Medical ultrasonography最新文献

Aim: The utility of the venous excess ultrasound (VExUS) score in predicting mortality remains uncertain in acute kidney injury (AKI) patients.

Material and methods: This was a post-hoc study involving 246 AKI patients presenting to a tertiary care emergency department. Venous ultrasound assessments were conducted to determine the VExUS score. Cox regressionanalysis was used to identify predictors of 6-month mortality.

Results: The study found no significant association between the VExUS score and 6-month mortality in AKI patients in the regression analyses. However, in the subgroup analyses, VExUS grades 2-3 were associated with lower survival rates in the cardiorenal subgroup (HR: 3.98 [95% CI: 1.33-11.93]), and in AKI grade 1 (HR: 4.07 [95% CI: 1.74-9.49]). This association was not present in other AKI subgroups. The predictors of mortality included higher age (OR: 1.024; 95% CI 1.005-1.043), malignancy (OR: 2.186; 95% CI 1.408-3.392), lower systolic blood pressure (OR: 0.990; 95% CI 0.982-0.998), elevated pulse (OR: 1.013; 95% CI 1.005-1.022), and higher lactate levels (OR: 1.210; 95% CI 1.097-1.334).

Conclusion: The VExUS score did not predict 6-month mortality in the general cohort of AKI patients in the emergency department. However, VExUS grades 2-3 were associated with lower survival rates in the cardiorenal subgroup and patients with AKI grade 1.

Aims: Peripheral artery disease (PAD) represents a high burden on the healthcare and social assistance systems. Revascularization reduces symptoms, amputation rate and increases the chances of social reintegration. Our aim was to evaluate the benefits of vascular duplex ultrasonography (DUS) for identifying patients suitable for direct percutaneous transluminal angioplasty (PTA) without the need for a prior angiography.Material and methodsː We included in the study 251 patients with PAD evaluated by DUS. Depending on the DUS findings the patients were split in two groups: group I, 143 patients (57%), in which selective angiography and direct PTA was performed and group 2, 108 patients (43%), in which invasive arteriography was considered necessary prior to a decision for revascularization. Resultsː The first group had a similar success rate (92.3% vs. 86.1%; p=0.111), but with a reduction in radioscopy time (minutes) (17.2 vs. 20.8; p=0.013), iodine contrast volume (ml) (190 vs. 227.5; p<0.001), days of hospitalization (4 vs. 7; p<0.001) and by 44.75% (p<0.001) of hospitalization costs when compared to the second group.Conclusionsː DUS allows the optimal selection of patients who can benefit from direct PTA. This strategy has a high success rate, with a significant decrease in radioscopy exposure time, volume of iodine contrast needed, duration and hospitalization costs, when compared to arteriography and PTA in two different sessions.

Aim: Diaphragm dysfunction (DD) is a keystone factor in difficult weaning from invasive mechanical ventilation (IMV). Diaphragm ultrasound (DUS) is the preferred method for the evaluation of diaphragm function in the Intensive Care Unit (ICU) setting, namely through the diaphragm thickening fraction (DTF). However, its potential role in the decision-making process of mechanical ventilation weaning is yet to be established. We aimed to assess the incidence of early DD and its role as a predictor of prolonged IMV.

Material and methods: We conducted a prospective, non-interventional study in a university hospital ICU. Non-consecutive adult patients subject to at least 48h of IMV were enrolled. Exclusion criteria was a prior period of IMV in the past three months. DUS was performed at 48h of IMV. End-inspiratory and end-expiratory diaphragm thickness were measured using M-mode, with a high-frequency linear probe placed at the zone of apposition of the diaphragm. The mean values of three measurements were used to calculate DTF. Interobserver measurement variability was not evaluated.

Results: Forty-five patients were included. Thirty-eight percent were female, average age was 62.3 years. Mean Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) at admission were 50.9 and 9.02, respectively. Mean DTF was 23.46%±17.15. Average IMV duration was 9.36±7.66 days. Half of patients had DD at 48h of IMV. A weak negative correlation was observed between DTF, days of endotracheal intubation (Sp -0.27; p=0.07) and days of IMV (Sp -0.25; p=0.09). Using DTF cut-off values of 20% and 30%, DTF at 48h of IMV was not associated with prolonged IMV (p-values 0.17 and 0.58, respectively).

Conclusion: In our study, there was a high prevalence of DD at 48h of IMV, as suggested in previous literature. Diaphragm dysfunction at 48h when measured through DTF did not seem to predict prolonged IMV. Late VAP incidence was associated with DD. Diaphragm ultrasound is well-established for diaphragm functional assessment, but further research regarding its trajectory during critical illness is needed to clarify its application in clinical practice.

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The present work describes the process of the sonographic examination, normal findings and measurements in the B-mode ultrasound evaluation. Reference is made to anatomical variants in shape, the pyramidal lobe, tubercle of Zuckerkandl, ectopic thyroid tissue, and their significance. Particular attention is paid to the reference values, the very miscellaneous reference values in different geographic regions of the world and influencing factors.

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has been publishing guidelines, position papers and also technical reviews. In addition, comments have been published for illustration of such papers including the hepatobiliary system, pancreas, lung and other organs. In the current paper, we aim to summarize the typical sonographic findings of the most commonly seen cutaneous neoplasms.

