Diagnostic Accuracy Of Ultrasound Research Articles

Diagnostic accuracy of abdominal ultrasound for detection if acute appendicitis taking operative findings as gold standard

This study objective is to assess the diagnostic accuracy of ultrasonography (USG). While evaluating acute abdominal conditions, including acute appendicitis acute cholecystitis, and pneumoperitoneum. In this study, 342 patients were evaluated to present with symptoms suggestive of acute abdominal pathology. Researchers included patient data including demographic information and USG findings were collected from medical records. In addition, diagnostic accuracy parameters, including sensitivity, specificity, positive predictive value (PPV). Moreover, negative predictive value (NPV), and overall diagnostic accuracy of USG, stratifiend and calculated based on age and gender. The average age of the study was 41.23 ± 6.75 years with a gender distribution. Though the (male: 197, female: 145). USG demonstrated high diagnostic accuracy in detecting acute appendicitis (sensitivity 89.60%, specificity 82.50%. the PPV 88.89%, NPV 83.54%, diagnostic accuracy 86.83%). While the acute cholecystitis (sensitivity 94.44%, specificity 87.10%, diagnostic accuracy 91.04%), and pneumoperitoneum (sensitivity 95.35%, specificity 88.89%, PPV 93.18%, NPV 92.31%, diagnostic accuracy 92.86%). The Stratified analyses by age and gender revealed consistent diagnostic performance of USG. The findings of this study found the diagnostic utility of ultrasonography in evaluating acute abdominal conditions. These results underscore the importance of USG as a frontline imaging modality in the management of acute abdominal emergencies

Ultrasound muscle assessment for sarcopenia detection in inflammatory bowel disease: A prospective study.

Sarcopenia is prevalent in patients with inflammatory bowel disease (IBD) and impacts surgical and therapeutic outcomes; thus, effective diagnostic tools are needed to assess muscle mass and function in this population. 153 consecutive patients were included, 100 in the training cohort and 53 in the study cohort. Three superficial muscles (rectus femoris=RF, rectus abdominis=RA, and biceps brachii=BB) were selected for the detection of sarcopenia using muscle ultrasound (US). The training cohort consisted of consecutive patients with or without IBD and was used to evaluate the feasibility and inter- and intra-observer variability of the US measurement. The study cohort consisted of only IBD patients and served to test US diagnostic accuracy. In the latter, muscle US, bioelectrical impedance analysis (BIA), and magnetic resonance imaging (MRI) were used to measure muscle parameters. Sarcopenia prevalence in IBD patients was 50%. Muscle US showed excellent inter-rater and intra-rater reliability (ICC >0.95) and a good diagnostic accuracy in detecting sarcopenia compared to BIA with area under the receiver operating characteristic curve (AUROC) values of 80% and 85% for RA and BB thickness, respectively. Moreover, an Ultrasound Muscle Index (USMI) was defined as the sum of the RA, BB, and RF thickness divided by the square of the patient's height, resulting in an AUROC of 81%. Muscle thresholds for sarcopenia were detected, with RA and USMI values correlated with the highest positive (84.3%) and negative (99%) predictive values, respectively. Additionally, the agreement between the US and MRI measurements of RA was excellent (ICC 0.96). The findings of this study emphasize the potential of muscle US as a reliable diagnostic tool for assessing sarcopenia in IBD patients. This research has significant implications for disease management in IBD patients and underscores the need for further investigations to validate these findings in larger cohorts.

Investigation of the Association of Abdominal Circumference Discord-ance and Estimated Fetal Weight Discordance in Twins with Birth Weight Discordance.

