Timo Turowski, Martin Fleck, Boris Ehrenstein, Wolfgang Hartung, Florian Günther
Ultra-high-frequency ultrasound (UHF-US) allows visualization of the epidermis, dermis, and subcutis and precise measurement of skin thickness. The aim of this study was to assess the performance and interobserver reliability of UHF-US for measuring skin thickness in patients with long-term systemic glucocorticoid (GC) therapy compared to patients without GC therapy or treated for a shorter period.156 patients with known or suspected inflammatory rheumatic diseases underwent US evaluation for skin thickness by 3 experts in 3 anatomical sites (hand, distal, and proximal forearm). 87 patients were classified as "frequent users" who had received continuous oral GCs for at least one year or at least 3 years with various interruptions. 69 patients without any oral GC therapy in the past or treated for a shorter period were classified as "non-frequent users".UHF-US allowed a precise measurement of skin thickness. Skin thickness at all 3 anatomical sites was significantly decreased in "frequent users" of GCs compared to "non-frequent users" (distal and proximal forearm: p < 0.001; hand: p < 0.05). At all 3 anatomical sites, skin thickness was decreased in patients with clinically assessed parchment-like skin compared to patients without parchment-like skin (distal and proximal forearm: p < 0.001; hand: p < 0.05). Interobserver variability was excellent [hand intraclass correlation coefficient (ICC) = 0.99; proximal forearm ICC = 0.85; distal forearm ICC = 0.84].These data support the idea of UHF-US as an objective and reliable imaging tool for monitoring skin atrophy as adverse effects of GC therapy.
{"title":"Performance of ultra-high-frequency ultrasound in the evaluation of skin atrophy in patients with long-term oral glucocorticoid therapy in a tertiary rheumatology center.","authors":"Timo Turowski, Martin Fleck, Boris Ehrenstein, Wolfgang Hartung, Florian Günther","doi":"10.1055/a-2479-8829","DOIUrl":"https://doi.org/10.1055/a-2479-8829","url":null,"abstract":"<p><p>Ultra-high-frequency ultrasound (UHF-US) allows visualization of the epidermis, dermis, and subcutis and precise measurement of skin thickness. The aim of this study was to assess the performance and interobserver reliability of UHF-US for measuring skin thickness in patients with long-term systemic glucocorticoid (GC) therapy compared to patients without GC therapy or treated for a shorter period.156 patients with known or suspected inflammatory rheumatic diseases underwent US evaluation for skin thickness by 3 experts in 3 anatomical sites (hand, distal, and proximal forearm). 87 patients were classified as \"frequent users\" who had received continuous oral GCs for at least one year or at least 3 years with various interruptions. 69 patients without any oral GC therapy in the past or treated for a shorter period were classified as \"non-frequent users\".UHF-US allowed a precise measurement of skin thickness. Skin thickness at all 3 anatomical sites was significantly decreased in \"frequent users\" of GCs compared to \"non-frequent users\" (distal and proximal forearm: p < 0.001; hand: p < 0.05). At all 3 anatomical sites, skin thickness was decreased in patients with clinically assessed parchment-like skin compared to patients without parchment-like skin (distal and proximal forearm: p < 0.001; hand: p < 0.05). Interobserver variability was excellent [hand intraclass correlation coefficient (ICC) = 0.99; proximal forearm ICC = 0.85; distal forearm ICC = 0.84].These data support the idea of UHF-US as an objective and reliable imaging tool for monitoring skin atrophy as adverse effects of GC therapy.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Swoboda, Johannes Deeg, Daniel Egle, Valentin Ladenhauf, Malik Galijasevic, Christoph Plöbst, Silke Haushammer, Birgit Amort, Mathias Pamminger, Leonhard Gruber
Ultrasound is a highly effective imaging tool for assessing abnormalities within the breast. However, especially the identification of malignant tumors of the breast mimicking fibroadenomas (MTMF) by means of breast ultrasound can be challenging. This study aimed to identify reliable imaging characteristics of MTMF.This retrospective study was approved by the local ethics review board. After screening 623 patients, 421 cases with histologically verified fibroadenomas and MTMF between 2011 and 2021 were included. Sonographic features were compared to histopathological results and an algorithm-based quantitative ranking of predictors contributing most to the correct classification of malignant tumors was conducted.A total of 363 benign, 18 intermediate, and 40 malignant lesions were analyzed. Algorithm-based quantitative ranking showed that the most predictive features indicating malignancy were a hyperechoic rim (gain ratio merit 0.135 ± 0.004), an irregular border (0.057 ± 0.002), perilesional stiffening (0.054 ± 0.002), pectoral contact (0.051 ± 0.003), an irregular shape (0.029 ± 0.001), and irregular vasculature (0.027 ± 0.002).Ultrasound findings for fibroadenomas vary, making identification of MTMF challenging. Features such as indistinct margins and increased perilesional echogenicity are predictors for malignancy and should be considered during sonographic evaluation of fibroadenomas and MTMF.
