High-resolution Ultrasound Scanning Research Articles

3D fascicular reconstruction of median and ulnar nerve: initial experience and comparison between high-resolution ultrasound and MR microscopy

BackgroundThe complex anatomy of peripheral nerves has been traditionally investigated through histological microsections, with inherent limitations. We aimed to compare three-dimensional (3D) reconstructions of median and ulnar nerves acquired with tomographic high-resolution ultrasound (HRUS) and magnetic resonance microscopy (MRM) and assess their capacity to depict intraneural anatomy.MethodsThree fresh-frozen human upper extremity specimens were prepared for HRUS imaging by submersion in a water medium. The median and ulnar nerves were pierced with sutures to improve orientation during imaging. Peripheral nerve 3D HRUS scanning was performed on the mid-upper arm using a broadband linear probe (10–22 MHz) equipped with a tomographic 3D HRUS system. Following excision, nerves were cut into 16-mm segments and loaded into the MRM probe of a 9.4-T system (scanning time 27 h). Fascicle and nerve counting was performed to estimate the nerve volume, fascicle volume, fascicle count, and number of interfascicular connections. HRUS reconstructions employed artificial intelligence-based algorithms, while MRM reconstructions were generated using an open-source imaging software 3D slicer.ResultsCompared to MRM, 3D HRUS underestimated nerve volume by up to 22% and volume of all fascicles by up to 11%. Additionally, 3D HRUS depicted 6–60% fewer fascicles compared to MRM and visualized approximately half as many interfascicular connections.ConclusionMRM demonstrated a more detailed fascicular depiction compared to 3D HRUS, with a greater capacity for visualizing smaller fascicles. While 3D HRUS reconstructions can offer supplementary data in peripheral nerve assessment, their limitations in depicting interfascicular connections and small fascicles within clusters necessitate cautious interpretation.Clinical relevance statementAlthough 3D HRUS reconstructions can offer supplementary data in peripheral nerve assessment, even in intraoperative settings, their limitations in depicting interfascicular branches and small fascicles within clusters require cautious interpretation.Key Points3D HRUS was limited in visualizing nerve interfascicular connections.MRM demonstrated better nerve fascicle depiction than 3D HRUS.MRM depicted more nerve interfascicular connections than 3D HRUS.Graphical

A prospective case series to evaluate subcostal nerve injury with high-resolution ultrasound in posterior retroperitoneoscopic adrenalectomy

BackgroundPosterior retroperitoneoscopic adrenalectomy has several advantages over transabdominal laparoscopic adrenalectomy regarding operating time, blood loss, postoperative pain, and recovery. However, postoperatively several patients report chronic pain or hypoesthesia. We hypothesized that these symptoms may be the result of damage to the subcostal nerve, because it passes the surgical area.MethodsA prospective single-center case series was performed in adult patients without preoperative pain or numbness of the abdominal wall who underwent unilateral posterior retroperitoneoscopic adrenalectomy. Patients received pre- and postoperative questionnaires and a high-resolution ultrasound scan of the subcostal nerve and abdominal wall muscles was performed before and directly after surgery. Clinical evaluation at 6 weeks was performed with repeat questionnaires, physical examination, and high-resolution ultrasound. Long-term recovery was evaluated with questionnaires, and photographs from the patients were examined for abdominal wall asymmetry.ResultsA total of 25 patients were included in the study. There were no surgical complications. Preoperative visualization of the subcostal nerve was possible in all patients. At 6 weeks, ultrasound showed nerve damage in 15 patients, with no significant association between nerve damage and postsurgical pain. However, there was a significant association between nerve damage and hypoesthesia (p = 0.01), sensory (p < 0.001), and motor (p < 0.001) dysfunction on physical examination. After a median follow-up of 18 months, 5 patients still experienced either numbness or muscle weakness, and one patient experienced chronic postsurgical pain.ConclusionIn this exporatory case series the incidence of postoperative damage to the subcostal nerve, both clinically and radiologically, was 60% after posterior retroperitoneoscopic adrenalectomy. There was no association with pain, and the spontaneous recovery rate was high.Graphical