Twin pregnancy is associated with a high risk of mortality and morbidity. It is necessary to estimate the weight difference of the fetuses with a reliable method to prevent possible complications. This study was conducted to compare the association between the Estimated fetal weight (EFW) discord-ance and the Abdominal Circumference (AC) discordance with birth weight in twins. This was a descriptive-analytical and retrospective study. The statistical population was all twin pregnant mothers referred to Imam Khomeini Hospital in Ahvaz from 2017 to 2019. The sample size was determined with a census (540 people). Based on AC , the size of head circumference (HC), femur length (FL), and the Biparietal Diameter (BPD), EFW was calculated. Then the EFW Dis-cordance and AC Discordance were calculated and compared with the birth weight. Data were analyzed using SPSS18. Unpaired, Two-Tailed T-test and Pearson correlation test were used. The results showed that the mean discordance of fetal weight in twin pregnancies in the EFW method was 9.25%, in the AC method was 9.89% and finally, at birth, was 10.72%. The correla-tion of the weight difference between the two embryos in the AC method with the time of birth (r = 0.922 and P < 0.001) was higher than in the EFW method with the time of birth (r = 0.69 and P < 0.001) and finally, it was found that in detecting the discordance more than 20% and 25%, AC diagnostic power was good, but EFW was moderate. Therefore, to evaluate the weight and weight difference in twin embryos, the AC method has the appropriate accuracy and compatibility. Another major prospective study to evaluate the diagnostic performance of AC and EFW mismatch based on gestational age at scan, incision point, and maternal and placental characteristics to determine true ultrasound diagnostic accuracy in predict-ing growth mismatch in twin pregnancy and optimal post-case management option is needed.

Diagnostic accuracy of ultrasonography in diagnosis of Carpal Tunnel Syndrome.

This study aimed to assess the diagnostic accuracy of Ultrasonography, considering nerve conduction study (NCS) as the gold standard diagnostic modality for carpal tunnel syndrome (CTS). A cross-sectional study was conducted at the Neurology Department of Allied Hospital, Faisalabad from August, 2020 to January, 2021. NCS and Ultrasonography of wrist were performed for diagnosis of CTS. The sensitivity, specificity, predictive value (NPV), positive predictive value (PPV), and diagnostic accuracy (DA) were calculated for the screening test (Ultrasonography of the wrist), taking NCS as the gold standard. The mean age of the study population was 41.53 ± 8.80 years, with female pre-dominance (71.66%). The right hand was involved in 24(40%) patients, left hand was involved in 4(6.66%) patients, and both hands were involved in 32(53.33%) patients. Among 60 patients, ultrasonography diagnosed 56 (TP+FN) as having CTS, confirmed via nerve conduction study. Sensitivity, specificity, NPV, PPV, and DA of Ultrasonography of the wrist for CTS were 92.8%, 75%, 42.8%, 98.1%, and 91.6%, respectively. Based on the sensitivity and specificity, Ultrasonography may assist in diagnosing CTS.

Head and neck ultrasound training improves the diagnostic performance of otolaryngology residents.

Surgeon-performed head and neck ultrasound (US) is increasingly used among otolaryngologists in office-based and surgical settings. However, it is unknown how formal US training affects otolaryngology residents' diagnostic workup of patients with cervical pathology. This study examined how a formal US course for residents affected their outpatient clinic US performance and diagnostic accuracy. We conducted a randomized cross-over trial, where 13 otolaryngology residents participated in a 6-h formal US course. Participants were randomized to perform head and neck US on four patient cases before and after completing the course. Eight patients with and without neck pathology were invited to participate as test cases. The ultrasound examinations were video recorded and anonymized before two consultants rated the US performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. Otolaryngology residents wrote an ultrasound report with a diagnosis based on their US examination, which was used to calculate the specificity and sensitivity. We found a statistically significant difference in the OSAUS score before compared to after the hands-on training (p = .035). The diagnostic accuracy also increased from 62% before the course to 75% after the course (p = .02). Specificity increased from 54% prior to the course to 62% following the course, and sensitivity increased from 64% prior to the course to 79% following the course. The intraclass correlation coefficient with "absolute agreement" was 0.63. This study demonstrates that short, formal ultrasound training can improve otolaryngology residents' ultrasound skills and diagnostic accuracy in an outpatient clinic setting. This study looks at the change of otolaryngology residents' diagnostic workup of patients after they take a formal ultrasound course and shows that they get better at using ultrasound and make more accurate diagnoses if they take a formal course. Level 2.

Accuracy of endobronchial ultrasound (EBUS) in the staging of lung cancer - A comparison of staging EBUS with postoperative pathological nodal staging.

Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TBNA) has replaced mediastinoscopy as the preferred investigation for evaluating mediastinum in staging lung cancer. There is little evidence of mediastinal staging by EBUS-TBNA from India. To study endobronchial ultrasound's diagnostic accuracy in staging lung cancer. We retrospectively analysed patients operated on for lung cancer where EBUS was performed preoperatively for mediastinal staging. We compared the histological findings obtained from different mediastinal lymph nodes (LNs) by EBUS-TBNA with the pathology of the same LNs obtained after surgical dissection as the reference standard. Seventy-six patients underwent curative surgery for lung cancer. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA in predicting mediastinal metastasis were 93.9%, 40%, 99%, 80% and 94.6%, respectively. Of the 115 LNs sampled, EBUS-TBNA was false negative in six nodes, resulting in an up-staging of six patients. EBUS-TBNA has a high diagnostic accuracy for lung cancer staging.

