Purpose: The cross-sectional area (CSA) of the cervical vagus nerve (VN), as assessed through ultrasonography, might be linked to autonomic nervous system dysfunction. Hypertension is the primary factor associated with cerebral white matter lesions (WMLs), but there is also evidence of a connection with autonomic nervous system dysfunction. However, the associations between WMLs and VN size are unclear. Our objective was to investigate the associations between WMLs and VN size in patients with vascular risk factors.
Methods: The CSA of the VN was evaluated using carotid ultrasonography in patients with a history of stroke (acute or chronic) and comorbidities (n = 196, 70.2 ± 12.7 years). Common carotid artery (CCA) intima-media thickness and interadventitial diameter (IAD) were also measured. The severity of the WMLs was assessed by the Fazekas classification and Scheltens' scale.
Results: The CSA of the right VN (2.08 ± 0.65 mm2) was significantly greater than that of the CSA of the left VN (1.56 ± 0.44 mm2) (P < 0.001). Multiple linear regression analyses revealed that older age, hypertension, increased right CCA IAD, and decreased CSA of the right VN (standardized partial regression coefficient [β] - 0.226; P < 0.001) were independently associated with the severity of WMLs (Scheltens' scale). A decreased CSA of the left VN was also associated with the severity of WMLs (β = - 0.239; P < 0.001).
Conclusion: VN size determined via ultrasonography was associated with the severity of WMLs. While these findings do not establish a causal relationship, they suggest that autonomic nervous system dysfunction is involved in the progression of WMLs.
{"title":"Vagus nerve size determined via ultrasonography is associated with white matter lesions in patients with vascular risk factors.","authors":"Tomohisa Nezu, Futoshi Eto, Akemi Hironaka, Shiro Aoki, Shuichiro Neshige, Saki Tasaka, Hikari Kirimoto, Hirofumi Maruyama","doi":"10.1007/s40477-024-00936-2","DOIUrl":"10.1007/s40477-024-00936-2","url":null,"abstract":"<p><strong>Purpose: </strong>The cross-sectional area (CSA) of the cervical vagus nerve (VN), as assessed through ultrasonography, might be linked to autonomic nervous system dysfunction. Hypertension is the primary factor associated with cerebral white matter lesions (WMLs), but there is also evidence of a connection with autonomic nervous system dysfunction. However, the associations between WMLs and VN size are unclear. Our objective was to investigate the associations between WMLs and VN size in patients with vascular risk factors.</p><p><strong>Methods: </strong>The CSA of the VN was evaluated using carotid ultrasonography in patients with a history of stroke (acute or chronic) and comorbidities (n = 196, 70.2 ± 12.7 years). Common carotid artery (CCA) intima-media thickness and interadventitial diameter (IAD) were also measured. The severity of the WMLs was assessed by the Fazekas classification and Scheltens' scale.</p><p><strong>Results: </strong>The CSA of the right VN (2.08 ± 0.65 mm<sup>2</sup>) was significantly greater than that of the CSA of the left VN (1.56 ± 0.44 mm<sup>2</sup>) (P < 0.001). Multiple linear regression analyses revealed that older age, hypertension, increased right CCA IAD, and decreased CSA of the right VN (standardized partial regression coefficient [β] - 0.226; P < 0.001) were independently associated with the severity of WMLs (Scheltens' scale). A decreased CSA of the left VN was also associated with the severity of WMLs (β = - 0.239; P < 0.001).</p><p><strong>Conclusion: </strong>VN size determined via ultrasonography was associated with the severity of WMLs. While these findings do not establish a causal relationship, they suggest that autonomic nervous system dysfunction is involved in the progression of WMLs.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Intramuscular heterogeneity exists in the shear modulus of the rectus femoris (RF) muscle. However, the underlying heterogeneity mechanisms are not entirely understood. Previous research has reported that detachment of superficial tissues reduces the shear modulus by 50%. The aim of this study was to examine the effects of the skin, deep fascia, and intermuscular connections on the shear modulus of the RF at multiple sites.