Resolution of PIN syndrome following Physiotherapy: A case report

This case report highlights the use of physiotherapy as monotherapy for non-traumatic posterior interosseus nerve palsy, which is a rare compression neuropathy that usually gets referred to a surgeon and for which the patient may undergo surgical decompression. However, in a resource limited setting, patients are often not able to afford advanced radiographic modalities like high resolution ultrasound and MRI scans. Hence the standard pathway to surgery is uncertain and they often get referred to physiotherapy while awaiting surgery. In this case, the patient was referred for Physiotherapy and the palsy improved. This suggests there was no defined surgical lesion, as has been found in many patients who have undergone ultrasound. This case highlights the need for robust research on the role of physiotherapy for PIN palsy in resource limited settings and a possible treatment algorithm that reserves investigations and surgery for patients whose PIN palsy does not improve with physiotherapy and for whom surgery is not clearly indicated from the outset.

UNCOMMON PARASITIC INFECTION: ISOLATED INTRAMUSCULAR CYSTICERCOSIS– A CASE REPORT

Human cysticercosis is caused by cysticercus cellulosae, larvae of a tapeworm, taenia solium. Cysticercois can involve any tissue in the body even it has maximum tendency towards neural tissue. The most common affected sites are central nervous system, subcutaneous tissue, eyes and muscles. An isolated case of intramuscular cysticercosis is a rare presentation. Here we present the case of a 35 year old female with a swelling on the posterolateral aspect of right arm and was diagnosed as myocysticercosis which was abuting to the extensor muscle that is triceps muscle on high resolution ultrasound and ct scan and it was managed by antihelminthic medications followed by surgical excision

Ultrasonographic Evaluation of Fetal Sacral Length: Correlation with Gestational Age

Introduction: Obstetricians need an accurate estimate of gestational age to decide when to terminate the pregnancy and how to deliver the baby. When unreliable menstrual history cannot be used to determine gestational age, ultrasonography comes in handy. Ultrasonography has been used to determine gestational age using a variety of parameters. However, all of these parameters are only reliable in the first and second trimesters of pregnancy. They become less reliable as the pregnancy progresses, due to a variety of factors, with a maximum variability of about 3 to 3.5 weeks in the third trimester. Methods: A total of 200 pregnant women participated in this prospective observational study at the Department of Radiology and Imaging, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine, and Metabolic Disorders. The research was carried out between January 2001 and December 2002. Result: The participants' average age was 24.54 years. Only 3% of the participants were in the oldest age range of 36-40 years, with 38 percent of the participants being between the ages of 21 and 25. The average height of the participants was 150-154 cm in 52 percent of the cases. The mean SD height and weight were 152.40±3.44 cm and 54.80±4.45 kg, respectively. There is a strong positive relationship between fetal sacral length and gestational age, according to BPD and FL. The relationship between gestational age and fetal sacral length was demonstrated to be statistically significant. There was no statistically significant relationship between fetal sacral length and maternal height. Conclusion: Fetal sacral length is well related to gestational age. If sacral length is measured accurately with a high-resolution ultrasound scanner, it can be used reliably as an additional parameter throughout pregnancy in conjunction with other established parameters.

Median and ulnar nerve fascicle imaging using MR microscopy and high-resolution ultrasound.