Diagnostic accuracy of ultrasonography in relation to salivary gland biopsy in Sjögren's syndrome: a systematic review with meta-analysis.

To evaluate the accuracy of major salivary gland ultrasonography (SGUS) in relation to minor salivary gland biopsy (mSGB) in the diagnosis of Sjögren's syndrome (SS). A systematic review and meta-analysis were performed. Ten databases were searched to identify studies that compared the accuracy of SGUS and mSGB. The risk of bias was assessed, data were extracted, and univariate and bivariate random-effects meta-analyses were done. A total of 5000 records were identified; 13 studies were included in the qualitative synthesis and 10 in the quantitative synthesis. The first meta-analysis found a sensitivity of 0.86 (95% CI: 0.74-0.92) and specificity of 0.87 (95% CI: 0.81-0.92) for the predictive value of SGUS scoring in relation to the result of mSGB. In the second meta-analysis, mSGB showed higher sensitivity and specificity than SGUS. Sensitivity was 0.80 (95% CI: 0.74-0.85) for mSGB and 0.71 (95% CI: 0.58-0.81) for SGUS, and specificity was 0.94 (95% CI: 0.87-0.97) for mSGB and 0.89 (95% CI: 0.82-0.94) for SGUS. The diagnostic accuracy of SGUS was similar to that of mSGB. SGUS is an effective diagnostic test that shows good sensitivity and high specificity, in addition to being a good tool for prognosis and for avoiding unnecessary biopsies. More studies using similar methodologies are needed to assess the accuracy of SGUS in predicting the result of mSGB. Our results will contribute to decision-making for the implementation of SGUS as a diagnostic tool for SS, considering the advantages of this method.

Investigation of Childhood Pneumonia With Thoracic Ultrasound: A Comparison Between X-ray and Ultrasound.

Childhood pneumonia is a common entity, and chest x-rays are widely used as an initial diagnostic step. To avoid radiation exposure in the pediatric age group, we assessed whether the diagnostic accuracy of ultrasound (US) imaging is sufficient in the diagnosis. One hundred thirty-three children with pneumonia (72 girls/61 boys) were participated to study between 2019 and 2021. All participants had a chest x-ray. Radiologists who perform the US scans and interpret the x-rays were blinded to each other. A comparative analysis was also done to assess US findings on pneumonia for different age groups. We compare the diagnostic accuracy of US and x-rays by McNemar test and receiver operating characteristic curves. Intraclass correlation coefficient values were calculated for the assessment of interobserver agreement of x-ray evaluation. The participants' ages ranged from 1 month to 17 years and 8 months with a median age of 24 months (Q 1 : 8 and Q 3 : 66 months). Hospital stay lengths were longer, consolidation depths were greater, and presence of air bronchogram or pleural effusion was more frequent in school-age children. The proportion of consolidation seen on chest x-ray and transthoracic US scan was significantly different ( P < 0.001). The area under the curve was greater in the US than in the chest x-ray (area under the curve, 0.94 and 0.76 respectively). There was a good agreement between the 2 interpreters on chest x-ray assessment ( κ = 0.661). The thoracic US can be used as a safe and efficient imaging tool in the diagnosis of pediatric pneumonia.

Transoral Ultrasound in the Outpatient Clinic for the Diagnostic Work-Up of Oropharyngeal Cancer: A Feasibility Study.

Magnetic resonance imaging (MRI) is the preferred imaging modality for oropharyngeal cancers (OPCs), but it has difficulties distinguishing between small OPCs and unilateral tonsil hypertrophy. We hypothesized that surgeon-performed transoral ultrasound (US) could be used to accurately detect T-stage OPCs. We performed a single-center prospective diagnostic accuracy study including patients with suspected or biopsy-verified OPCs during outpatient appointments. All patients were offered transoral US and MRI. If transoral US could not be tolerated by the patient, transcervical US was performed. The primary outcome was the diagnostic accuracy of detecting OPCs with US compared to MRI, using histopathology as the reference standard. The secondary outcome was comparing the primary tumor diameters between US and MRI blinded to each other. Out of the 26 patients included in the study, 21 (81%) had OPCs. Transoral US could be performed in 21/21 and 1/5 patients with suspected palatine and lingual tonsil OPCs, respectively. Overall, US diagnostic accuracy was 92%, compared to 81% with MRI (p = 0.37). US and MRI had a high correlation between tumor diameters in the anteroposterior diameter (R = 0.80, p < 0.001), corresponding to the depth axis on US. In conclusion, this small study showed the promise and feasibility of transoral US to improve the initial clinical evaluations of patients with suspected OPCs.

