Ultraschall in Der Medizin最新文献

This continuing medical education article highlights the central role of transcutaneous sonography in diagnosing parenchymal pancreatic diseases. It emphasizes the importance of in-depth knowledge of sonographic imaging of organ anatomy and a structured examination methodology, particularly for identifying acute and chronic pancreatitis and related complications. The article provides detailed guidance for optimized examination techniques and equipment settings, even under challenging conditions, and discusses the application of ultrasound in various scenarios of pancreatic diseases. Moreover, the relevance of advanced sonographic techniques such as high-frequency sonography, elastography, and contrast-enhanced sonography is illuminated in the context of expanded diagnostic workup.

US-guided (Ultrasound-guided) percutaneous transthoracic core needle biopsy (CNB) is a favorable method for establishing the correct diagnosis of mediastinal masses. However, studies in this area are scant and often include small samples, thus making it difficult to provide robust evidence regarding the safety and efficacy of this procedure. Thus, we aimed to report on the 20 years of experience at our center with regard to US-guided CNB.We included all consecutive patients referred to our center to undergo US-guided percutaneous transthoracic CNB for a mediastinal mass between 1999 and 2022. Descriptive statistics were used to display data. A multivariate logistic regression analysis was used to inquire about predictors of diagnostic sampling.The final cohort included 140 patients with a median age of 37 years. In 20.7% of the cases, the mediastinal mass was an incidental finding. The parasternal approach was used most often. US-guided CNB was diagnostic in 84.3% of the patients and most of the diagnoses included hematological neoplasms. The reasons for non-diagnostic sampling included firm lesion consistency, low quantity of samples, and lesion necrosis. The parasternal approach resulted in an independent predictor of diagnostic sampling (AOR 4.16, 95% CI 1.14-15.23, p=0.031), while a bulky feature revealed only a trend for diagnostic sampling. One non-severe adverse event occurred, with spontaneous resolution.US-guided percutaneous transthoracic CNB is an effective and safe procedure that allows the diagnosis of mediastinal masses. The identification of patients that could benefit from this technique should be the next step in researching this topic.

Before removal of retained pancreatic stents placed during endoscopic retrograde cholangiopancreatography to avoid post-ERCP pancreatitis, imaging is recommended. The aim of the present study was to evaluate a new ultrasound-based algorithm.Patients who received a pancreatic stent for PEP prophylaxis were included. Straight 5Fr (0.035inch) 6cm stents with an external flap that were visualized by ultrasound were removed endoscopically with no further imaging. If the ultrasound result reported the stent to be dislodged or was inconclusive, X-ray imaging was performed. The endpoints were positive and negative predictive value, specificity, sensitivity, and contingency coefficient between ultrasound and X-ray and/or endoscopy.88 patients were enrolled in the present study. X-ray was performed in 23 (26%) patients. Accordingly, the ultrasound algorithm saved an X-ray examination in 65 cases, leading to a reduction of 74%. Stents were retained in 67 patients (76%) and visualized correctly by ultrasound in 54 patients with a sensitivity of 81%. The positive predictive value was 83%. The specificity was 48%, because ultrasound described 10/21 dislodged stents correctly. The negative predictive value was 43%, since 10/23 stents were correctly classified by ultrasound as dislodged. In 11 patients (13%), esophagogastroduodenoscopy was performed even though the pancreatic stent was already dislodged.A novel ultrasound-based algorithm reduced the need for X-ray imaging by three quarters. To avoid unnecessary endoscopic examinations, the algorithm should be implemented with a learning phase and procedures should be performed by experienced examiners. An important limitation might be stent length since shorter stents might be more difficult to visualize by ultrasound.

This study aimed to examine the perfusion characteristics of benign and malignant soft-tissue tumors (STT) using contrast-enhanced ultrasound (CEUS) and to correlate STT micro-perfusion with malignancy. Findings were compared with patient characteristics, clinical presentations, MRI findings, and histopathological outcomes.This prospective single-center study involved patients with unclear STTs who were scheduled for STT biopsy. Clinical assessments and preoperative MRI were conducted along with CEUS. Perfusion quantification was performed, and perfusion parameters (peak enhancement [PE], rise time, wash-in perfusion index, and washout rate) were calculated. Perfusion characteristics of different STTs were compared.187 patients were included in the final analysis. Significant differences in CEUS perfusion between benign and non-benign STTs were demonstrated. Non-benign tumors showed significantly higher tumor perfusion and differences were also significant when comparing semi-malignant, malignant, and metastatic STTs. (PE-benign 107.74 [34.65-345.62]; PE-semi-malignant 166.06 [60.14-374.47]; PE-malignant 1042.24 [358.15-4917.74]; PE-metastasis 2632.37 [2249.46-3788.94]. ROC analysis demonstrated a sensitivity of 80% and a PPV of 69% for malignant tumor detection using a cut-off value for peak enhancement of 137 [a.u.].CEUS appears to be a promising tool for primary STT evaluation in addition to MRI. Furthermore, it can detect vital areas within the tumor tissue and could be utilized to increase biopsy accuracy.

