This book is a comprehensive reference and practical guide on the technology and application of ultrasound to the musculoskeletal system. It is organized into two main sections. The first is devoted ...to general aspects, while the second provides a systematic overview of the applications of musculoskeletal ultrasound in different areas of the body. Each chapter of the second section provides an introduction on clinical anatomy and the essentials of clinical history and physical examination. Thereafter, performance of the ultrasound study is explained and the normal and pathological anatomy is reviewed. To assist in understanding, the ultrasound scans are correlated with drawings, photographs, images obtained using other modalities, and anatomic specimens. There is a generous complement of high-quality illustrations based on high-end equipment. This book contains a wealth of invaluable information.
Objectives
In sonographic evaluations of peripheral nerves, the healthy, contralateral side may be used as an internal control for the pathologic one. Therefore, the inherent side‐to‐side differences ...must be minimal. The goal of this study was to determine the reliability of side‐to‐side measurements of upper extremity nerves in healthy volunteers.
Methods
Forty participants with no upper extremity abnormalities were included. Upper limb nerves were evaluated bilaterally at the usual pathologic sites by 3 musculo‐skeletal radiologists in separate sessions. To assess intraobserver and interobserver agreement, sonographic examinations were repeated 2 months after the first evaluations. The median nerve, ulnar nerve, musculocutaneous nerve, and radial nerve were considered. Nonparametric tests were used for statistical analysis.
Results
Minimum detectable differences with relative 95% confidence intervals were reported. Intraobserver and interobserver agreements were good (0.73 < κ < 0.85). When the combined influence of the observer and the repeated measurement was evaluated, the reliability was 80% to 87%.
Conclusions
In general, the healthy contralateral side can be used as an internal control considering that changes in minimum detectable differences are related to the anatomic site considered.
Objectives
To update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe.
Methods
Twenty-one musculoskeletal ...imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%.
Results
A total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication.
Conclusions
Four new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate.
Key Points
• Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications.
• Four new A evidence levels were found for the hip, knee, ankle, and foot.
• There was no level A evidence for elastography.
Introduction: Nerve involvement in immune‐related neuropathies is non‐homogeneous, and therefore characterization of ultrasound (US) abnormalities is difficult. We developed two measures to quantify ...US abnormalities in immune‐related neuropathies. Methods: Intranerve cross‐sectional area (CSA) variability for each nerve was calculated as: maximal CSA/minimal CSA. Internerve CSA variability for each patient was calculated as: maximal intranerve CSA variability/minimal intranerve CSA variability. Six patients underwent US evaluation of the median, ulnar, and fibular nerves, and the abnormalities were scored with our newly developed measures. Results: The new measures were applicable to all nerves and patients. The highest degree of intra‐ and internerve CSA variability was observed in multifocal motor neuropathy, consistent with the asymmetric characteristics of this neuropathy. Conclusions: The application of intra‐ and internerve CSA variability measures allows us to quantify the heterogeneity of nerves and nerve segments and identify different US patterns in diverse immune‐related neuropathies. Muscle Nerve, 2012
ABSTRACT
Introduction
We prospectively compared ultrasound (US) and MRI in patients with common fibular neuropathy.
Methods
Forty adult patients with clinical suspicion of common fibular neuropathy ...and 40 healthy controls underwent both US and MRI. US and MRI datasets were randomized for prospective reading.
Results
The overall sensitivity of US and MRI for diagnosing fibular neuropathy was 90% (95% confidence interval CI, 79.7%‐97.3%) and 87.5% (95% CI, 71.55%‐93.1%), respectively. The overall specificity of US and MRI was 92% (95% CI, 77.45%‐96.1%) and 85% (95% CI, 73.3%‐94.4%), respectively. The overall sensitivity and specificity of US combined with MRI were 94% (95% CI, 0.80%‐0.99%) and 84% (95% CI, 0.70%‐0.91%), respectively. Overall intra‐ and inter‐observer agreements among 3 readers were 0.76% (95% CI, 0.62%‐0.85%) and 0.74% (95% CI, 0.65%‐0.81%).
