MHz Probe Research Articles

Is the intima-media thickness of temporal and axillary arteries influenced by cardiovascular risk?

To measure with US the intima-media thickness (IMT) of temporal (superficial, parietal and frontal branches) and axillary arteries in subjects without a diagnosis of GCA and/or PMR with different cardiovascular (CV) risk; and to assess the performance of previously proposed cut-off values for normal IMT. Subjects ≥ 50 years without a diagnosis of GCA or PMR were included. Bilateral US of the temporal arteries, including the frontal and parietal branches, and axillary arteries was performed by two sonographers using a 10-22 MHz and 6-18 MHz probe. The following previously proposed cut-offs were considered: superficial temporal artery: 0.42 mm; frontal branch: 0.34 mm; parietal branch: 0.29 mm; axillary artery: 1.0 mm. A total of 808 arteries in 101 subjects were evaluated; of these, 31 (30.7%) were classified as very high CV risk, seven (6.9%) as high, 34 (33.7%) as moderate and 29 (28.7%) as low risk. Subjects with very high or high risk showed higher IMT than those with moderate or low risk in the superficial temporal arteries [0.23 (s.d. 0.07) vs 0.20 (s.d. 0.04), P < 0.01] and in the axillary arteries [0.54 (s.d. 0.17) vs 0.48 (s.d. 0.10), P = 0.002] . The IMT was higher than the reference cut-off in 13/808 (1.6%) arteries, in ≥1 artery in 10/101 subjects (10.1%). Of these 10 subjects, 8 (80%) were classified as having very high or high risk. Our results suggest that CV risk might influence the US-determined IMT of the temporal and axillary arteries in subjects without GCA. Therefore, in patients with suspected GCA, particular attention should be paid when measuring the IMT in those patients with very high/high CV risk.

Ultra-high-frequency ultrasound monitoring of plaque psoriasis during ixekizumab treatment.

High-frequency ultrasound (HFUS) is a non-invasive method that detects superficial skin features. Ultra-high frequencies (50-100MHz) can reveal epidermis and dermis structures. In this study, we describe the psoriatic plaque using a new device equipped with a 70MHz probe (VEVO® MD, Fujifilm, VisualSonics) and we assess the lesion before and after ixekizumab. We examined the superficial hyperechoic band, the subepidermal hypoechoic band (SLEB), and the vascularization of the plaque in ten patients affected by plaque psoriasis. The average superficial hyperechoic band thickness was 0.2157mm before treatment, 0.1611mm after 15days, and 0.1354mm (P<.05) after 30days. The SLEB thickness was 0.7535mm at baseline, 0.3300mm after 15days (P<.05), and 0.2007mm (P<.05) after 30days. The average percentage vascularization was 50.21% at baseline, 13.15% after 15days (P<.05), and 5.97% after 30days. UHFUS assessment highlighted the rapid action of the drug in terms of the decrease in vascularization after 15days. It revealed a statistically significant reduction in SLEB thickness after 15days and a significant reduction in the hyperechoic superficial band after 30days. VEVO® MD provides physicians with high-resolution details of the psoriatic plaque, thus enabling tailored-made treatments.

Effect of Dietary Supplementation of Crushed Soybean and Flaxseed on Estrus Attributes in Postpartum Crossbred Cows

The objective of the present study was to examine the effect of dietary supplementation of crushed soybean and flaxseed on estrus attributes and preovulatory follicle size in postpartum cows. A total 20 postpartum crossbred multiparous cows from 2nd to 4th lactation with normal calving history were selected and randomly divided into two groups viz. Group 1 (T1) cows fed with roasted crushed soybean @10% of DM (300 g /100 Kg of body weight/day) till 50 and then after continued with crushed flaxseed @ 15% of DM (300 g /100 Kg of body weight/day) and group 2 (T2- without additional fat). Cows from both the groups were subjected to an ovsynch synchronization protocol on day 60 postpartum and observed for induced estrus response, time required for onset of induced estrus, intensity and duration of induced estrus. The diameter of preovulatory follicles was studied transrectaly with a linear-array 7.5 MHZ probe before the second buserelin acetate injection. The dietary supplementation of soybean and flaxseed influenced estrus response, intensity of estrus and time required for onset of induced estrus and duration of estrus however the difference was statistically non significant. At the same time the mean preovulatory follicle diameter was significantly higher in supplemented group.

Colour Doppler ultrasound study in patients with frontal fibrosing alopecia.

