Clinical Ultrasonography Research Articles

Prehospital point of care ultrasound in Helicopter Emergency Medical Services: a 5-year experience study in Belgium

IntroductionThe utilization of Clinical Ultrasound (CUS) in Helicopter Emergency Medical Services (HEMS) has become increasingly prevalent, reflecting its significant role in emergency care.MethodsThis descriptive, monocentric study, conducted at the Helicopter Medical Center (CMH) of Bra-sur-Lienne, Belgium, aimed to describe the use of CUS within HEMS and evaluate its potential impact on diagnostic accuracy, therapeutic interventions, and hospital destination decisions.ResultsOver a 5-year period, from January 2018 to December 2022, our retrospective analysis included 6,126 HEMS interventions, with CUS performed in 29.55% of cases. The study demonstrated that CUS led to therapeutic changes in 30.88% of instances and affected the hospital destination in 9% of cases, despite a potential bias toward directing patients to the University Hospital Center of Liège (CHU of Liège) due to operational constraints. The agreement between prehospital CUS findings and hospital imaging was substantial, with an 80.39% concordance rate, underscoring CUS's utility in enhancing prehospital diagnostic accuracy. We found no significant increase in on-scene time due to CUS usage, with most exams completed in <5 min.DiscussionOur findings highlight the interesting role of CUS in HEMS, facilitating more informed and confident medical decision-making in prehospital emergency care. However, variability in CUS application emphasize the need for standardized guidelines to optimize its use. The study's limitations include its retrospective, monocentric design and the focus on on-scene ultrasound evaluations. Future research should aim at a more extensive, prospective analysis to further validate the benefits of CUS in emergency medical services.

Colour Doppler Sonography of the Ovarian Vein: Recognition and Associated Lesions.

The purpose of this study was to evaluate the diagnostic value of colour Doppler sonography for ovarian veins. The clinical incidence of ovarian venous lesions is relatively low and often overlooked. The ovarian veins are located deep in the pelvis, and they are relatively elongated, which could make medical imaging more difficult. Therefore, there is limited literature on the diagnosis of ovarian venous disease. The purpose of this study was to evaluate the diagnostic value of colour Doppler sonography towards ovarian vein. A total of 37 consecutive patients with clinically suspected ovarian venous disorders were included. All the patients underwent colour Doppler sonography. CTV was performed in 31 patients, while retrograde phlebography was performed in 6 patients. CT/phlebography was the established diagnostic criterion for ovarian vein disorders. The SPSS 22.0 program was used for statistical analysis. Sensitivity, specificity, and positive and negative predictive values for colour Doppler sonography were calculated. k-test was used to evaluate consistency between colour Doppler sonography and CT/phlebography. In the 37 patients,18 cases were positive for ovarian vein disorders and 19 cases were negative, as assessed with colour Doppler sonography. The associated lesions included ovarian vein thrombosis (7 cases), ovarian varicocele (3 cases), and ovarian venous leiomyoma (8 cases). The calculated values of sensitivity, specificity, and positive and negative predictive value were 94.4%, 94.7%, 94.4%, and 94.7%, respectively. The overall accuracy rate was 94.9%. The k level of the degree of agreement between CT/phlebography and colour Doppler sonography was 0.892. Colour doppler sonography can provide sufficient imaging information. In clinical ultrasonography, attention should be paid to recognizing and detecting ovarian venous lesions.

Contrast-enhanced ultrasound (CEUS) for characterisation of focal liver lesions

Due to the trend towards increased use of imaging and rising awareness among high-risk patients, gastroenterologists and hepatologists are more frequently confronted with patients with focal liver lesions. In the differentiation of these lesions, CT and MRI have increasingly found their way into primary diagnostic steps in everyday clinical practice. Contrast-enhanced sonography, on the other hand, is a very effective and cost-efficient method for assessing focal liver lesions. The success of the method is not only based on the visualisation of microvascularisation in real time. If sonography is performed by the treating physician, he can use the exact knowledge of history and clinical findings to specifically adapt the examination procedure and to interpret the sonographic findings with greater accuracy ("clinical sonography"). At the same time, the method enables the practitioner to combine diagnostics and management decisions in his or her own hands. To achieve excellent results with contrast-enhanced sonography-as with any other imaging method-it is necessary that the examiner is sufficiently qualified.This article systematically presents the sonographic characteristics of the most common liver lesions and clearly shows their contrast patterns using videos (available via QR code). The article illustrates that CEUS could-and from the authors' point of view, should-have an even greater significance in the future.