{"title":"Identification of differentiating sonographic features between fibroadenomas and malignant tumors of the breast mimicking fibroadenomas: 10-year experience in 421 histologically verified cases.","authors":"Michael Swoboda, Johannes Deeg, Daniel Egle, Valentin Ladenhauf, Malik Galijasevic, Christoph Plöbst, Silke Haushammer, Birgit Amort, Mathias Pamminger, Leonhard Gruber","doi":"10.1055/a-2474-6617","DOIUrl":"https://doi.org/10.1055/a-2474-6617","url":null,"abstract":"<p><p>Ultrasound is a highly effective imaging tool for assessing abnormalities within the breast. However, especially the identification of malignant tumors of the breast mimicking fibroadenomas (MTMF) by means of breast ultrasound can be challenging. This study aimed to identify reliable imaging characteristics of MTMF.This retrospective study was approved by the local ethics review board. After screening 623 patients, 421 cases with histologically verified fibroadenomas and MTMF between 2011 and 2021 were included. Sonographic features were compared to histopathological results and an algorithm-based quantitative ranking of predictors contributing most to the correct classification of malignant tumors was conducted.A total of 363 benign, 18 intermediate, and 40 malignant lesions were analyzed. Algorithm-based quantitative ranking showed that the most predictive features indicating malignancy were a hyperechoic rim (gain ratio merit 0.135 ± 0.004), an irregular border (0.057 ± 0.002), perilesional stiffening (0.054 ± 0.002), pectoral contact (0.051 ± 0.003), an irregular shape (0.029 ± 0.001), and irregular vasculature (0.027 ± 0.002).Ultrasound findings for fibroadenomas vary, making identification of MTMF challenging. Features such as indistinct margins and increased perilesional echogenicity are predictors for malignancy and should be considered during sonographic evaluation of fibroadenomas and MTMF.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2025-02-05DOI: 10.1055/a-2464-5428
V Cantisani, C F Dietrich, C Jenssen, M Bertolotto, B Brkljačić, A De Silvestri, V Scotti
{"title":"MPUS is a big step forward for small organs.","authors":"V Cantisani, C F Dietrich, C Jenssen, M Bertolotto, B Brkljačić, A De Silvestri, V Scotti","doi":"10.1055/a-2464-5428","DOIUrl":"https://doi.org/10.1055/a-2464-5428","url":null,"abstract":"","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":"46 1","pages":"8-13"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-02-09DOI: 10.1055/a-2249-6791
Florian Bitterer, Andreas Bauer, Gunther Glehr, Stefan Brunner, Katharina Schmidt, Hans Jürgen Schlitt, Ernst Michael Jung, Christina Hackl
Purpose: Complete resection of the affected tissue remains the best curative treatment option for liver-derived tumors and colorectal liver metastases. In addition to preoperative cross-sectional imaging, contrast-enhanced intraoperative ultrasound (CE-IOUS) plays a crucial role in the detection and localization of all liver lesions. However, its exact role is unclear. This study was designed to evaluate the clinical and oncological impact of using CE-IOUS in the surgical treatment of these diseases.