The sonographic characteristics of frontal fibrosing alopecia have been scarcely studied. The aim of this study was to perform a colour Doppler ultrasound evaluation in frontal fibrosing alopecia. A cross-sectional study including 99 women with frontal fibrosing alopecia and 40 control subjects was performed using ultrasound equipment with a lineal 18MHz probe. Three areas were evaluated per patient: the alopecic area (a), the hairline implantation area (b) and healthy scalp (c). The diameter (cm) and flow (m/s) of the two most significant vessels were recorded. With regard to the hairline implantation area, patients presented higher vessel diameter (0.127cm vs 0.103cm, P=.03) and vessel flow (8.183m/s vs 7.670m/s, P=.05) than the control group. Vessel diameter was higher in the healthy scalp area in patients than in the control group (0.088cm vs 0.078cm, P=.03). Patients presented higher vessel diameter and flow in the hairline implantation area compared to the control group.

Intraoperative contrast-enhanced ultrasound can have a crucial role in surgical decision-making during hepato-pancreatico-biliary surgery - Analysis of impact and input.

To assess the impact and procedural input of intraoperative ultrasound (IOUS) with contrast-enhanced ultrasound (CEUS) and ultrasound elastography on surgical decision making during the procedure and consequently the outcome after hepato-pancreatico-biliary (HPB) surgery. Data of 50 consecutive patients, who underwent HPB surgery from 04/2018 to 07/2018 were prospectively collected for this study. During surgery, IOUS with a high-resolution ultrasound device using CEUS after bolus injection of 2.4-5 ml dulphur hexafluoride microbubbles using a 6-9 MHz probe and a share wave and strain elastography was performed by an experienced examiner. Process and time analysis were carried out using mobile phone timer. The IOUS with CEUS and elastography correctly identified 42 malignant tumors and 4 benign lesions. In 3 cases, the examination provided false positive result (identifying 3 benign lesions as malignant) and in 1 case a malignant lesion was incorrectly assessed as benign (sensitivity 97,7%, specificity 57,1%, PPV 93,3% and NPV 80%).The specific question by the surgeon could be answered successfully in 98% of the cases. In 76% of the cases, there was a modification (42%) or a fundamental change (34%) of the planned surgical approach due to the information provided by the IOUS. Within the last group, the IOUS had a major impact on therapy outcome. In 7 patients an additional tumor resection was required, in 5 patients the tumor was assessed as inoperable, and in total in 5 patients an intraoperative RFA (4/5) or postoperative RITA (1/5) was required.Regarding procedural input, there was only a slight, but significant difference between the transport and set-up times before the intraoperative use (mean: 14 min 22 s) and the return transport (mean 13 min 6 s), (p = 0,038). The average examination time was 14 minutes, which makes only one third of the overall time demand. Combination of IOUS with CEUS and elastography in oncological HPB surgery provides valuable information that affects surgical decision-making. The procedural input of about 45 minutes seems to be a good investment considering the improvement of the surgical procedure and a significant modification of the therapy approach in the majority of the cases.

Пренатальная диагностика персистирующей правой пупочной вены

Objective. To determine the incidence of persistent right umbilical vein (PRUV), as well as to study the prognostic value of as a marker of fetal developmental anomalies and neonatal outcomes. Patients and methods. 12,945 pregnant women whose gestation period was 18–41 weeks were examined. Ultrasound scanning was performed using a 3–5 MHz probe. A detailed fetal anatomy assessment was carried out, PRUV was diagnosed on the transverse scan of the fetal abdominal cavity. Results. 23 fetuses with PRUV were revealed: in 22 fetuses – an intrahepatic PRUV as a single anomaly was found, in 1 fetus – an extrahepatic PRUV (frequency 1:562). In all cases of intrahepatic PRUV, associated anomalies of fetal development were not revealed, pregnancy proceeded without complications with a favorable postnatal outcome. In one case of extrahepatic PRUV, cardiomegaly and hyper-echogenic bowel were diagnosed. Conclusion. The presence of PRUV in fetus is a marker of developmental anomalies and it warns a doctor about possible complications. Pregnancy, complicated by PRUV, requires a detailed dynamic observation, as in 30% of cases, there is a fetal growth retardation. The results of our study indicate that PRUV, when it is the only anomaly, has a favorable outcome, but based on the data of other authors, the fetus should be more carefully examined for other congenital malformations. Key words: persistent right umbilical vein, prenatal diagnosis, ultrasound diagnosis

Can Dermoscopy and Ultrasonography be Considered a Prognostic Tool in Management of Psoriasis?

