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The use of 3D ultrasound in comparing surgical techniques for posterior wall prolapse repair: a pilot randomised controlled trial.
Derpapas, A, Vijaya, G, Nikolopoulos, K, Nikolopoulos, M, Robinson, D, Fernando, R, Khullar, V
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2021;(4):594-600
Abstract
The most appropriate method for repairing posterior vaginal wall prolapse is still debatable. Women with symptomatic prolapse scheduled to undergo surgical repair in the posterior compartment were randomised to standard posterior colporrhaphy (SPC) or fascial and vaginal epithelial plication (FEP). Participants were assessed with the Prolapse Quality of Life (P-QOL) questionnaire, pelvic organ prolapse quantification (POP-Q) examination and three-dimensional ultrasound (3D US) prior to surgery and 6 months postoperatively. The research hypothesis is that 3D US of the pelvic floor is a reliable tool in comparing the anatomical outcomes of the two different surgical techniques. Differences in anatomical outcomes, assessed clinically and by ultrasonographic evaluation, were compared between the two groups using the Independent Mann-Whitney U-test and the Wilcoxon signed-rank sum test. Twenty-two women were included in the analysis. Six months postoperatively, women in the FEP arm had better anatomical outcomes compared to those who had undergone SPC (p = .02). Repeatability of the ultrasound technique was confirmed, showing moderate to very good agreement in all parameters and the 3D US evaluation was corroborated with the clinical examination, showing a greater reduction in the urogenital size in the FEP group.Impact statementWhat is already known on this subject? The low cost and universal availability of the ultrasound (US) makes it the most commonly used diagnostic modality. The ability to see beyond surface anatomy is important and useful in the assessment of the posterior vaginal wall prolapse and the obstructed defaecation, where this method may replace the defaecation proctography (Dietz 2019). Recent advances in pelvic floor ultrasonography (3D US) have achieved repeatability in the measurement of the levator hiatal (LH) dimensions, introducing a valid and readily available tool for researchers and clinicians (Dietz et al. 2005). Ultrasound may distinguish a true rectocele due to the weakening of the rectovaginal fascia from an enterocele, a rectal intussusception, or just a deficient perineum (Guzman Rojas et al. 2016).What do the results of this study add? Our study demonstrates that 3D translabial pelvic floor ultrasound is a useful and reliable tool in assessing the anatomical outcome of prolapse surgery.What are the implications of these findings for clinical practice and/or further research? Our study demonstrates that 3D translabial ultrasound of the pelvic floor is a useful and reproducible method in evaluating the anatomical outcomes of surgical repair for posterior wall prolapse. Genital hiatus (GH) and levator hiatus (LH) dimensions measured by ultrasound can be used as surrogate anatomical markers in comparing the efficacy of different surgical techniques.
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Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate-rich drink in young children: A randomized crossover study.
Zhang, YL, Li, H, Zeng, H, Li, Q, Qiu, LP, Dai, RP
Paediatric anaesthesia. 2020;(5):599-606
Abstract
BACKGROUND A recent consensus statement in Europe has suggested that the fasting time for clear liquid in children can be shortened to 1 hour before a surgery. However, the study to show that 1-hour fasting time for clear fluids is safe in young children is still lacking. This study aimed to investigate the gastric emptying time for carbohydrate-rich drink and regular 5% glucose solution in children aged 3-7 years. METHODS After overnight fasting, individuals were randomly assigned to ingest 5 mL kg-1 of either carbohydrate-rich drink or 5% glucose solution. One week later, the same subjects were asked to ingest the other one. Ultrasonography was performed to examine the gastric contents. Gastric antral cross-sectional area was measured, and the gastric fluid volume was calculated before and after fluid ingestion within 120 minutes. The primary outcome was the gastric emptying time for both the clear fluids calculated using the antral cross-sectional area and logarithms of gastric fluid volume. The degrees of thirst and hunger of two drinks were evaluated using a visual analogue scale as the secondary outcomes. RESULTS Data from 16 individuals were analyzed. In the glucose solution group, the antral cross-sectional area and logarithms of gastric fluid volume returned to baseline at 30 minutes after ingestion. However, in the carbohydrate-rich drink group, the median [interquartile range; range] antral cross-sectional area (3.69 [2.64-5.15; 1.83-8.93] cm2 vs 2.41 [2.10-2.96; 1.81-4.37] cm2 , P < .001) and mean (95% confidence interval) logarithms of gastric fluid volume (2.54 [2.30-2.79] mL vs 2.12 [1.94-2.30] mL, P = .048) were still higher than at 60 minutes and returned to the baseline values at 90 minutes after ingestion, respectively. The degree of thirst was lower in the glucose solution group than that in the carbohydrate-rich drink group. CONCLUSIONS Gastric emptying of carbohydrate-rich drink is slower than that of 5% glucose solution but the residual gastric fluid volume is low one hour after ingestion of 5 mL kg-1 of either fluid.
