Ultraschall in Der Medizin最新文献

This CME article explores the evolving role of endosonography in otorhinolaryngology and head and neck surgery. Endosonography offers significant potential to improve imaging inside the upper respiratory tract, particularly with advancements in probe technology and imaging resolution. The article will describe the sonoanatomy of the oral cavity, pharynx, and larynx and the selection of probes and scanning techniques used for the various anatomical sites. Transoral ultrasound can be used to improve the diagnosis of salivary gland diseases, oropharyngeal abscesses, and ultrasound-guided puncture and biopsy. Endoscopic endolaryngeal ultrasound is used especially for diagnosing small laryngeal cancer and determining infiltration status. The article highlights the role of endosonography in managing oncologic diseases, especially in oral tongue carcinoma, where it aids in surgical planning by assessing the depth of invasion. In cases of HPV-positive carcinoma of unknown primary, high-frequency endosonography is crucial for detecting small tumors in the oropharyngeal region. In summary, the article advocates the broader integration of endosonography in clinical practice, highlighting its potential to enhance diagnostic accuracy and improve patient outcomes in head and neck oncology.

This study aimed to identify the structures and tissues of the dorsal aspect of the metacarpophalangeal joint (MCPJ) using ultrasound, with gross anatomy as a comparator and learning source. In addition, the composition of several MCPJ tissues was investigated by histology and immunohistochemistry.The study comprised 3 steps. First, 4 rheumatologist ultrasonographers identified on B-mode imaging the tissue patterns of the structures in the dorsal aspect of the MCPJ in fresh-frozen cadaveric hands. In the second step, 2 anatomists performed dissections on fresh-frozen and embalmed cadaveric hands to characterize the components of the dorsal MCPJ, providing anatomy-based feedback to aid ultrasound tissue interpretation. Histological and immunohistochemical analyses were also conducted on selected dorsal MCPJ tissues. In the third step, the anatomy and histology-based knowledge were applied to identify and evaluate these structures in healthy subjects using B-mode and Doppler mode ultrasound.Ultrasound examination of the cadaveric hands identified the key dorsal MCPJ structures, including the extensor tendon, joint capsule, dorsal plate, synovial recesses, and metacarpal head cartilage. Anatomical and histological analyses further characterized these structures, enhancing their identification in healthy subjects. Additionally, new insight into the histological and immunohistological features of these structures is provided.Ultrasound successfully identified the main structures of the dorsal MCPJ. Integrating anatomical and histological features improved ultrasound imaging observations and confidence.

To evaluate the significance of high-resolution ultrasound (HRUS) and shear wave elastography (SWE) in the diagnosis of diabetic peripheral neuropathy (DPN) to clarify their possible roles as early predictors of the occurrence of this important complication.The study included 90 patients with diabetes mellitus with different clinical stages of DPN as well as 30 healthy controls. A full history, clinical examination, and assessment of both the Toronto Clinical Neuropathy Score (TCNS) and HbA_1c were performed, followed by real-time HRUS and SWE examinations of their right and left tibial and median nerves to assess their cross-sectional area (CSA) and nerve stiffness, respectively.The CSA and stiffness of tibial and median nerves were significantly increased in patients with diabetes compared to controls, with higher values associated with the severity of their DPN. Both parameters were correlated with each other and with the duration of the disease, TCNS, and HbA_1c. The CSA cut-off value of both tibial and median nerves to detect DPN in patients was 13.5 mm², meanwhile, the SWE cut-off values were 68.5 and 61.5 KPa, respectively. SWE showed a higher AUC than CSA for the prediction of DPN.Measurement of the CSA and stiffness of the peripheral nerves could be a reliable tool for early detection of DPN. Therefore, we recommend adding these noninvasive diagnostic parameters as complementary diagnostic tools to the routine follow-up schedule of diabetic complications, especially in long-standing cases.

To evaluate the performance of the cerebroplacental ratio (CPR) in predicting operative delivery for intrapartum fetal compromise (OD for IFC) and adverse perinatal outcomes in uncomplicated twin pregnancies with attempted vaginal delivery.This was a retrospective cohort study of 72 twin pregnancies in a single tertiary referral center between January 2018 and August 2024. All MCDA and DCDA twin pregnancies with an attempted vaginal delivery after 34+0 weeks were screened for eligibility and those without further risk factors were included in the study. Outcome parameters were OD for IFC and a composite of adverse perinatal outcomes (CAPO) including OD for IFC, 5-minute Apgar score <7, umbilical artery pH <7.10, or admission to the neonatal intensive care unit (NICU). The predictive performance of CPR was evaluated using ROC analyses and multivariable logistic regression.16 MCDA and 56 DCDA pregnancies met the inclusion criteria. CAPO of at least one of the twins occurred in 27 (37.5%) of the cases. ROC analyses showed that low CPR MoM of neither the presenting twin nor the second twin predicted CAPO. Similarly, the prediction of the need for OD for IFC of twin 2 was not possible using low CPR MoM as the predicting variable. However, logistic regression analyses showed that nulliparity and twin-to-twin delivery time interval were independently associated with CAPO.Low CPR MoM was not predictive for CAPO or OD for IFC in uncomplicated twin pregnancies after 34 weeks of gestation. However, nulliparity and twin-to-twin delivery time interval were independently associated with CAPO.

