Journal of Ultrasound最新文献

Purpose: To evaluate the role of multiparametric ultrasound (mpUS) in the characterization of focal breast lesions (FBLs).

Methods: This prospective study enrolled patients undergoing multiparametric breast ultrasound for FBLs. An experienced breast radiologist evaluated the following ultrasound features: US BI-RADS category, vascularization pattern (internal, vessels in rim and combined) and presence of penetrating vessels with each Doppler method (Color-Doppler, Power-Doppler, Microvascular imaging), strain ratio (SR) and Tsukuba score (TS) with Strain Elastography (SE), E_max, E_mean, E_min and E_ratio with 2D-shear wave elastography (2D-SWE). Core biopsy for all BI-RADS 4-5 FBLs and 24-month follow-up for all BI-RADS 2-3 FBLs were considered for standard of reference. The diagnostic performance was assessed with the area under curve (AUCs) and cut-off values were determined according to the Youden's index.

Results: A total of 139 FBLs were included with 75/139 (53.9%) benign and 64/139 (46.1%) malignant FBLs. Internal vascularization patterns (p < 0.001), penetrating vessels (p < 0.001), TS 4-5 (p < 0.001) and all 2D-SWE parameters (p < 0.001) were significantly different between benign and malignant FBLs. The BI-RADS score provided an AUC of 0.876 (95% CI 0.810-0.926) for the diagnosis of malignant FBLs. Among the 2D-SWE measurements, an excellent diagnostic performance was observed for E_max with an AUC of 0.915 (95% CI 0.856-0.956) and E_mean of 0.908 (95% CI 0.847-0.951). Optimal cutoff for the diagnosis of malignant FBLs were US BI-RADS > 3, Strain Ratio > 2.52, Tsukuba Score > 3, E_max > 82.6 kPa, E_mean > 66.0 kPa, E_min > 54.4 kPa and E_ratio > 330.8. Multiparametric ultrasound, particularly SWE, can improve specificity in the characterization of FBLs.

Melanoma is an extremely aggressive malignant neoplasm. Uveal melanoma is the most common primary intraocular malignancy in adults, representing 3-5% of all melanomas. Liver metastases can be clinically detected in 10-20% of patients with metastatic disease from cutaneous melanoma. However, while liver is typically not the first site of disease spread in cutaneous melanoma, ocular melanoma has been showed to primarily metastasize from the eye to the liver; indeed, liver metastases are detected in approximately 87% of patients with metastatic uveal melanoma. Therefore, liver metastasis can be challenging to identify in early stages, thus being essentially asymptomatic until the disease has advanced. Here we report the case of a patient who came to our ultrasound unit reporting a large liver mass. Both contrast-enhanced abdominal computed tomography and magnetic resonance imaging did not establish a definitive diagnosis. The final diagnosis was made only through an ultrasound-guided biopsy of the mass, thus revealing a uveal melanoma metastasis. This is followed by a review of the literature on imaging follow-up of patients with melanoma.

Purpose: Ultrasound is essential in the clinical practice of many medical specialties due to non-invasiveness, rapidity of examination, low costs and simplicity. Many specialized companies and universities pointed out its potential as a teaching tool for medical students. The aim of our study is to evaluate the impact of an ultrasound course on a sample of students attending the fourth, fifth and sixth year of the degree course in Medicine, highlighting changing in satisfaction and preparation. Another target is to verify the capability of a course on ultrasound to positively impact on participants knowledge and competences.

Methods: Students attending 6 training courses of Medicine held between 2017 and 2019 were recruited. Five trainings held during an Italian society of ultrasound in medicine and biology (SIUMB) congress, in a session dedicated to students, and one during an elective didactic activity (ADE) held in Chieti University. A questionnaire was given to the students before and after the course, in order to assess the impact of the course on the motivation and knowledge. Moreover, a test was also administered at the end of the theoretical part, with questions relating to the notions learned.

Results: There was an 81% of correct response to the learning questionnaire by calculating the mean of 5 SIUMB courses performed. The students are strongly motivated to continue learning ultrasound already from the beginning of the course, and this result remains unchanged in the questionnaire administered at the end. The interest of students towards this method is high, and they would ultrasound courses within the Medicine degree, even before participating in the training. It was evident how students positively assessed the course in relation to the acquisition of skills and knowledge, albeit with a tendency to acquire more knowledge rather than skills.

Conclusions: Our data support the usefulness of including ultrasound into the curriculum of medical students and on its use as a teaching tool. Students are highly motivated and perceive a significant improvement in both skills and knowledge following the proposed courses. Hands-on part is necessary in the training course on ultrasonography.