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Musculoskeletal ultrasound to complement clinical evaluation and drive treatment of rheumatoid arthritis patients in remission does not prevent worsening of patient-reported outcomes: the ULTRAPRO randomised controlled study.
Sifuentes-Cantú, C, Butrón-Hernández, D, Contreras-Yáñez, I, Pascual-Ramos, V
Clinical and experimental rheumatology. 2020;(6):1182-1190
Abstract
OBJECTIVES The primary objective was to determine the impact of sharing musculoskeletal ultrasound (MUS) results with rheumatologists on worsening patient-reported outcomes (PROs) at 6 months of follow-up in rheumatoid arthritis (RA) patients with clinical remission. Secondary objectives were to describe MUS findings and to compare the proportion of patients with flares, according to the DAS28-ESR, following the intervention. METHODS Ninety-four consecutive outpatients with clinical remission had PROs and a treatment proposal recorded at study entry. MUS was then performed by trained specialists who were blinded to clinical assessments. Forty-seven patients were randomised (1:1) to either the intervention group (MUS data shared with the primary rheumatologist) or the control group (data not shared); changes in the treatment proposal were recorded. PROs worsening and the proportion of patients with ares were compared between both groups at 6±2 months of follow-up. The study received IRB approval. Appropriate statistics were used. RESULTS At baseline, patients from the intervention and control groups had similar characteristics; 43 and 41 patients, respectively, completed the 6-month follow-up period. PROs worsening at 6 months of follow-up were similar between groups, as were the DAS28-ESR and the proportion of patients who flared. In general, MUS findings were in accordance with the clinical remission status, although power Doppler synovitis was detected in up to 37% of the patients. RA-related treatment was increased in all the patients from the intervention group with discordant findings between clinical and MUS assessments. CONCLUSIONS The addition of MUS to clinical evaluation of RA outpatients in remission did not prevent worsening PROs at 6 months.
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Abdominal Ultrasound Does Not Reveal Significant Alterations in Patients With Nonceliac Wheat Sensitivity.
Soresi, M, Mansueto, P, Terranova, A, D'Alcamo, A, La Blasca, F, Cavataio, F, Iacobucci, R, Carroccio, A
Journal of clinical gastroenterology. 2019;(1):e31-e36
Abstract
GOALS The goal of this study was (A) to evaluate abdominal ultrasound signs in nonceliac wheat sensitivity (NCWS) patients for features useful in diagnosis and (B) to compare these aspects with those of celiac patients to assess whether ultrasound can be useful in the differential diagnosis between NCWS and celiac disease (CD). BACKGROUND NCWS diagnosis is difficult as no biomarkers of this condition have as yet been identified. In CD ultrasound aspects have been identified that have a good diagnostic accuracy. STUDY We prospectively recruited 45 NCWS patients (11 males, 34 females; mean age 35.7 y). Three control groups were included: (A) 99 age-matched CD patients; (B) 18 patients with seronegative CD; (C) 50 patients with irritable bowel syndrome (IBS) who did not improve on a wheat-free diet. NCWS diagnosis was confirmed on the basis of an elimination diet and double-blind placebo-controlled (DBPC) challenge. Ultrasound sign investigation included: dilatation of the small bowel loops, thickening of the small bowel wall, hyperperistalsis, enlarged mesenteric lymph nodes, ascites, hyposplenism, altered diameter of the portal vein. RESULTS NCWS patients showed a low frequency of pathologic ultrasound findings. Dilated or thickened loops appeared more often in CD patients than in NCWS patients (88.8% vs. 20%; P<0.0001). These US signs were significantly more frequent in seronegative CD than in NCWS patients (both P<0.0001), whereas no difference was found between NCWS patients and IBS controls. CONCLUSIONS In NCWS patients' ultrasound does not show a characteristic pattern which could be helpful for diagnosis. However, US can be useful to differentiate between NCWS and CD patients and especially those with seronegative CD. (ClinicalTrials.gov NCT03017274).