Materials and methods: Eleven donors were fixed using the Thiel method. Measurements were performed at 0°, 60°, and 120° knee flexion in a neutral hip position. Tissue processing was performed under four conditions: superficial tissue (CONT), skin off (SKIN), deep fascia detachment (FASC), and intermuscular connections detachment (ALL). The shear modulus at the proximal, central, and distal regions were measured using ultrasound shear wave elastography. The study was approved by the Sapporo Medical University Ethical Committee.
Results: Three-way ANOVA revealed no significant interaction between treatment, site, and angle (P = 0.156), treatment and angle (P = 0.067), or site and angle (P = 0.441). There was a significant effect of treatment (P < 0.001), site (P = 0.010), and angle (P < 0.001) and interaction between treatment and site (P < 0.001). The proximal shear modulus was greater than the central for CONT. There were no significant differences between the measurement sites for SKIN. The distal shear modulus was greater than the proximal for FASC. The distal shear modulus was also greater than the proximal and central for ALL.
Conclusions: Intramuscular regional differences that influence superficial tissue and intermuscular connections of RF elasticity heterogeneity were observed.
{"title":"Effects of superficial tissue and intermuscular connections on rectus femoris muscle shear modulus heterogeneity.","authors":"Taiki Kodesho, Takuya Kato, Gakuto Nakao, Yu Yokoyama, Yuhei Saito, Kota Watanabe, Yuki Ohsaki, Masaki Katayose, Keigo Taniguchi","doi":"10.1007/s40477-022-00769-x","DOIUrl":"10.1007/s40477-022-00769-x","url":null,"abstract":"<p><strong>Introduction: </strong>Intramuscular heterogeneity exists in the shear modulus of the rectus femoris (RF) muscle. However, the underlying heterogeneity mechanisms are not entirely understood. Previous research has reported that detachment of superficial tissues reduces the shear modulus by 50%. The aim of this study was to examine the effects of the skin, deep fascia, and intermuscular connections on the shear modulus of the RF at multiple sites.</p><p><strong>Materials and methods: </strong>Eleven donors were fixed using the Thiel method. Measurements were performed at 0°, 60°, and 120° knee flexion in a neutral hip position. Tissue processing was performed under four conditions: superficial tissue (CONT), skin off (SKIN), deep fascia detachment (FASC), and intermuscular connections detachment (ALL). The shear modulus at the proximal, central, and distal regions were measured using ultrasound shear wave elastography. The study was approved by the Sapporo Medical University Ethical Committee.</p><p><strong>Results: </strong>Three-way ANOVA revealed no significant interaction between treatment, site, and angle (P = 0.156), treatment and angle (P = 0.067), or site and angle (P = 0.441). There was a significant effect of treatment (P < 0.001), site (P = 0.010), and angle (P < 0.001) and interaction between treatment and site (P < 0.001). The proximal shear modulus was greater than the central for CONT. There were no significant differences between the measurement sites for SKIN. The distal shear modulus was greater than the proximal for FASC. The distal shear modulus was also greater than the proximal and central for ALL.</p><p><strong>Conclusions: </strong>Intramuscular regional differences that influence superficial tissue and intermuscular connections of RF elasticity heterogeneity were observed.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9215747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2023-04-08DOI: 10.1007/s40477-023-00778-4
Michalis Sotiriou, Christakis Damianou
Purpose: The aim of this study is to evaluate the acoustic and thermal properties of a plaque phantom. This is very important for the effective implementation of ultrasound not only in diagnosis but especially in treatment for the future.
Material and methods: An evaluation of acoustic and thermal properties of plaque phantoms to test their suitability mainly for ultrasound imaging and therapy was presented. The evaluation included measurements of the acoustic propagation speed using pulse-echo technique, ultrasonic attenuation coefficient using through transmission immersion technique, and absorption coefficient. Moreover, thermal properties (thermal conductivity, volumetric specific heat capacity and thermal diffusivity) were measured with the transient method using a needle probe.