Background:Dermoscopy can reliably predict the diagnosis of plaque psoriasis. Ultrasonography has been increasingly used in dermatology in inflammatory diseases like psoriasis as a tool for evaluation. Hence, this study was done to evaluate the role of dermoscopy and ultrasonography as prognostic aid in plaque psoriasis.Aims and Objectives:To study the sonographic and dermoscopic findings of clinically diagnosed psoriatic lesions and the changes in the psoriatic lesions if any, with the treatment. How these findings can be utilized to assess the prognosis in these patients.Materials and Methods:The present study comprised 50 patients with clinically diagnosed plaque psoriasis. Lesions were assessed with Dino-Lite digital microscope AM7515MZT, followed by ultrasonography using a 15 MHz probe, and findings were recorded. All the patients included in this study were given appropriate treatment (topical/systemic) for 6 weeks and were followed up twice i.e., at 3 weeks and 6 weeks after initiating treatment.Results:Whitish scales were the most common scale color seen in our study seen in 35/50 patients (70%). All the vascular structures were reddish, red dots and globules being the predominant type and with the improvement of the lesions, brown structures increased. A total of 28 (56%) patients had a regular pattern of vessel arrangement. Mean capillary size was 0.097 ± 0.012 mm that reduced to 0.075 ± 0.019 mm at the end of the third week and 0.027 ± 0.032 mm at the end of 6 weeks. In ultrasonographic assessment, mean epidermal thickness reduced from 0.1008 to 0.0764 cm at third week and 0.068 cm at the sixth week, and mean dermal thickness reduced from 0.2692cm to 0.1906cm at the third week and then to 0.1906cm 0.1806cm at the sixth week. In our study, clinical improvement preceded dermoscopic improvement. Newer structures identified in the study are a perifollicular arrangement of capillaries and the presence of lacunar structures in the healing lesions.Conclusion:The scale distribution, capillary number, and capillary size in dermoscopic assessment, and epidermal and dermal thickness in ultrasonography showed statistically significant changes with treatment and thus may be taken as the prognostic indicators. Thus, both these noninvasive modalities may be useful in the therapeutic monitoring of plaque psoriasis.

Intra-operative ocular ultrasonography of iodine-125 brachytherapy plaques in patients with uveal melanoma.

PurposeBrachytherapy with iodine-125 (125I) has been extensively used as a conservative treatment for uveal melanoma (UM). Surgical technique for correct placement of episcleral radioactive plaques (ERP) in UM cases with posterior choroidal location and/or small size can be difficult and inaccurate. In this study, the correct positioning of plaques was assessed by intra-operative ultrasound control.Material and methodsThis was a longitudinal, retrospective study of consecutive 20 patients with UM (small-medium size and/or posterior location) who received 125I brachytherapy. Location of plaques was adjusted by intra-operative ocular ultrasonography control. To perform ocular intra-operative ultrasonography, a 10 MHz probe was used to longitudinal and transverse bases in corresponding dummy plaques.ResultsThe study included 8 males and 12 females, with a mean age of 66.3 years (SD = 14.53), 5 right eyes (RE) and 15 left eyes (LE). In ultrasound examination, 4 UMs were of mushroom morphology and the rest nodular. Means of the size of UM by ultrasound were (mm): Lb: 10.60 (SD = 2.24) × Tb: 9.88 (SD = 1.54) × H: 4.02 (SD = 1.44) (3 cases corresponding to small size of collaborative ocular melanoma study (COMS), and 17 cases to medium). The plaques used were between 14 and 20 mm in diameter, with an average distance between the edge of greater base of the tumor and the edge of plate of 2.44 mm (SD = 0.34). It was necessary to surgically reposition the plaque in 4 cases (20%).ConclusionsIntra-operative ultrasound control improves the accuracy of radioactive plaque placement for the treatment of medium-small UMs in posterior location. Probably, this technique should be applied in all cases of brachytherapy, regardless of the isotope chosen and the location of tumor mass, in order to perfectly adjust therapeutic position.