Diverse ultrasound image features of unilateral genital tract obstruction with ipsilateral renal anomaly syndrome on genitourinary system segmental sequential ultrasound screening and the accuracy of ultrasonic diagnosis.

Unilateral genital tract obstruction with ipsilateral renal anomaly (UGTOIRA) syndrome is a rare congenital urogenital anomaly, characterized by different combinations of uterine abnormalities, unilateral cervical-vaginal obstruction, and ipsilateral renal abnormalities. Timely and correct diagnosis is critical. In this study, we analyzed the diverse ultrasound image features of UGTOIRA syndrome on genitourinary system segmental sequential ultrasound screening (SSUS) and the accuracy of ultrasonic diagnosis. The data from 59 patients with UGTOIRA syndrome over the last decade were analyzed retrospectively, which included ultrasound presentations and diagnoses of abnormalities of the uterus, cervix, and vagina, as well as the conditions associated with the bilateral fallopian tubes, ovaries, pelvis, kidneys and ureters, bladder, and urethra. All 59 patients (100%) were found to have ipsilateral renal agenesis, and the diagnostic accuracy of ultrasound was 100%. The uterus was correctively diagnosed as complete bicorporal uterus in 42 cases (71.2%), bicorporal septate uterus in 7 cases (11.9%), complete uterus septate in 8 cases (13.6%), partial uterus septate in 1 case (1.7%), and unilateral isthmus atresia in 1 case (1.7%). The cervix was correctively diagnosed as septate cervix in 28 cases (47.5%), double cervix in 17 cases (28.8%), unilateral small cervix in 5 cases (8.5%), unilateral obliterated cervical orifice in 5 cases (8.5%), partial development of the unilateral cervix with a blind end in 3 cases (5.1%), and unilateral completely undeveloped cervix appearing as a normal cervix in 1 case (1.7%). The vagina was correctively diagnosed as oblique vaginal septum (OVS) in 45 cases (76.3%), and normal vagina in 13 cases (22.0%) via preoperative ultrasound. In 1 case (1/59, 1.7%) of high OVS with ipsilateral obliterated external cervical orifice, the OVS was missed by preoperative ultrasound. The ultrasound diagnostic accuracy rates of uterine malformation, cervical malformation, vaginal malformation, hematoma location and volume, uterine communication, and cervical communication were respectively 100%, 100%, 98.3%, 100%, 100%, and 100%. The ultrasonic detection rate for a hole on the OVS was 0%, and the missed diagnosis rate was 100%. SSUS can be used to accurately evaluate uterine, cervical, and vaginal malformation, obstruction site, location and volume of keratocele, cervical or uterine communication, and ovarian endometriosis cyst in patients with UGTOIRA syndrome and ipsilateral urinary system malformation. However, ultrasound is unable to identify a hole on the OVS.

Diagnostic Accuracy of Ultrasonography in Diagnosis of Parotid Gland Lesions Using Fine-Needle Aspiration Cytology as The Gold Standard

Objective: To determine the diagnostic accuracy of ultrasound by using ultrasound-guided FNAC as the gold standard for diagnosing parotid salivary gland conditions. Methods: A prospective observational study was conducted at the Radiology department of Islamabad Diagnostic Centre from January 2022 to December 2022. Patients of all ages and genders with suspected major salivary gland conditions were included. All patients underwent ultrasonography and FNAC after providing informed consent and receiving an explanation of the procedure. Following local anesthesia, a needle was inserted under ultrasound guidance to aspirate tissue samples. The aspirated material was labeled, handled, and transported for laboratory analysis. Data were collected using a self-designed form, and data analysis was carried out using SPSS version 20. Results: A total of 47 cases were evaluated, with a mean participant age of 47.31 years. Of all participants, 57.4% were males, and 42.6% were females. Among the cases with benign FNAC results, 19 were correctly identified as benign in histopathology (True Positives, TP), while 2 were incorrectly classified as malignant (False Positives, FP). Conversely, for the cases with malignant FNAC results, 6 were falsely identified as benign (False Negatives, FN), and 20 were correctly classified as malignant (True Negatives, TN). Sensitivity was found to be 76%, and specificity was 95%. The positive predictive value (PPV) was 90%, and the negative predictive value (NPV) was 76%. The overall accuracy of ultrasound-guided FNAC was calculated to be 82%. Conclusion: Ultrasonography has proven to be an effective, non-invasive, and reliable diagnostic tool for assessing parotid gland pathology. It demonstrated a strong capability in accurately distinguishing between benign and malignant cases, with high sensitivity and specificity.