Aim: Accurate prediction of preoperative molecular subtypes of breast cancer is crucial for treatment planning and prognosis evaluation of patients. This systematic review aims to investigate the capacity of ultrasound radiomics in accurately identifying the molecular subtypes of breast cancer.

Material and methods: We conducted a thorough search of  PubMed, Embase, and Cochrane databases to identify relevant research up until May 2024. We pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under the curve (AUC) to summarize the ability of ultrasound radiomics to predict Luminal type and triple negative breast cancer (TNBC) type in patient with breast cancer. Results: Our meta-analysis found that nine studies provided ultrasound radiomics predictions for TNBC. Pooled sensitivity, specificity, and AUC were 0.64, 0.89, and 0.86, respectively. Four studies have provided the ultrasound radiomics prediction of Luminal molecular subtype breast cancer. Pooled sensitivity, specificity, and AUC were 0.89, 0.79, and 0.90, respectively. There are two studies that predict Luminal A, Luminal B and Her 2+molecular subtype by ultrasound radiology, but they cannot be synthesized quantitatively because of the small number of studies.

Conclusion: Ultrasound radiomics has a good diagnostic performance in predicting molecular subtypes in breast cancer.

Aim: To evaluate the efficacy of ultrasound-guided ilioinguinal and iliohypogastric nerve block (IIHB) in children undergoing surgery for inguinal hernias.

Material and methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched to January 4, 2024. For continuous data, the effect sizes were presented as weighted mean differences (WMDs), and for categorical data, they were reported as relative ratios (RR), each accompanied by 95% confidence intervals (CIs).

Results: IIHB demonstrated a longer duration before the need for the first analgesic compared to transverse abdominis plane (TAP), caudal epidural block (CEB), and pre-incisional wound infiltration (PWI), but a shorter duration than quadratus lumborum block (QLB). The IIHB group had a higher probability of requiring rescue analgesics compared to other blocks or PWI (RR: 1.69, 95% CI: 1.25 to 2.28, p=0.001). Higher FLACC scores were noted at 12 hours for the IIHB group (WMD:0.50, 95% CI: 0.13 to 0.86, p=0.008). IIHB required more intraoperative fentanyl compared to controls (RR: 2.14, 95% CI:1.17 to 3.92, p=0.014).

Conclusion: While IIHB may have some benefits, it does not appear to be more effective overall in managing postoperative pain in pediatric inguinal hernia surgery patients compared to other blocks or PWI.

Aims: To evaluate important imaging findings and prognostic factors of incidentally detected gallbladder cancer (IDGC). Materials and methods: Patients with surgically proven IDGC (n=85) and benign GB diseases (n=100) were retrospectively enrolled. All patients had preoperative CT and eighty-two patients had US images. Two radiologists independently assessed image findings and analyzed findings suggestive of IDGC and recurrence after surgery. Univariate and multivariate analyses were performed to identify significant predictors for IDGC and recurrence.

Results: 87% (74/85) of IDGC belonged to early cancer. On US, mucosal irregularity (odds ratio (OR), 26.29; 95% confidence interval (CI), 2.66-259.42; p=0.005) was a significant predictor of IDGC. Enhancement pattern of wall (OR, 7.78; 95% CI, 2.84-21.39; p<0.001), and maximum wall thickness (OR, 1.31; 95% CI, 1.11-1.55; p=0.002) were significant predictors of IDGC on CT. Twenty-two patients showed recurrence. For clinical factors, T-, N-stage were associated with recurrence (p<0.001). For imaging, focal wall thickening (OR, 8.74; 95% CI, 1.13-67.49, p=0.038) on US and lymph node enlargement (LNE) (OR, 8.93; 95% CI, 1.44-55.19, p=0.018) on CT were significant predictors of recurrence.

Conclusion: Image findings are useful to predict IDGC using mucosal disruption, maximum wall thickness, enhancement pattern of wall. In addition, focal wall thickening and LNE were useful for predicting recurrence.

Aim: We aimed (1) to determine optimal PET-CT SUV and ultrasound (US) features associated for malignant smallintermediate size supraclavicular lymph nodes (SCN) and (2) to evaluate technical efficacy of core needle biopsy (CNB). Materials and methods: Between 2020 and 2023, CNB of SCN with short-axis less than 15 mm were included. PET-CT was evaluated for optimal SUV cut-off value. Multivariate logistic regression was performed for US features. Technical efficacy of CNB (success rate) was calculated, and US features were compared between satisfactory CNB specimen and unsatisfactory CNB specimen.

Results: Eighty-four SCN per 80 patients (age 64.0±17.2 years, 45.2% female) were included. The optimal SUV cut-off value was 1.1 with diagnostic accuracy of 89.8%. US features associated with malignancy were anteroposterior dimension ≥9 mm and absence of hilum. The overall CNB success rate was 94%, and unsatisfactory specimen demonstrated shorter transverse diameter (12 mm vs 5 mm, p<0.001), and non-parallel orientation (20.3% vs. 100%, p<0.001).

Conclusion:  CNB should be considered for small-intermediate size SCN with SUV exceeding 1.1, anteroposterior dimension ≥9 mm, and absence of hilum. SCN with shorter transverse diameter and non-parallel orientation may result in unsatisfactory CNB specimen.