Neural network combining with clinical ultrasonography: A new approach for classification of salivary gland tumors.

Little information is available about deep learning methods used in ultrasound images of salivary gland tumors. We aimed to compare the accuracy of the ultrasound-trained model to computed tomography or magnetic resonance imaging trained model. Six hundred and thirty-eight patients were included in this retrospective study. There were 558 benign and 80 malignant salivary gland tumors. A total of 500 images (250 benign and 250 malignant) were acquired in the training and validation set, then 62 images (31 benign and 31 malignant) in the test set. Both machine learning and deep learning were used in our model. The test accuracy, sensitivity, and specificity of our final model were 93.5%, 100%, and 87%, respectively. There were no over fitting in our model as the validation accuracy was similar with the test accuracy. The sensitivity and specificity were comparable with current MRI and CT images using artificial intelligence.

Implementation of clinical ultrasonography in an oral and maxillofacial radiology residency curriculum

Implementation of clinical ultrasonography in an oral and maxillofacial radiology residency curriculum

Sonographische Differenzialdiagnostik fokaler Leberläsionen

Rapid diagnostic assessment is crucial for the clinical management of focal liver lesions. In addition to standard B‑mode sonography, color-coded Doppler sonography and contrast-enhanced ultrasound are widely used for the classification of liver tumors. In gastroenterology, clinical sonography plays an important role in the detection of tumors, in the follow-up of oncological patients and for the screening for hepatocellular carcinoma. Thereby, correctly classifying focal liver lesions essentially requires the interpretation of ultrasound findings in the clinical context (e.g., incidental finding, known risk factors, history of liver cirrhosis or malignant disease). In this review, we summarize the available ultrasound techniques for the characterization of focal liver lesions and discuss their importance and relevance for the differential diagnosis and further diagnostic and therapeutic management.

Impact of clinical ultrasound in patients with heart failure treated in home

Background and objectiveIn Spain, more than 10% of patients discharged with acute heart failure (AHF) are readmitted in the first 30 days. This study is designed to assess whether the treatment of AHF guided by clinical ultrasound (CU) in the setting of hospitalization at home (HAH) reduces the incidence of readmission and mortality compared to the standard care (SC). Patients and methodsA randomized, open, parallel, single-center and controlled clinical trial (RCT) was designed (NT05042752). Patients >18 years of age admitted for AHF to HAD from January 2021 to April 2021 at the Reina Sofía Hospital in Tudela were consecutively included. The patients were randomized to the “UG-ultrasound group” (SC and CU performed) and the “CG-control group” (SC). The diuretic treatment was tailored according to the findings of the SC together with the CU or according to the findings of the SC respectively. The main variables were the relative risk of readmission and mortality from AHF. ResultsA total of 79 patients were randomized, 39 to UG and 40 to CG. Of these, only 35 of the UG and 35 of the CG completed the intervention. The risk of readmission due to AHF was reduced by 60% in UG compared to CG (RR 0.4; 95% CI: 0.1–1) and mortality by 30% (RR 0.7; 95% CI: 0.2–2.2). Despite the relevant magnitude of the effect found, the results did not reach statistical significance due to lack of power. ConclusionOur results suggest that in HAH, a CE guided strategy for AHF could reduce the risk of readmission and mortality compared to SC alone. However, studies with greater statistical power are needed to confirm these results.