Materials and methods: Over the three-year study period, 206 patients with primary liver tumors and hepatic metastases were enrolled in this prospective, monocentric study to evaluate the impact of CE-IOUS in liver surgery. Secondary outcomes included comparing the sensitivity and specificity of CE-IOUS with existing preoperative imaging modalities and identifying preoperative parameters that could predict a strategic impact of CE-IOUS. In addition, the oncological significance of CE-IOUS was evaluated using a case-cohort design with a minimum follow-up of 18 months.
Results: CE-IOUS findings led to a change in surgical strategy in 34% of cases (n=70/206). The accuracy in cases with a major change could be confirmed histopathologically in 71.4% of cases (n=25/35). The impact could not be predicted using parameters assumed to be clinically relevant. An oncological benefit of a CE-IOUS adapted surgical approach was demonstrated in patients suffering from HCC and colorectal liver metastases.
Conclusion: CE-IOUS may significantly increase R0 resection rates and should therefore be used routinely as an additional staging method, especially in complex liver surgery.
{"title":"Intraoperative contrast-enhanced ultrasound has an outcome-relevant impact on surgery of primary and metastatic liver lesions.","authors":"Florian Bitterer, Andreas Bauer, Gunther Glehr, Stefan Brunner, Katharina Schmidt, Hans Jürgen Schlitt, Ernst Michael Jung, Christina Hackl","doi":"10.1055/a-2249-6791","DOIUrl":"10.1055/a-2249-6791","url":null,"abstract":"<p><strong>Purpose: </strong>Complete resection of the affected tissue remains the best curative treatment option for liver-derived tumors and colorectal liver metastases. In addition to preoperative cross-sectional imaging, contrast-enhanced intraoperative ultrasound (CE-IOUS) plays a crucial role in the detection and localization of all liver lesions. However, its exact role is unclear. This study was designed to evaluate the clinical and oncological impact of using CE-IOUS in the surgical treatment of these diseases.</p><p><strong>Materials and methods: </strong>Over the three-year study period, 206 patients with primary liver tumors and hepatic metastases were enrolled in this prospective, monocentric study to evaluate the impact of CE-IOUS in liver surgery. Secondary outcomes included comparing the sensitivity and specificity of CE-IOUS with existing preoperative imaging modalities and identifying preoperative parameters that could predict a strategic impact of CE-IOUS. In addition, the oncological significance of CE-IOUS was evaluated using a case-cohort design with a minimum follow-up of 18 months.</p><p><strong>Results: </strong>CE-IOUS findings led to a change in surgical strategy in 34% of cases (n=70/206). The accuracy in cases with a major change could be confirmed histopathologically in 71.4% of cases (n=25/35). The impact could not be predicted using parameters assumed to be clinically relevant. An oncological benefit of a CE-IOUS adapted surgical approach was demonstrated in patients suffering from HCC and colorectal liver metastases.</p><p><strong>Conclusion: </strong>CE-IOUS may significantly increase R0 resection rates and should therefore be used routinely as an additional staging method, especially in complex liver surgery.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":"49-56"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: While mild fetal ventriculomegaly is frequently observed as an incidental and benign finding, it is also known to be linked with structural, genetic, and neurodevelopmental abnormalities. The objective of this study was to conduct a systematic review of the existing literature in order to evaluate the association between apparently isolated fetal mild ventriculomegaly with the presence of additional structural defects detected by fetal brain MRI, chromosomal or other genetic anomalies, and neurodevelopmental delay.
Methods: This systematic review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Modern literature was searched from January 1, 2011, to July 31, 2023.
Results: 23 studies were included, comprising a total of 2590 patients. Nine studies assessed the association between fetal mild ventriculomegaly and neurodevelopmental impairment, including 536 cases, with normal neurodevelopmental outcomes ranging from 64% to 96.5%. Ten studies evaluated the additive value of fetal MRI, including 1266 fetuses, with the detection rate of additional brain defects that eventually altered the clinical management ranging from 0% to 19.5%. Seven studies investigated the association of mild ventriculomegaly with the presence of underlying chromosomal or genetic conditions, including 747 cases, with the rate ranging from 1.1% to 15.4%.