Understanding nerve microanatomy is important as different neuropathies and some nerve neoplasms present with fascicle enlargement. The aim of our study was to gain clinically oriented knowledge on nerve fascicular anatomy using imaging modalities. On a cadaveric upper extremity, high-resolution ultrasound (HRUS) scan with 22MHz probe was performed. Sections of the median and ulnar nerves were excised at the level of the distal arm and after magnetic resonance microscopy (MRM), histological cross-sections (HCS) were prepared. Cross-referencing of the MRM and HRUS images with HCS was performed. Fascicle and nerve contouring was performed with morphometric software in order to assess nerve and fascicular cross-sectional area (CSA), fascicle count, and interfascicular distances. Based on fascicle differentiation, factual fascicle (FF) group and fascicular cluster (FC) group were defined. On the cross-referenced imaging material, fascicles were differentiated in 92.7% on MRM and in 57.3% on HRUS. High to very high positive correlation among imaging material was observed for the fascicle CSA. FF depiction was 30.1% on HRUS. In comparison to the FF group, the FC group had significantly larger fascicle CSA and shorter interfascicular distances. The findings of our study contribute to understanding of fascicle depiction on imaging modalities. HRUS offers good visualization of fascicles. The capability of differentiating fascicles is modality specific and depends on the fascicle CSA and the amount of interfascicular epineurium.

Artificial Intelligence in the Research of Origins of Vein Insufficiency

Artificial intelligence (AI) is currently used to enhance research whenever huge amounts of data have to be handled. AI means much more than just digital data processing; in particular, it requires the implementation of multiple hierarchies of multiple algorithms. In past years, our institution collected high-resolution ultrasound scans of more than 18,000 single leg vein valves from patients of all CEAP stages, leading to a new etiological classification (EPS). However, longitudinal studies would require spans of at least 10 to 20 years.

An ultrasonography-based approach for tissue modelling to inform photo-therapy treatment strategies.

Currently, diagnostic medicine uses a multitude of tools ranging from ionising radiation to histology analysis. With advances in piezoelectric crystal technology, high-frequency ultrasound imaging has developed to achieve comparatively high resolution without the drawbacks of ionising radiation. This research proposes a low-cost, non-invasive and real-time protocol for informing photo-therapy procedures using ultrasound imaging. We combine currently available ultrasound procedures with Monte Carlo methods for assessing light transport and photo-energy deposition in the tissue. The measurements from high-resolution ultrasound scans are used as input for optical simulations. Consequently, this provides a pipeline that will inform medical practitioners for better therapy strategy planning. While validating known inferences of light transport through biological tissue, our results highlight the range of information such as temporal monitoring and energy deposition at varying depths. This process also retains the flexibility of testing various wavelengths for individual-specific geometries and anatomy.

Optimized Backing Layers Design for High Frequency Broad Bandwidth Ultrasonic Transducer.

Ultrasonic transducers with broad bandwidth are considered to have high axial resolution and good ultrasound scanning flexibility for the clinical applications. The limitations of spatial resolution due to bandwidth are of great concern in ultrasound medical imaging. The method of acoustic impedance matching between the piezoelectric element and medium is commonly used to obtain broad bandwidth and high resolution. In this study, an optimized backing layer design was proposed to broaden the bandwidth by adding a tunable acoustic impedance matching layer of backing (AIMLB) between the backing layer and the piezoelectric ceramic element. The Mason equivalent circuit method was used to analyze the effect of the backing material composition and its structure on the bandwidth of the transducer. The optimized transducer was simulated using the finite-element method with the PZFlex software. Based on the PZFlex simulations, a 20-MHz ultrasonic transducer using the AIMLB with a bandwidth of approximately 92.29% was fabricated. The experimental results were in good agreement with the simulations. The ultrasonic imaging indicated that the designed ultrasonic transducer with an additional AIMLB had high performance with good imaging capability.

Silent Rupture of Silicone Gel Breast Implants: High-Resolution Ultrasound Scans and Surveys of 584 Women.