An Artificial Intelligence Ultrasound Platform for Screening and Staging Thyroid C

<h3>Purpose/Objective(s)</h3> Thyroid cancer is one of the most rapidly increasing cancer in the US, largely due to increased detection. BRAF mutation (V600E) is common in thyroid cancer and is a druggable mutation. The purpose of this study was to establish a multimodal artificial intelligence (AI) ultrasound platform that consists of radiomics, topological data analysis (TDA), machine learning (ML)TI-RADS features, and deep learning (DL) to predict malignancy, pathological, and genomic outcome in patients with thyroid cancer. <h3>Materials/Methods</h3> Between 2010 and 2021, 1,346 thyroid nodule images through routine diagnostic ultrasound from 784 patients. The ultrasound images were divided into two datasets, one for internal training and validation, and one for external validation. Malignancy was confirmed with samples obtained from fine needle biopsy. Pathological staging and mutational status were confirmed with operative reports and genomic sequencing, respectively. To achieve maximum malignancy prediction, a quad-model AI method was performed – (1) radiomics which employs high-throughput quantitative analysis of image features, (2) TDA which analyzes geometric relationships between data points in images, (3) machine learning (ML) which algorithm that utilizes TI-RADS-defined ultrasound properties as ML features, (ML)TI-RADS, (4) deep learning (DL) which employed convoluted neural network algorithms to achieve prediction. For prediction of tumor (T) stage, nodal (N) stage, extrathyroidal extension, and BRAF, a tri-model that consists of radiomics, TDA, and (ML)TI-RADS was used. One hundred and four quantitative radiomics features, 476 topological algebraic-geometric features, and 5 TI-RADS features were obtained for all nodules. Linear discriminant analysis (LDA) and the Pearson correlation coefficient (0.85 threshold) were employed for feature extraction. Support vector machine (SVM) was chosen as the machine learning classifier. <h3>Results</h3> For malignancy prediction, radiomics, TDA, (ML)TI-RADS, and DL individual model achieves an accuracy of 89% (0.87 AUC), 81% (0.81 AUC), 80% (0.76 AUC), and 87% (0.92 AUC), respectively. Our quad-model achieves a 98.7% accuracy, 0.98 AUC, 96% precision, 98% sensitivity and specificity for malignancy prediction, which is significantly improved when compared to individual model (radiomics, TDA, (ML)TI-RADS: p<0.001, deep learning: p=0.002). Using the external validation dataset, the quad-model achieves a 93% accuracy (0.94 AUC) for malignancy prediction. Our tri-model yields an accuracy of 93% accuracy (0.93 AUC), 89% accuracy (0.88 AUC), 98% (0.96 AUC), and 96% (0.97 AUC) for prediction of T, N, extrathyroidal extension, and BRAF mutation, respectively. <h3>Conclusion</h3> Using routine clinical ultrasonography, we have established a robust AI platform that allows prediction of malignancy, pathological stage, and BRAF mutation for thyroid cancer with high accuracy.

Objective assessment of segmentation models for thyroid ultrasound images.

Ultrasound features related to thyroid lesions structure, shape, volume, and margins are considered to determine cancer risk. Automatic segmentation of the thyroid lesion would allow the sonographic features to be estimated. On the basis of clinical ultrasonography B-mode scans, a multi-output CNN-based semantic segmentation is used to separate thyroid nodules' cystic & solid components. Semantic segmentation is an automatic technique that labels the ultrasound (US) pixels with an appropriate class or pixel category, i.e., belongs to a lesion or background. In the present study, encoder-decoder-based semantic segmentation models i.e. SegNet using VGG16, UNet, and Hybrid-UNet implemented for segmentation of thyroid US images. For this work, 820 thyroid US images are collected from the DDTI and ultrasoundcases.info (USC) datasets. These segmentation models were trained using a transfer learning approach with original and despeckled thyroid US images. The performance of segmentation models is evaluated by analyzing the overlap region between the true contour lesion marked by the radiologist and the lesion retrieved by the segmentation model. The mean intersection of union (mIoU), mean dice coefficient (mDC) metrics, TPR, TNR, FPR, and FNR metrics are used to measure performance. Based on the exhaustive experiments and performance evaluation parameters it is observed that the proposed Hybrid-UNet segmentation model segments thyroid nodules and cystic components effectively.

Accuracy of the ‘CUT’ Score for Assessing Malignancy in Bethesda 3 and 4 Thyroid Nodules in North American population: a retrospective study.