Conclusion: The prevalence of aneuploidy and genetic abnormalities in ventriculomegaly, especially in isolated cases, is reported to be quite low and the incidence of neurodevelopmental delay appears to be similar to that of the general population in cases that are apparently and truly isolated.
导言:虽然胎儿轻度脑室肥大常常是一个偶然的良性发现,但它也与结构、遗传和神经发育异常有关。本研究旨在对现有文献进行系统回顾,以评估明显孤立的胎儿轻度脑室肥大与胎儿脑磁共振成像检测到的其他结构缺陷、染色体或其他遗传异常以及神经发育迟缓之间的关联:本系统综述根据《系统综述和元分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)指南设计。结果:共纳入 23 项研究,包括 2590 名患者。9项研究评估了胎儿轻度脑室肥大与神经发育障碍之间的关系,共纳入536例病例,神经发育正常率从64%到96.5%不等。10项研究评估了胎儿核磁共振成像的附加价值,包括1266例胎儿,最终改变临床管理的额外脑损伤检出率从0%到19.5%不等。七项研究调查了轻度脑室肥大与潜在染色体或遗传病的相关性,包括 747 个病例,检出率从 1.1%到 15.4%不等:结论:据报道,脑室肥大中的非整倍体和遗传异常的发生率相当低,尤其是在孤立的病例中,神经发育迟缓的发生率似乎与普通人群相似。
{"title":"Prenatal detection of mild fetal ventriculomegaly - a systematic review of the modern literature.","authors":"Ioakeim Sapantzoglou, Georgios Asimakopoulos, Zacharias Fasoulakis, Konstantinos Tasias, Georgios Daskalakis, Panagiotis Antsaklis","doi":"10.1055/a-2375-0118","DOIUrl":"10.1055/a-2375-0118","url":null,"abstract":"<p><strong>Introduction: </strong>While mild fetal ventriculomegaly is frequently observed as an incidental and benign finding, it is also known to be linked with structural, genetic, and neurodevelopmental abnormalities. The objective of this study was to conduct a systematic review of the existing literature in order to evaluate the association between apparently isolated fetal mild ventriculomegaly with the presence of additional structural defects detected by fetal brain MRI, chromosomal or other genetic anomalies, and neurodevelopmental delay.</p><p><strong>Methods: </strong>This systematic review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Modern literature was searched from January 1, 2011, to July 31, 2023.</p><p><strong>Results: </strong>23 studies were included, comprising a total of 2590 patients. Nine studies assessed the association between fetal mild ventriculomegaly and neurodevelopmental impairment, including 536 cases, with normal neurodevelopmental outcomes ranging from 64% to 96.5%. Ten studies evaluated the additive value of fetal MRI, including 1266 fetuses, with the detection rate of additional brain defects that eventually altered the clinical management ranging from 0% to 19.5%. Seven studies investigated the association of mild ventriculomegaly with the presence of underlying chromosomal or genetic conditions, including 747 cases, with the rate ranging from 1.1% to 15.4%.</p><p><strong>Conclusion: </strong>The prevalence of aneuploidy and genetic abnormalities in ventriculomegaly, especially in isolated cases, is reported to be quite low and the incidence of neurodevelopmental delay appears to be similar to that of the general population in cases that are apparently and truly isolated.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":"73-85"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-01DOI: 10.1055/a-2280-4756
Constantin von Kaisenberg, Peter Kozlowski, Karl-Oliver Kagan, Markus Hoopmann, Kai-Sven Heling, Rabih Chaoui, Philipp Klaritsch, Barbara Pertl, Tilo Burkhardt, Sevgi Tercanli, Jochen Frenzel, Christine Mundlos
This extensive AWMF 085-002 S2e-guideline "First Trimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation" has systematically analyzed high-quality studies and publications and the existing evidence (evidence tables) and produced recommendations (level of recommendation, level of evidence, strength of consensus).This guideline deals with the following topics in the context of the 11-13+6 weeks scan: the legal basis, screening for anatomical malformations, screening for chromosomal defects, quality assessment and audit, screening for preeclampsia and FGR, screening for