High-resolution Ultrasonographic Diagnosis of Plantar Fasciitis: An Association of Magnetic Resonance Imaging and Ultrasound

Objective: To assess the role played by ultrasound in evaluating plantar fasciitis and associate the findings with Magnetic resonance imaging.&#x0D; Study Design: Case series.&#x0D; Place and Duration of Study: Department of Radiology, Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Nov 2020 to Apr 2021.&#x0D; Methodology: All the patients underwent ultrasonography and magnetic resonance imaging scanning. The study and control Groups consisted of 38 patients. &#x0D; Results: Out of 38 patients, plantar fascia thickness in symptomatic feet was measured with ultrasound for both the Study and Control Groups. The Control Group had slightly thinner plantar fasciitis (1.1-2.4 mm, 1.7 ± 0.06 mm; p =0.03) compared to the Study Group (2.9-6.9 mm; 4.9±1.4 mm). In addition, this study compared other plantar fasciitis diagnostic signs on sonography with the magnetic resonance imaging findings. The diagnostic accuracy of plantar fascia pathological focal echogenicity, plantar fascia oedema, perifascial oedema, and plantar fascia rupture was 15(80.6%), 12(60.7%), 15(77.1%), and 13(68.6%) respectively. The diagnostic accuracy of ultrasonography was lower while evaluating for calcaneal spurs.&#x0D; Conclusion: The present study concluded that ultrasonography could be the basic initial diagnostic imaging modality to confirm clinically suspected cases of plantar fasciitis. However, magnetic resonance imaging could be the preferred diagnostic modality for suspected complex pathology and lack of clinical presentation.

Accuracy of Multimodality Fetal Imaging (US, MRI, and CT) for Congenital Musculoskeletal Anomalies.

Ultrasonography (US) is the first-line diagnostic tool used to assess fetal musculoskeletal (MSK) anomalies. Associated anomalies in other organ systems may benefit from evaluation via Magnetic Resonance Imaging (MRI). In this study, we compared the diagnostic accuracy of US and MRI to diagnose fetal MSK (primary objective) and non-MSK anomalies (secondary objective). We describe additional findings by low-dose computerized tomography (CT) in two cases incompletely characterized via US and MRI. This was an IRB-approved retrospective study of consecutive patients with suspected fetal MSK anomalies examined between December 2015 and June 2020. We compared individual MSK and non-MSK anomalies identified via US, MRI, and CT with postnatal outcomes. Sensitivity and specificity for US and MRI were calculated and compared. A total of 31 patients with 112 MSK and 43 non-MSK anomalies were included. The sensitivity of MRI and US for MSK anomalies was not significantly different (76.6% vs. 61.3%, p = 0.3). Low-dose CT identified eight additional skeletal anomalies. MRI diagnosed a higher number of non-MSK anomalies compared to US (81.4% vs. 37.2%, p < 0.05). Fetal MRI and US have comparable sensitivity for MSK anomalies. In selected cases, low-dose CT may provide additional information. Fetal MRI detected a larger number of non-MSK anomalies in other organ systems compared to US. Multimodality imaging combining all the information provided by MRI, US, and CT, if necessary, ultimately achieved a sensitivity of 89.2% (95% CI: 83.4% to 95.0%) for the diagnosis of musculoskeletal anomalies and 81.4% for additional anomalies in other organs and systems.

Prenatal ultrasound monitoring and diagnostic accuracy rates of fetal congenital heart disease: A meta-analysis.

