Dynamic Ultrasound Technique Research Articles

The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging.

V-flow is a dynamic ultrasound technique that visualizes perfusion patterns by displaying dynamic arrows that change in response to the flow of erythrocytes. Furthermore, it provides quantitative values for the maximum and mean velocity of blood flow as well as a percentage value for turbulence. The aim was to enhance the preoperative diagnostic accuracy of thyroid lesions by combining V-flow with established ultrasound modes.B-mode, CCDS, elastography, CEUS, and V-flow were performed on 101 patients. After the ultrasound examination, every nodule was confirmed as benign or malignant via histopathology. The Kruskal-Wallis test, ROC curve, and binary logistic regression were used for the statistical analysis.93 benign regressive thyroid nodules and 8 carcinomas were included in this study. The average mean velocity value for benign lesions was measured at 19.5 cm/s and at 10.7 cm/s for malignant lesions (p = 0.039). The average turbulence percentage was 26.1% for benign nodules and 46.7% for carcinomas (p = 0.016). Carcinomas exhibited a slower and more turbulent perfusion pattern compared to benign tumors. A V-flow-centered system achieves a sensitivity of 100.0% and a specificity of 84.9% in predicting malignancy. This system could have reduced the number of unnecessary thyroid surgeries for benign lesions in our patient group by 70%.The capillary perfusion of thyroid nodules represents a significant indicator of its status. By analyzing the velocity and turbulence level of microvascular blood flow, V-flow offers promising prospects for accurately distinguishing between benign and malignant thyroid lesions. When integrated into a comprehensive multimodal sonographic imaging approach, V-flow further enhances diagnostic accuracy. · V-flow allows for qualitative and quantitative analysis of microvascular perfusion. · Malignant tumors are associated with slower and more turbulent microvascular hemodynamics. · Combining V-flow with other ultrasound modes eases the diagnosis of thyroid carcinomas. · Brandenstein MK, Zhang L, Scharf G et al. The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging. Fortschr Röntgenstr 2024; DOI 10.1055/a-2350-0107.

A pictorial guide for performing dynamic musculoskeletal ultrasound techniques of the Upper Limb

IntroductionDynamic techniques should be used to compliment static imaging in the field of Musculoskeletal ultrasound. Performing limb movements and imaging simultaneously, allows for diagnosing certain musculoskeletal conditions not otherwise confirmed by still images. This article aims to provide guidance on how to perform a selection of these dynamic musculoskeletal ultrasound techniques with a focus on the upper limb. MethodsThis pictorial guide features techniques gathered from literature review and experience gained in the field. ResultsApplication of dynamic ultrasound techniques has been evidenced in the literature to diagnose conditions such as trigger finger, dislocating tendons and causes of peripheral neuropathy. ConclusionMusculoskeletal conditions only elicited during limb movement can be difficult to diagnose. Appropriate use of dynamic techniques increases likelihood of correct diagnosis of the described conditions. Implications for practiceUltrasound provides a unique opportunity to visualise these conditions thus ultrasound users should aim to familiarise themselves with dynamic ultrasound techniques to improve patient outcomes.

Comparison Static and Dynamic Ultrasound Techniques of DDH: The Role of the Patient's Position.

The ultrasound examination of the hip joint is performed in the static (Graf) technique in the lateral recumbent position and in the dynamic technique in the supine position. This study compares the two static and dynamic techniques and assesses the role of the patient's position in the examination of DDH. This cross-sectional study was conducted in 2020-2021 at Akbar Hospital, Mashhad University of Medical Sciences, Iran. 126 patients suspected of having DDH (199 hip) infants were enrolled in the study. All ultrasound examinations were performed with two static and dynamic techniques by a pediatric radiologist. In the static and dynamic ultrasound examinations, the average alpha angle was 51.57 ± 6.41 degrees, and 53.41 ± 6.94 degrees, respectively. These changes were not statistically significant (P = 0.312). The relationship and agreement between instability with dynamic technique and instability with static technique (IIC unstable, D, III, and IV) were investigated. Significant agreement (Kappa=0.77 (95% CI: 0.66-0.87) with excellent clinical significance was obtained between the two ultrasound examination method. Also, in terms of DDH types in the static method with instability types in the dynamic method, a substantial agreement was found between the two examination methods (Kappa =0.67; (95% CI: 0.59-0.75) with good clinical significance. In the ultrasound examination of DDH with static and dynamic techniques, the change in the alpha angle was not statistically significant. Therefore, the hand of the radiologist is open in measuring alpha angles and there is no need to emphasize a specific position. The type of DDH in the static technique completely corresponded to the type of stability or instability in the dynamic technique.