preterm birth, screening for abnormally invasive placenta (AIP) and placenta accreta spectrum (PAS), screening for velamentous cord insertion and vasa praevia, screening for diabetes mellitus and LGA.Screening for complications of pregnancy can best be carried out @ 11-13+6 weeks of gestation. The issues of how to identify malformations, chromosomal abnormalities and certain disorders of placentation (high blood pressure and proteinuria, intrauterine growth retardation) have been solved. The problem of how to identify placenta percreta and vasa previa has been partially solved. What is still unsolved is how to identify disorders of glucose metabolism and preterm birth.In the first trimester, solutions to some of these problems are available: parents can be given extensive counselling and the risk that a pregnancy complication will manifest at a later stage can be delayed and reduced. This means that screening is critically important as it helps in decision-making about the best way to manage pregnancy complications (prevention and intervals between follow-up examinations).If no treatment is available and if a termination of pregnancy is considered, the intervention can be carried out with far lower complications compared to the second trimester of pregnancy. In most cases, further examinations are not required and the parents can be reassured. A repeat examination at around week 20 of gestation to complete the screening for malformations is recommended. NOTE:: The guideline will be published simultaneously in the official journals of both professional societies (i.e. Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM and Geburtshilfe und Frauenheilkunde for the DGGG).
这份内容广泛的 AWMF 085-002 S2e-指南 "妊娠 11-13+6 周的第一孕期诊断与治疗 "对高质量的研究和出版物以及现有证据(证据表)进行了系统分析,并提出了建议(建议级别、证据级别、共识强度)。本指南涉及 11-13+6 周扫描的以下主题:法律依据、解剖畸形筛查、染色体缺陷筛查、质量评估和审核、子痫前期和 FGR 筛查、早产筛查、异常侵入性胎盘(AIP)和胎盘早剥谱系(PAS)筛查、绒毛膜性脐带插入和前庭大血管筛查、糖尿病和 LGA 筛查。妊娠并发症筛查最好在妊娠 11-13+6 周时进行。如何识别畸形、染色体异常和某些胎盘疾病(高血压和蛋白尿、宫内发育迟缓)的问题已经解决。如何识别前置胎盘和前置血管的问题也已部分解决。目前仍未解决的问题是如何识别糖代谢紊乱和早产。在妊娠头三个月,这些问题中的一些问题已经有了解决方案:可以为父母提供广泛的咨询,并可以推迟和降低妊娠并发症在晚期出现的风险。这意味着筛查是至关重要的,因为它有助于决策处理妊娠并发症的最佳方法(预防和后续检查的间隔时间)。如果没有治疗方法,如果考虑终止妊娠,可以进行干预,并发症远低于妊娠后三个月。在大多数情况下,无需进行进一步检查,父母也可以放心。建议在妊娠 20 周左右再次进行检查,以完成畸形筛查。注:该指南将同时在两个专业协会的官方期刊上发表(即 DEGUM 的 Ultraschall in der Medizin/European Journal of Ultrasound 和 DGG 的 Geburtshilfe und Frauenheilkunde)。
{"title":"Firsttrimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation - Part 1.","authors":"Constantin von Kaisenberg, Peter Kozlowski, Karl-Oliver Kagan, Markus Hoopmann, Kai-Sven Heling, Rabih Chaoui, Philipp Klaritsch, Barbara Pertl, Tilo Burkhardt, Sevgi Tercanli, Jochen Frenzel, Christine Mundlos","doi":"10.1055/a-2280-4756","DOIUrl":"10.1055/a-2280-4756","url":null,"abstract":"<p><p>This extensive AWMF 085-002 S2e-guideline \"First Trimester Diagnosis and Therapy @ 11-13<sup>+6</sup> Weeks of Gestation\" has systematically analyzed high-quality studies and publications and the existing evidence (evidence tables) and produced recommendations (level of recommendation, level of evidence, strength of consensus).This guideline deals with the following topics in the context of the 11-13<sup>+6</sup> weeks scan: the legal basis, screening for anatomical malformations, screening for chromosomal defects, quality assessment and audit, screening for preeclampsia and FGR, screening for preterm birth, screening for abnormally invasive placenta (AIP) and placenta accreta spectrum (PAS), screening for velamentous cord insertion and vasa praevia, screening for diabetes mellitus and LGA.Screening for complications of pregnancy can best be carried out @ 11-13+6 weeks of gestation. The issues of how to identify malformations, chromosomal abnormalities and certain disorders of