Ultraschall in Der Medizin最新文献

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.

Metabolic dysfunction-associated steatotic liver disease (MASLD) can progress to fibrosis and cirrhosis. Fibrosis and steatosis assessment with vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) requires a dedicated device and time to obtain ≥10 reliable measurements. Auto pSWE allows for the simultaneous collection of 15 ARFI-based liver stiffness measurements (LSM) and UDFF-based steatosis assessment in a single acquisition.This prospective study included patients undergoing liver biopsy, primarily during bariatric surgery, between 11/2021-12/2023. Paired LSM by Auto pSWE/VCTE and steatosis assessments by UDFF/CAP were performed within a median of 1 day before or after biopsy.134 patients (65% women, mean age: 42.6±13.3 years) with a high prevalence of obesity (mean BMI: 42.7±10.4; MASLD etiology: 88%) were included. Liver biopsy showed significant fibrosis (≥F2) in 27% of patients and moderate steatosis (≥S2) in 51%. A single 1×15 Auto pSWE acquisition and one UDFF measurement were as accurate as the median of 5 measurements. Auto pSWE (AUC: ≥F2=0.58, ≥F3=0.96, F4=0.97) and VCTE (AUC: ≥F2=0.60, ≥F3=0.92, F4=0.93) demonstrated high accuracy for advanced fibrosis stages. UDFF (AUC: ≥S1=0.79, ≥S2=0.78, S3=0.67) and CAP showed similar diagnostic accuracy.Auto pSWE and UDFF provide accurate, noninvasive tests for advanced liver fibrosis and steatosis in MASLD, even in severely obese patients. Notably, Auto pSWE captures 15 LSM with UDFF in a single acquisition, saving time and eliminating the need for a dedicated device.

Ultrasonography is increasingly being discussed as an alternative to X-rays in emergency department settings. Systematic comparisons of the 2 modalities are often based on the use of computed tomography as a reference. When diagnosing patients with elbow trauma, the physicians at our emergency department experienced that ultrasonography can be more informative than cone beam computed tomography for identifying radial head fractures. Our goal is to share this experience with the scientific community.All patients diagnosed with a radial head fracture in our emergency department between January 2021 and November 2022 were identified. The images of 18 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.The 8 examples illustrate that ultrasonography can be more informative than cone beam computed tomography or vice versa.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.

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.

This study examines whether combining conventional textbook materials with the app-based ultrasound simulator Scanbooster enhances learning outcomes in fetal echocardiography, compared to using either method alone. It also evaluates the impact of the learning sequence.210 medical students were randomized into two groups: · PDF → App group (n=103): Textbook study followed by the Scanbooster ultrasound simulator app. · App → PDF group (n=107): Scanbooster ultrasound simulator app followed by textbook study. Knowledge was assessed before and after by identifying marked structures in ultrasound videos.There were no significant differences between the groups regarding age (p=0.564) and prior ultrasound experience (p=0.746). Both groups showed a significant improvement in identifying sonographic structures after the learning phase (p<0.001), with a mean learning effect of 104.96% and 102.16%, respectively, for fetal echocardiography-specific knowledge. The order of learning materials had no significant effect on learning success (p>0.05). In comparison with our previous study, we found that the combination of app-based simulation and textbooks led to the best learning outcomes in fetal echocardiography. This approach resulted in significantly higher performance compared to pure PDF learning (p<0.001) and was slightly, yet still significantly better than pure simulation (p=0.031).The combination of conventional textbook materials and app-based ultrasound simulation is the most effective approach for teaching fetal echocardiography. The learning sequence does not significantly impact the outcome.

CDH fetuses may present with abnormal brain volume and cerebral fissures. Since cardiac function and size may also be altered, we hypothesized that abnormal cardiac function may contribute to the impaired brain development in these fetuses. The aim of this study is to evaluate whether cardiac dimensions and function correlate with brain development in CDH fetuses.All fetuses with left CDH who underwent ultrasound evaluation of cardiac function and brain development between 2018 and 2023 were included. We analyzed the correlation between cardiac size and function parameters with the parieto-occipital (POF) and Sylvian (SF) fissures and insular depth (ID) in 2 gestational periods (GP). Cardiac and brain anatomical measures were corrected for head circumference, and cardiac function parameters were corrected for estimated fetal weight or GA. Correlations were analyzed using the Pearson test. A p-value <0.05 was considered significant.24 fetuses with left CDH were included. Between 20 and 24 weeks of gestation, POF, SF, and ID were significantly correlated with aortic flow. Right ventricle E/A was significantly correlated with POF and SF, with a trend toward a correlation with ID, approaching the threshold of significance. In this GP, the ID was also significantly correlated with the left ventricle area, E/A, and E', S' and A'. Most correlations were lost in the next GP.Between 20 and 24 weeks of gestation, brain development in fetuses with CDH is significantly correlated with cardiac function. Most of these correlations were lost at 25-28 weeks of gestation. Further studies are needed to confirm our results and to evaluate whether these findings have postnatal clinical significance.

Sensing ultrasound localization microscopy (sULM) enables radiation-free imaging of microvascular architecture and blood flow dynamics by tracking intravasal microbubble contrast agents. This technical development aims to enable the visualization of glomeruli in the renal cortex of neonates serving as a potential imaging biopsy.This technical report describes the first use of sULM in the human neonatal kidney. Neonatal subjects were examined by transabdominal contrast-enhanced ultrasound using a standard clinical ultrasound device. An image-based motion correction algorithm was implemented and the filtering, localization, and tracking of microbubbles during sULM analysis were refined. sULM algorithms were applied next to depict fast- and slow-moving microbubbles separately and to identify glomeruli by distance metric calculations.Five neonates were investigated. Slow-moving microbubbles were detected mainly in the cortical region, travelling a typical route through a glomerulus. By calculating the cumulative movement of every microbubble, the number of glomeruli could be counted over the entire organ.We report an effective sULM workflow within the human neonate and the first microvascular sULM maps of neonatal renal vascularity up to the scale of a single glomerulus. The assessment of glomeruli as smallest functional units over the whole kidney has high potential to serve as a non-invasive imaging biomarker in future studies.

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.

Head rotation and subsequent hypoperfusion of the brain stem might be possible causal factors of sudden infant death. This study aimed to determine the quantitative changes of cerebral blood flow as assessed on ultrasound (US) Doppler with respect to dependence on the position and age of the subject.This single-center retrospective study was performed to assess US Doppler measurements on vertebral and basilar arteries of neonates and infants. After measuring peak systolic flow (Vs) and time-averaged velocity (TAM) in the middle supine position, each subject was positioned with the head rotated to the right and left both in a supine and a prone position. Both vertebral arteries were measured, and results were correlated to individual age at the time of investigation.A total of n=1889 subjects were analyzed. Vs was 63.0±15.3cm/s in the supine middle position and reduced after head rotation to 59.9±21.6 m/s (P <0.0001, head rotated right) and 59.4±15.6cm/s (P <0.0001, left). In the prone position Vs was 58.4±14.8cm/s (P <0.0001, head rotated right) and 58.1±15.0cm/s (P <0.0001, left). Comparable measurements were made for TAV. There was a correlation of TAV and Vs with individual postnatal age.Head rotation and different positioning of the neonate/young infant leads to lower Vs and TAV values in the basilar artery. It remains unclear if these changes may help to identify patients at risk of SIDS. Furthermore, Vs and TAV are age-dependent, which should be considered in the workup of transfontanellar US Doppler investigations.