European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology最新文献

Objective: To evaluate the safety and compliance of outpatient echo-guided liver biopsy (ELB) when compared to those performed on inpatients (IP). Methods: From June 1996 to November 2000, we carried out 418 ELB on patients with diffuse liver disease: 246 inpatients (IP ELB) and 172 in a Day Hospital setting (DH ELB). The same inclusion and exclusion criteria were followed for both groups of patients, performing the same echo-guided intercostal liver biopsy with free-hand technique and post biopsy assessment with colordoppler examination; post biopsy follow-up consisted of 6-h bed rest and blood pressure and heart rate monitoring up to discharge. DH patients were discharged 8 h after biopsy, if they did not live further than a 30-min trip from the hospital. In both groups, the following data was evaluated: death rate, sample adequacy, number of passages, major and minor complications, pain score. Results: The data analysed in our series show that ELB DH presents no fundamental differences in morbidity and mortality when compared to ELB IP.

Aim: To quantify the observer variation in the sonographic measurement of optic nerve sheath diameter (ONSD) in normal adults. Materials and methods: Sixty-seven normal adult volunteers underwent ultrasound examination of each eye by three independent observers using a 7 MHz sector probe. Three measurements were made of each eye by each observer and a mean value calculated for each eye. Median and 5th–95th centile values for both intra- and inter-observer variation were calculated for the three observers. Results: The median intra-observer variation was ±0.1 mm, with 5th–95th centile values of ±0–0.4 mm. The median inter-observer variation was ±0.2–0.3 mm, with 5th–95th centile values of ±0–0.7 mm. Careful review of examination technique by the three observers after the first 17 examinations was shown to reduce both intra- and inter-observer variation. Conclusion: The sonographic measurement of ONSD is a readily learned, reproducible technique with low intra- and inter-observer variation. The average inter-observer variation (±0.2 mm) is comparable to the inherent variability of the ultrasound machine. The importance of standardisation of examination technique is stressed.

The objective of this study is to clarify whether the combination of carotid duplex sonography (CD) and transcranial color-coded sonography (TCCS) can accurately detect occlusive lesions in extra and intracranial brain arteries in acute stroke patients, using angiography as the standard. Just before angiography, we performed CD and TCCS in 40 consecutive patients within 24 h after stroke onset. We assessed 320 vessels in total, bilateral internal carotid arteries, vertebral arteries, M1 segments of middle cerebral arteries (MCAs), and P2 segments of posterior cerebral arteries (PCAs). Out of all vessels, 250 (78.1%) could be evaluated by neurosonography because 32 MCAs and 38 PCAs were excluded due to inadequate acoustic windows for TCCS. Significant occlusive lesions (>50%) were observed in 21 out of 250 vessels by neurosonography. Angiography confirmed 20 occlusive lesions as revealed by neurosonography. In the remaining 229 neurosonographically normal vessels, angiography showed no significant lesions except M2 occlusions. The accuracy, sensitivity, and specificity of neurosonography for the detection of occlusive vessels were 99.6, 100 and 99.6%, respectively. Occlusive lesions were observed in 20 of all patients by neurosonography. Nineteen of them were confirmed by angiography. The combination of CD and TCCS can make an accurate diagnosis for significant occlusive lesions in brain arteries in acute stroke patients.

Objective: To determine the value of high frequency ultrasound biomicroscopy (UBM) in the assessment of pars planitis, and in particular to correlate UBM findings and ophthalmoscopy findings. Methods: All patients with pars planitis were identified from the uveitis database of the Department of Ophthalmology, University of Aberdeen. Fifteen consecutive patients (age 14–52 years) underwent complete ophthalmological examination. UBM was performed at a sound frequency of 50 MHz on 17 eyes of 10 patients to determine the extent of disease. UBM findings were evaluated by two investigators in a blinded fashion and graded from 0 to 3 according to the following grading criteria: 0=no cells, 1=mild cells, 2=marked cells, 3=organization of cells. Opthalmoscopy findings were also graded using the same criteria. UBM and ophthalmoscopy findings were independently graded and compared. Results: We found a good inter-observer correlation for the UBM grading of pars planitis (ρ=0.86). There was no significant difference in the grading of pars planitis by indirect ophthalmoscopy as compared to grading by UBM (P>0.05). Conclusion: UBM appears to be a valuable and reliable diagnostic technique for the evaluation of patients with pars planitis and may be useful especially in patients with media opacities to diagnose and/or monitor efficacy of treatment.