Pregnancy diagnosis in goat by using vaginal cytology and trans-abdominal ultrasonography

The present study was conducted in a goat farm for pregnancy diagnosis by using vaginal cytology and B-mode real time ultrasound using 5 MHz probe by transabdominal method. Seventeen pregnant does were used for this study. The objective of the study was to determine the earliest day of pregnancy and describe the chronological characteristics of pregnancy from day 22 to day 40 for vaginal cytology and day 25 to day 60 for ultrasonography of gestation. The differences among the average percentage of cell value in different age of pregnancy were significant (p < 0.05). The average percentage of intermediate cells (81.12%) was also significantly (p < 0.05) higher than superficial (9.41%), keratinized (7.10%) and neutrophil (2.61%) on 22-40th days of pregnancy. In case of real time B-mode ultrasonography, the gestational sac was observed only in three does out of seventeen (17.6 %) at 25-30 days whereas the placentomes and heart beat of the foetus were first detected at 31-35 days in six does (35.3%). The foetal leg buds were first visualized at 36-40 days in four does (23.5%) whereas the foetal vertebral column was first observed at 36-40 days of gestation in only three does (17.6%). In conclusion, vaginal cytology and trans-abdominal ultrasonography can be used for detection of early pregnancy in does.

Ultrasound image of healthy skin in newborns in the first 24 hours of life.

IntroductionUltrasound imaging is a safe, repeatable and easily available imaging procedure. Based on these qualities, it may become a useful tool for skin assessment in newborns. Aims: The aim of the study was to evaluate the usefulness of high-frequency ultrasound imaging for neonatal skin assessment. Another aim was to identify differences in ultrasound features of the skin in newborns depending on the examination site, sex, age, birth weight, and arterial blood gas results.Material and methodA total of 72 newborns in the first 24 hours of life, without any skin lesions, were included in the study. All newborns underwent ultrasound skin examinations in three body sites (forearm, abdomen and thigh) during the first 24 hours of life. DermaMed Ultrasound Scanner with a 48 MHz probe was used for imaging. A total of three structures were identified in the ultrasound images: epidermal echo, dermis, and subcutaneous tissue. The study assessed the thickness of the epidermis and dermis, and the echogenicity of the dermis and subcutaneous tissue. Data were analysed to determine possible links with sex, post-conceptional age, body weight, birth route, and results of umbilical cord blood gas analysis.ResultsDepending on the body site examined, the mean epidermal thickness was 0.081 to 0.083 mm, while the mean thickness of the dermis ranged between 0.679 and 0.722 mm. The newborns with higher birth weights were shown to have a thicker epidermis regardless of the examined site [R (correlation coefficient) for the forearm: 0.47 (p <0.001), abdomen: 0.53 (p <0.001), thigh: 0.48 (p <0.001)]. A positive correlation was found between epidermal and dermal thickness (R = 0.34; p = 0.004), but a comparison of the three examined sites revealed no significant differences in the thickness of the two structures. The sex of the newborn had no significant effect on the ultrasound features of the skin. None of the ultrasound parameters under study was found to correlate with the pH level in umbilical cord blood gas analysis. Subcutaneous oedema was detected in the examined sites in all the newborns studied.ConclusionsHigh-frequency ultrasound imaging may become a useful method for neonatal skin assessment, complementing existing diagnostic techniques for monitoring pathologically altered skin.

Interstitial lung opacities in patients with severe COVID-19 pneumonia by bedside high-resolution ultrasound in association to CO2 retention.

Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS). This single centre cross-section study aimed to grade the severity of pneumonia by bed-side lung ultrasound (LUS). A scoring system discriminates 5 levels of lung opacities: A-lines (0 points),≥3 B-line (1 point), coalescent B-lines (2 points), marked pleural disruptions (3 points), consolidations (4 points). LUS (convex 1-5 MHz probe) was performed at 6 defined regions for each hemithorax either in supine or prone position. A lung aeration score (LAS, maximum 4 points) was allocated for each patient by calculating the arithmetic mean of the examined lung areas. Score levels were correlated with ventilation parameters and laboratory markers. LAS of 20 patients with ARDS reached from 2.58 to 3.83 and was highest in the lateral right lobe (Mean 3.67). Ferritin levels (Mean 1885μg/l; r = 0.467; p = 0.051) showed moderate correlation in spearman roh calculation. PaCO2 level (Mean 46.75 mmHg; r = 0.632; p = 0.005) correlated significantly with LAS, while duration of ventilation, Horovitz index, CRP, LDH and IL-6 did not. The proposed LAS describes severity of lung opacities in COVID-19 patients and correlates with CO2 retention in patients with ARDS.

Diagnostic accuracy of B-scan in predicting retinoblastoma in children, taking Magnetic Resonance Imaging of orbits as gold standard.