The “Triangle Sign”: A Novel Dynamic Ultrasound Technique for Identifying an Obliterated Cul-De-Sac in Patients with a Retroverted Uterus

The “Triangle Sign”: A Novel Dynamic Ultrasound Technique for Identifying an Obliterated Cul-De-Sac in Patients with a Retroverted Uterus

EP31.16: The “Triangle Sign”: a novel dynamic ultrasound technique for identifying an obliterated cul‐de‐sac in patients with a retroverted uterus

EP31.16: The “Triangle Sign”: a novel dynamic ultrasound technique for identifying an obliterated cul‐de‐sac in patients with a retroverted uterus

Dynamic ultrasound assessment of hip instability and anterior and posterior hip impingement.

In this technical report, we describe our protocol for the dynamic sonographic evaluation of the hip and assess reliability of the ultrasound assessment of hip microinstability. Our clinical experience with a standardized dynamic ultrasound of the hip performed in a series of 27 patients with imaging performed by an experienced musculoskeletal radiologist during physical examination by an orthopedic surgeon specializing in hip preservation is illustrated with clinical photographs and ultrasound images from volunteers and selected patients. Interrater reliability for the diagnosis of microinstability was calculated. Dynamic ultrasound technique and findings of hip instability, femoroacetabular impingement, and ischiofemoral impingement with corresponding clinical photos showing the necessary physical examination maneuvers are described. Interrater agreement for the diagnosis of microinstability was substantial (κ 0.606 [0.221-0.991]). At our institution, dynamic ultrasound of the hip during physical examination complements information gathered from static imaging by providing real-time correlation of symptoms with what is occurring anatomically.

Comparison of Ultrasound-Guided Central Venous Catheter Placement Techniques Using an Easily Made Simulator Model.

Central venous catheter (CVC) placement is an important procedure which is frequently performed in the emergency department (ED) and can cause serious complications. The aim of this study is to introduce a simulation-based tissue model for ultrasound (US)-guided central venous access practices and to compare the effectiveness of static and dynamic US techniques through this model. This was a prospective study on US-guided CVC placement techniques simulated with a chicken tissue model. This model is based on the principle of placing two cylindrical balloons filled with colored water (red for arterial and blue for venous) between a raw chicken breast and wrapping the formed structure with plastic wrap. The study was conducted in an academic tertiary care hospital with Emergency Medicine (EM) residents who have received basic US training, including vascular access procedures. All participants performed simulated CVC placement procedures with both static and dynamic US techniques. At the end of the study, the practitioners were asked to rate usefulness of these techniques between one and ten (one was the lowest and ten was the highest score). A total of 32 EM residents were included in the study. Their median age was 29 (IQR = 27 - 31) years and 72% of them were male. Their median duration in ED was 19 (IQR = 12 - 34) months. According to the results of simulated CVC placement procedures, there was no significant difference between the static and dynamic US techniques in terms of puncture numbers, procedure durations, and success rates. However, according to the usefulness scores given by the practitioners, the dynamic US technique was found to be more useful (P < .001). The chicken tissue model is a convenient tool for simulating US-guided CVC placement procedures. The dynamic US technique is considered to be more useful in this field than the static technique, but the results of practitioner-dependent practices may not always support this generalization.

Ultrasound of the neonatal hip as a screening tool for DDH: how to screen and differences in screening programs between European countries.