Results: It was shown that acoustic and thermal properties of atherosclerotic plaque phantoms fall well within the range of reported values for atherosclerotic plaque and slightly different for thermal diffusivity and volumetric specific heat capacity for soft tissues. The mean value of acoustic and thermal properties and their standard deviation of plaque phantoms were 1523 ± 23 m/s for acoustic speed, 0.50 ± 0.02 W/mK for thermal conductivity, 0.30 ± 0.21 db/cm-MHz for ultrasonic absorption coefficient and 1.63 ± 0.46 db/cm-MHz for ultrasonic attenuation coefficient.
Conclusions: This study demonstrated that acoustic and thermal properties of atherosclerotic plaque phantoms were within the range of reported values. Future studies should be focused on the optimum recipe of the atherosclerotic plaque phantoms that mimics the human atherosclerotic plaque (agar 4% w/v, gypsum 10% w/v and butter 10% w/v) and can be used for HIFU therapy.
{"title":"Evaluating acoustic and thermal properties of a plaque phantom.","authors":"Michalis Sotiriou, Christakis Damianou","doi":"10.1007/s40477-023-00778-4","DOIUrl":"10.1007/s40477-023-00778-4","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study is to evaluate the acoustic and thermal properties of a plaque phantom. This is very important for the effective implementation of ultrasound not only in diagnosis but especially in treatment for the future.</p><p><strong>Material and methods: </strong>An evaluation of acoustic and thermal properties of plaque phantoms to test their suitability mainly for ultrasound imaging and therapy was presented. The evaluation included measurements of the acoustic propagation speed using pulse-echo technique, ultrasonic attenuation coefficient using through transmission immersion technique, and absorption coefficient. Moreover, thermal properties (thermal conductivity, volumetric specific heat capacity and thermal diffusivity) were measured with the transient method using a needle probe.</p><p><strong>Results: </strong>It was shown that acoustic and thermal properties of atherosclerotic plaque phantoms fall well within the range of reported values for atherosclerotic plaque and slightly different for thermal diffusivity and volumetric specific heat capacity for soft tissues. The mean value of acoustic and thermal properties and their standard deviation of plaque phantoms were 1523 ± 23 m/s for acoustic speed, 0.50 ± 0.02 W/mK for thermal conductivity, 0.30 ± 0.21 db/cm-MHz for ultrasonic absorption coefficient and 1.63 ± 0.46 db/cm-MHz for ultrasonic attenuation coefficient.</p><p><strong>Conclusions: </strong>This study demonstrated that acoustic and thermal properties of atherosclerotic plaque phantoms were within the range of reported values. Future studies should be focused on the optimum recipe of the atherosclerotic plaque phantoms that mimics the human atherosclerotic plaque (agar 4% w/v, gypsum 10% w/v and butter 10% w/v) and can be used for HIFU therapy.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9615325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-02-08DOI: 10.1007/s40477-023-00849-6
Valentina Marinato, Alice Phillips, Leonardo Giuliano, Tommaso Cascella, Giorgio Greco, Rodolfo Lanocita
Background: A biloma refers to an abnormal, well-defined accumulation of bile outside the biliary tree within the abdomen, which can be either intra- or extra-hepatic in nature. It can result from traumatic or iatrogenic causes, leading to a disruption in the biliary system. Without prompt diagnosis and appropriate management, it can result in significant morbidity and mortality. While magnetic resonance cholangiopancreatography (MRCP) is the typical diagnostic method, there are instances where it may not provide conclusive results.
Case presentation: We present the case of a 72-year-old woman who underwent an hepatic resection of the seventh segment after recurrence of hepatocellular carcinoma (HCC). During the ultrasound (US) follow-up, she developed a peri-hepatic collection which proved to be a biloma continuously refurnished by the biliary tree. Neither the MRCP nor the percutaneous transhepatic cholangiography (PTC) were able to clearly detect the exact site of the bile leak. While awaiting the Endoscopic Retrograde Cholangio-Pancreatography (ERCP), a Contrast-Enhanced Ultrasound (CEUS) was conducted administering the contrast agent directly through the percutaneous drainage catheter placed in the biloma. This revealed the presence of contrast flow from the collection to a peripheral right bile duct, confirming the intra-hepatic leak communication.