Background:Patient compliance has been low for U.S. Food and Drug Administration–recommended magnetic resonance imaging scans to screen silicone gel breast implants for silent rupture. High-resolution ultrasound scans are a convenient, in-office alternative that may improve screening compliance; however, women’s attitudes and feelings about silent rupture and their desire for rupture screening are unknown.Methods:Plastic surgeons and staff in nine private practices received 1-day training in high-resolution ultrasound scanning, then screened women with silicone gel implants implanted since 2000. Suspect scans were reviewed by a high-resolution ultrasound–experienced plastic surgeon to determine if they showed ruptures. Surgical and scan findings were correlated. To learn attitudes and feelings about silent rupture, women took surveys before and after the scan.Results:Of 584 women screened, 82 (14.0 percent) had scans showing ruptures; of 1153 implants, 92 (8.0 percent) showed ruptures. Forty women with scans showing ruptures underwent surgery, of which 30 (75 percent) had their ruptures confirmed. Surveys found 99.5 percent of women want to know if they have a rupture and 95.2 percent want the ruptured implant removed. If the scan showed no rupture, women felt relieved and 95.5 percent would get future high-resolution ultrasound screening for silent rupture. If a rupture was found, women expressed various concerns and 87.8 percent would remove the ruptured implant within 12 months.Conclusions:Surveys show that women with silicone gel implants have concerns and feel anxious about possible silent rupture. Based on 14 percent of women showing a ruptured implant on high-resolution ultrasound scans and 75 percent of ruptures on high-resolution ultrasound scans surgically confirmed, 10.6 percent of women in this study have a silent rupture.CLINICAL QUESTION/LEVEL OF EVIDENCE:Diagnostic, IV.

A System for Co-Registration of High-Resolution Ultrasound, Magnetic Resonance Imaging, and Whole-Mount Pathology for Prostate Cancer.

In order to evaluate the diagnostic accuracy of high-resolution ultrasound (HRUS) for detection of prostate cancer, it must be validated against whole-mount pathology. An ex-vivo HRUS scanning system was developed and tested in phantom and human tissue experiments to allow for in-plane computational co-registration of HRUS with magnetic resonance imaging (MRI) and whole-mount pathology. The system allowed for co-registration with an error of 1.9mm±1.4mm, while also demonstrating an ability to allow for lesion identification.Clinical Relevance- Using this system, a workflow can be established to co-register HRUS with MRI and pathology to allow for the diagnostic accuracy of HRUS to be determined with direct comparison to MRI.

Deep multi-sensorial data analysis for production monitoring in hard metal industry

The industry practice of machining hard metal parts using CNC lathe turning machines is through grinding and milling procedures. The typical practice for quality control is through manual inspection, as automated solutions are difficult to integrate in production and do not reach the same level of accuracy. In this scope, the proposed system aims to automate the manufacturing process for the machine condition monitoring and 3D inspection of defective hard metal parts, by utilizing deep neural networks (DNNs) and investigating the defects on real production samples. Concretely, data are collected with (a) shop floor sensors, (b) high-resolution laser microprofilometer and (c) ultrasound scanner. The proposed system analyzes the collected data through AI models for quality control. Moreover, a fusion scheme is proposed to further improve accuracy. The system is validated on the classification of defective and non-defective samples, using metrics including accuracy, F-score, precision and recall for the performance evaluation.

THE VALIDITY AND RELIABILITY OF THE HANDHELD OXIMETER TO DETERMINE LIMB OCCLUSION PRESSURE FOR BLOOD FLOW RESTRICTION EXERCISE IN THE LOWER EXTREMITY.

The limb occlusion pressure (LOP) is determined to calculate the relative LOP. The different levels of relative LOP (percentage of LOP) influence the treatment effect and perceived discomfort during low-load blood flow restriction (BFR) strength training. Thus, determining the LOP is of the utmost importance when using BFR in clinical practice. The objective of this study was to investigate the concurrent validity and intra-rater (test-retest), intra-day reliability of an inexpensive, portable, easy-to-use handheld (HH) oximeter compared to a high-resolution Doppler ultrasound scanner in detecting LOP in the lower extremity. Cross-sectional validity and reliability study. Two raters who were blinded from each other simultaneously assessed 50 healthy participants (mean age of 25.8 years). A 20 cm-wide thigh cuff with an attached sphygmomanometer was inflated until the raters independently registered the LOP with the HH oximeter and the Doppler ultrasound scanner. The test session was repeated once after a five-minute time interval. The HH oximeter recorded a non-significantly higher LOP than the Doppler ultrasound scanner, with a mean difference of 6.3 mmHg in the test session (95% limits of agreement (LoA): -16.2 to 28.8, p = 0.13) and 5.4 mmHg in the retest session (95% LoA: -13.3 to 24.0, p = 0.10). The intra-rater reliability for both devices was moderate (ICC = 0.72-0.79). The measured LOP was significantly lower (p < 0.005) in the retest session than in the test session for both the HH oximeter (mean difference: -5.7 mmHg) and the Doppler ultrasound scanner (mean difference: -4.8 mmHg). The HH oximeter is a valid and reliable measuring device for determining the LOP in the lower extremity in healthy adults. The authors recommend performing at least two LOP measurements with a one-minute rest interval. 2, Validity and reliability study.