Objective: To evaluate the capability of contrast-enhanced wideband harmonic imaging (WHI) to detect liver metastases in comparison with fundamental B-mode US and postcontrast CT. Methods: We studied 27 patients with hepatic metastases from different malignancies with conventional B-mode sonography, WHI 3 min after injection of contrast agent (Levovist® 2.5 g, 300 mg/ml) and postcontrast helical CT (HCT). The number and location of the lesions and the smallest lesion for each patient were noted by two different observers and compared. Results: Both readers recorded an increase in the number of lesions in harmonic mode compared with conventional B-mode in all 27 patients with hepatic metastases with a mean increase in both observers from 9.3 lesions with B-mode to 18.8 lesions with WHI. The smallest lesions were detected with WHI when compared with conventional US and HCT (2 mm with WHI, 5 mm with B-mode and 5 mm with CT). WHI detected more lesions than conventional US or HCT. Conclusions: Contrast-enhanced WHI seems superior to conventional US and HCT for the detection of hepatic metastases, specially for those nodules under 1 cm of diameter.

The present paper summarizes some of the epidemiological studies of in utero ultrasound exposure and subsequent childhood development. Emphasis is placed on birth weight, childhood malignancies, neurological development, handedness and speech development. The epidemiological evidence does not indicate any association between diagnostic ultrasound exposure during pregnancy and reduced birth weight, childhood malignancies or neurological development. However, a statistically significant association between ultrasound and left-handedness among males has been found in three studies. Thus, there is still need for more research.

This paper describes the methods applied in a software package developed by the authors for use in a performance testing protocol for medical ultrasound equipment. The history of performance testing of medical ultrasound equipment is briefly reviewed. This paper is confined to the testing of performance of usage aspects, i.e. imaging performance and Doppler velocity estimation performance. Simple test objects are used which have a long life expectancy. The tests performed both in fundamental and in (tissue) harmonic modes when applicable are spatial resolution, contrast sensitivity, and clutter. The concept of a computational observer is used to define the lesion signal-to-noise ratio and the tissue-to-clutter ratio. Further imaging performance features are penetration depth, slice thickness and geometric conformity of display. Pulsed Doppler velocity measurement features tested are: sensitivity, depth and 3D size of the sample volume, velocity measurement, channel separation. The whole performance measurement protocol as well as the quantitative measurements in the digitized images are implemented in software, together with the graphs and data obtained from the measurements.

Background: the sonographic pattern of bacterial pneumonia is predominantly well known and characterized by an air bronchogram, a marked vascularity on color Doppler sonography, and a high-impedance arterial flow pattern on Doppler spectral analysis. Methods: in a retrospective study the sonographic findings in seven patients with peripheral BAC on X-ray examination were evaluated in relation to number, size, margins, echomorphology and sonographic arterial flow patterns of the lesions. Results: the following sonomorphologic characteristics were found: multiple foci (n=4), single foci (n=3), smooth margins (n=5), irregular margins (n=2) and maximal diameter of size (range 5–15 cm). The echomorphology of the lesions was homogenously hypoechoic (n=1) or showed airbronchograms (n=6). Color Doppler sonography revealed a vascular tree pattern (n=5) or a marked presence of blood vessels (n=2). Doppler flow spectral analysis of arteries in investigated patients (n=5) demonstrates a high impedance (triphasic) flow pattern in four patients and a low impedance (monophasic) flow pattern in one patient. Conclusions: these findings indicate that BAC frequently shows a sonographic pattern of ‘pneumonia’.

A training program of “limited goal-oriented abdominal sonography” for general practitioners (GPs) was planned, set up and tested. After 1 month of intensive training (about 100 examinations), four test subjects succeeded in technically performing examinations in four patients out of five patients, and were able to rule out or exclude fluid collections, aortic aneurysms and common gallbladder disease.