Ultraschall in Der Medizin最新文献

Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology that causes progressive and destructive inflammation in the joints. Superb microvascular imaging (SMI) is a new ultrasound technique that allows visualization of slow blood flow in synovitis. This study aimed to report on the clinical value and utility of the SMI technique and its grading for monitoring RA by determining the correlation with clinical disease activity scores (DAS 28) and power Doppler ultrasound (PDUS).All RA patients with clinically apparent synovitis were assessed using DAS 28. Synovitis was investigated with PDUS and SMI and each joint was graded semi-quantitatively. All assessments were carried out at baseline and repeated at least at the 4-month follow-up. Correlations between scores were investigated using Spearman's correlation.60 RA patients with 552 affected joints were recruited. Clinical and sonographic scores were significantly improved at follow-up (p<0.001). SMI showed significantly more joint count and flow signal scores than clinical examination and PDUS. Moderate correlations were found between the SMI score and clinical scores (p<0.001, 0.586 for SMI score vs. DAS 28-CRP, p=0.001, 0.432 for SMI vs. DAS 28-ESR). There were also stronger correlations between the SMI score and PDUS score at both baseline and follow-up (p<0.001, r = 0.817, 0.842 respectively).SMI provides greater utility and ability to detect synovial vascularity and to monitor disease activity than PDUS. A new activity scoring system based on SMI and clinical objective findings is required to improve reliability and validity.

Breast ultrasound has been established for many years as an important method in addition to mammography for clarifying breast findings. The goal of the Best Practice Guidelines Part III of the DEGUM breast ultrasound working group is to provide colleagues working in senology with information regarding the specific medical indications for breast ultrasound in addition to the current ultrasound criteria and assessment categories published in part I and the additional and optional sonographic diagnostic methods described in part II. The value of breast ultrasound for specific indications including follow-up, evaluation of breast implants, diagnostic workup of dense breast tissue, diagnostic workup during pregnancy and lactation, and the diagnostic workup of breast findings in men is discussed. Each section after the general information section contains a description of specific pathologies, followed by a short summary and DEGUM recommendations for the particular indications. The latest S3 guidelines and AGO guidelines were taken into consideration.

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.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.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.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.

Post-stroke depression (PSD) is a common complication after stroke and has a substantial effect on the quality of life of patients. Nevertheless, reliable individual prediction of PSD is not possible. As depressive symptoms have been associated with brainstem raphe (BR) hypoechogenicity on transcranial sonography (TCS), we aimed to explore the association of BR hypoechogenicity and the occurrence of PSD.The Prognostic Markers of Post-Stroke Depression (PROMoSD) study is a prospective, observational, single-center, investigator-initiated study that included patients with acute ischemic stroke (AIS) to investigate the presence of BR hypoechogenicity by TCS early after symptom onset. The primary outcome was the presence of PSD assessed at the three-month follow-up investigation by a blinded psychiatrist and defined according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V criteria).From 105 included AIS patients, 99 patients completed the study. AIS patients with a hypoechogenic BR developed a PSD at three months more frequently compared to patients with normal echogenicity (48.0% versus 4.1%, P <0.001). After adjustment for confounders (sex, mRS at follow-up, previous depressive episode), a hypoechogenic BR remained independently associated with a substantial increase in the appearance of PSD (adjusted OR: 6.371, 95%-CI: 1.181-34.362).A hypoechogenic BR is a strong and independent predictor of PSD at three months after AIS. TCS could be a routine tool to assess PSD risk in clinical practice, thereby streamlining diagnostic and therapeutic algorithms.

Diseases of the salivary glands are as common as they are diverse and can have different causes. Clinicians can differentiate salivary gland changes based on chronic systemic diseases, congenital and vascular malformations, and benign and malignant tumors. Acute infectious pathologies can also arise as a result of obstructive pathologies. A large number of diseases with similar clinical presentations have to be differentiated. Due to the improved resolution of ultrasound technology over the last 20 years, it is now used as the first imaging modality to examine salivary gland pathologies. It allows a quick, dynamic, and non-invasive examination of the salivary glands and the soft tissue of the neck. In order to accurately diagnose and treat patients, a very good knowledge of these diseases and their appearance on sonography is required.

To investigate the associations between contrast-enhanced ultrasound imaging features and disease recurrence among patients with locally advanced breast cancer treated with neoadjuvant chemotherapy.In the study, pre- and post-neoadjuvant chemotherapy contrast-enhanced ultrasound images of 43 patients with breast cancer were retrospectively analysed. Post-acquisition image processing involved the placement of freehand-drawn regions of interest, followed by the generation of blood flow kinetics representing blood volume and velocity for these regions of interest. Qualitative and quantitative contrast-enhanced ultrasound parameters were compared to predict recurrence, and receiver operating characteristic analysis was used to evaluate predictive ability.Among the 43 patients, 10 (23%) exhibited disease recurrence (median [range]: 27 [4-68] months). Post-neoadjuvant chemotherapy peak enhancement, wash-in area under the curve, wash-out area under the curve, and wash-in and wash-out area under the curve (p=0.003, p=0.004, p=0.026, and p=0.014, respectively) differed between the no-recurrence and recurrence groups. The area under the receiver operating characteristic curve (0.88; 95% confidence interval: 0.75-1.00) for post-neoadjuvant chemotherapy peak enhancement was the highest among the contrast-enhanced ultrasound parameters, with a cut-off of 13.33 arbitrary units.Higher peak enhancement on post-neoadjuvant chemotherapy contrast-enhanced ultrasound images was associated with recurrence in women with locally advanced breast cancer and is a potential biomarker of tumor recurrence.

This study aims to investigate placental and fetal lung stiffness in pregnant women with and without gestational diabetes, considering the well-established delay in fetal lung maturation associated with gestational diabetes.This prospective cohort study was conducted at a tertiary center and included pregnant women who underwent a 75-gram oral glucose tolerance test between 24-28 weeks of gestation. Elastography measurements were performed using point shear wave elastography (pSWE).The study included 60 pregnant women diagnosed with gestational diabetes and 60 pregnant women in the control group. The SWE velocity of the peripheral placenta, central placenta, and lung was higher in the gestational diabetes group compared to the control group. Furthermore, the SWE velocity of the peripheral placenta, central placenta, and lung was higher in newborns with neonatal respiratory morbidity. Based on the ROC analysis of patients with gestational diabetes, the AUC for lung SWE velocity was 0.88 (cut-off 12.4 kPa, 95% CI: 0.77-0.99, p<0.001) with a sensitivity of 71.4% and specificity of 95.6% for predicting neonatal respiratory morbidity.Fetal placental and lung stiffness increase in fetuses of pregnant women with diabetes. Moreover, higher fetal lung stiffness during the fetal period is associated with increased neonatal respiratory morbidity.