The objective of this study was to determine the diagnostic accuracy of B-scan in predicting retinoblastoma (Rb) taking Magnetic Resonance Imaging (MRI) as a gold standard. A cross-sectional validation study was conducted in the Radiology Department of Fauji Foundation Hospital from May 20 to Nov 20, 2017. Children fulfilling the inclusion criteria were selected after informed consent and detailed history was taken for investigation of Rb. B-scan of both eyes was done using 7.5-10 MHz probe, followed by MRI of both eyes in the same patients using 1.5 Tesla MRI machine with the help of qualified MRI technicians. Data analysis was done by SPSS version 16.0. The diagnostic accuracy, sensitivity, specificity, PPV and NPV of B-scan in prediction of Rb as compared to MRI was 90.45%, 82.28%, 90.54% and 90.28% respectively. The study concluded that diagnostic accuracy of B-scan as compared to MRI is substantial in Retinoblastoma.

Building Capacity and Assessing Stroke Risk with Transcranial Doppler Ultrasonography in Sub-Saharan Africa: The Reach Experience

Introduction: Transcranial Doppler (TCD) screening data from Uganda, Tanzania, and Nigeria have documented elevated velocities in &amp;gt;20% of children with sickle cell anemia (SCA) not receiving hydroxyurea treatment. Realizing Effectiveness Across Continents with Hydroxyurea (REACH, NCT01966731) has demonstrated the safety, feasibility, and benefits of hydroxyurea for children with SCA living in sub-Saharan Africa, especially when escalated to maximum tolerated dose (MTD). Whether hydroxyurea also confers protection against stroke risk in this setting remains unproven, though hydroxyurea-associated increases in hemoglobin and fetal hemoglobin, plus decreases in TCD arterial flow velocities, should lower the risk of both primary and secondary stroke. The availability of TCD equipment and appropriately trained and certified TCD examiners to perform this non-invasive and inexpensive procedure is an important limitation in low-resource settings. Methods: REACH teams in Angola, Democratic Republic of Congo, Kenya, and Uganda identified two local persons at each site to receive formal TCD training and certification from two experienced and certified super-users, one from Uganda and one from the US. Initial training included hands-on teaching at each site by the Ugandan trainer, followed by didactic teaching and hands-on examinations at a central African location with both trainers and all four REACH teams. Follow-up training included monthly web-based teaching sessions of TCD technique and discussion of centrally reviewed exams. Each local examiner had at least 30 completed examinations reviewed, critiqued, and discussed together with the trainers before becoming formally certified as a REACH TCD examiner. After certification, all REACH participants taking hydroxyurea at a stable dose were eligible for TCD using a standardized protocol with identical Sonara/tek advanced non-imaging TCD ultrasound units with 2MHz probes and version 7 software (Natus, Middleton, WI). Time-averaged maximum velocities (TAMV) were measured in the middle cerebral artery, distal internal carotid artery, and the bifurcation. The highest TAMV was recorded and categorized as normal (&amp;lt;170 cm/sec), conditional (170-199 cm/sec), or abnormal (≥200 cm/sec) and correlated with laboratory and clinical parameters. Results: Between November 2018 and March 2020, a total of 481 children in REACH received TCD screening; the average age was 9.3 ± 2.6 years, on hydroxyurea for 43 ± 8 months at an average dose of 23.5 ± 5.0 mg/kg/day with good response (Hb = 8.4 ± 1.3 g/dL, HbF = 23.9 ± 5.0%). There were 16 (3.3%) inadequate exams, defined as no vessel flow in either hemisphere; 5 inadequate exams were in children with prior stroke at hydroxyurea initiation and 1 with stroke on treatment. Of 465 adequate exams, the overall median TAMV was 128 cm/sec (IQR 25 cm/sec) with 449 normal velocities (96.6% overall, range by site 95.1-99.2%), 16 conditional velocities (3.4% overall, range by site 2.3-4.9%), and no abnormal velocities. In univariate analysis, maximum TAMV was inversely correlated with hemoglobin (r = -0.29, p&amp;lt;0.0001), age (r = -0.23, p&amp;lt;0.0001), and fetal hemoglobin (r = -0.12, p=0.027); and positively correlated with reticulocytes (r = 0.17, p&amp;lt;0.001). No gender difference was noted, but alpha thalassemia trait (2-gene deletion) was associated with significantly lower TCD velocities, while G6PD A- deficiency had no observed effects. Conclusions: Robust TCD screening capability was developed in REACH with detailed training, certification, and oversight of local personnel, most of whom had no prior experience. Compared to untreated children, very few REACH participants had elevated TAMV velocities, confirming that hydroxyurea lowers TCD velocities and reduces stroke risk for children with SCA in sub-Saharan Africa. The observed associations between TAMV and both hemoglobin and fetal hemoglobin document the importance of escalating hydroxyurea to achieve and maintain an optimized dose. In low-resource settings, TCD screening efforts by trained and certified examiners should be aligned with hydroxyurea treatment protocols that feature dose escalation, to provide a feasible and effective stroke prevention program. TCD screening of African children with SCA will allow early identification of stroke risk and optimized hydroxyurea dosing, thereby reducing morbidity and mortality in this vulnerable population. Disclosures Aygun: National Heart, Lung, and Blood Institute: Research Funding; bluebird bio: Membership on an entity's Board of Directors or advisory committees, Research Funding; Patient-Centered Outsomes Research Institute: Research Funding; National Institute of Nursing Research: Research Funding.