Background The CUT score is a thyroid nodule malignancy risk assessment scoring system intended to guide surgeons in treating Bethesda 3 and 4 thyroid nodules. It is based on clinical (C) and ultrasonographic (U) features and a five-tiered (T) representing cytology. Purpose Our study aimed to assess the utility of the CUT score in predicting thyroid malignancy in the North American population. The main reason for creating this score is to reduce unnecessary surgeries on these challenging thyroid nodules. Materials and Methods A retrospective record review study applied the CUT score to 219 Bethesda 3 and 4 thyroid nodules. A total of 203 Bethesda 3 and 16 Bethesda 4 nodules from patients treated between January 2015 and December 2019 at a single institution were assessed. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the CUT diagnostic test. Binary logistic regression analysis was performed. Iteration of analysis was performed after stratification according to body mass index to assess CUT score accuracy in obese and non-obese patients. Results Of 219 nodules analyzed, 148 were characterized as benign and 71 as malignant. Prevalence rates of malignancy were 29.6% (n = 60) and 68.8% (n = 11) in Bethesda 3 and 4 nodules, respectively. The mean CU (clinical, ultrasonography) score was 5.35 ± 1.38 in benign nodules versus 4.96 ± 1.5 in malignant nodules (p = 0.08). The area under the curve (AUC =0.433) for the association of CUT scores with nodule malignancy was not significant (p = 0.13). The CUT score was insignificant as a diagnostic test for nodule malignancy in obese (AUC =0.45; p = 0.72) and non-obese patients (AUC =0.39; p = 0.08). Conclusion The CUT score did not correlate with preoperative malignancy risk estimates in Bethesda 3 thyroid nodules and, therefore, may have limited utility as a predictor of malignancy in these thyroid nodules.

The effectiveness of intratissue percutaneous electrolysis for the treatment of tendinopathy: a systematic review.

Tendinopathy is highly prevalent in the general public and common in athletes. It makes up nearly 50% of all sport injuries. A number of treatment techniques with varying evidence of effectiveness are currently available. Intratissue percutaneous electrolysis (EPI) is one such modality, however little consensus exists for EPI's efficacy or the most effective treatment parameters. To review and appraise available evidence for Intratissue Percutaneous Electrolysis (EPI) in the treatment of tendinopathy, examining the effectiveness of EPI in conjunction with other modalities and identifying the strengths and limitations of the evidence base for EPI in order to make evidence-based recommendation for future studies of EPI. PubMed, Embase and Scopus were searched with keywords related to EPI and tendinopathy. Grey literature searches were conducted with Embase, OpenGrey, and ProQuest. Extensive citation searching was undertaken. Randomised controlled trials (RCTs), uncontrolled and observational studies of the application of EPI in patients aged 18-65 years with Magnetic Resonance Imaging (MRI) or clinical Ultrasonography (US) confirmed diagnosis of tendinopathy were eligible. Eleven studies met inclusion criteria: six randomised control trials (RCTs) and five uncontrolled studies. Clinical trials of EPI as an adjunct modality with physical therapy reporting greater decreased pain and return to function than treatment with physical therapy alone. The evidence for EPI is limited and influenced by small sample sizes, varying treatment protocols, clinical heterogeneity and high risk of bias. It is currently not possible to conclude that EPI is an effective modality for the treatment of tendinopathy. RCTs with clearly described EPI treatment protocols, larger sample sizes and intervention reporting sufficient to support reproducibility are needed to determine the effectiveness of EPI for the treatment of tendinopathy.

Malignancy risk of thyroid nodules: quality assessment of the thyroid ultrasound report

