Endoscopic ultrasound/ultrasonography‐guided biliary drainage (EUS‐BD) is a relatively new modality for biliary drainage after failed or difficult transpapillary biliary cannulation. Despite its ...clinical utility, EUS‐BD can be complicated by severe adverse events such as bleeding, perforation, and peritonitis. The aim of this paper is to provide practice guidelines for safe performance of EUS‐BD as well as safe introduction of the procedure to non‐expert centers. The guidelines comprised patient–intervention–comparison–outcome‐formatted clinical questions (CQs) and questions (Qs), which are background statements to facilitate understanding of the CQs. A literature search was performed using the PubMed and Cochrane Library databases. Statement, evidence level, and strength of recommendation were created according to the GRADE system. Four committees were organized: guideline creation, expert panelist, evaluation, and external evaluation committees. We developed 13 CQs (methods, device selection, supportive treatment, management of adverse events, education and ethics) and six Qs (definition, indication, outcomes and adverse events) with statements, evidence levels, and strengths of recommendation. The guidelines explain the technical aspects, management of adverse events, and ethics of EUS‐BD and its introduction to non‐expert institutions.
Highlight
Isayama and colleagues present the first clinical practice guidelines for endoscopic ultrasound‐guided biliary drainage (EUS‐BD), including indications, clinical results, procedures, devices and education. Their primary purpose is to improve the outcomes of EUS‐BD for biliary tract diseases by facilitating the safe introduction and performance of the procedure at non‐expert centers.
Objectives
To compare health‐economic aspects of multiple imaging modalities used to monitor renal cysts, the present study evaluates costs and outcomes of patients with Bosniak IIF and III renal ...cysts detected and followed‐up by either contrast‐enhanced computed tomography (ceCT), contrast‐enhanced magnetic resonance imaging (ceMRI), or contrast‐enhanced ultrasonography (CEUS).
Patients and Methods
A simulation using Markov models was implemented and performed with 10 cycles of 1 year each. Proportionate cohorts were allocated to Markov models by a decision tree processing specific incidences of malignancy and levels of diagnostic performance. Costs of imaging and surgical treatment were investigated using internal data of a European university hospital. Multivariate probabilistic sensitivity analysis was performed to confirm results considering input value uncertainties. Patient outcomes were measured in quality‐adjusted life years (QALY), and costs as averages per patient including costs of imaging and surgical treatment.
Results
Compared to the ‘gold standard’ of ceCT, ceMRI was more effective but also more expensive, with a resulting incremental cost‐effectiveness ratio (ICER) >€70 000 (Euro) per QALY gained. CEUS was dominant compared to ceCT in both Bosniak IIF and III renal cysts in terms of QALYs and costs. Probabilistic sensitivity analysis confirmed these results in the majority of iterations.
Conclusion
Both ceMRI and CEUS can be used as alternatives to ceCT in the diagnosis and follow‐up of intermediately complex cystic renal lesions without compromising effectiveness, while CEUS is clearly cost‐effective. The economic results apply to a large university hospital and must be adapted for smaller hospitals.
Ultrasonographic Applications in the Thorax Gunluoglu, Mehmet Zeki; Ormeci, Tugrul; Sen, Selva
Current medical imaging reviews,
01/2023, Letnik:
19, Številka:
2
Journal Article
Recenzirano
Rapid developments and increasing technological knowledge have changed perspectives on ultrasonography. Previously, ultrasonography was used to evaluate chest wall pathologies, to distinguish between ...pleural effusion and consolidation, to evacuate pleural effusion, or to evaluate diaphragm movement. Today, it is also used in a wide range of pleural and parenchymal diseases. Ultrasonography is not just used in the emergency department and the intensive care units, it is also utilized in many clinical branches dealing with the respiratory system-due to its ease of use, fast access, price advantage, non-radiation exposure, higher diagnostic sensitivity, and specificity in many clinical situations-and has become a part of the examination. In this review, we have assessed not just transthoracic ultrasonography but also more focal and targeted sonographic applications, such as the endobronchial ultrasound and esophageal ultrasound.