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Evaluation of the ablation margin of hepatocellular carcinoma using CEUS-CT/MR image fusion in a phantom model and in patients.
Li, K, Su, Z, Xu, E, Huang, Q, Zeng, Q, Zheng, R
BMC cancer. 2017;(1):61
Abstract
BACKGROUND To assess the accuracy of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion in evaluating the radiofrequency ablative margin (AM) of hepatocellular carcinoma (HCC) based on a custom-made phantom model and in HCC patients. METHODS Twenty-four phantoms were randomly divided into a complete ablation group (n = 6) and an incomplete ablation group (n = 18). After radiofrequency ablation (RFA), the AM was evaluated using ultrasound (US)-CT image fusion, and the results were compared with the AM results that were directly measured in a gross specimen. CEUS-CT/MR image fusion and CT-CT / MR-MR image fusion were used to evaluate the AM in 37 tumors from 33 HCC patients who underwent RFA. RESULTS The sensitivity, specificity, and accuracy of US-CT image fusion for evaluating AM in the phantom model were 93.8, 85.7 and 91.3%, respectively. The maximal thicknesses of the residual AM were 3.5 ± 2.0 mm and 3.2 ± 2.0 mm in the US-CT image fusion and gross specimen, respectively. No significant difference was observed between the US-CT image fusion and direct measurements of the AM of HCC. In the clinical study, the success rate of the AM evaluation was 100% for both CEUS-CT/MR and CT-CT/MR-MR, and the duration was 8.5 ± 2.8 min (range: 4-12 min) and 13.5 ± 4.5 min (range: 8-16 min) for CEUS-CT/MR and CT-CT/MR-MR, respectively. The sensitivity, specificity, and accuracy of CEUS-CT/MR imaging for evaluating the AM were 100.0, 80.0, and 90.0%, respectively. CONCLUSIONS A phantom model composed of carrageenan gel and additives was suitable for the evaluation of HCC AM. CEUS-CT/MR image fusion can be used to evaluate HCC AM with high accuracy.
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Association between omentin-1, adiponectin and bone health under consideration of osteoprotegerin as possible mediator.
Menzel, J, Di Giuseppe, R, Biemann, R, Aleksandrova, K, Kuxhaus, O, Wittenbecher, C, Fritsche, A, Schulze, MB, Isermann, B, Boeing, H, et al
Journal of endocrinological investigation. 2016;(11):1347-1355
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Abstract
PURPOSE Several studies implicated a crosstalk between bone and fat in the pathogenesis of osteoporosis. Few studies indicated an association between adiponectin and omentin-1 on the bone remodeling process and bone mineral density, and suggested osteoprotegerin (OPG) as a mediator of this relationship. However, only limited evidence on this relationship is available in humans. Therefore, this study aimed to investigate the association between omentin-1, adiponectin and broadband ultrasound attenuation (BUA) in peri-/premenopausal and postmenopausal women, and to assess the role of OPG as a possible mediator. METHODS Data from the German population-based EPIC-Potsdam cohort comprising 637 women were analyzed. Multivariable-adjusted ANCOVA including age, BMI, waist circumference, smoking status, education, physical activity, adiponectin or omentin-1 and hormone use was used to investigate potential relationships between the adipokines and BUA levels. A mediation analysis assessed the mediating effect of OPG on the association of BUA and omentin-1 levels. RESULTS Peri-/premenopausal women had higher BUA levels (112.5 ± 10.1 dB/MHz), compared to postmenopausal women (106.3 ± 10.0 dB/MHz). In peri-/premenopausal women neither adiponectin nor omentin-1 was significantly associated with BUA. In postmenopausal women, adiponectin was not associated with BUA, but 10 % increase in the omentin-1 concentration was significantly associated with 0.44 dB/MHz lower BUA levels (p = 0.01). Omentin-1 was positively associated with OPG (p = 0.02); however, OPG was not significantly related to BUA (p = 0.62). CONCLUSION Our study provides evidence for an inverse association between circulating omentin-1 and BUA levels in postmenopausal women. However, the present findings do not support a mediating effect of OPG in the adipose tissue-bone pathway.