Congenital heart disease (CHD) is the most common birth defect that is caused by genetic and acquired factors. Accurate prenatal diagnosis of congenital heart disease (CHD) can ensure proper delivery and in-time postpartum management, but the diagnostic rate is not clear. PubMed, CNKI, Web of Science, Wanfang, and VIP databases were searched for publications investigating CHD during prenatal ultrasound scans. Original studies with strict screening and diagnostic criteria were included. Fixed effect model or random effect model was used according to homogeneity statistical test. A total of 859 CHD cases were diagnosed by ultrasound, and 1394 cases were confirmed by induced labor autopsy or at birth. The heterogeneity of the analysis was 100% and the accuracy of CHD diagnosis using prenatal ultrasound was 76% (95%CI: 50.00%-102%). The diagnostic yield of fetal CHD screening using ultrasound alone is still not very high, which lower than the combined diagnostic yield of other studies. This suggests the need to combine other monitoring methods that do not harm fetal development. When economic conditions permit, the diagnosis of CHD can be recommended to use no less than two monitoring methods.

Comparison of Cranial Ultrasound and Computed Tomographic Scan Finding in Infants with Post Meningitis Complications

Objective: To compare the findings of cranial ultrasound and computed tomographic (CT) scans in infants with post-meningitis complications. Methodology: A prospective analysis of 124 consecutive term infants was conducted in the department of radiology at the Pakistan Institute of Medical Sciences, Islamabad from August 2021 to April 2022. Transfontanelle ultrasonography was performed with a two-dimensional Sonoace 1500 ultrasound scanner (Medison Inc, South Korea 1995) equipped with a 6.5 megahertz (MHz) curvilinear small head probe. Sagittal and coronal sections were scanned using standard techniques. We included all 124 confirm cases of meningitis came to our hospital in the period through consecutive non probability sampling, which fulfilled the required sample size to test the objective in our population. Results: The average age of the infants was 4 months, with 71 (57.3%) males and 53 (42.7%) were females. Ultrasonography results were confirmed by CT scans in all patients. The diagnostic accuracy of ultrasonography was found to be 32.14%. Seizures disorders were the most common complication observed in the study population. Conclusion: Using transfontanelle ultrasound, it is possible to diagnose lesions inside the infant's brain. Transfontanelle ultrasound scans are most often requested for hydrocephalus detection and for abnormal findings. Infants with post-meningitic complications commonly suffer seizures. In post meningitic complications, ultrasound can still be used as an early non-invasive diagnostic modality despite its low diagnostic accuracy. Improved collaboration between radiologists and pediatricians can lead to better outcomes and reduced mortality and morbidity in neonates and infants.

Does hepatic steatosis impact chronic hepatitis B?

Does hepatic steatosis impact chronic hepatitis B?

Histopathological Results and the Outcome of Women Who Underwent Postpartum Evacuation and Pelvic Ultrasound Scan.

This study aimed to assess the proportion of women who underwent postpartum evacuation and were histopathologically confirmed to have retained products of conception (RPOC), compare the reliability of histopathology and ultrasound (US) in determining the presence of RPOC, and assess the maternal complications associated with postpartum evacuation. A retrospective cross-sectional study was conducted on all women who delivered and had postpartum evacuation at a tertiary teaching hospital in Oman over 11 years from May 2009 to May 2020. The participants were divided into two groups based on their histopathology results. McNemar test was used to compare the sonographic results with the histopathological findings. A total of 151 women were included in this study. The diagnosis of RPOC was confirmed in histopathological reports of 64 (42.4%) women (group 1) but not in 87 (57.6%) women (group 2). There was no significant difference between the two groups in maternal characteristics. Parameters of clinical presentation including fever and abdominal pain were significantly different between the two groups (p =0.026 and p =0.028, respectively). Vaginal bleeding was not significantly different between the groups (p =0.255). Pelvic US detected RPOC in 135 (89.4%) women whereas the histopathology confirmed it in 64 (42.4%) women (p < 0.001). The sensitivity of US compared to histopathology in diagnosing RPOC was 98.4% (95% CI: 91.60-99.96) and the specificity was 17.2% (95% CI: 9.98-26.84). The overall diagnostic accuracy of US in detecting RPOC was 51.7%. Two (1.3%) women had hysterectomy as a result of the evacuation. Histopathology showed smooth muscle in 20 (13.2%) women. Significant bleeding during surgery occurred in 17 (11.3%) cases. Diagnosis of postpartum RPOC is challenging. Our results highlighted the complexity of diagnosing RPOC. Special training is needed for doctors to diagnose RPOC from transvaginal scans. A multicenter study in Oman with a larger sample size is recommended to confirm our findings.