Power and spectral Doppler ultrasound in suspected active sacroiliitis: a comparison with magnetic resonance imaging as gold standard

The objectives of this study were to study with Power Doppler US (PDUS) the SI joints (SIJs) of patients with suspected active sacroiliitis, to describe SIJ flows with spectral wave analysis (SWA) on Doppler US, and to correlate US data with both clinical characteristics and presence of SIJ bone marrow oedema (BME) in subsequent MRI. A total of 42 patients (32 females and 10 males, mean age 46.8 years) with recent onset of inflammatory back pain (IBP) were included. Every patient underwent US examination with a convex 1-8 MHz probe [scoring PDUS signals with a three-point scale and describing flows in SWA calculating the mean Resistive Index (RI)] and subsequent MRI of the SIJs. PDUS signals were detected in 34 patients and 62 SIJs. In 29 patients and 56 SIJs, MRI revealed BME. A definite diagnosis of SpA was made in 32 patients. PDUS signals were more frequent (P < 0.0001) in patients with a final diagnosis of SpA, yielding a higher PDUS score (P = 0.0304). PDUS grading correlated with both BME grading (r = 0.740, P = 0.0001) and AS DAS (ASDAS) (r = 0.6257, P = 0.0004), but not with inflammatory reactants nor anthropometric data. Mean RI were, respectively, 0.60 and 0.73 (P < 0.0001) in patients with or without diagnosis of active sacroiliitis. The most inclusive RI cut-off resulted <0.70 [positive predictive value (PPV) 94%, accuracy 90%, P = 0.0001]. The best Likelihood Ratio (5.471) for RI to detect pathologic cases was obtained with a cut-off of <0.60 (PPV 96%). PDUS and SWA of SIJs demonstrate good diagnostic accuracy for active sacroiliitis compared with MRI.

Diagnosis of Carpal Tunnel Syndrome using Shear Wave Elastography and High-frequency Ultrasound Imaging

The performance of ultrasound features from shear wave elastography (SWE) and high-frequency ultrasound imaging was evaluated independently and in combination to diagnose carpal tunnel syndrome (CTS). Twenty-five subjects were imaged in a sitting position with an arm extended and palm facing up. SWE of the medial nerve (MN) was acquired at the wrist level (site 1) and proximal to the pronator quadratus muscle (site 2). Cross-sectional area (CSA) and vascularity of the MN were assessed at the wrist using a 24 MHz probe. Color and power Doppler imaging (CDI and PDI), monochrome and color-coded Superb Microvascular Imaging (SMI) were performed for vascularity assessments. The diagnosis and severity of CTS was determined by clinical and electrodiagnostic tests. Diagnostic performance of the ultrasound features was assessed by t-tests, ANOVAs, and ROC analysis. The study included 20 control hands and 27 hands with CTS. All ultrasound features except for the stiffness ratio were significantly different between the CTS and control wrists (p<0.04). The stiffness of MN at site 1 showed a higher accuracy than at site 2. The combination of CSA and MN stiffness from site 2 showed an overall accuracy of 95% with a specificity and sensitivity of 100% and 93%, respectively. The CSA, MN stiffness from site 2, and CDI combination improved the accuracy to 96% with specificity and sensitivity of 100% and 93%, respectively. However, no ultrasound features (independently or in combination) differentiated all stages of CTS severity. SWE with high-frequency ultrasound imaging showed potential for the diagnosis of CTS.