To establish a discriminant function model combining clinical data and multimodal ultrasound to predict the degree of renal fibrosis in patients with chronic kidney disease (CKD) and to explore the application value of the non-invasive assessment of renal fibrosis by new ultrasound techniques.Clinical data and ultrasonography, shear wave elastography, and angio planewave ultrasensitive imaging characteristics of patients with CKD were collected. The significant indicators were screened to establish discriminant function models to distinguish the degree of renal fibrosis, and the diagnostic efficacy was evaluated.The 158 patients were divided into 4 groups according to pathological results. The significant indicators among or within the 4 groups were mainly age, estimated glomerular filtration rate, serum creatinine, peak systolic velocity and resistance index of renal arteries, kidney elasticity, and arcuate artery vascular density (p<0.05). The discriminant function models exhibited good diagnostic efficiency and higher accuracy compared to any single indicator.The SWE elasticity value of the kidney increases with the degree of fibrosis, while AP can visualize microvascular conditions qualitatively and quantitatively. Multimodal ultrasound combined with clinical data is a non-invasive strategy for the assessment of renal fibrosis.

Evaluation of the possible role of microvascular imaging (MI) for the detection of vascularization of renal lesions, while comparing it with contrast-enhanced ultrasound (CEUS).137 patients (160 renal lesions, 64 solid and 96 cystic) were enrolled in this single-center, retrospective, observational study. For solid masses, both the intralesional and the peripheral vascularization was analyzed and quantified by MI and then compared to peak enhancement on CEUS. Regarding cystic lesions, we evaluated the presence or absence of vascularization within the cystic wall and/or septa. MI results were compared with CEUS findings using Pearson's Chi square test. An optimal size cut-off for renal lesions was determined with the Youden test.For solid lesions, a statistically significant correlation (p <0.05) was observed between the MI parameters and the peak enhancement on CEUS. The detection rate (DR) for lesional vascularization on MI was 87.5%, while if we consider only lesions larger than the optimal cut-off (14mm), the DR increases to 98%. In cystic lesions, the MI showed a high specificity (93.9%) in predicting CEUS results and a high positive predictive value (84.2%). The concordance was 100% in Bosniak I lesions and 80% in Bosniak IV lesions, while it was lower for the other classes. Furthermore, we found a statistically significant correlation (p <0.05) between Bosniak grade and lesional vascularity on MI.Our preliminary study shows that MI cannot replace CEUS, but could reduce its use, especially in solid lesions larger than 14mm and in cysts classified as Bosniak IV, a goal that is particularly important in an active surveillance setting.

To identify the sonomorphological appearance and to measure the thickness of the piriformis muscle (PM) and the proximal portion of the sacral nerve roots S1-S3 in healthy premenopausal women.This prospective multicentric observational study included a consecutive series of women undergoing transvaginal sonography (TVS) at 2 tertiary gynecological referral centers. Standardized assessment of the pelvic organs was performed, followed by an attempt to visualize the right and left PM and sacral nerve roots S1-S3 at their origin in proximity to the sacral neuroforamen. Visualization rates, diameters of the muscle and nerve thickness, and the time needed to identify the PM were recorded.305 patients were included in the study. In 293 women (96.1%), the PM was identified bilaterally. The median diameter of the PM was 18.3mm on the right side and 18.4mm on the left side. S1 nerve roots were successfully identified bilaterally in 224 (73.4%) patients. Their right and left median diameters were 4.8mm. Both S2 nerves were successfully identified in 215 (70.5%) patients. Their median diameter were 4.3mm on both sides. S3 nerve roots were successfully identified in 203 (66.6%) patients. Their median diameter were 3.2mm on both sides.We describe methods which allow consistent and rapid identification of the PM and the S1-S3 sacral nerve roots using TVS. Visualization of the PM and the proximal portion of the sacral plexus may be useful regarding identification of pathological changes in PM thickness and could help to distinguish perineural cysts from other gynecological pathologies.

Arterial thoracic outlet syndrome (aTOS) is a rare condition, but if undiagnosed, it can have serious consequences for affected patients, up to and including limb loss. Ultrasound could be used here as a widely available method for screening, but it is said to have very high investigator dependence. The fact that ultrasound can be used safely for diagnostic purposes has already been demonstrated. The aim of this study was to evaluate the repeatability of a standardized examination for the diagnosis of aTOS.We recruited inpatients with high-grade suspected arterial thoracic outlet syndrome who were evaluated for invasive therapy at our TOS center. Routine diagnostics were performed according to clinic standards. In addition, 2 sonographers, one highly experienced and one less experienced, performed ultrasound diagnosis according to a standardized protocol. Image acquisition and interpretation were performed independently, and sonographers were mutually blinded. For analysis, the experienced sonographer served as a reference. Agreement between assessors was analyzed using concordance analysis.51 consecutive patients (67% female) aged 39.3±13.0 years were included within 11 months. The standardized ultrasound protocol could be performed in all patients. The prevalence of TOS was high (79.4%; CI: 71.4-87.3%) in our cohort. Ultrasound inter-rater agreement using the standardized protocol was very good at 0.820 (CI: 0.624-1.000).Ultrasound diagnosis of TOS using a standardized protocol can be performed effectively and shows a high agreement between 2 sonographers.