Conclusions: This case demonstrates that Contrast-Enhanced Ultrasound (CEUS) presents a straightforward, secure, and precise approach to detect biliary leakage responsible for the formation of a biloma. Additionally, the adoption of CEUS offers the dual benefit of minimizing radiation exposure for the patient and obviating the requirement for anesthesia. In summary, CEUS emerges as a compelling alternative to conventional diagnostic methods for effectively managing a biloma.
{"title":"The role of CEUS in the management of biloma.","authors":"Valentina Marinato, Alice Phillips, Leonardo Giuliano, Tommaso Cascella, Giorgio Greco, Rodolfo Lanocita","doi":"10.1007/s40477-023-00849-6","DOIUrl":"10.1007/s40477-023-00849-6","url":null,"abstract":"<p><strong>Background: </strong>A biloma refers to an abnormal, well-defined accumulation of bile outside the biliary tree within the abdomen, which can be either intra- or extra-hepatic in nature. It can result from traumatic or iatrogenic causes, leading to a disruption in the biliary system. Without prompt diagnosis and appropriate management, it can result in significant morbidity and mortality. While magnetic resonance cholangiopancreatography (MRCP) is the typical diagnostic method, there are instances where it may not provide conclusive results.</p><p><strong>Case presentation: </strong>We present the case of a 72-year-old woman who underwent an hepatic resection of the seventh segment after recurrence of hepatocellular carcinoma (HCC). During the ultrasound (US) follow-up, she developed a peri-hepatic collection which proved to be a biloma continuously refurnished by the biliary tree. Neither the MRCP nor the percutaneous transhepatic cholangiography (PTC) were able to clearly detect the exact site of the bile leak. While awaiting the Endoscopic Retrograde Cholangio-Pancreatography (ERCP), a Contrast-Enhanced Ultrasound (CEUS) was conducted administering the contrast agent directly through the percutaneous drainage catheter placed in the biloma. This revealed the presence of contrast flow from the collection to a peripheral right bile duct, confirming the intra-hepatic leak communication.</p><p><strong>Conclusions: </strong>This case demonstrates that Contrast-Enhanced Ultrasound (CEUS) presents a straightforward, secure, and precise approach to detect biliary leakage responsible for the formation of a biloma. Additionally, the adoption of CEUS offers the dual benefit of minimizing radiation exposure for the patient and obviating the requirement for anesthesia. In summary, CEUS emerges as a compelling alternative to conventional diagnostic methods for effectively managing a biloma.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1007/s40477-024-00947-z
Sonal Saran, Kapil Shirodkar, Mohsin Hussein, K Durgaprasad Bhamidipaty, Robert Henderson, Christine Azzopardi, G R Madhu Mallik, Karthikeyan P Iyengar, Rajesh Botchu
Introduction: Pathologies of the scapulothoracic articulation may lead to painful symptoms such as crepitus and bursitis. While conservative treatments are preferred, persistent symptoms may require image-guided injections. This study aims to determine the optimal hand positioning during ultrasound to maximize the distance between the scapula and thoracic wall, and improve its accessibility during injections.
Methods: This cross-sectional observational study included ten healthy adult volunteers without scapulothoracic issues or history of trauma/surgery. Two musculoskeletal radiologists independently measured the scapulothoracic distance on Ultrasound in three hand positions: 1. Hands under the head; 2. Hands by the side of the trunk; and 3. Hands hanging by the side of the couch. Data was analyzed using SPSS 24.0. Continuous variables were described using mean and standard deviation (SD), with significance set at p < 0.05.