Deep inferior epigastric artery perforator (DIEP) flaps remain the gold standard of autologous breast reconstruction. However, the surgical technique entails a steeper learning curve and typically requires a higher mean surgical time, in part due to the time and effort involved in physical localization of appropriate perforators at the time of surgery. This is typically performed using Doppler ultrasound, and is a potentially challenging and time-consuming task in the hands of an untrained operator. In order to mitigate these challenges, ease time pressures, promote efficient utilization of our operating theatres and improve surgical outcomes, our institution routinely performs skin-marking in advance at the Breast Radiology department. In this article, we describe our technique and experience with the procedure.

Purpose: Management of cervical radicular pain is complex and may be resistant to conservative treatment. The primary aim of this study was to evaluate the efficacy of ultrasound-guided selective cervical nerve root pulsed radiofrequency (US-SCNR PRF) treatment in patients with radicular neck pain due to cervical disc herniation who did not respond to conservative treatment. The secondary aim was to determine the efficacy of the treatment in terms of functionality, neuropathic pain, and treatment-related adverse events.

Methods: This study included 62 patients with chronic cervical radicular pain who underwent US-SCNR PRF treatment. Pain intensity was assessed using the Numerical Rating Scale before treatment and at 1, 3, and 6 months after treatment. The Neck Disability Index and Douleur Neuropathique 4 Questions were used to assess functionality and neuropathic pain before and 6 months after treatment. Significant pain relief was defined as ≥ 50% reduction in the pain score compared with the pre-treatment score.

Results: Cervical radicular pain was significantly reduced at 1, 3, and 6 months after pulsed radiofrequency compared to pre-treatment (P < 0.001). Successful pain relief was achieved in 59.6% of the patients at 6 month. However, there was no significant difference between the mean pain scores in the 1st month, 3rd month and 6th month. In addition, the functionality and neuropathic pain scores were significantly reduced at 6 month.

Conclusions: These results suggest that US-SCNR PRF treatment is effective for cervical radicular pain, functionality, and neuropathic pain for at least six months in the majority of patients with refractory cervical radicular pain, and is considered a safer and preferable treatment modality due to real-time visualization of the cervical nerve roots and adjacent neurovascular structures and no radiation exposure.

Aims: Lung ultrasound (LUS) is increasingly used in Internal Medicine to complement medical examination, documenting pleural and lung conditions. This study aimed to compare the accuracy of handheld ultrasound device (HHUSD) with high-end ultrasound device (HEUSD) in patients with heart failure or pneumonia, also including the assessment of costs and time-savings.

Methods: In this observational study 72 patients (aged ≥ 18) admitted to Internal Medicine Unit for heart failure or pneumonia underwent LUS plus evaluation of inferior cava vein (ICV) when indicated, using both HHUSD and HEUSD. Each evaluation, independently performed by 2 different experienced operators, included B-lines number, pleural effusion, lung consolidations, ICV ectasia and its respiratory excursions.

Results: Concordance between HHUSD and HEUSD findings was 79.3% ± 17.7 (mean ± SD) for B-lines, 88.6% for pleural effusion, 82.3% for consolidations and 88.7% and 84.9% for ICV ectasia and its respiratory excursions respectively. BMI didn't significantly influence concordance between the two methods. Moreover, examination time (as mean ± SD) was shorter with HHUSD (8 ± 1.5 min) compared to HEUSD (10 ± 2.5 min).

Conclusions: HHUSD demonstrated high accuracy in detecting B-lines, pleural effusions, lung consolidations and ICV evaluation when compared to HEUSD. Thus, HHUSD, not only is characterized by accessibility, portability, and easy handling due to its small size, but it also offers advantages in terms of saving costs and time, ultimately contributing to faster patient assessment compared to HEUSD.

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.

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.

Gastro-intestinal ultrasound (GIUS) is a non-invasive and cost-effective tool, widely used as a first-line diagnostic method in patients presenting with abdominal complaints, especially in patients affected by inflammatory bowel disease (IBD), such as Crohn's disease and ulcerative colitis. In this setting, gastro-intestinal ultrasound has been especially used to evaluate the bowel wall features (thickening, stratification, vascularization) and complications related to IBD (fistulas, abscesses). Nevertheless, gastro-intestinal ultrasound can be also used to detect and evaluate the content of several segments of the gut. In fact, there is a growing interest in utilizing GIUS for suspected functional disorders, where assessing intestinal content may play a significant diagnostic role, as well as directing therapy. In our review, we provided a sonographic description of GIUS appearances of bowel content in various pathological and physiological conditions, offering potential applications in clinical practice and providing insights for further research.