Conclusions
US diagnostic accuracy for common fibular neuropathy was slightly higher than that of MRI. Muscle Nerve 55: 849–857, 2017
The possibility to realize a quantitative evaluation of nerve density on ultrasound is clinically important to enhance the evaluation of peripheral nerve disorders. We developed software that ...quantifies the ratio between the hypoechoic and hyperechoic areas of peripheral nerves on ultrasound. Nerve density was defined as (hypoechoic pixels)/(total pixels) and the purpose of our study was to asses if nerve density can be used to differentiate pathologic conditions affecting peripheral nerves. Ultrasound images of peripheral nerves were obtained with a high-frequency probe (17-5 MHz, 288 elements). Sixty-five different patients and (n = 65) controls (age range, 35-81 years; mean 55 years) were prospectively evaluated. Thirty-five patients had carpal tunnel syndrome and 30 patients had neurofibromas. Three radiologists performed a semiautomated evaluation with intra and interobserver agreement. A complete automatic evaluation was performed with no need of intra and interobserver evaluation. With the semiautomated evaluation, mean intraobserver agreement was good (K = 0.85). Interobserver agreements was good as well (reader 1 vs reader 2: k = 0.72; reader 2 vs reader 3: k = 0.80; reader 3 vs reader 1: k = 0.72). Differences among value of nerve density in normal nerves, CTS and neurofibromas were statistically significant (p < 0.0001). There were no statistically significant differences between the results obtained using the automatic or the semiautomatic method. Nerve density is capable of discriminating between normal and pathologic nerves of patients affected by carpal tunnel syndrome or neurofibromas. Moreover, nerve density measure is useful to discriminate between patients with mild and severe CTS.
Ultrasound (US) is a fundamental diagnostic tool in breast imaging. However, US remains an operator-dependent examination. Research into and the application of artificial intelligence (AI) in breast ...US are increasing. The aim of this rapid review was to assess the current development of US-based artificial intelligence in the field of breast cancer.
Two investigators with experience in medical research performed literature searching and data extraction on PubMed. The studies included in this rapid review evaluated the role of artificial intelligence concerning BC diagnosis, prognosis, molecular subtypes of breast cancer, axillary lymph node status, and the response to neoadjuvant chemotherapy. The mean values of sensitivity, specificity, and AUC were calculated for the main study categories with a meta-analytical approach.
A total of 58 main studies, all published after 2017, were included. Only 9/58 studies were prospective (15.5%); 13/58 studies (22.4%) used an ML approach. The vast majority (77.6%) used DL systems. Most studies were conducted for the diagnosis or classification of BC (55.1%). At present, all the included studies showed that AI has excellent performance in breast cancer diagnosis, prognosis, and treatment strategy.
US-based AI has great potential and research value in the field of breast cancer diagnosis, treatment, and prognosis. More prospective and multicenter studies are needed to assess the potential impact of AI in breast ultrasound.
Introduction: In peripheral nerve ultrasound, the healthy contralateral side may be used as internal control. Therefore, inherent side‐to‐side differences must be minimal. The goal of this study was ...to assess intrastudy, intraobserver, and interobserver reproducibility of ultrasound in comparative side‐to‐side evaluation of lower limb nerves. Methods: Lower limb nerves of 60 normal subjects were evaluated by 3 radiologists. Bilateral sciatic, tibial, common fibular, sural, lateral femoral cutaneous, femoral, obturator, and saphenous nerves were evaluated. Results: Overall, side‐to‐side differences were not statistically significant at any level. In the lower limb nerves, in a between‐limb comparison, the minimum detectable difference of cross‐sectional area ranged from 16.4 mm2 (sciatic nerve at the level of piriformis muscle) to 0.4 mm2 (saphenous nerve). Conclusion: In general, the healthy contralateral side can be used as an internal control. Muscle Nerve 46: 717–722, 2012
Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. ...As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or collateral damage in traumatic insults. Scanning of the cutaneous nerves is challenging due to fewer anatomic landmarks for referencing. Therefore, the aim of the present article is to summarize the anatomy of the limb cutaneous nerves, to elaborate the scanning techniques, and also to discuss the clinical implications of pertinent entrapment syndromes of the medial brachial cutaneous nerve, intercostobrachial cutaneous nerve, medial antebrachial cutaneous nerve, lateral antebrachial cutaneous nerve, posterior antebrachial cutaneous nerve, superficial branch of the radial nerve, dorsal cutaneous branch of the ulnar nerve, palmar cutaneous branch of the median nerve, anterior femoral cutaneous nerve, posterior femoral cutaneous nerve, lateral femoral cutaneous nerve, sural nerve, and saphenous nerve.
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