placentation (high blood pressure and proteinuria, intrauterine growth retardation) have been solved. The problem of how to identify placenta percreta and vasa previa has been partially solved. What is still unsolved is how to identify disorders of glucose metabolism and preterm birth.In the first trimester, solutions to some of these problems are available: parents can be given extensive counselling and the risk that a pregnancy complication will manifest at a later stage can be delayed and reduced. This means that screening is critically important as it helps in decision-making about the best way to manage pregnancy complications (prevention and intervals between follow-up examinations).If no treatment is available and if a termination of pregnancy is considered, the intervention can be carried out with far lower complications compared to the second trimester of pregnancy. In most cases, further examinations are not required and the parents can be reassured. A repeat examination at around week 20 of gestation to complete the screening for malformations is recommended. NOTE:: The guideline will be published simultaneously in the official journals of both professional societies (i.e. Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM and Geburtshilfe und Frauenheilkunde for the DGGG).</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":"36-48"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2025-02-05DOI: 10.1055/a-2513-7158
{"title":"Thank you very much!","authors":"","doi":"10.1055/a-2513-7158","DOIUrl":"https://doi.org/10.1055/a-2513-7158","url":null,"abstract":"","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":"46 1","pages":"93-94"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thyroid nodules are common incidental findings. Most of them are benign, but many unnecessary fine-needle aspiration procedures, core biopsies, and even thyroidectomies or non-invasive treatments have been performed. To improve thyroid nodule characterization, the use of multiparametric ultrasound evaluation has been encouraged by most experts and several societies. In particular, US elastography for assessing tissue stiffness and CEUS for providing insight into vascularization contribute to improved characterization. Moreover, the application of AI, particularly machine learning and deep learning, enhances diagnostic accuracy. Furthermore, AI-based computer-aided diagnosis (CAD) systems, integrated into the diagnostic process, aid in risk stratification and minimize unnecessary interventions. Despite these advancements, challenges persist, including the need for standardized TIRADS, the role of US elastography in routine practice, and the integration of AI into clinical protocols. However, the integration of clinical information, laboratory information, and multiparametric ultrasound features remains crucial for minimizing unnecessary interventions and guiding appropriate treatments. In conclusion, ultrasound plays a pivotal role in thyroid nodule management. Open questions regarding TIRADS selection, consistent use of US elastography, and the role of AI-based techniques underscore the need for ongoing research. Nonetheless, a comprehensive approach combining clinical, laboratory, and ultrasound data is recommended to minimize unnecessary interventions and treatments.
甲状腺结节是常见的偶然发现。它们大多是良性的,但也有很多不必要的细针穿刺术、核心活检,甚至甲状腺切除术或无创治疗。为了改善甲状腺结节的特征描述,大多数专家和一些学会都鼓励使用多参数超声评估。尤其是用于评估组织硬度的 US 弹性成像和用于深入了解血管情况的 CEUS,都有助于改善特征描述。此外,人工智能的应用,尤其是机器学习和深度学习,提高了诊断的准确性。此外,基于人工智能的计算机辅助诊断(CAD)系统集成到诊断过程中,有助于风险分层,最大限度地减少不必要的干预。尽管取得了这些进步,但挑战依然存在,包括需要标准化的 TIRADS、美国弹性成像在常规实践中的作用以及将人工智能整合到临床方案中。然而,整合临床信息、实验室信息和多参数超声特征对于减少不必要的干预和指导适当的治疗仍然至关重要。总之,超声在甲状腺结节的治疗中起着举足轻重的作用。有关 TIRADS 的选择、美国弹性成像的一致使用以及基于人工智能技术的作用等未决问题凸显了持续研究的必要性。尽管如此,我们还是建议采用结合临床、实验室和超声数据的综合方法,以尽量减少不必要的干预和治疗。