Results: Measurements on 20 scapulothoracic articulations (10 volunteers) showed the following findings: Position 1: Baseline value of 1. Position 2: Distance increased by 1.515 mm ± 3.617 (95% CI [- 0.0178, 3.208]. Position 3: Distance increased by 2.175 mm ± 0.66 (95% CI [0.793, 3.557]. Statistical analysis indicated no significant difference (p = 0.39) between positions. However, both radiologists subjectively noted that positions 2 and 3 provided better access for interventions.
Conclusion: This study highlights the importance of hand positioning in optimizing the scapulothoracic distance for therapeutic interventions. While no significant statistical differences were found, the results suggest potential benefits for clinical practice. Further research with larger samples is needed to establish evidence-based guidelines for scapulothoracic injections.
{"title":"Optimizing scapulothoracic injections: the role of hand positioning in enhancing procedural ease.","authors":"Sonal Saran, Kapil Shirodkar, Mohsin Hussein, K Durgaprasad Bhamidipaty, Robert Henderson, Christine Azzopardi, G R Madhu Mallik, Karthikeyan P Iyengar, Rajesh Botchu","doi":"10.1007/s40477-024-00947-z","DOIUrl":"https://doi.org/10.1007/s40477-024-00947-z","url":null,"abstract":"<p><strong>Introduction: </strong>Pathologies of the scapulothoracic articulation may lead to painful symptoms such as crepitus and bursitis. While conservative treatments are preferred, persistent symptoms may require image-guided injections. This study aims to determine the optimal hand positioning during ultrasound to maximize the distance between the scapula and thoracic wall, and improve its accessibility during injections.</p><p><strong>Methods: </strong>This cross-sectional observational study included ten healthy adult volunteers without scapulothoracic issues or history of trauma/surgery. Two musculoskeletal radiologists independently measured the scapulothoracic distance on Ultrasound in three hand positions: 1. Hands under the head; 2. Hands by the side of the trunk; and 3. Hands hanging by the side of the couch. Data was analyzed using SPSS 24.0. Continuous variables were described using mean and standard deviation (SD), with significance set at p < 0.05.</p><p><strong>Results: </strong>Measurements on 20 scapulothoracic articulations (10 volunteers) showed the following findings: Position 1: Baseline value of 1. Position 2: Distance increased by 1.515 mm ± 3.617 (95% CI [- 0.0178, 3.208]. Position 3: Distance increased by 2.175 mm ± 0.66 (95% CI [0.793, 3.557]. Statistical analysis indicated no significant difference (p = 0.39) between positions. However, both radiologists subjectively noted that positions 2 and 3 provided better access for interventions.</p><p><strong>Conclusion: </strong>This study highlights the importance of hand positioning in optimizing the scapulothoracic distance for therapeutic interventions. While no significant statistical differences were found, the results suggest potential benefits for clinical practice. Further research with larger samples is needed to establish evidence-based guidelines for scapulothoracic injections.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-25DOI: 10.1007/s40477-024-00940-6
Amir Kazory, Olanrewaju A Olaoye, Abhilash Koratala
{"title":"Point-of-care lung and inferior vena cava ultrasound in hemodialysis: more complex than it appears.","authors":"Amir Kazory, Olanrewaju A Olaoye, Abhilash Koratala","doi":"10.1007/s40477-024-00940-6","DOIUrl":"https://doi.org/10.1007/s40477-024-00940-6","url":null,"abstract":"","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1007/s40477-024-00948-y
Nidhi Agrawal, Kapil Shirodkar, Sindhura Mettu, Ankit B Shah, Bipin R Shah, Karthikeyan P Iyengar, Rajesh Botchu
The novel BAASIK (B-Botchu,Bipin, A-Agrawal, A-Ankit, S- Sindhura, I-Iyengar, K- Kapil) technique is a combined ultrasound-guided injection into the subacromial-subdeltoid (SASD) bursa and the biceps tendon sheath to treat shoulder pain associated with biceps tendonitis/tendinopathy, subacromial bursitis, rotator cuff impingement or to determine the source of shoulder pain. This technique aims in reducing shoulder pain, improving functional activities and enhancing treatment delivery. A single-entry supine ultrasound-guided injection of the subacromial-subdeltoid (SASD) bursa and biceps tendon sheath involves using a single needle insertion point to access both structures for therapeutic injection. This technique could become a favoured alternative technique, rather than subjecting patients to two needlesticks and preparing two separate injections to address often concomitant pathologies.