BackgroundThyroid nodules are a challenge in clinical practice and thyroid ultrasonography is essential for assessing the risk of malignancy. The use of ultrasound-based malignancy risk classification systems has been recommended by several scientific societies but radiologist’s adherence to these guidelines may vary. The authors aimed to analyze the quality of the information provided by the thyroid ultrasound report, to assess the malignancy risk of thyroid nodules, in Portugal.MethodsMulticenter and retrospective study, conducted in three of the five Portuguese NUTS2 corresponding to about 88.3% of the mainland population. We included 344 consecutive unselected participants aged ≥ 18 years who underwent thyroid ultrasonography in 2019. The description of six features of the dominant thyroid nodule was analyzed: maximum size, shape, margins, composition, echogenicity and echogenic foci. A utility score, including these six features, was used as an indicator of the report’s quality. A score of 4 was considered as a minimum value.ResultsMaximum diameter was reported for all nodules. Shape, margins, composition, echogenicity and echogenic foci were reported in 8.1%, 25.0%, 76.5%, 53.2% and 20.9%, respectively. Only 21.8% of the nodules had a score ≥ 4. At least one of four suspicious features, including marked hypoechogenicity, microcalcifications, irregular margins and non-oval shape, was identified in 8.7% of the nodules. Cervical lymph nodes’ status was reported in 93% of the exams. The risk category was only reported in 7.8% of the participants.ConclusionThe adherence of Portuguese radiologists to a standardized reporting model and to an ultrasound-based malignancy risk stratification system is still low and has implications for the correct characterization of the malignancy risk of nodules and the decision to perform fine-needle aspiration biopsy.

In Memory of Professor Karim Vesal: How a Genius Physician Paved the Road for the Development of Clinical Radiology, Nuclear Medicine, Ultrasonography and Medical Physics

In Memory of Professor Karim Vesal: How a Genius Physician Paved the Road for the Development of Clinical Radiology, Nuclear Medicine, Ultrasonography and Medical Physics

Impacto de la ecografía clínica en pacientes con insuficiencia cardíaca atendidos en hospitalización a domicilio

Background and objectiveIn Spain, more than 10% of patients discharged with acute heart failure (AHF) are readmitted in the first 30 days. This study is designed to assess whether the treatment of AHF guided by clinical ultrasound (CU) in the setting of hospitalization at home (HAH) reduces the incidence of readmission and mortality compared to the standard care (SC). Patients and methodsA randomized, open, parallel, single-center and controlled clinical trial (RCT) was designed (NT05042752). Patients >18 years of age admitted for AHF to HAD from January 2021 to April 2021 at the Reina Sofía Hospital in Tudela were consecutively included. The patients were randomized to the UG-ultrasound group (SC and CU performed) and the CG-control group (SC). The diuretic treatment was tailored according to the findings of the SC together with the CU or according to the findings of the SC respectively. The main variables were the relative risk of readmission and mortality from AHF. ResultsA total of 79 patients were randomized, 39 to UG and 40 to CG. Of these, only 35 of the UG and 35 of the CG completed the intervention. The risk of readmission due to AHF was reduced by 60% in UG compared to CG (RR 0.4; 95% CI: 0.1–1) and mortality by 30% (RR 0.7; 95% CI: 0.2–2.2). Despite the relevant magnitude of the effect found, the results did not reach statistical significance due to lack of power. ConclusionOur results suggest that in HAH, a CE guided strategy for AHF could reduce the risk of readmission and mortality compared to SC alone. However, studies with greater statistical power are needed to confirm these results.

Homoeopathic Treatment of Fibrocystic Breast Diseases: A Case Series

AbstractFibrocystic changes are the most frequently occurring benign conditions of breast disease. Women of 20 to 50 years of age who frequently encounter various forms of stressors have the highest incidence of fibrocystic breast disease (FBD). In cases, where any palpable mass is detected after clinical examination, mammograms and ultrasonography (USG) are the most common investigative tools for the next level of assessment. Five patients with FBD were treated with homoeopathic medicines in our hospital within a period of 3 years under the project: ‘Homoeopathic management of benign neoplastic lesions of breast: an evidence-based study’. The diagnosis was based on clinical examination and USG. We followed standard homoeopathic guidelines for the final selection of medicines. Individualised homoeopathic medicines were used to treat these cases. The clinical assessment was done every month and objective assessment was done after serial USG reports at every 6-month interval. All the patients had notable improvements during treatment as inferred clinically as well as from the USG reports. Few associated symptoms improved too. Assessment of the causal attribution of the outcomes of the treated cases to the homoeopathic intervention was done using Modified Naranjo Criteria. ‘Definite’ association was found in four out of five cases and one case showed a ‘probable’ association. Therefore, we may conclude that homoeopathic treatment can be useful in treating FBD. Good-quality clinical trials are needed before making any firm recommendation.