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Sonographic inferior vena cava measurements to assess hydration status in college football players during preseason camp.
Waterbrook, AL, Shah, A, Jannicky, E, Stolz, U, Cohen, RP, Gross, A, Adhikari, S
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2015;(2):239-45
Abstract
OBJECTIVES The purpose of this study was to determine whether sonographic measurement of the inferior vena cava (IVC) in college football players during preseason camp is a reliable way to detect and monitor dehydration. Our primary hypothesis was that IVC diameter measurements, the postpractice caval index, and expiratory diameter were significantly related to percent weight loss after a preseason football practice. METHODS A prospective cohort sample of Division I intercollegiate football players in preseason training camp was recruited before practice. All football players on the active roster who were at least 18 years of age were eligible to participate in the study. Sonographic IVC measurements were obtained in the long axis using either the subcostal or subxiphoid approach during inspiration and expiration both before and after an approximately 3-hour practice with moderate to high levels of exertion at high ambient temperatures. Player weights were recorded in the locker room before and after practice. RESULTS A total of 27 prepractice and postpractice sonographic measurements were obtained. The postpractice expiratory IVC diameter was significantly related to percent weight loss after practice (R(2) = 0.153; P = .042), with the IVC diameter being significantly inversely correlated with percent weight loss; the regression coefficient was -1.07 (95% confidence interval, -2.09 to -0.04). There was no statistically significant relationship between percent weight loss and the postpractice caval index; the regression coefficient was 0.245 (95% confidence interval, -0.10 to 0.59; R(2) = 0.078; P = .16). CONCLUSIONS The postpractice expiratory IVC diameter was significantly related to percent weight loss after practice, whereas the caval index was not found to correlate with weight loss.
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Differentiation of branch duct intraductal papillary mucinous neoplasms from serous cystadenomas of the pancreas using contrast-enhanced sonography.
Chen, F, Liang, JY, Zhao, QY, Wang, LY, Li, J, Deng, Z, Jiang, TA
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2014;(3):449-55
Abstract
OBJECTIVES The purpose of this study was to determine whether contrast-enhanced sonography can improve the ability to differentiate branch duct intraductal mucinous neoplasms from serous cystadenomas of the pancreas compared to conventional (unenhanced) sonography alone. METHODS Between March 2008 and May 2012, there were 20 patients with branch duct intraductal mucinous neoplasms and 25 with serous cystadenomas in our institute, for whom preoperative conventional and contrast-enhanced sonographic results were available. The final diagnosis was obtained by histopathology. Various conventional and contrast-enhanced sonographic characteristics were retrospectively evaluated by 2 radiologists in consensus. A receiver operating characteristic curve analysis was used to evaluate the diagnostic value of conventional and contrast-enhanced sonography for discriminating between the two entities. RESULTS Three conventional sonographic characteristics (microcysts, cysts with internal echoes, and main pancreatic duct dilatation) and 2 contrast-enhanced sonographic characteristics (communication between the lesion and main pancreatic duct and enhancement of mural nodules) significantly improved the ability to differentiate branch duct intraductal mucinous neoplasms from serous cystadenomas. The area under the receiver operating characteristic curve increased from 0.691 with conventional sonography to 0.859 with combined contrast-enhanced and conventional ultrasonography (P = .043). CONCLUSIONS In this series of patients, the addition of contrast-enhanced sonography to conventional sonography improved the ability to differentiate branch duct intraductal mucinous neoplasms from serous cystadenomas.
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Comparison of Kupffer-phase Sonazoid-enhanced sonography and hepatobiliary-phase gadoxetic acid-enhanced magnetic resonance imaging of hepatocellular carcinoma and correlation with histologic grading.