{"title":"BAASIK technique: an innovative single needle technique of performing shoulder corticosteroid injections.","authors":"Nidhi Agrawal, Kapil Shirodkar, Sindhura Mettu, Ankit B Shah, Bipin R Shah, Karthikeyan P Iyengar, Rajesh Botchu","doi":"10.1007/s40477-024-00948-y","DOIUrl":"https://doi.org/10.1007/s40477-024-00948-y","url":null,"abstract":"<p><p>The novel BAASIK (B-Botchu,Bipin, A-Agrawal, A-Ankit, S- Sindhura, I-Iyengar, K- Kapil) technique is a combined ultrasound-guided injection into the subacromial-subdeltoid (SASD) bursa and the biceps tendon sheath to treat shoulder pain associated with biceps tendonitis/tendinopathy, subacromial bursitis, rotator cuff impingement or to determine the source of shoulder pain. This technique aims in reducing shoulder pain, improving functional activities and enhancing treatment delivery. A single-entry supine ultrasound-guided injection of the subacromial-subdeltoid (SASD) bursa and biceps tendon sheath involves using a single needle insertion point to access both structures for therapeutic injection. This technique could become a favoured alternative technique, rather than subjecting patients to two needlesticks and preparing two separate injections to address often concomitant pathologies.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1007/s40477-024-00924-6
Logeswaran Selvarajah, Mark Cresswell, Romain David, Paul Winston, Timothy Murray
Shoulder ultrasound is a key tool used by musculoskeletal practitioners to diagnose and treat a variety of upper girdle diseases. While magnetic resonance imaging is the cornerstone of shoulder imaging, sonography is readily available, practical and superior in its ability for dynamic assessment of musculoskeletal pathologies. The subscapularis, teres major and latissimus dorsi muscles are commonly involved in a myriad of pathology including myofascial pain and spasticity. There is scarce literature on the assessment of these muscles for diagnostic and therapeutic purposes. Conventional approaches to shoulder ultrasound have not included a dedicated assessment of the subscapularis muscle due to its inherent anatomical location deep to the scapular blade which blocks sound wave penetration. We describe an approach to visualizing the subscapularis muscle as a short addition to the established shoulder sonography format, which also permits assessment of both the latissimus dorsi and teres major muscles, which are important muscles for shoulder spasticity. The patient is imaged in a semi-recumbent position with the arms elevated above and behind the head in the ABduction and External Rotation (ABER) position. The relative ease of positioning and sonographic access to the musculature coupled with the potential for assessment and intervention makes this approach extremely desirable to the musculoskeletal practitioner looking to diagnose or treat muscle belly pathologies of the subscapularis, teres major or latissimus dorsi.