Antenatal ultrasound diagnosis and neonatal results of the congenital cystic adenomatoid malformation of the lung

Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung di sease, and in the most of cases, prenatal diagnosis is feasible. There are discrepancies regarding pre natal management and postpartum treatment. To analyze prenatally diagnosed CCAM in our hospitals, in order to evaluate ultrasound findings with fetal and postnatal evolution. Retrospective study of all cases diagnosed prenatally by ultrasound between 2005 and 2016 in two reference hospitals. The ultrasounds were performed using high-resolution ultrasound scanners, Toshiba Xario and Voluson 730 Expert Pro, with follow-up from diagnosis to delivery. The variables analyzed included gestational age at diagnosis, the characteristics of the lung lesion, associated malformations, cytogenetic study, the evolution of pregnancy, type of delivery, presence of respiratory distress, need for complementary imaging tests, pediatric clinical course, and necessary postnatal treatments. It was considered a resolution the total disappearance of the lesion in the pre natal ultrasound or that the postnatal chest X-ray showed no lesion. 17 cases were prenatally diagnosed. The evolution ranges from the prenatal resolution of the lesion to the persistence after bir th. Three patients voluntarily decided to have an abortion due to ultrasound findings of poor progno sis. Of the fourteen remaining cases there were no cases of fetal or neonatal deaths, one case required surgery after birth and four patients had mild symptoms during the first year of life. One case of false negative with neonatal death has been reported which necropsy reported as CCAM type 0. Conclu sions: This pulmonary malformation presents good prognosis, excluding cases with fetal hydrops. Two-dimensional ultrasound is usually enough for diagnosis and follow-up. Computed tomography is the technique of choice to confirm the resolution of lesions after birth. Surgical treatment is pre ferable over conservative management, although it is unknown if the potential complications of this disease, even when asymptomatic, justify surgical morbidity.

Masseter Muscle Thickness in Unilateral Partial Edentulism: An Ultrasonographic Study.

Introduction:Teeth and facial muscles play a very important role in occlusal equilibrium and function. Occlusal derangement, seen in unilateral partially edentulous individuals, has an effect on masseter muscle anatomy and function. The present study aims to evaluate masseter muscle thickness in unilateral partial edentulism.Patients and Methods:Institutional ethics committee approval was obtained before the commencement of the study. The study involved patients who routinely visited the Department of Oral Medicine and Radiology, Sri Ramachandra University. The study sample included 27 unilateral edentulous patients (Group E) and 30 controls (Group C). The masseter muscle thickness was evaluated using high-resolution ultrasound real-time scanner (linear transducer − 7.5–10 MHz) at both relaxed and contracted states.Statistical Analysis Used:The results were analyzed using paired t-test and independent t-test. Duration of edentulism and muscle thickness was assessed using Pearson's correlation coefficient.Results:The study patients’ age ranged between 25 and 48 years (mean – 36 years). The comparative evaluation of masseter muscle thickness between the dentulous and edentulous sides of experimental group was statistically significant (P < 0.05). However, no statistically significant difference in masseter muscle thickness was found between the dentulous side of control and experimental groups. The correlation between the duration of partial edentulism and muscle thickness was statistically insignificant.Conclusion:The study proves masseter atrophy in the edentulous side. However, since the difference is found to be marginal with the present sample, a greater sample is necessary to establish and prove the present findings as well as to correlate with the duration of edentulism. Further studies are aimed to assess the muscle morphology after prosthetic rehabilitation.

