Ultraschall in Der Medizin最新文献

A wide range of medical specialists increasingly use thoracic ultrasound and transthoracic ultrasound-guided interventions in their clinical practice. To ensure high quality and standardized practice across specialties, this position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) describes the training requirements for thoracic ultrasound. The recommendations follow the three EFSUMB competency levels for medical ultrasound practice. Level 1 describes the skills required to perform basic thoracic ultrasound examinations and basic interventions independently, level 2 includes more advanced transthoracic ultrasound imaging and guided interventions, while level 3 involves the practice of high-level thoracic ultrasound and the use of advanced technologies. Previously, a predefined minimum number of ultrasound examinations was used to determine competence, but in recent years, a general shift towards competency-based training and assessment has been implemented. For each EFSUMB level, we outline the theoretical knowledge and practical skills needed for clinical practice.

Ultrasound (US) is the preferred imaging modality in pediatrics for diagnostic and therapeutic issues. The absence of radiation and the constant on-site accessibility make it the ideal tool for children. However, despite remarkable technical advances in resolution and applicability, many sophisticated medical questions still require profound expertise on the part of the examiner, thus often hampering fast decisions particularly outside regular working hours.This single-center study, at a university children's hospital evaluated the use of US during emergency service. A four-week documentation period was followed by a subsequent eight-week supervision period with live supervision availability on demand guided by a remote US expert. The demand for expert support, diagnosis, grading of urgency, duration and success of examination, and satisfaction of both examiners were analyzed.108 patients (mean age 9.7 years) were included. In 38% of cases, US was supervised on demand with a definite diagnosis in 92.6% of cases (25/27). Image quality and technical performance were graded sufficient in 100% of cases. Supervised compared to non-supervised US examinations were prolonged (14.4 min vs. 7.1 min, p<0.001), were more prevalent within the first 24 h in the hospital (70% vs. 56.8%, p=0.06), and were classified more frequently as emergency (22.2% vs. 2.3%; p=0.015). All participants classified the availability of US supervision as decisively helpful.Remote live supervised pediatric US was feasible and effective. It combined timely, high-quality diagnostics even in the case of challenging medical questions with simultaneous US training.

Approximately 0.8 % of all children are born with heart defects, with the prenatal incidence naturally being even higher. Among all congenital heart defects (CHD), conotruncal anomalies are the most common critical heart defects - after ventricular and atrial septal defects. Conotruncal anomalies are anomalies of the infundibulum (conus arteriosus) and great vessels (truncus arteriosus). These anomalies predominantly affect the right ventricular outflow tract and account for about 25-30 % of all CHD cases. Based on their incidence and clinical relevance, this article describes perimembranous ventricular septal defects (VSD), tetralogy of Fallot (TOF), pulmonary atresia with VSD (PAVSD), transposition of the great arteries (TGA), and the less common double outlet right ventricle (DORV) and truncus arteriosus communis (TAC).Conotruncal anomalies are usually associated with a normal 4-chamber view, so the prenatal detection rate during prenatal care tends to be low. However, because undetected conotruncal anomalies have high rates of postnatal mortality and morbidity, in accordance with internationally recommended policies, the foetal heart should always be examined systematically and segmentally in different sectional planes, including the outflow tract and in combination with the color Doppler, to achieve a higher detection rate. This article provides an overview of prenatal sonographic diagnosis of conotruncal anomalies based on extensive imaging material.

To investigate the correlation between different prenatal imaging techniques in congenital diaphragmatic hernia (CDH) and their prognostic value.209 fetuses with CDH were enrolled in this retrospective cohort study. The prenatal ultrasound-based and MRI-based (MRI: magnetic resonance imaging) observed-to-expected lung-to-head ratio (o/e-LHR) and MRI-based relative fetal lung volume (rFLV) were evaluated and compared. Their prediction component with respect to clinical outcome was evaluated. Mean values were compared by two-sample t-tests or the Mann-Whitney U-test. The Chi-square or Fisher's exact test was used in order to compare qualitative parameters. Kappa coefficients, McNemar test, and Bowker's test were used to assess the degree of agreement.The study population included 183 fetuses with left-sided and 26 fetuses with right-sided CDH. Survival did not differ significantly (74.3% vs. 80.8%, p=0.053). For every imaging technique, incidences of extracorporeal membrane oxygenation (ECMO) and chronic lung disease decreased, and the probability of survival increased gradually reaching minima and maxima for o/e-LHR and rFLV above 35%. Outcome improved if rFLV was above 35% - compared to MRI-based measurement of o/e-LHR above 35%.Our data confirm the predictive value of o/e-LHR for CDH - irrespective of the diagnostic modality. MRI evaluation of o/e-LHR was not superior compared to sonography. MRI evaluation of rFLV correlated with morbidity and mortality which can be beneficial for fetuses with an otherwise good prognosis based on higher o/e-LHR as 2D imaging techniques can underestimate the fetuses' risk for pulmonary hypertension and ECMO.

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.