{"title":"Trans-axillary sonography in the ABER (ABduction and External Rotation) position: a window to the subscapularis, teres major and latissimus dorsi.","authors":"Logeswaran Selvarajah, Mark Cresswell, Romain David, Paul Winston, Timothy Murray","doi":"10.1007/s40477-024-00924-6","DOIUrl":"https://doi.org/10.1007/s40477-024-00924-6","url":null,"abstract":"<p><p>Shoulder ultrasound is a key tool used by musculoskeletal practitioners to diagnose and treat a variety of upper girdle diseases. While magnetic resonance imaging is the cornerstone of shoulder imaging, sonography is readily available, practical and superior in its ability for dynamic assessment of musculoskeletal pathologies. The subscapularis, teres major and latissimus dorsi muscles are commonly involved in a myriad of pathology including myofascial pain and spasticity. There is scarce literature on the assessment of these muscles for diagnostic and therapeutic purposes. Conventional approaches to shoulder ultrasound have not included a dedicated assessment of the subscapularis muscle due to its inherent anatomical location deep to the scapular blade which blocks sound wave penetration. We describe an approach to visualizing the subscapularis muscle as a short addition to the established shoulder sonography format, which also permits assessment of both the latissimus dorsi and teres major muscles, which are important muscles for shoulder spasticity. The patient is imaged in a semi-recumbent position with the arms elevated above and behind the head in the ABduction and External Rotation (ABER) position. The relative ease of positioning and sonographic access to the musculature coupled with the potential for assessment and intervention makes this approach extremely desirable to the musculoskeletal practitioner looking to diagnose or treat muscle belly pathologies of the subscapularis, teres major or latissimus dorsi.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1007/s40477-024-00942-4
Ricardo de Souza Tesch, Esther Rieko Takamori, Rosana Bizon Vieira Carias, Juliana Oliveira de Medeiros Vilela, Thayanne Brasil Barbosa Calcia
Purpose: Temporomandibular joint osteoarthritis (TMJ-OA) management is complex, and several conservative and minimally invasive protocols have been proposed. Intra-articular injections of medications directed at OA have been performed, but in some cases, these medications do not directly contact the tissue lesion sites. Here, we propose a new real-time ultrasound-guided technique to inject medications directly into the subchondral bone.
Methods: Ultrasound image screening was carried out with the point-of-care Clarius L15 device. Then, with the patient's mouth closed, a stainless-steel cannula with a concentric trocar was US-guided using an in-plane approach until the perforating tip of the internal trocar touched the lateral pole of the mandibular condyle. Then, the trocar was inserted through the medullary bone, where a posterior injection was made.
Results: The technique's precision was confirmed by capturing an iodine contrast solution that imaged the medullary condyle of fresh anatomical specimens processed by computed tomography.
Conclusion: The proposed technique was effective in accessing the mandibular condyle subchondral bone in the inferior TMJ space for the simultaneously intra-articular (IA) and intra-osseous (IO) in-plane US-guided injections. Thus, its implementation may represent an important advance in early TMJ-OA treatment. This may be a promising approach, especially in OA cases in which the cortical bone is still preserved.
目的:颞下颌关节骨关节炎(TMJ-OA)的治疗非常复杂,目前已提出了几种保守和微创方案。针对 OA 的关节内药物注射已经开展,但在某些情况下,这些药物不能直接接触组织病变部位。在此,我们提出一种新的实时超声引导技术,将药物直接注入软骨下骨:方法:使用护理点 Clarius L15 设备进行超声图像筛查。然后,在患者闭口的情况下,在超声引导下使用平面内方法插入带有同心套管的不锈钢套管,直到内部套管的穿孔尖端接触到下颌骨髁状突的外侧极。然后,将套管插入髓质骨,进行后方注射:结果:通过捕捉碘造影剂溶液,对经计算机断层扫描处理的新鲜解剖标本的髓髁部进行成像,证实了该技术的精确性:结论:所提出的技术能有效进入颞下颌关节下间隙的下颌骨髁状突软骨下骨,同时进行关节内(IA)和骨内(IO)平面内 US 引导注射。因此,它的实施可能代表着早期颞下颌关节-OA 治疗的重要进步。这可能是一种很有前景的方法,尤其是在皮质骨仍被保留的 OA 病例中。