Introduction: Acute appendicitis poses a diagnostic challenge in a low-resource setting like ours. Without timely and appropriate management, acute appendicitis can lead to prolonged morbidity and ...mortality. We describe the clinical profile of acute appendicitis at the national referral hospital in Bhutan.
Method: This was a cross-sectional descriptive study of all cases of acute appendicitis managed at the National Referral Hospital, Bhutan from 1st January-31st December 2016. Data related to patients’ symptoms, clinical examination and ultrasonographic findings, treatment details, length of hospital stay, and histopathology report were analyzed.
Results: Of the 3291 surgical admissions, there were 173 patients with acute appendicitis contributing to 5.3% of the total surgical burden. The median age was 27 years (IQR 20, 39), 60.1% were males. 96.5% and 91.9% of the patients presented with right iliac fossa pain and tenderness respectively. While 74.6%(n=129) had primary surgery, 18.9%(n=32) were managed conservatively. Of the 32 patients, 37.5%(n=12) had surgery after failed conservative management. Seventy-five percent presented with intraoperative features of complicated appendicitis. The negative appendectomy rate was 2.2%. The median length of hospital stay was three days (range 3–60). Ultrasonographic diagnosis compared to histopathological confirmation had a sensitivity of 87.8%, kappa agreement of 87.3%, and specificity of 66.7%.
Conclusion: Acute appendicitis is a common surgical emergency. Ultrasonography in the diagnosis of acute appendicitis was useful in a low-resource setting. A high proportion of complicated acute appendicitis in our setting needs effective interventional strategies.
Objectives
To investigate the brain tissue elasticity in normal term and premature neonates using compression elastography and shear wave elastography.
Methods
This prospective observational study ...enrolled term and premature neonates admitted to the Third Affiliated Hospital of Guangzhou Medical University between July 2019 and December 2020.
Results
A total of 106 neonates, including 65 premature neonates and 41 term neonates, were enrolled. The elastic modulus of the frontal white matter in males was significantly lower than in females (11.67 ± 0.98 versus 12.25 ± 1.31, P = .030), but the shear wave velocity of the thalamus in males was significantly lower than in females (1.18 ± 0.13 versus 1.82 ± 0.10, P < .001). There was no significant correlation between real‐time body weight and brain tissue elasticity including elastic modulus and shear wave velocity. But, the shear wave velocity of parietal white matter (r = 0.319, P = .014) and thalamus (r = −0.268, P = .040) and the elastic modulus of parietal white matter (r = 0.356, P = .006) were correlated with corrected gestational age.
Conclusions
Clinicians may consider using elastography to determine brain tissue elasticity in term and preterm neonates.
Purpose A novel platform was developed that fuses pre-biopsy magnetic resonance imaging with real-time transrectal ultrasound imaging to identify and biopsy lesions suspicious for prostate cancer. ...The cancer detection rates for the first 101 patients are reported. Materials and Methods This prospective, single institution study was approved by the institutional review board. Patients underwent 3.0 T multiparametric magnetic resonance imaging with endorectal coil, which included T2-weighted, spectroscopic, dynamic contrast enhanced and diffusion weighted magnetic resonance imaging sequences. Lesions suspicious for cancer were graded according to the number of sequences suspicious for cancer as low (2 or less), moderate (3) and high (4) suspicion. Patients underwent standard 12-core transrectal ultrasound biopsy and magnetic resonance imaging/ultrasound fusion guided biopsy with electromagnetic tracking of magnetic resonance imaging lesions. Chi-square and within cluster resampling analyses were used to correlate suspicion on magnetic resonance imaging and the incidence of cancer detected on biopsy. Results Mean patient age was 63 years old. Median prostate specific antigen at biopsy was 5.8 ng/ml and 90.1% of patients had a negative digital rectal examination. Of patients with low, moderate and high suspicion on magnetic resonance imaging 27.9%, 66.7% and 89.5% were diagnosed with cancer, respectively (p <0.0001). Magnetic resonance imaging/ultrasound fusion guided biopsy detected more cancer per core than standard 12-core transrectal ultrasound biopsy for all levels of suspicion on magnetic resonance imaging. Conclusions Prostate cancer localized on magnetic resonance imaging may be targeted using this novel magnetic resonance imaging/ultrasound fusion guided biopsy platform. Further research is needed to determine the role of this platform in cancer detection, active surveillance and focal therapy, and to determine which patients may benefit.