Developmental dysplasia of the hip comprises a broad spectrum of abnormalities in hip development, of variable severity. Besides physical examination, ultrasound is the preferred imaging modality for screening for developmental dysplasia of the hip in children aged younger than six months. The Graf method is the most widely used ultrasound technique for infant hips; a stepwise approach will be shown in this article. Furthermore, the process of dynamic ultrasound imaging will be explained as well as the use of transinguinal ultrasound in infants wearing a spica cast. There is no consensus on the best way to screen for developmental dysplasia of the hip, which is probably the reason why different screening programs exist throughout Europe, as will be discussed in this article. The use of universal versus selective ultrasound remains a controversy, as does the timing. Is it better to perform sonography in all newborn infants like in Germany and Austria? Or should we examine only the infants with clinical hip instability or risk factors (breech position, positive family history), like in the UK and the Netherlands? This article reviews the epidemiology, static and dynamic ultrasound techniques in screening for developmental dysplasia of the hip, and differences in screening programs throughout Europe. Set aside the uncertainties about whom and when to screen, it needs to be emphasized that ultrasound screening for developmental dysplasia of the hip is important, since the disease is initially occult and easier to treat when identified early. In this way, the radiologist can aid in preventing serious disability of the hip.

36: Correlation of endometriosis on preoperative MRI and surgical pathology

The aim of this study is to assess whether the use of MRI as part of preoperative workup in the setting of patients with chronic pelvic pain and presumed diagnosis of endometriosis is predictive of pathology-proven endometriosis. Retrospective chart review of patients operated on by one fellowship trained minimally invasive gynecologist over the course of 16 months was completed. All surgical cases performed at one of two tertiary hospitals between November 2017 and February 2019 were reviewed and laparoscopic cases were identified. Laparoscopic cases in which a preoperative MRI was performed were then identified. These cases were reviewed to assess for presence or absence of: (1) a preoperative prediction of endometriosis, (2) identification of endometriosis on preoperative MRI, and (3) surgical diagnosis of endometriosis based on intraoperative findings or surgical pathology. 25 surgical cases had MRI performed preoperatively. 10 predicted endometriosis preoperatively and all had pathology confirmed endometriosis. Of the patients with positive MRIs and positive pathology for endometriosis, 5(50%) were stage 4, 3(30%) stage 3, 1(10%) stage 2, and 1(10%) stage 1. Of the 15 of the preoperative MRIs that did not predict endometriosis, 7 had pathology confirmed endometriosis and 8 were pathology confirmed negative for endometriosis. Of the patients with negative MRIs and positive pathology for endometriosis, 4(57.1%) were stage 1, 2(28.6%) stage 2, and 1(14.3%) stage 3. A Fisher exact test for equality of accuracy in the patients showed that patients who had a positive MRI had a significantly higher endometriosis pathologic diagnosis accuracy than patients who had a negative MRI (p<0.05). Ultrasound is the most common form of imaging done in the setting of suspected endometriosis. The advanced dynamic ultrasound techniques in the literature for endometriosis assessment is not universally available in the US. Preoperative MRI may be used as part of the workup of patients with presumed endometriosis because it allows for evaluation of all pelvic compartments as well as increased accuracy in suspected diagnosis. MRI is also less susceptible to interobserver variability that can be associated with ultrasound, which is dependent on the technician and the radiologist. Preoperative MRI was predictive for both presence and absence of endometriosis. The MRI was more predictive of advanced stage endometriosis. Advanced disease endometriosis is best treated by a surgeon with advanced surgical skills and experience with endometriosis so that the patient has clear expectations of outcomes and recurrence, to optimize resection, to minimize complications, and to reduce need for repeat surgery due to inadequate resection.

VIDEO: Dynamic Ultrasound Evaluation for Soft-Tissue Injuries of the Extremities: Hand, Wrist, and Ankle.

OBJECTIVE. The purpose of this article is to show the sonographic anatomy of the extremities relevant to various ligamentous, tendinous, and articular injuries occurring in the hand, wrist, and ankle. A brief discussion and depiction of the specific elements relevant to the pathophysiologic mechanism of these entities is followed by demonstrations of the dynamic ultrasound techniques that can be used to diagnose these injuries. The schematics and video clips illustrate the normal and pathologic features of these injuries. The first two videos discuss soft-tissue injuries to the hand and wrist, and the third addresses ankle injuries. CONCLUSION. After clinical assessment, dynamic ultrasound examination is a useful tool for diagnosing and assessing the degree of severity of several soft-tissue injuries to the extremities, some of which can be detected only during active movement. Familiarity with these specific dynamic techniques will enhance the value of the ultrasound examination.