Sugimoto, K, Moriyasu, F, Saito, K, Taira, J, Saguchi, T, Yoshimura, N, Oshiro, H, Imai, Y, Shiraishi, J
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2012;(4):529-38
Abstract
OBJECTIVES To determine the relative wash-out of hepatocellular carcinomas and dysplastic nodules using Kupffer-phase sonography with Sonazoid (Daiichi-Sankyo, Tokyo, Japan) enhancement and hepatobiliary-phase gadoxetic acid-enhanced magnetic resonance imaging (MRI) in the evaluation of the histopathologic grades of individual nodules. METHODS This retrospective study included 66 consecutive patients with 78 histologically confirmed hepatocellular carcinomas and dysplastic nodules. In patients with carcinomas, 33 were well differentiated; 29 were moderately differentiated; and 11 were poorly differentiated; and there were 5 dysplastic nodules. All patients underwent both gadoxetic acid-enhanced MRI and Sonazoid-enhanced sonography. The interval between the two imaging examinations was less than 30 days. Six radiologists independently reviewed both images and rated the degree of relative wash-out between the tumorous and nontumorous areas on Kupffer- and hepatobiliary-phase images using a continuous rating scale. We compared these results with the histopathologic grade of each nodule, and the results were then analyzed with multireader multicase receiver operating characteristic analysis. RESULTS The average Kupffer-phase (P < .001) and hepatobiliary-phase (P = .004) rating scores increased as the carcinomas became less differentiated (Kruskal-Wallis test). The diagnostic accuracies of the average area under the receiver operating characteristic curve, which were estimated using the confidence levels of the relative wash-out of the Kupffer- and hepatobiliary-phase images, were 0.705 and 0.785 for dysplastic nodules versus well-, moderately, and poorly differentiated carcinomas (P = .517), 0.791 and 0.687 for dysplastic nodules and well-differentiated carcinomas versus moderately and poorly differentiated carcinomas (P = .093), and 0.871 and 0.716 for dysplastic nodules and well-and moderately differentiated carcinomas versus poorly differentiated carcinomas (P = .005), respectively. CONCLUSIONS Kupffer-phase Sonazoid-enhanced sonography and hepatobiliary-phase gadoxetic acid-enhanced MRI may be useful in estimating the histologic grade, although Kupffer-phase Sonazoid-enhanced sonography may be more accurate in distinguishing hepatocellular carcinomas, especially moderately and poorly differentiated types.
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Prostate volume contouring: a 3D analysis of segmentation using 3DTRUS, CT, and MR.
Smith, WL, Lewis, C, Bauman, G, Rodrigues, G, D'Souza, D, Ash, R, Ho, D, Venkatesan, V, Downey, D, Fenster, A
International journal of radiation oncology, biology, physics. 2007;(4):1238-47
Abstract
PURPOSE This study evaluated the reproducibility and modality differences of prostate contouring after brachytherapy implant using three-dimensional (3D) transrectal ultrasound (3DTRUS), T2-weighted magnetic resonance (MR), and computed tomography (CT) imaging. METHODS AND MATERIALS Seven blinded observers contoured 10 patients' prostates, 30 day postimplant, on 3DTRUS, MR, and CT images to assess interobserver variability. Randomized images were contoured twice by each observer. We analyzed length and volume measurements and performed a 3D analysis of intra- and intermodality variation. RESULTS Average volume ratios were 1.16 for CT/MR, 0.90 for 3DTRUS/MR, and 1.30 for CT/3DTRUS. Overall contouring variability was largest for CT and similar for MR and 3DTRUS. The greatest variability of CT contours occurred at the posterior and anterior portions of the midgland. On MR, overall variability was smaller, with a maximum in the anterior region. On 3DTRUS, high variability occurred in anterior regions of the apex and base, whereas the prostate-rectum interface had the smallest variability. The shape of the prostate on MR was rounder, with the base and apex of similar size, whereas CT contours had broad, flat bases narrowing toward the apex. The average percent of surface area that was significantly different (95% confidence interval) for CT/MR was 4.1%; 3DTRUS/MR, 10.7%; and CT/3DTRUS, 6.3%. The larger variability of CT measurements made significant differences more difficult to detect. CONCLUSIONS The contouring of prostates on CT, MR, and 3DTRUS results in systematic differences in the locations of and variability in prostate boundary definition between modalities. MR and 3DTRUS display the smallest variability and the closest correspondence.