To examine the effect of discovery learning on musculoskeletal ultrasound (MSUS) performance and to explore how expert learners engage in a collaborative learning environment.Experts in MSUS participated in a discovery learning session where they were divided into groups. Each participant had one attempt to solve the same MSUS case and could seek assistance from other group members or learning resources. The video-recorded sessions were analyzed using both quantitative and qualitative methods. Performance was assessed using the validated Objective Structured Assessment of Ultrasound Skills (OSAUS) tool (1-5 points per item), and an outcome score was calculated based on the number of correct MSUS images (0-4). Participants' comfort and perception of discovery learning were evaluated using a 5-point Likert scale questionnaire.28 MSUS experts from 13 different countries completed the study. The mean OSAUS score (standard deviation) was 3.96 (0.5), and the mean outcome score was 1.89 (0.9). Using Pearson's correlation coefficient, we found a significant correlation between the OSAUS score and the outcome score (0.72, p < .001). The qualitative analysis revealed that the experts used actions associated with adaptive expertise and that social hierarchy persisted in the collaborative learning environment. Finally, we found high comfort with and acceptance of the discovery learning approach.Discovery learning may be an effective teaching strategy for future advanced MSUS courses, including international Teach-the-Teachers courses. Since social hierarchy was present, a facilitator is necessary during collaborative training.

Misplacement of ventricular catheters during shunt surgery occurs in 40% of cases using a freehand technique and therefore represents a risk for early shunt failure. The goal of this retrospective, single-center study is to analyze the impact of real-time ultrasound guidance on ventricular catheter positioning and early outcome of shunt survival.We analyzed the charts and images of all patients who underwent shunt surgery from 09/2017 to 12/2022 and compared the position of the ventricular catheter using the freehand technique and real-time ultrasound guidance. Central catheter position was graded as grade I (optimal), II (contact with ventricle structures or contralateral), and III (misplacement).A ventricular catheter was placed in 244 patients using real-time US guidance and in 506 patients using a freehand technique. The mean age (53.4 and 53.6 years, respectively) and the preoperative frontal occipital horn ratio (FOHR; 0.47 versus 0.44) were almost equal in both groups. In the study group, grade I catheter position was achieved in 64% of cases, grade II in 34%, and grade III in 2%. The control group showed grade I position in 45%, grade II in 32%, and grade III in 23% of cases (p<0.05). An early central catheter failure rate was the highest in grade III (40.5%) compared to 4% in grade I.Our data demonstrate that real-time US guidance leads to a significant improvement in ventricular catheter placement. Consequently, early shunt revisions decrease significantly. Further prospective, randomized, and controlled studies comparing the standard method to real-time ultrasound catheter placement are required.

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).

The goal of breast-conserving surgery is to achieve negative tumor margins, since insufficient marginal distance is associated with more local and distant recurrences. This study investigates whether IOUS (intraoperative ultrasound) can reduce the re-resection rate compared to standard breast surgery, regardless of tumor biology and focality.The present study is a monocentric, prospective, randomized, and non-blinded parallel group study conducted between 7/2015 and 2/2018. Patients with sonographically visible breast cancer were randomized into two study arms: 1) breast-conserving surgery with IOUS; 2) conventional arm.364 patients were included in the study and underwent surgery. Tumor biology, size, and focality were equally distributed in both groups (p = 0.497). The study arms did not differ significantly in the proportion of preoperative wire markings (p= 0.084), specimen weight (p = 0.225), surgery duration (p = 0.849), and the proportion of shavings taken intraoperatively (p = 0.903). Positive margins were present in 16.6% of the cases in the IOUS arm and in 20.8% in the conventional arm (p = 0.347). Re-operation was necessary after intraoperative shavings in 14.4% of cases in the US arm and in 21.3% in the conventional arm (p = 0.100).Although the present study showed a clear difference in the rate of positive tumor margins with IOUS compared to conventional breast surgery without IOUS, this was not statistically significant in contrast to the current literature. This could be due to the high expertise of the breast surgeons, the precise wire marking, or the fact that the IOUS technique was not standardized.