Ultraschall in Der Medizin最新文献

Introduction: Successful placentation is crucial for fetal development and maintaining a healthy pregnancy. Placental insufficiency can cause a variety of obstetric complications. Despite the many efforts to enhance diagnosing placental insufficiency, no imaging technique has proven satisfactory. A promising imaging technique is contrast-enhanced ultrasound (CEUS) using microbubbles which has proven capable of (micro)vascular imaging. Its use for placental vascularization assessment in human pregnancies remains constrained by limited evidence and safety concerns. This scoping review aims to demonstrate the safety of CEUS used in human pregnancy in the published literature to date.

Material and methods: A systematic search using PubMed, Medline, Embase, and Cochrane databases was performed. All studies where contrast-enhanced ultrasound was used in pregnant humans were included. Studies, where there was a planned termination of pregnancy, were excluded. To assess the safety of CEUS during pregnancy, relevant outcomes were divided into the following 3 categories; fetal outcome, maternal outcome, and pregnancy and neonatal outcomes.

Results: A total of 13 articles were included, in which 256 women underwent CEUS during pregnancy. No clinically significant maternal or fetal adverse events or negative pregnancy or neonatal outcomes associated with CEUS were described.

Conclusion: Based on our findings, we consider expanding the knowledge of this promising diagnostic technique in future larger clinical studies to be safe and relevant.

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.

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.

Purpose: To analyze the ultrasound characteristics, clinical management, and pregnancy outcomes of heterotopic intramural pregnancies (HIMPs) after embryo transfer.

Methods: This was a retrospective observational study of women who were diagnosed with HIMPs. The ultrasound characteristics, clinical treatment, and pregnancy outcomes of patients with HIMPs were evaluated.

Results: Eight women with HIMPs were included. Among them, 6 patients were diagnosed by transvaginal sonography, and 2 patients were misdiagnosed with heterotopic interstitial pregnancy. The diagnostic accuracy was 75% (6/8). Five patients with HIMPs were diagnosed at the time of the initial scan (5+6-6+3 weeks). An intramural gestational sac was observed in all 6 patients, and an embryo with cardiac activity was detected in one patient on the follow-up scans. Intrauterine pregnancies (IUPs) were revealed in all 6 patients, and embryo(s) with cardiac activity were observed in 5 patients at the time of the initial diagnosis or later. The patients receiving expectant treatment all presented with bagel signs, while patients with embryos with cardiac activity all underwent surgery. Among the 6 diagnosed women, 1 patient was initially treated medically, 4 were treated expectantly, and 1 was treated surgically. Among the 6 diagnosed patients, the IUPs of 5 patients resulted in live infants.

Conclusion: Single ET should be recommended to decrease the possibility of HIMP. An accurate diagnosis of HIMP was reached in most cases by detailed ultrasound early in the first trimester. Most IUPs of HIMPs seem to have good outcomes with timely and proper management. Expectant management might be a possible choice for nonviable intramural pregnancies.

During embryogenesis, the vertebrae begin development during the 6th week of gestation via two lateral chondrification centers per segment. It was assumed that when disruptions occur in the process of somitogenesis during membranous vertebral body formation, chondrification and ossification will follow the anomalous membranous vertebral body scaffolding, resulting in an anomalous vertebral formation, such as a hemivertebra. Another hypothesis is that hemivertebra may result from anomalous distribution of intersegmental arteries of the vertebral column. There is no description in the medical literature of "excess linear calcifications" of part of the fetal vertebra, characterized by the presence of linear calcifications in the vertebrae of a developing fetus. In the first two trimesters of pregnancy, the fetal vertebrae usually show three calcified points in an axial section: the vertebral body and two transverse processes. Premature linear vertebral calcification was defined as an anterior or posterior echogenic connection between two of the points (Fig. 1). In this study, we describe seven cases of premature fetal linear vertebral calcification.

Purpose: To describe the feasibility of our preliminary outpatient fallopian tube catheterization procedure under 3D vaginal ultrasound (US) guidance followed by highly selective hysterosalpingo-foam sonography (HyFoSy) in infertile women diagnosed with proximal tubal obstruction.

Materials and methods: A prospective trial was conducted from October 2022 to December 2023. 3D vaginal US was used to establish the precise location of the tip of the selective salpingography catheter at the tubal ostium. A roadrunner was used to cannulate the occluded portion of the fallopian tube. After tubal cannulation, ExEm foam was injected under direct US guidance to confirm tubal recanalization and its passage through the fallopian tubes.