{"title":"Multiparametric ultrasound evaluation of thyroid nodules.","authors":"Vito Cantisani, Jörg Bojunga, Cosimo Durante, Vincenzo Dolcetti, Patrizia Pacini","doi":"10.1055/a-2329-2866","DOIUrl":"10.1055/a-2329-2866","url":null,"abstract":"<p><p>Thyroid nodules are common incidental findings. Most of them are benign, but many unnecessary fine-needle aspiration procedures, core biopsies, and even thyroidectomies or non-invasive treatments have been performed. To improve thyroid nodule characterization, the use of multiparametric ultrasound evaluation has been encouraged by most experts and several societies. In particular, US elastography for assessing tissue stiffness and CEUS for providing insight into vascularization contribute to improved characterization. Moreover, the application of AI, particularly machine learning and deep learning, enhances diagnostic accuracy. Furthermore, AI-based computer-aided diagnosis (CAD) systems, integrated into the diagnostic process, aid in risk stratification and minimize unnecessary interventions. Despite these advancements, challenges persist, including the need for standardized TIRADS, the role of US elastography in routine practice, and the integration of AI into clinical protocols. However, the integration of clinical information, laboratory information, and multiparametric ultrasound features remains crucial for minimizing unnecessary interventions and guiding appropriate treatments. In conclusion, ultrasound plays a pivotal role in thyroid nodule management. Open questions regarding TIRADS selection, consistent use of US elastography, and the role of AI-based techniques underscore the need for ongoing research. Nonetheless, a comprehensive approach combining clinical, laboratory, and ultrasound data is recommended to minimize unnecessary interventions and treatments.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":"14-35"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-03-21DOI: 10.1055/a-2292-0530
Theresa Lüdke, Alexander Paliege, Anne Kluge, Falk-Tony Olesch, Gregor Hilger, Thomas Beleites, Max Kemper
Purpose: Ultrasound-guided puncture and punch biopsy pose a particular challenge in ultrasound examination training. These techniques should be learned and performed several times using a simulation model that is as realistic as possible before being applied to patients. While the use of agar-agar-based models is extensively documented in the literature, there is a discernible gap in publications specifically addressing their use in punch biopsy and puncture. The aim was to develop a cost-effective model for the simulation of ultrasound-guided interventions.
Materials and methods: The developed simulation model is based on the vegetable gelatine agar-agar. The agar-agar powder is boiled in water and colored. Various objects are added to the mass. Blueberries, olives, tomatoes, and cornichons imitate solid structures. Liquid-filled balloons are used to simulate cystic structures. Adding stones can make the exercises more difficult due to hyperechoic reflexes with distal shadowing.
Results: With the model, ultrasound-guided puncture and punch biopsies could be successfully simulated, and ultrasound images can be generated for this purpose. The cost of a single model is about 2 euros. Production takes less than 2 hours, including cooling. The pure processing time is 30 minutes. The durability of the models is limited by mold, which occurs after 5 days when stored at room temperature and after 5 weeks in the refrigerator.
Conclusion: It was shown that it is possible to produce an inexpensive agar-agar-based ultrasound model in a short time and with easily available ingredients to learn ultrasound-guided puncture and punch biopsies.
