Ultraschall in Der Medizin最新文献

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 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.

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.

Since the first intrauterine interventions were carried out in the 1970 s under what today would be considered basic conditions, the range of prenatal interventions has steadily expanded, as has the frequency with which these interventions are carried out at specialized centers. Although most of these procedures are minimally invasive, they are invariably associated with considerable risks for the fetus and, depending on the surgical method, also for the expectant mother. For this reason, most centers worldwide limit themselves to interventions for fetal diseases which, if untreated, have a fatal course or experience a significant deterioration in the postnatal prognosis during the course of intrauterine development. This is all the more significant as only a small proportion of prenatal interventions have been successfully investigated in controlled clinical trials. The only exceptions are laser therapy for feto-fetal transfusion syndrome, intrauterine closure of spina bifida, and tracheal occlusion for diaphragmatic hernia with severe pulmonary hypoplasia. This article is intended to provide an overview of the fetal conditions that are candidates for intrauterine therapy and of the evidence for the individual interventions.

To explore the relationship between ultrasound signs of suspected fetal malformation of cortical development (MCD) and genetic MCD.The retrospective study involved fetuses with one of the following 10 neurosonography (NSG) signs: (A) abnormal development of the Sylvian fissure; (B) delayed achievement of cortical milestones; (C) premature or aberrant appearance of sulcation; (D) irregular border of the ventricular wall or irregular shape of the ventricle; (E) abnormal shape or orientation of the sulci; (F) hemispheric asymmetry; (G) non-continuous cerebral cortex; (H) intraparenchymal echogenic nodules; (I) persistent ganglionic eminence (GE) or GE cavitation; (J) abnormal cortical lamination.95 fetuses were included in the study. Chromosomal microarray (CMA) combined with exome sequencing (ES) was available in 40 fetuses, CMA was abnormal in nine and ES in 22. Sign C (7/7, 100%), sign H (2/2, 100%), sign A (18/19, 94.7%), and sign B (12/13, 92.3%) were the signs leading to the highest probability of genetic MCD. The incidence of genetic MCD for sign E, sign I, and sign D was 66.7-73.7%. Only one or none of the fetuses with sign J, sign F, or sign G underwent CMA+ES. The signs in the fetuses with FGFR3, CCND2, FLNA, or TSC2 mutations had the expected features. The other fetuses with different gene mutations showed several non-specific NSG signs.Several reliable signs for genetic MCD can be detected by NSG, and the probability varies with different signs. Most signs are not associated with a specific gene. Therefore, CMA combined with ES is preferred.

Aortic arch branching variants have recently been found to have an impact in neonates undergoing surgical interventions involving the thoracic aorta such as aortic coarctation repair. They have been described prenatally in 6% of neonates, whereas they occur in up to 26% postnatally. To explore whether the branching variations might have been underdiagnosed in utero, we comprehensively assessed the aortic arch and its branching patterns in a low-risk population between the 19^th and 22^nd week of gestation.This prospective cohort study included 139 low-risk singleton pregnancies. During a standardized fetal echocardiography examination, we investigated the aortic arch in a sagittal view according to predefined landmarks. Based on video clips, its branching pattern was categorized as normal branching or branching variants by 2 operators who were blinded to each other.Classification of aortic arch branching was achieved in 127/139 cases (91.4%). 103 cases (81.1%) showed a normal pattern, and 24 cases (18.9%) showed a branching variant. Both operators agreed on 18 brachiobicephalic trunks (the so-called bovine arch), 4 aberrant left vertebral arteries, 1 aortic arch with 5 branching vessels. In 1 case there was disagreement regarding the type of variant.Prenatal targeted echocardiography could identify 18.9% prevalence of aortic arch branching variants in a low-risk population. Future studies are warranted to assess the clinical impact of our findings on neonates with congenital heart defects.