1852 The Prevalence of Pouch of Douglas Obliteration Depicted on Basic Transvaginal Ultrasound by a Negative Sliding Sign in a General Population

Study Objective Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty in patients with symptoms of endometriosis using transvaginal ultrasound (TVS). Studies on POD obliteration and the sliding sign, as part of an expert-guided deep endometriosis (DE) TVS, have always focused on populations in tertiary care centres with high disease prevalence. Our aim is to determine the prevalence of a negative sliding sign on basic TVS in a general population. Design Prospective observational study. Setting Gynecology-focused ultrasound practice. Patients or Participants Consecutive patients visiting the practice for a gynecological TVS. Interventions The sliding sign was performed to determine the POD state. Measurements and Main Results Descriptive statistics were applied to the entire population and subgroups of patients high- and low-risk for endometriosis. High-risk for endometriosis was defined as having a TVS referral for endometriosis-related pelvic pain or specifically “endometriosis” and/or clinical symptoms suggestive of endometriosis. Low-risk was defined by the absence of these features. 1043 patients underwent TVS. Patients who underwent a transabdominal ultrasound (5.6%) and history of hysterectomy (1.3%) were excluded; 971 were eligible. The sliding sign was performed and interpreted in 922 patients. Prevalence of a negative sliding sign in the general, high-risk, and low-risk populations was 47/922 (5.1%), 25/243 (10.3%), 22/639 (3.4%) (p Conclusion We have shown that the prevalence of POD obliteration on ultrasound evaluation in the general population is roughly 1 in 20, which may serve as the foundation for future studies on the sliding sign in lower-risk populations as this dynamic ultrasound technique becomes increasingly understood and adopted.

Assessment of Diagnostic Value of Single View Dynamic Technique in Diagnosis of Developmental Dysplasia of Hip: A Comparison with Static and Dynamic Ultrasond Techniques.

Developmental dysplasia of hip (DDH) is a common childhood disorder, and ultrasonography examination is routinely used for screening purposes. In this study, we aimed to evaluate a modified combined static and dynamic ultrasound technique for the detection of DDH and to compare with the results of static and dynamic ultrasound techniques. In this cross-sectional study, during 2013- 2015, 300 high-risk infants were evaluated by ultrasound for DDH. Both hips were examined with three techniques: static, dynamic and single view static and dynamic technique. Statistical analysis was performed using SPSS version 11.5. Patients aged 9 days to 83 weeks. 75% of the patients were 1 to 3 months old. Among 600 hip joints, about 5% were immature in static sonography and almost all of them were unstable in dynamic techniques. 0.3% of morphologically normal hips were unstable in dynamic sonography and 9% of unstable hips had normal morphology. The mean β angle differences in coronal view before and after stress maneuver was 14.43±5.47° in unstable hips. Single view static and dynamic technique revealed that all cases with acetabular dysplasia, instability and dislocation, except two dislocations, were detected by dynamic transverse view. For two cases, Ortolani maneuver showed femoral head reversibility in dislocated hips. Using single view static and dynamic technique was indicative and applicable for detection of more than 99% of cases. Single view static and dynamic technique not only is a fast and easy technique, but also it is of high diagnostic value in assessment of DDH.

Static Versus Dynamic Musculoskeletal Ultrasound for Detection of Plantar Plate Pathology.

Diagnostic Level II, Prospective.

Prospective Multicenter Trial Comparing Echodefecography With Defecography in the Assessment of Anorectal Dysfunction in Patients With Obstructed Defecation