This is the first part of the Guidelines on Interventional Ultrasound of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and covers all general aspects of ...ultrasound-guided procedures (long version).
To achieve efficient ultrasonography-guided photodynamic therapy (PDT), two major obstacles need to be overcome. On the one hand, O2-dependent PDT produces limited effects on hypoxic solid tumors. On ...the other hand, small particles facilitate tumor accumulation whereas large ones strengthen ultrasound (US) imaging, which makes the development of an ultrasonographic probe showing effective tumor accumulation and high US sensitivity an intractable challenge. Therefore, an intelligent perfluorohexane (PFH)-based nanodroplet, PFH@Ce6@O2, was fabricated in order to simultaneously solve the above problems. The nanoscale PFH@Ce6@O2 particles were firstly delivered to elevate the local O2 level of tumors, which is critical for achieving excellent PDT effect under laser irradiation. Then, a spontaneous “small-to-large” growth of droplet at tumor acidic microenvironment resulted in an echo-contrast enhancement for high-performance US imaging of tumor. The in vitro and in vivo results manifested the advantage of PFH@Ce6@O2 in alleviating hypoxic status to inhibit tumor growth. Overall, PFH@Ce6@O2 integrating US/FL bimodal imaging and PDT effect appears to be a promising nanoplatform for ultrasonography-guided PDT of solid tumors.
Inspection, palpation, percussion, and auscultation have been the 4 pillars of clinical bedside medicine. Although these basic methods of physical examination have served us well, traditional bedside ...examination, for a number of reasons including diminishing interest and expertise, performs well less than what is required of a modern diagnostic strategy. Improving the performance of physical examination is vital given that it is crucial to guide diagnostic possibilities and further testing. Current efforts at improving physical examination skills during medical training have not been very successful, and incorporating appropriate technology at the bedside might improve its performance. Selective use of bedside ultrasound (or insonation) can be one such strategy that could be incorporated as the fifth component of the physical examination. Seeing pathology through imaging might improve interest in physical examination among trainees, and permit appropriate downstream testing and possibly superior decision making. Current ultrasound technology makes this feasible, and further miniaturization of ultrasound devices and reduced cost will allow for routine use at the bedside. It is time to have a wider debate and a possible consensus about updates required to enhance current paradigms of physical examination.
Computer-aided diagnosis (CAD) systems hold potential to improve the diagnostic accuracy of thyroid ultrasound (US). We aimed to develop a deep learning-based US CAD system (dCAD) for the diagnosis ...of thyroid nodules and compare its performance with those of a support vector machine (SVM)-based US CAD system (sCAD) and radiologists. dCAD was developed by using US images of 4919 thyroid nodules from three institutions. Its diagnostic performance was prospectively evaluated between June 2016 and February 2017 in 286 nodules, and was compared with those of sCAD and radiologists, using logistic regression with the generalized estimating equation. Subgroup analyses were performed according to experience level and separately for small thyroid nodules 1-2 cm. There was no difference in overall sensitivity, specificity, positive predictive value (PPV), negative predictive value and accuracy (all p > 0.05) between radiologists and dCAD. Radiologists and dCAD showed higher specificity, PPV, and accuracy than sCAD (all p < 0.001). In small nodules, experienced radiologists showed higher specificity, PPV and accuracy than sCAD (all p < 0.05). In conclusion, dCAD showed overall comparable diagnostic performance with radiologists and assessed thyroid nodules more effectively than sCAD, without loss of sensitivity.
PDF