Effect of a Multiorgan Focused Clinical Ultrasonography on Length of Stay in Patients Admitted With a Cardiopulmonary Diagnosis

There are accumulating data about the utility of diagnostic multiorgan focused clinical ultrasonography (FCU) in the assessment of patients admitted with cardiopulmonary symptoms. To determine whether adding multiorgan FCU to the initial clinical evaluation of patients admitted with cardiopulmonary symptoms reduces hospital length of stay, hospital readmissions, and in-hospital costs. This is a prospective, parallel-group, superiority, randomized clinical trial with a 1:1 allocation ratio. The study was conducted at The Royal Melbourne Hospital, a tertiary public hospital located in Melbourne, Victoria, Australia. Adults aged 18 years or older admitted to the internal medicine ward with a cardiopulmonary diagnosis were enrolled between September 2018 and December 2019 and were followed up until hospital discharge. Data analysis was performed from August 2020 to January 2021. The intervention involved an internal medicine physician-performed heart, lung, and 2-point vein compression FCU in addition to standard clinical evaluation. The primary outcome was the difference in the mean length of hospital stay, defined as the number of hours from admission to the internal medicine ward to hospital discharge. A difference of 24 hours was defined as clinically important. Secondary outcomes included hospital readmissions at 30 days and hospital care costs. A total of 250 participants were enrolled and 2 were excluded, leaving 248 participants (mean [SD] age, 80.1 [11.0] years; 121 women [48.7%]) in the final analysis. There were 124 patients in the intervention group and 124 patients in the control group. The most common initial diagnoses were acute decompensated heart failure (113 patients [45.5%]), pneumonia (45 patients [18.1%]), and exacerbated chronic pulmonary disease (32 patients [12.9%]). The length of hospital stay was 113.4 hours (95% CI, 91.7-135.1 hours) in the FCU group and 125.3 hours (95% CI, 101.7-148.8 hours) in the control group (P = .53). The 30-day readmission rate was not different between groups (FCU vs control, 20 of 124 patients [16.1%] vs 15 of 124 patients [12.0%]), nor were total in-hospital costs (FCU vs control, A$7831.1 [95% CI, A$5586.1-A$10 076.1] vs A$7895.7 [95% CI, A$6385.9-A$9.405.5]). In this randomized clinical trial, adult patients admitted to an internal medicine ward with a cardiopulmonary diagnosis, who underwent multiorgan FCU of the heart, lungs, and lower extremities veins during their initial clinical assessment, did not have a shorter hospital length of stay by more than 24 hours, compared with patients who received standard care. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12618001442291.

Läsionen der Trizepssehne

The triceps brachii muscle is the main extender of the elbow joint. Triceps tendon rupture or tearing presents arare injury pattern in general. Distal tendon ruptures occur most commonly in the area of the insertion of the olecranon. Fractures of the radial head are reported as the most common concomitant injury. In many cases, pre-existing degenerative damage predisposes for tendon injury. These include local steroid injections, anabolic steroid abuse, renal insufficiency requiring dialysis, hyperparathyroidism, lupus erythematosus and Marfan's syndrome. However, the most frequent trauma mechanism is adirect fall onto the extended forearm or ablow to the elbow. Beside clinical examination and sonography, magnetic resonance imaging is the diagnostic gold standard. The treatment of triceps tendon injuries includes conservative as well as operative approaches, whereby the indications for surgical treatment must be generously considered depending on the patient's age, functional demands of the patient, involvement of the dominant extremity as well as on the extent of the tendon rupture.

Teaching Seasoned Doctors New Technology: An Intervention to Reduce Barriers and Improve Comfort With Clinical Ultrasound.