{"title":"Low-cost simulation model for ultrasound-guided punch biopsy and puncture: Construction manual and photo examples.","authors":"Theresa Lüdke, Alexander Paliege, Anne Kluge, Falk-Tony Olesch, Gregor Hilger, Thomas Beleites, Max Kemper","doi":"10.1055/a-2292-0530","DOIUrl":"10.1055/a-2292-0530","url":null,"abstract":"<p><strong>Purpose: </strong>Ultrasound-guided puncture and punch biopsy pose a particular challenge in ultrasound examination training. These techniques should be learned and performed several times using a simulation model that is as realistic as possible before being applied to patients. While the use of agar-agar-based models is extensively documented in the literature, there is a discernible gap in publications specifically addressing their use in punch biopsy and puncture. The aim was to develop a cost-effective model for the simulation of ultrasound-guided interventions.</p><p><strong>Materials and methods: </strong>The developed simulation model is based on the vegetable gelatine agar-agar. The agar-agar powder is boiled in water and colored. Various objects are added to the mass. Blueberries, olives, tomatoes, and cornichons imitate solid structures. Liquid-filled balloons are used to simulate cystic structures. Adding stones can make the exercises more difficult due to hyperechoic reflexes with distal shadowing.</p><p><strong>Results: </strong>With the model, ultrasound-guided puncture and punch biopsies could be successfully simulated, and ultrasound images can be generated for this purpose. The cost of a single model is about 2 euros. Production takes less than 2 hours, including cooling. The pure processing time is 30 minutes. The durability of the models is limited by mold, which occurs after 5 days when stored at room temperature and after 5 weeks in the refrigerator.</p><p><strong>Conclusion: </strong>It was shown that it is possible to produce an inexpensive agar-agar-based ultrasound model in a short time and with easily available ingredients to learn ultrasound-guided puncture and punch biopsies.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":"86-92"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology that causes progressive and destructive inflammation in the joints. Superb microvascular imaging (SMI) is a new ultrasound technique that allows visualization of slow blood flow in synovitis. This study aimed to report on 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).All RA patients with clinically apparent synovitis were assessed using DAS 28. Synovitis was investigated with PDUS and SMI and each joint was graded semi-quantitatively. All assessments were carried out at baseline and repeated at least at the 4-month follow-up. Correlations between scores were investigated using Spearman's correlation.60 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 the 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 the SMI score and PDUS score at both baseline and follow-up (p<0.001, r = 0.817, 0.842 respectively).SMI provides greater utility and ability to detect synovial vascularity and to monitor disease activity than PDUS. A new activity scoring system based on SMI and clinical objective findings is required to improve reliability and validity.
目的:类风湿性关节炎(RA)是一种病因不明的全身性自身免疫性疾病,会导致关节出现进行性和破坏性炎症。超微血管成像(SMI)是一种新型超声技术,可观察滑膜炎的缓慢血流。本研究旨在通过确定 SMI 技术与临床疾病活动评分(DAS 28)和动力多普勒超声(PDUS)的相关性,报告 SMI 技术及其分级在监测 RA 方面的临床价值和实用性:方法: 使用 DAS 28 对所有临床表现为滑膜炎的 RA 患者进行评估。用 PDUS 和 SMI 检查滑膜炎,并对每个关节进行半定量分级。所有评估均在基线时进行,并在至少 4 个月的随访中重复进行。采用斯皮尔曼相关性分析了各评分之间的相关性:结果:共招募了 60 名 RA 患者,他们有 552 个受影响的关节。随访期间,临床和声像图评分均有明显改善(p 结论:SMI 提供了更高的实用性和能力:与 PDUS 相比,SMI 在检测滑膜血管和监测疾病活动性方面具有更高的实用性和能力。需要一种基于 SMI 和临床客观检查结果的新活动度评分系统来提高可靠性和有效性。
{"title":"The reliability and validity of superb microvascular imaging as a potential disease activity marker in rheumatoid arthritis.","authors":"Esin Kurtulus Ozturk, Saffet Ozturk, Ayse Bahar Kelesoglu Dincer","doi":"10.1055/a-2463-8297","DOIUrl":"10.1055/a-2463-8297","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology that causes progressive and destructive inflammation in the joints. Superb microvascular imaging (SMI) is a new ultrasound technique that allows visualization of slow blood flow in synovitis. This study aimed to report on 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).All RA patients with clinically apparent synovitis were assessed using DAS 28. Synovitis was investigated with PDUS and SMI and each joint was graded semi-quantitatively. All assessments were carried out at baseline and repeated at least at the 4-month follow-up. Correlations between scores were investigated using Spearman's correlation.60 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 the 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 the SMI score and PDUS score at both baseline and follow-up (p<0.001, r = 0.817, 0.842 respectively).SMI provides greater utility and ability to detect synovial vascularity and to monitor disease activity than PDUS. A new activity scoring system based on SMI and clinical objective findings is required to improve reliability and validity.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}