Clinical Utility of High-Frequency Musculoskeletal Ultrasonography in Foot and Ankle Pathology: How Ultrasound Imaging Influences Diagnosis and Management

The use of high-frequency (high-resolution) musculoskeletal ultrasonography is increasing and has shown promising utility in many areas of medicine. The utility of musculoskeletal ultrasonography for foot and ankle complaints has not been widely investigated, however. Although some conditions of the foot and ankle are easily diagnosed by physical examination, others can have nonspecific examination findings, making optimal treatment decisions difficult. We hypothesized that high-resolution musculoskeletal ultrasound scanning of the foot and ankle can affect the diagnosis and/or treatment for patients presenting with foot or ankle complaints. Retrospectively, the cases of 98 patients who had undergone musculoskeletal ultrasound scanning of the foot or ankle were reviewed. The pre-ultrasound clinical diagnosis and treatment were compared with the post-ultrasound diagnosis and treatment. In 64% of the patients, the diagnosis or treatment changed after the ultrasound examination. In 43% of patients, both the diagnosis and the treatment changed after ultrasound scanning. For those patients for whom the diagnosis and treatment were unchanged after the ultrasound examination, the ultrasound findings were concordant with the pre-ultrasound clinical diagnosis for 100% of the patients. These results suggest that in a large proportion of patients, high-resolution musculoskeletal ultrasonography of the foot or ankle can facilitate appropriate diagnosis and management.

Point of care high resolution ultrasound in the evaluation of Bangladeshi women presenting to a breast care center

Background: Mammography and ultrasound examinations for diagnosis and staging of breast problems have been traditionally performed in specialized facilities, which circumstances are associated with increased costs and inconvenience for patients. Point of care or clinical office provision of high resolution ultrasound may allow addressing these equity barriers to health services, but there are limited data in Bangladesh about such practice and the associated quality of care.Objective: To ascertain the advantage of ultrasonogram in the diagnosis of breast disease and screening of breast cancer.Methods: From February through November 2014, 1085 women presented to the Amader Gram Breast Care Center in Khulna. In each of these women in addition to standard history and physical examination, a high resolution ultrasound scan was performed of both breasts. Standard clinical and ultrasound practice definitions of breast conditions were applied to each case by an specialist surgeon trained in breast sonology.Results: Two thirds of women had history, physical examination and ultrasound findings consistent with fibrocystic conditions. 12% had fibro adenomas, 5% inflammatory infectious conditions, 2% obvious or strongly suspected breast malignacy, and 1% had masses of uncertain nature. 3% had more than one abnormal breast condition and 3% had no breast abnormalities at all. The overwhelming majority of women benefitted from having ultrasound examination which contributed to prompt, definitive characterization of their breast conditions and which pictorial demonstration contributed to patient education about the clinical diagnosis.Conclusion: Point of care high resolution breast ultrasound can contribute favorably to quality and equity of care for Bangladeshi women with breast problems.Bang Med J (Khulna) 2016; 49 : 3-6

Abstract 11198: Heritability of Vascular Structure and Function: A Parent-child Study