Results: During the study period, a total of 14 women with proximal tubal occlusion underwent this procedure. Tubal patency was obtained in 92.8%. No immediate and remote complications were observed. To date three (21.4%) of the patients conceived after tubal catheterization and one had a live birth.

Conclusion: Outpatient fallopian tube catheterization under 3D vaginal US guidance followed by selective HyFoSy can be successfully implemented for the diagnosis and treatment of patients with proximal tubal occlusion. The 3D modality enables volume capture of the required acquisitioning and the subsequent post imaging analysis permitting further examination and study. Additional experience is needed to consolidate the feasibility of this innovative procedure and identify the patient subgroups that would benefit the most from this approach.

Purpose: Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) or two-dimensional shear wave elastography (2D-SWE) is recommended to assess the risk of liver fibrosis and advanced chronic liver disease. Even though both techniques measure liver stiffness, their numerical results often diverge. Confounders and reliability criteria for 2D-SWE have not been systematically investigated.

Materials and methods: We prospectively recruited participants with paired LSM by VCTE and the novel 2D-SWE technique ElastQ (Philips) in three European tertiary centers. The following parameters were recorded: sex, age, body mass index (BMI), etiology, laboratory markers of liver damage and function, as well as cholestasis, LSM by VCTE and controlled attenuation parameter (CAP), interquartile range (IQR)/median for VCTE-LSM and ElastQ-LSM, and the skin-to-liver capsule distance.

Results: We included 840 participants: 447 (53.2%) males; median age 57.0 [IQR:19.0] years; median BMI 25.4 [6.0] kg/m²; median VCTE-LSM 7.25 [9.2] kPa; median ElastQ-LSM 6.7 [5.4] kPa. On uni- and multivariable modeling (adjusted for LSM), we found that the discrepancy increased with liver stiffness and markers of disease severity. Skin-to-liver capsule distance and BMI affected VCTE-LSM more compared to ElastQ-LSM and significantly increased the discordance between the two measurements.

Conclusion: The discrepancy of ElastQ-LSM to VCTE-LSM increases with liver stiffness and disease severity. BMI and skin-to-liver capsule distance increase the discrepancy between VCTE- and ElastQ-LSM but affect ElastQ-LSM less. The quality criterion IQR/median ≤ 30% indicates reliable ElastQ-LSM.

Purpose: Since handheld ultrasound devices are becoming increasingly ubiquitous, objective criteria to determine image quality are needed. We therefore conducted a comparison of objective quality measures and clinical performance.

Material and methods: A comparison of handheld devices (Butterfly IQ+, Clarius HD, Clarius HD3, Philips Lumify, GE VScan Air) and workstations (GE Logiq E10, Toshiba Aplio 500) was performed using a phantom. As a comparison, clinical investigations were performed by two experienced ultrasonographers by measuring the resolution of anatomical structures in the liver, pancreas, and intestine in ten subjects.

Results: Axial full width at half maximum resolution (FWHM) of 100µm phantom pins at depths between one and twelve cm ranged from 0.6-1.9mm without correlation to pin depth. Lateral FWHM resolution ranged from 1.3-8.7mm and was positively correlated with depth (r=0.6). Axial and lateral resolution differed between devices (p<0.001) with the lowest median lateral resolution observed in the E10 (5.4mm) and the lowest axial resolution (1.6mm) for the IQ+ device. Although devices showed no significant differences in most clinical applications, ultrasonographers were able to differentiate a median of two additional layers in the wall of the sigmoid colon and one additional structure in segmental portal fields (p<0.05) using cartwheel devices.

Conclusion: While handheld devices showed superior or similar performance in the phantom and routine measurements, workstations still provided superior clinical imaging and resolution of anatomical substructures, indicating a lack of objective measurements to evaluate clinical ultrasound devices.

Simulation-based training (SBT) is increasingly acknowledged worldwide and has become a popular tool for ultrasound education. Ultrasound simulation involves the use of technology and software to create a virtual training setting. Simulation-based training allows healthcare professionals to learn, practice, and improve their ultrasound imaging skills in a safe learning-based environment. SBT can provide a realistic and focused learning experience that creates a deep and immersive understanding of the complexity of ultrasound, including enhancing knowledge and confidence in specific areas of interest. Abdominal ultrasound simulation is a tool to increase patient safety and can be a cost-efficient training method. In this paper, we provide an overview of various types of abdominal ultrasound simulators, and the benefits, and challenges of SBT. We also provide examples of how to develop SBT programs and learning strategies including mastery learning. In conclusion, the growing demand for medical imaging increases the need for healthcare professionals to start using ultrasound simulators in order to keep up with the rising standards.