasound diagnosis according to a standardized protocol. Image acquisition and interpretation were performed independently, and sonographers were mutually blinded. For analysis, the experienced sonographer served as a reference. Agreement between assessors was analyzed using concordance analysis.51 consecutive patients (67% female) aged 39.3±13.0 years were included within 11 months. The standardized ultrasound protocol could be performed in all patients. The prevalence of TOS was high (79.4%; CI: 71.4-87.3%) in our cohort. Ultrasound inter-rater agreement using the standardized protocol was very good at 0.820 (CI: 0.624-1.000).Ultrasound diagnosis of TOS using a standardized protocol can be performed effectively and shows a high agreement between 2 sonographers.

To identify the sonomorphological appearance and to measure the thickness of the piriformis muscle (PM) and the proximal portion of the sacral nerve roots S1-S3 in healthy premenopausal women.This prospective multicentric observational study included a consecutive series of women undergoing transvaginal sonography (TVS) at 2 tertiary gynecological referral centers. Standardized assessment of the pelvic organs was performed, followed by an attempt to visualize the right and left PM and sacral nerve roots S1-S3 at their origin in proximity to the sacral neuroforamen. Visualization rates, diameters of the muscle and nerve thickness, and the time needed to identify the PM were recorded.305 patients were included in the study. In 293 women (96.1%), the PM was identified bilaterally. The median diameter of the PM was 18.3mm on the right side and 18.4mm on the left side. S1 nerve roots were successfully identified bilaterally in 224 (73.4%) patients. Their right and left median diameters were 4.8mm. Both S2 nerves were successfully identified in 215 (70.5%) patients. Their median diameter were 4.3mm on both sides. S3 nerve roots were successfully identified in 203 (66.6%) patients. Their median diameter were 3.2mm on both sides.We describe methods which allow consistent and rapid identification of the PM and the S1-S3 sacral nerve roots using TVS. Visualization of the PM and the proximal portion of the sacral plexus may be useful regarding identification of pathological changes in PM thickness and could help to distinguish perineural cysts from other gynecological pathologies.

Ectopic pregnancy - any pregnancy outside the uterine cavity - affects 1-2 % of all pregnancies. While the diagnosis and treatment of the most common ectopic pregnancy (tubal pregnancy which accounts for > 90 % of cases) is established, other forms, such as Caesarean scar pregnancy, pose an increasing challenge. This article describes the different forms of ectopic pregnancies and the respective therapeutic options.

Evaluation of the possible role of microvascular imaging (MI) for the detection of vascularization of renal lesions, while comparing it with contrast-enhanced ultrasound (CEUS).137 patients (160 renal lesions, 64 solid and 96 cystic) were enrolled in this single-center, retrospective, observational study. For solid masses, both the intralesional and the peripheral vascularization was analyzed and quantified by MI and then compared to peak enhancement on CEUS. Regarding cystic lesions, we evaluated the presence or absence of vascularization within the cystic wall and/or septa. MI results were compared with CEUS findings using Pearson's Chi square test. An optimal size cut-off for renal lesions was determined with the Youden test.For solid lesions, a statistically significant correlation (p <0.05) was observed between the MI parameters and the peak enhancement on CEUS. The detection rate (DR) for lesional vascularization on MI was 87.5%, while if we consider only lesions larger than the optimal cut-off (14mm), the DR increases to 98%. In cystic lesions, the MI showed a high specificity (93.9%) in predicting CEUS results and a high positive predictive value (84.2%). The concordance was 100% in Bosniak I lesions and 80% in Bosniak IV lesions, while it was lower for the other classes. Furthermore, we found a statistically significant correlation (p <0.05) between Bosniak grade and lesional vascularity on MI.Our preliminary study shows that MI cannot replace CEUS, but could reduce its use, especially in solid lesions larger than 14mm and in cysts classified as Bosniak IV, a goal that is particularly important in an active surveillance setting.

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.