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

Objective: To investigate the effect of vinpocetine on cerebral blood flow (CBF) in the compromised circulation of a stroke affected hemisphere using transcranial Doppler (TCD) and near infrared spectroscopy (NIRS) methods. Methods: 43 patients with ischemic stroke were randomized into vinpocetine (VP) and placebo group in a double blind, placebo-controlled study of the effect of a single-dose i.v. infusion of vinpocetine on cerebral blood perfusion and oxygenation. In the VP group 20 mg VP in 500 ml saline, in the placebo group 500 ml saline alone were administered. The concentrations of oxy-, reduced- and total hemoglobin were measured by NIRS frontolaterally on the side of lesion while the mean cerebral blood flow velocity (CBFV), the pulsatility index (PI) and Doppler spectral intensity (DSI) were monitored by TCD in the middle cerebral artery on the same side. Values were averaged for the first 5 min prior to the infusion and for the last 5 min of infusion and they were compared between groups. Results: The concentration of all three chromophores increased during infusion in the VP group (mean dHbT=1.03, CI₉₅=0.84, P=0.058; mean dHbO=0.92, CI₉₅=0.91, P=0.071; mean dHb=0.10, CI₉₅=0.21, P=0.297). The HbT and HbO showed a substantially smaller increase in the placebo group (mean dHbT=0.31, CI₉₅=0.74, P=0.22; mean dHbO=0.57, CI₉₅=0.80, P=0.094) while the Hb decreased (mean dHb=−0.26, CI₉₅=0.29, P=0.05). Comparing to the placebo group Hb increased significantly in the VP group (P=0.027) while the increase of HbO and HbT did not reach the level of significance (P=0.29 and 0.11). DSI showed a significantly larger increase in the VP than in placebo group (dDSI=25.8 CI₉₅=8.8 [VP]; dDSI=3.3, CI₉₅=3.7 [Placebo], P<0.005). The CBFV and PI did not differ significantly between groups. (dVm=5.0±2.98 cm/s [VP], dVm=4.1±2.57 cm/s [Placebo], P=0.28; dPI=0.08 [VP], dPI=0.09 [Placebo]; P=0.47). Conclusion: VP increases cerebral perfusion and parenchymal oxygen extraction as well. The increased perfusion was indicated by NIRS and by TCD measurement of DSI while conventional velocity and pulsatility measurements failed to detect theses effects. NIRS is a sensitive, feasible method of measuring changes in regional blood flow and tissue oxygenation in the superficial cortex.

Objective: To evaluate which velocity, or combination of velocities, from carotid Doppler ultrasonography (DU), achieved the closest agreement with an assessment of suitability for carotid endarterectomy from intra-arterial angiograms (IAA). Methods: We prospectively collected data from 148 consecutive patients (288 carotids), who had DU and IAA (blinded assessment) before possible carotid endarterectomy. We halved our data by randomly selecting the left or right carotid artery for each patient. We used one half to calibrate our DU results to IAA (to decide which velocity corresponded with what degree of angiographic stenosis). Using this analysis, each artery in the other half of the data was defined as suitable (80–99% stenosed) or unsuitable for carotid endarterectomy. We evaluated every individual, and combination of, velocities (strategies) to see which gave the closest agreement with IAA. Results: Of all 80 strategies, six resulted in better agreement than others of the same or lower complexity. Five of these strategies gave better agreement than the internal carotid artery peak systolic velocity (ICA PSV) (kappa 0.78), but the improvement was small. Conclusion: Using the ICA PSV alone is adequate for assessing carotid stenosis before endarterectomy using DU, as long as the machine is calibrated to IAA. However, the addition of the ratio of the ICA PSV to the common carotid artery PSV adds only one further measurement, slightly increases the agreement with IAA, and would be reasonable to use on a daily basis.