Relation of glycosylated hemoglobin and obesity indices with diastolic dysfunction in participants with type 2 diabetes mellitus

Background: Diabetes is an important risk factor of cardiomyopathy which can eventually lead to acute or chronic heart failure. Many factors such as obesity, hyperglycemia, suboptimal glycemic control, and hyperlipidemia predispose as well as aggravate long-term complications in diabetes mellitus (DM). Aim: The present study was conducted to assess the relation of glycosylated hemoglobin (HbA1c) and obesity indices (body mass index [BMI], waist circumference [WC]) with diastolic dysfunction in participants with type 2 DM (T2DM). Methods: This was a cross-sectional study conducted at the teaching hospital during a 1-year period. All 100 consecutive T2DM participants were investigated for HbA1c, blood sugars and lipid profile parameters, and echocardiography. Standardized transthoracic echocardiographic examination was performed (American Society of Echocardiography) using Vivid S6 ultrasound machine with 4–5 MHz probe. Left ventricular diastolic dysfunction (LVDD) was labeled if 3 or more of these variables were abnormal: “Septal e 14, LA volume index >34 mL/m2, and Peak TR velocity >2.8 m/s.” Results: Out of the total 100 diabetics, 37% had diastolic dysfunction (Grade I: 30 [81.08%] and Grade II: 7 [18.91%]). The peak early transmitral filling wave velocity (E) in diabetics with obesity was low as compared to diabetics with normal weight (44 ± 11 cm/s vs. 52 ± 7.5 cm/s). Higher BMI was associated with higher peak late transmitral velocity (A) (61 ± 14 cm/s vs. 38 ± 6.24 cm/s). The mean of E/A ratio was significantly lower in diabetics with obesity. The E/e' ratio was higher in diabetics with obesity (14.8 ± 2.8 vs. 12.86 ± 2.14). The mean of WC was 90.18 ± 6.82 cm in participants of diastolic dysfunction, whereas it was 86.46 ± 6.42 cm in those without dysfunction. Diastolic dysfunction was present in participants with a suboptimal glycemic control, HbA1c ≥ 6.% (40%), with longer duration of diabetes (62.16%) (P = 0.003). Thus, a higher BMI was associated with higher diastolic dysfunction (P = 0.027). Conclusions: The present study reveals burden of LVDD in asymptomatic T2DM participants with its significant association with age, obesity indices (WC and BMI), HbA1c levels, and longer duration of diabetes. This highlights the magnitude of obesity and suboptimal glycemic control that should be considered in the management of cardiac complications in the form of development of diastolic dysfunction. It will benefit in triage for the optimal management of diabetes.

The qualitative and quantitative assessment of the renal cortex of the clinically healthy rabbits

Qualitative ultrasonographic images in diagnosing renal parenchymal diseases can be inadequate. The relationship between renal cortical echogenicity and parenchymal disease has been demonstrated in people. However, it is difficult to determine diffuse fat vacuoles and the parenchymal diseases at qualitative renal assessment. Disorders of the renal cortex are frequently seen in rabbits. The aim of this study was to qualitatively and quantitatively evaluate the echogenicity of the renal cortex in clinically healthy rabbits. Fourty-two clinically normal and with no history of renal disease rabbits were used. The each rabbit was investigated by complete blood count, urinalysis and renal biopsy. Renal ultrasonography was performed with a 6.5 MHz probe. For each image, three equally sized regions of interest was detected within the renal cortex. The mean pixel intensity was determined using an 8-bit grayscale, with 256 colour of grey colours. Qualitative echogenicity was evaluated by two observers. Observer 1 evaluated as an isoechoic (36/42) and hyperechoic (6/42). Observer 2 evaluated as an isoechoic (35/42) and hyperechoic (7/42). Quantitatively, the mean pixel intensities analysed for the renal cortex was 59.2±2.23 (range: 28-91). The result of this study indicates that analysis of digitized renal cortical ultrasonographic images from rabbits using the histogram technique can be used to quantitatively determine echogenicity.

Comparison of ultrasonography and X-ray test for lateral malleolar fracture in ankle sprain

Introduction: The use of ultrasonography for diagnosing musculoskeletal injuries, especially fractures, in the emergency department is on the rise because of its good diagnostic value. This study aimed to evaluate the diagnostic value of bedside ultrasonography in detecting the patients suffering from lateral malleolar fractures with an ankle sprain mechanism.&#x0D; Methods: This prospective study was conducted on patients having acute ankle injuries with ankle sprain mechanism and diagnosed with lateral malleolar tenderness. All patients underwent bedside ultrasonography with a 7.5 - 10 MHz probe by an emergency medicine specialist who was assisted by a radiologist. Next, they underwent lateral ankle and anteroposterior (AP) X-rays by another emergency medicine specialist who was blinded from the ultrasonography results. The ultrasonography and X-Ray results were then compared.&#x0D; Results: A total of 244 patients participated in this study, of whom 92 (37.70%) were diagnosed with lateral malleolar fracture through bedside ultrasonography and X-Ray tests. The results showed that ultrasonography had a sensitivity of 96.84% and a specificity of 97.31%. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 36.07 and 0.0325, respectively, and the positive and negative predictive values of bedside ultrasonography were 95.83% and 97.98%, respectively. Finally, the results indicated a percent agreement (accuracy) of 97.13% between the two tests with Kappa coefficient of 0.94 (z = 14.68, P value &lt; 0.01).&#x0D; Conclusion: The results of this study showed that bedside ultrasonography has a high sensitivity and specificity in the diagnosis of lateral malleolar fractures with an ankle sprain mechanism. Conducting further studies will lead to the use of this diagnostic test in the emergency department.