The diagnostic accuracy of ultrasonography over manual aspiration for gastric reserve volume estimation in critically ill patients.

Although gastric reserve volume (GRV) is a surrogate marker of gastrointestinal dysfunction and feeding intolerance, there is ambiguity in its estimation due to problems associated with its measurement. Introduction of point-of-care ultrasound as a tool for anesthetists kindled interest in its use for GRV estimation. In this prospective observational study, we recruited 57 critically ill patients and analyzed 586 samples of GRV obtained by both ultrasonography (USG) and manual aspiration. The analysis showed that USG-guided GRV was significantly correlated (r=0.788, P<0.001) and in positive agreement with manual aspiration based on Bland-Altman plot, with a mean difference of 8.50±14.84 (95% confidence interval, 7.389-9.798). The upper and lower limits of agreement were 37.7 and -20.5, respectively, within the ±1.96 standard deviation (P<0.001). The respective sensitivity and positive predictive value, specificity and negative predictive value, and area under the curve of USG for feeding intolerance were 66.67%, 98.15%, and 0.82%, with 96.49% diagnostic accuracy. Ultrasonographic estimation of GRV was positively, significantly correlated and in agreement with the manual aspiration method and estimated feeding intolerance earlier. Routine use of gastric USG could avoid clinical situations where feeding status is unclear and there is high risk of aspiration and could become a standard practice of critical care.

Ultrasonographic features of ulnar nerve instability around the elbow in fresh cadavers.

Ultrasound (US) is commonly used to evaluate ulnar nerve instability (UNI) and snapping of the medial head of the triceps brachii muscle (ST). We aimed to determine the diagnostic accuracy of US in evaluating UNI, through cadaveric dissection, and to evaluate the US features and relationships of UNI and ST according to elbow flexion. Dynamic US was performed with elbow extension, 90° flexion, and full flexion positions on 18 elbows from 9 fresh cadavers. UNI was classified into N (normal), S (subluxation), and D (dislocation) types. On US exams, the following findings and parameters were evaluated: the presence of UNI and ST; the horizontal distance from the apex of the medial epicondyle (ME) to the margins of the UN and medial head of the triceps brachii muscle (ME_UN and ME_TB, respectively); cross-sectional area and flattening ratio (FR) of UN. After US, all cadavers were dissected to expose the UN and TB, and elbow flexion and extension were simulated to confirm UNI and ST. The gross anatomic findings of UNI and ST were consistent with the US findings. In extension and 90° flexion positions, all cases were type N. In full flexion position, types N and S occurred in 10 (56%) and 8 (44%) elbows, respectively. FR and ME_UN in 90° flexion position, FR, ME_UN, and ME_TB in full flexion position differed significantly between types S and N. Positive correlations were found between ME_UN and ME_TB in 90° flexion and full flexion positions. Dynamic US accurately assessed UNI and ST. UNI was positively correlated to medial TB movement.

Positive Predictive Value of Ultrasonography for Detection of Ovarian Masses Taking Magnetic Resonance Imaging as a Gold Standard

Aim: To determine the efficacy of ultrasonography in the detection of ovarian masses considering MRI a Gold standard. Study design: Prospective analytical cross-sectional study Place and duration of study: Dow Institute of Radiology, Dow University of Health Sciences Karachi, Pakistan from 1st June 2018 to 30th November 2019. Methodology: One hundred and forty eight ovarian cancer patients were enrolled. Results: The mean age of the patient was 41.87±16.30 years. The majority of the patients were age ≥20 years (29.10%) and obese (33.1%). Malignant tumors were 56.1% (n=83) and 64.2% (n=95) respectively on ultrasound and magnetic resonance imaging. Ultrasound had a positive predictive value of 80%, sensitivity of 98.11%, and specificity of 86.32 % for the diagnosis of ovarian masses. Overall diagnostic accuracy of ultrasonography was 90.54%. There was an excellent agreement between the ultrasonography and magnetic resonance imaging (kappa=0.84, p-value &lt;0.001) and area under the curve was 92.2%. Conclusion: Ultrasonography has excellent diagnostic accuracy in the detection of ovarian masses. Keywords: Ovarian mass/tumor, Ultrasonography, MRI, Positive predictive value, Benign, Malignant