Objective: To investigate if US-visualisation of the needle tip echo during US-guided punctures could be improved by use of new technological applications. Method: an US-guided 18 G Trocar needle was inserted into targets of a puncture phantom. The punctures were performed in series of 10 using different settings of the US-scanner (GE Logic 700 Expert). At 7-cm of puncture depth the quality of the echo was tested using four different settings; normal (N), N+automatic tissue optimising (ATO), coded harmonic imaging (CHI), CHI+ATO and at 13-cm of puncture depths six different settings; N, N+ATO, coded excitation (CE), CE+ATO, CHI, CHI+ATO. In total 100 (40+60) images were randomly numbered and read independently by three radiologists with regard to scoring of the quality of the echoes from the needle tip, needle shaft and the target. Results: US visualisation of the needle tip was significantly (P<0.005) improved as compared to normal settings (N) when the settings of ATO and CE were used. CHI resulted in the lowest score. A high agreement between observers was registered. Similar results were registered with regard to scorings from the needle shaft and target. Conclusion: Not only changes of needle designs and puncture techniques can enhance echoes from the needle but also changes in the settings of the US-scanner with the use of new technological applications can improve visualisation of the needle echo.

Hepatic artery thrombosis after liver transplant is associated with biliary sepsis and irretrievable loss of the graft. Early identification of hepatic artery thrombosis, using a ‘high-specification’ ultrasound machine incorporating spectral Doppler, is crucial to patient management in the postoperative period with portable ultrasound as the first line of investigation for evaluation of the hepatic artery. We evaluated the efficacy of the SonoSite™ portable ultrasound machine, which uses power Doppler only, in the evaluation of the post transplant hepatic artery. An Acuson 128/XP10 ultrasound machine was used as the comparison ‘reference-standard’ with identification of the hepatic artery by both colour and spectral Doppler trace. The SonoSite™ accurately identified the hepatic artery in 88.4% of patients with power Doppler. The SonoSite™ was easier to transport and manage at the bedside leading to considerable time saving. In 11.6% of patients a repeat ultrasound using the ‘reference-standard’ machine would be necessary.

A case of subcutaneous neoplastic seeding after fine needle aspiration biopsy of a pancreatic liver metastasis is reported. Neoplastic seeding is a rare complication after fine needle biopsy (FNB). The seeding appeared 3 months after the biopsy with a subcutaneous hypoechoic nodule; diagnosis was confirmed by fine needle aspiration of the nodule. The neoplastic seeding did not change the outcome of the patient.

Objective: The early diagnosis of neonatal hip instability is well recognized in preventing possible late developmental dysplasia of the hip. The optimal scheme of its diagnosis is essential. The role of combined approach of clinical and ultrasonographic evaluation of hip instability in newborns is evaluated in the present study. Methods: Hips of 9030 consecutive neonates were examined independently by clinical and ultrasonographic means, separately by neonatologists and orthopedic surgeons, without initial sharing of information. When hip pathology was diagnosed by one of the modalities and missed by another, re-examination was performed. The rate of initially undiagnosed, clinically or ultrasonographically unstable hips and the 1-year follow up of the effected newborns were recorded. Results: Instability was diagnosed in 1.4% of all hips, but only 63% of unstable hips were diagnosed on the initial clinical examination. In the remainder, the clinical pathology was established on clinical re-examination after the sonographic abnormality was recognized. Similarly, but to a much lesser extent, sonographic pathology was detected only on the re-examination in 5% of the clinically unstable hips. Although the overall initial under-diagnosis rate of hip instability was 0.6% of all hips, the rate for treated hips was 0.1%. Conclusion: These data should be taken into consideration in planning an efficient DDH screening policy.

Objectives: To diagnose and characterize subepithelial lesions of the gastrointestinal (GI) tract using endoscopic ultrasonography (EUS) and search for markers of malignancy in stromal cell tumors. Methods: Fifty-four patients with suspected subepithelial lesions at endoscopy were examined using miniature ultrasound probes, integrated ultrasound endoscopes, or both. Surgical treatment was considered if a solid lesion had a maximum diameter of at least 3 cm, mixed echogenicity, or an ill-defined or irregular border. Results: EUS disclosed 37 solid lesions and ten fluid-filled structures. In seven patients, including two with protrusion from a normal spleen, no pathology could be demonstrated. Thirteen patients were operated and 41 were observed clinically with (n=9) or without EUS (n=32) for a median follow-up period of 36 months. Twenty-three patients had an intramural stromal cell tumor. None of these were malignant, but increased mitotic activity was found in two medium-sized resected tumors with mixed echogenicity and bleeding lesions of the endoluminal surface. Conclusion: EUS can detect and characterize subepithelial masses in the GI tract. Pathologic lesions of the overlying mucosa may indicate malignant development in stromal cell tumors, but valid markers of malignant potential are still lacking.