Multi Display Scan in Detecting Weld Discontinuity of Thick Carbon Steel Plate using Ultrasonic Testing Phased Array (UTPA) with Comparison to Conventional Ultrasonic Testing (UT)

Non-destructive testing (NDT) is a method of testing and analysis that relies on the application of physical principles to determine the integrity of materials without causing damage. The existence of weld discontinuity can affect the service ability of the structures. Ultrasonic testing Phases Array (UTPA) is advanced ultrasonic testing technology widely practiced in many industries. The multiple ultrasonic elements and electronic time delay will create constructive and destructive interference and steering capability, which could improve detectability compared to a single element of conventional UT. The multi displays presented in A-Scan, S-scan, B-Scan, and C-Scan of UTPA equipment capable of locating, inspecting, and characterise defects within the welded component. Two carbon steel plates with thickness 18 mm and 24 mm were prepared and cut to V-shape configuration and welded using shielded metal arc welding (SMAW) process, labelled as NDE-8826 and NDE-8827 respectively. Both samples were induced with artificial defects of the weld. 16 elements of phased array probe with 0.5 mm pitch and 4 MHz were carried out for this study with encoded scanning to identify weld discontinuity plotted in different types of UT displays. Additional testing was performed using conventional ultrasonic testing (UT) using a 4 MHz probe to compare with the UTPA results and the acceptability of each defect detections. The length and datum of toe crack, slag, and lack of inter run fusion detected by UTPA in NDE-8826 give the same value as the actual value. However, the localisation of the defect is slightly different at 1.0 mm for UT detection. While the detection value for slag gives the same values for UT and UTPA, which also the same as the actual values. The detection of lack of penetration and lack of fusion in sample NDE-8827 was precisely can be detected by UT and UTPA; hence their datum value has slightly different in the centerline crack and porosity at 2.0 mm for UT measurement, and as for UTPA, it was found that the porosity at 3.0 mm which higher value compared to the actual value, 250 mm. From the result, a relevant indication from the UTPA and conventional UT collected it was found that the UTPA technique is capable of improving the Probability of Detection (POD) of defects compared to the conventional UT.

Evaluation of 20-MHz high-frequency ultrasonography for the diagnosis of choroidal nevi.

Evaluate short-term intraoperator reproducibility of ultrasonographic measurements of choroidal nevi using 10- and 20-MHz probes, and the efficacy of the high-frequency probes for the diagnosis of choroidal nevi. Diameters and thicknesses of choroidal nevi were measured using a 10-MHz probe and a high-frequency long focal length 20-MHz probe (Quantel Medical™). The first part of the study evaluated intraoperator reproducibility of measurements of choroidal nevi with 10- and 20-MHz probes and the second part of the study allowed the comparisons of the measurements of largest tumor diameter (LDT) of choroidal nevi of 40 patients between the 10- and 20-MHz probes. The two-way random average agreement intraclass correlation coefficients (ICC), Bland-Altman plot, and a paired t test were used. The intraoperator reproducibility of choroidal nevi measurements with 10- and 20-MHz probes was excellent (ICC > 0.9, n = 20). Four flat nevi, not detectable at 10MHz, could be located with the high-frequency probe (p = 0.12). There was no significant difference in thickness or LTD measurements between the 10- and 20-MHz probes (n = 31). Both techniques showed an excellent agreement (ICC > 0.8) for thickness and LTD measurements. All the choroidal nevi that were not measurable with the 10-MHz probe (n = 7) were measured with the 20-MHz probe. The high-frequency 20-MHz probe allows additional detection and measurements of flat choroidal nevi. When detectable, the ultrasonographic measurements of thickness and diameter of choroidal nevi are similar with both the 10- and the 20-MHz probes.