Introduction: Vascular structure and function can be measured non-invasively in both children and adults. Understanding the heritability of these measures may aid in risk stratification and atherosclerosis prevention efforts. Data on the heritable contribution from parent to offspring for vascular measures are limited. Hypothesis: We hypothesized that measures of vascular structure and function would be modestly heritable in this large parent-child study. Methods: High-resolution ultrasound scans of the brachial and carotid arteries were obtained in parents (n=558; mean age=39.2±2.1) and their offspring (n=369; mean age 12.4±4.6). In the brachial artery, flow-mediated dilation (FMD) and lumen diameter (bLD) were measured. In the carotid artery, intima-media thickness (cIMT), lumen diameter (cLD), incremental elastic modulus (cIEM), diameter distensibility (cDD), and cross-sectional distensibility were measured (cCSD). Carotid-radial pulse wave velocity (PWV) was also obtained. Heritability analysis (h 2 , expressed as %) was performed using SOLAR on the entire cohort and adjusted for age, gender, race, body-mass index, smoking, and systolic blood pressure. Data are presented as mean (SE). Results: Measures of bLD (h 2 = 25.2(8.6), p&lt;0.001), cLD (h 2 = 55.4(8.8), p&lt;0.001), cIMT (h 2 = 28.1(12.6), p=0.014), cDD (h 2 = 28.2(7.1), p&lt;0.001), cCSD (h 2 = 27.1(6.9), p&lt;0.001), and PWV (h 2 = 26.3(8.9), p&lt;0.001) were significantly heritable. Only FMD (h 2 = 1.6(8.4), p=0.44), and cIEM (h 2 = 12.7(9.3), p=0.081) were not significantly heritable. Conclusions: These data suggest that the majority of non-invasive measures of vascular structure and function are modestly heritable from parent to child. Early interventions targeted at youth with elevated vascular risk and/or a high familial cardiovascular risk profile may be able to modify vascular structure and function to prevent further dysfunction as these children transition into adulthood.

Adding carotid total plaque area to the Framingham risk score improves cardiovascular risk classification.

IntroductionCardiovascular events (CE) due to atherosclerosis are preventable. Identification of high-risk patients helps to focus resources on those most likely to benefit from expensive therapy. Atherosclerosis is not considered for patient risk categorization, even though a fraction of CE are predicted by Framingham risk factors. Our objective was to assess the incremental value of combining total plaque area (TPA) with the Framingham risk score (FramSc) using post-test probability (Ptp) in order to categorize risk in patients without CE and identify those at high risk and requiring intensive treatment.Material and methodsA descriptive cross-sectional study was performed in the primary care setting in an Argentine population aged 22–90 years without CE. Both FramSc based on body mass index and Ptp-TPA were employed in 2035 patients for risk stratification and the resulting reclassification was compared. Total plaque area was measured with a high-resolution duplex ultrasound scanner.Results57% male, 35% hypertensive, 27% hypercholesterolemia, 14% diabetes. 20.1% were low, 28.5% moderate, and 51.5% high risk. When patients were reclassified, 36% of them changed status; 24.1% migrated to a higher and 13.6% to a lower risk level (κ index = 0.360, SE κ = 0.16, p < 0.05, FramSc vs. Ptp-TPA). With this reclassification, 19.3% were low, 18.9% moderate and 61.8% high risk.ConclusionsQuantification of Ptp-TPA leads to higher risk estimation than FramSc, suggesting that Ptp-TPA may be more sensitive than FramSc as a screening tool. If our observation is confirmed with a prospective study, this reclassification would improve the long-term benefits related to CE prevention.

Imaging of common bile duct by linear endoscopic ultrasound.

Imaging of common bile duct (CBD) can be done by many techniques. Endoscopic retrograde cholangiopancreaticography is considered the gold standard for imaging of CBD. A standard technique of imaging of CBD by endoscopic ultrasound (EUS) has not been specifically described. The available descriptions mention different stations of imaging from the stomach and duodenum. The CBD lies closest to duodenum and choice of imaging may be restricted to duodenum for many operators. Generally most operators prefer multi station imaging during EUS and the choice of selecting the initial station varies from operator to operator. Detailed evaluation of CBD is frequently the main focus of imaging during EUS and in such situations multi station imaging with a high-resolution ultrasound scanner may provide useful information. Examination of the CBD is one of the primary indications for doing an EUS and it can be done from five stations: (1) the fundus of stomach; (2) body of stomach; (3) duodenal bulb; (4) descending duodenum; and (5) antrum. Following down the upper 1/3(rd) of CBD can do imaging of entire CBD from the liver window and following up the lower 1/3(rd) of CBD can do imaging of entire CBD from the pancreatic window. This article aims at simplifying the techniques of imaging of CBD by linear EUS.