Defecography is the gold standard for assessing functional anorectal disorders but is limited by the need for a specific radiologic environment, exposure of patients to radiation, and inability to show all anatomic structures involved in defecation. Echodefecography is a 3-dimensional dynamic ultrasound technique developed to overcome these limitations. This study was designed to validate the effectiveness of echodefecography compared with defecography in the assessment of anorectal dysfunctions related to obstructed defecation. Multicenter, prospective observational study. Women with symptoms of obstructed defecation. Six centers for colorectal surgery (3 in Brazil, 1 in Texas, 1 in Florida, and 1 in Venezuela). Defecography was performed after inserting 150 mL of barium paste in the rectum. Echodefecography was performed with a 2050 endoprobe through 3 automatic scans. The κ statistic was used to assess agreement between echodefecography and defecography in the evaluation of rectocele, intussusception, anismus, and grade III enterocele. Eighty-six women were evaluated: median Wexner constipation score, 13.4 (range, 6-23); median age, 53.4 (range, 26-77) years. Rectocele was identified with substantial agreement between the 2 methods (defecography, 80 patients; echodefecography, 76 patients; κ = 0.61; 95% CI = 0.48-0.73). The 2 techniques demonstrated identical findings in 6 patients without rectocele, and in 9 patients with grade I, 29 with grade II, and 19 patients with grade III rectoceles. Defecography identified rectal intussusception in 42 patients, with echodefecography identifying 37 of these cases, plus 4 additional cases, yielding substantial agreement (κ = 0.79; 95% CI = 0.57-1.0). Intussusception was associated with rectocele in 28 patients for both methods (κ = 0.62; 95% CI = 0.41-0.83). There was substantial agreement for anismus (κ = 0.61; 95% CI = 0.40-0.81) and for rectocele combined with anismus (κ = 0.61; 95% CI = 0.40-0.82). Agreement for grade III enterocele was classified as almost perfect (κ = 0.87; 95% CI = 0.66-1.0). Echodefecography had limited use in identification of grade I and II enteroceles because of the type of probe used. Echodefecography may be used to assess patients with obstructed defecation, as it is able to detect the same anorectal dysfunctions found by defecography. It is minimally invasive and well tolerated, avoids exposure to radiation, and clearly demonstrates all the anatomic structures involved in defecation.

Comparison of dynamic ultrasound and stress radiology for assessment of inferior glenohumeral laxity in asymptomatic shoulders

To determine the level of agreement between dynamic ultrasound imaging and stress radiography used for the measurement of inferior glenohumeral laxity in asymptomatic shoulders, and to determine the repeatability of the dynamic ultrasound technique. Using a custom-made stress device to apply an inferior displacement force of 90 N, we assessed 20 asymptomatic male subjects for inferior glenohumeral laxity, using stress radiography and dynamic ultrasound. Paired differences between the two methods were evaluated by the 95% limits of agreement method. At a separate session, 19 subjects had inferior glenohumeral laxity assessed by two observers, using dynamic ultrasound. Inter- and intra-observer repeatability was determined for the ultrasound technique. The mean [(+/-standard deviation (SD)] inferior translation was 4.7+/-4.1 mm by stress radiography and 4.4+/-2.3 mm by dynamic ultrasound. The 95% limits of agreement showed good agreement between the two methods. The paired difference between the two measurement methods varied with the magnitude of the measurement (P<0.001). Intra-observer repeatability of dynamic ultrasound was determined by the use of intra-class correlation coefficients and was 0.94 and 0.89 for the two investigators. Inter-observer repeatability was 0.85. The standard error of the measurement was 0.60 mm and 0.66 mm, for repeated measurements by the two investigators, and 0.85 mm between investigators. Repeatability coefficients demonstrated excellent consistency of measurement between sessions and good consistency between observers. Dynamic ultrasound is a valid and reproducible method for the assessment and quantification of inferior glenohumeral laxity.

Comparison of Dynamic Sonography to Stress Radiography for Assessing Glenohumeral Laxity in Asymptomatic Shoulders

Background Stress radiography has been the established imaging method for quantifying glenohumeral joint laxity. Dynamic ultrasound is an alternative imaging method that may be used to measure glenohumeral laxity; however, validity and repeatability have not been examined. Objective To determine criterion-related validity and repeatability of a sonographic imaging method for measuring glenohumeral laxity in asymptomatic shoulders. Study Design Controlled laboratory study. Methods In experiment 1, 20 subjects were assessed for glenohumeral laxity using stress radiography and dynamic ultrasound. In the second experiment, 13 subjects were assessed for laxity in 2 separate test sessions using the dynamic ultrasound technique. Results Correlational analysis between the sonographic and radiographic measures revealed an r = 0.79 (r2 = 0.62), indicating excellent criterion-related validity for the sonographic imaging method. Test-retest repeatability was 0.72 and 0.85 for anterior and posterior translation, respectively, and interrater repeatability was 0.96 and 0.99 for anterior and posterior translation, respectively. Conclusions Dynamic ultrasound appears to be a valid and repeatable method for assessing glenohumeral laxity in a clinical setting. Clinical Relevance Based on the results of this study, dynamic ultrasound is a repeatable and valid method for measuring glenohumeral laxity and therefore may be used as a viable replacement for stress radiography during assessments of glenohumeral laxity.