IntroductionAlthough clinical ultrasound (CUS) is a core skill that is a requirement for emergency medicine (EM) residency graduation, only a fraction of EM practitioners who trained prior to this requirement are certified in CUS. The objective of the study was to implement a CUS workshop for practicing EM physicians, identify barriers to utilization, and assess comfort with the machine, obtaining and interpreting images, and incorporating CUS into clinical practice.MethodsThis was a prospective descriptive cohort study of EM physician faculty who participated in an interactive 5-hour CUS workshop intervention that introduced four core CUS modalities via didactics and hands-on scanning stations. Pre- and post-surveys were administered to identify barriers to utilization and assess perceived comfort with CUS using a 5-point Likert scale. Results were analyzed using Fisher’s exact and paired t-tests.ResultsThirty-five EM physicians participated with a 100% survey response rate. Only five of the physicians were ultrasound certified at the time of the workshop. On average, physicians were 16 years post-residency. Prior to the workshop, 29% had minimal ultrasound experience and 43% had not performed more than 50 ultrasounds. In the pre-course survey, every physician expressed at least one barrier to CUS utilization. Post-workshop, physicians felt significantly more comfortable using the ultrasound machine (p=0.0008), obtaining and interpreting images (p=0.0009 and p=0.0004), and incorporating CUS into clinical practice (p=0.002).ConclusionThis workshop is an effective tool to expose practicing physicians to core concepts of CUS, improve their comfort level, and reduce barriers to ultrasound utilization.

Relationship between the ratio of optic nerve sheath diameter to eyeball transverse diameter and morphological characteristics of dogs.

To assess the feasibility of ocular ultrasonography for measurement of the ratio of optic nerve sheath diameter (ONSD) to eyeball transverse diameter (ETD) in dogs with various morphologies and to evaluate the interobserver reliability of the ONSD/ETD ratio and its correlation with various morphological variables. 45 healthy dogs of various breeds. Height, head circumference, body weight, body condition score, intraocular pressure, and blood pressure were recorded for each dog. Unsedated dogs underwent bilateral ocular ultrasonography once. A veterinarian and board-certified ophthalmologist who were unaware of subject signalment independently reviewed the ultrasonographic videos and selected 1 image for each eye on which the ETD and ONSD were measured. The ONSD/ETD ratio was calculated and compared between the 2 observers. Correlations between the ONSD/ETD ratio and various physiologic and morphological variables were assessed. 172 ONSD/ETD ratios were recorded. The ONSD/ETD ratio was calculated for at least 1 eye for 44 of the 45 (98%) dogs. Mean ± SD time required to complete the ultrasonographic examination was 90 ± 30 seconds (range, 15 seconds to 3 minutes). The mean ± SD ONSD/ETD ratio was 0.17 ± 0.01 (range, 0.15 to 0.20). The ONSD/ETD ratio did not differ significantly between the left and right eyes or the 2 observers and was not correlated with any of the variables assessed. Ocular ultrasonography was a rapid, noninvasive, and reliable method for measurement of the ONSD/ETD ratio. The ONSD/ETD ratio did not appear to be influenced by dog morphology.

Epineurectomy of Facial Nerve Trunk for Refractory Oral-Ocular and Oculo-Oral Synkinesis Following Bell Palsy.

Synkinesis is a common sequelae after incomplete recovery from Bell palsy. Current first-line treatments include botulinum toxin injection and physical therapy. However, patients unresponsive to these treatments may require further surgery. Various surgical treatments have been reported, but no consensus has been reached for the optimal surgery. In a guinea pig model of synkinesis, the facial nerve trunk (FNT) was observed using a scanning electron microscope. Based on the results of scanning electron microscope and clinical ultrasonography, the authors chose FNT as the therapeutic target. The authors performed epineurectomy of FNT for 11 patients with refractory oral-ocular and oculo-oral synkinesis under abnormal muscle response and facial electromyography monitoring. The postoperative assessments at 1 year were conducted using Sunnybrook Facial Grading System and Facial Disability Index scale. Furthermore, the epineurium excised during the operation was collected as the specimen and submitted for histopathological examination; the cadaveric FNT served as the control group. The follow-up results showed significant relief from synkinesis (4.91 ± 0.37 versus 10.18 ± 0.64, P < 0.01), improvement of physical (84.55 ± 1.96 versus 73.18 ± 3.65, P < 0.01) and social functions (77.09 ± 3.24 versus 61.82 ± 6.28, P < 0.01), with no worsening of facial paralysis in the patients. The histopathological examination revealed many nerve fibers in the epineurium, suggesting that FNT was the area of aberrant axon regeneration. Epineurectomy of FNT is a safe and effective surgical remedy. It can be considered as a surgical option for patients with refractory oral-ocular and oculo-oral synkinesis following Bell palsy.