{"title":"Intra-articular and intraosseous approach to temporomandibular joint-targeted injections: a cadaveric investigation.","authors":"Ricardo de Souza Tesch, Esther Rieko Takamori, Rosana Bizon Vieira Carias, Juliana Oliveira de Medeiros Vilela, Thayanne Brasil Barbosa Calcia","doi":"10.1007/s40477-024-00942-4","DOIUrl":"https://doi.org/10.1007/s40477-024-00942-4","url":null,"abstract":"<p><strong>Purpose: </strong>Temporomandibular joint osteoarthritis (TMJ-OA) management is complex, and several conservative and minimally invasive protocols have been proposed. Intra-articular injections of medications directed at OA have been performed, but in some cases, these medications do not directly contact the tissue lesion sites. Here, we propose a new real-time ultrasound-guided technique to inject medications directly into the subchondral bone.</p><p><strong>Methods: </strong>Ultrasound image screening was carried out with the point-of-care Clarius L15 device. Then, with the patient's mouth closed, a stainless-steel cannula with a concentric trocar was US-guided using an in-plane approach until the perforating tip of the internal trocar touched the lateral pole of the mandibular condyle. Then, the trocar was inserted through the medullary bone, where a posterior injection was made.</p><p><strong>Results: </strong>The technique's precision was confirmed by capturing an iodine contrast solution that imaged the medullary condyle of fresh anatomical specimens processed by computed tomography.</p><p><strong>Conclusion: </strong>The proposed technique was effective in accessing the mandibular condyle subchondral bone in the inferior TMJ space for the simultaneously intra-articular (IA) and intra-osseous (IO) in-plane US-guided injections. Thus, its implementation may represent an important advance in early TMJ-OA treatment. This may be a promising approach, especially in OA cases in which the cortical bone is still preserved.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1007/s40477-024-00935-3
Mariana S Barbagianni, Stefanos G Georgiou, Pagona G Gouletsou, Apostolos D Galatos, Irene Valasi, Elena Pappa, Anargyros T Karatrantos, Athanasios Giannoukas
Venous thrombosis has been widely studied in humans, but not in dogs. This study was designed to evaluate a venous thrombus in dogs, from creation to solution, by means of various ultrasonographic techniques. Nine healthy Beagle dogs were included in the study. The venous thrombus was formatted by puncturing the lumen of the external jugular veins and then, the veins were examined with B-mode, color Doppler, pulsed-wave Doppler, and contrast-enhanced ultrasound (CEUS) techniques, at regular intervals, within 210-270 min after venipuncture. Haemodynamic parameters were calculated at two different locations, before and after the site of the thrombus formation. The existence of a thrombus was confirmed by CEUS technique. Thrombus volume and echogenicity were evaluated. The results showed that the visualization of the venous thrombus by color Doppler modality was not feasible in some veins. The blood volume was the parameter that could more precisely indicate the presence or absence of a thrombus. In cases where thrombus volume was less than 0.001 cm3, it was impossible to detect its presence using haemodynamic parameters. The CEUS imaging depicted accurately the size and shape of an anechoic venous thrombus, even when its volume was 0.001cm3.
{"title":"Imaging of experimental venous thrombus by means of Doppler and CEUS techniques in dogs.","authors":"Mariana S Barbagianni, Stefanos G Georgiou, Pagona G Gouletsou, Apostolos D Galatos, Irene Valasi, Elena Pappa, Anargyros T Karatrantos, Athanasios Giannoukas","doi":"10.1007/s40477-024-00935-3","DOIUrl":"https://doi.org/10.1007/s40477-024-00935-3","url":null,"abstract":"<p><p>Venous thrombosis has been widely studied in humans, but not in dogs. This study was designed to evaluate a venous thrombus in dogs, from creation to solution, by means of various ultrasonographic techniques. Nine healthy Beagle dogs were included in the study. The venous thrombus was formatted by puncturing the lumen of the external jugular veins and then, the veins were examined with B-mode, color Doppler, pulsed-wave Doppler, and contrast-enhanced ultrasound (CEUS) techniques, at regular intervals, within 210-270 min after venipuncture. Haemodynamic parameters were calculated at two different locations, before and after the site of the thrombus formation. The existence of a thrombus was confirmed by CEUS technique. Thrombus volume and echogenicity were evaluated. The results showed that the visualization of the venous thrombus by color Doppler modality was not feasible in some veins. The blood volume was the parameter that could more precisely indicate the presence or absence of a thrombus. In cases where thrombus volume was less than 0.001 cm<sup>3</sup>, it was impossible to detect its presence using haemodynamic parameters. The CEUS imaging depicted accurately the size and shape of an anechoic venous thrombus, even when its volume was 0.001cm<sup>3</sup>.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}