Sensitivity Of Ultrasound Examination Research Articles

Этиология и патогенез острых пиелонефритов у детей

Introduction. Acute pyelonephritis in children takes a leading place among the reasons for hospitalization. Objective. To study the epidemiological, anamnestic, diagnostic and clinical features of the course of pyelonephritis in children. Materials and methods. We have carried out a retrospective study of case histories of 142 children admitted to the urology department of the Emergency hospital №2 (Tomsk) with a diagnosis of acute pyelonephritis. Results. According to the results of our study, children of both sexes of young age (up to 1 year оf age) suffer from acute complicated pyelonephritis, whereas acute uncomplicated pyelonephritis is typical for girls over 3 years old. The sensitivity of ultrasound examination of the kidneys in acute pyelonephritis was 76.8%. The vast majority (96,8%) of acute uncomplicated pyelonephritis were caused by Escherichia coli. Escherichia coli was the cause of acute complicated pyelonephrities only in 30.8% of patients, Pseudomonas aeruginosa was ranked in second in frequency (15.4%), and Enteroccoccus faecalis was ranked third (11.5%). The following antibiotics retained their effectiveness among all the identified causative flora of uncomplicated pyelonephritis: fosfomycin, furagin, gentamicin, amikacin. Only amikacin showed absolute efficiency (100%) in the group of complicated pyelonephritis. 90% of bacteria showed sensitivity to fosfomycin, and 88.5% to cefepime and ertapenem. For children with acute pyelonephritis, the acute phase process of cytomegalovirus, Ebstein-Barr viral infections, previous herpes simplex virus infection, as well as contact with Chlamydia trachomatis, Ureaplasma urealуticum and Mycoplasma hominis are specific. Conclusion. The results of the study indicate the dynamics in the etiology and pathogenesis of acute pyelonephritis in children and a need for an annual monitoring in order to correct therapy.

A Pilot Prospective Study to Validate Point-of-Care Ultrasound in Comparison to X-Ray Examination in Detecting Fractures

Despite its limitations, conventional radiography is the method of choice for fracture evaluation in the emergency department. Only a few studies, moreover in limited populations, have evaluated the possible benefits of ultrasound (US), and especially of point-of-care ultrasound (POCUS), in the diagnosis of fractures. We sought to compare the accuracy of POCUS with that of conventional radiography in the diagnosis of bone fractures. This prospective study with a non-randomly allocated convenience sample was conducted at two academic medical centers. Four physicians, with focused training in musculoskeletal POCUS, evaluated consecutive patients with suspected orthopedic injury. US and X-ray examination results were treated as dichotomous variables with either fracture present or fracture absent. Descriptive statistics were calculated in addition to prevalence, sensitivity, specificity, positive predictive value and negative predictive value including 95% confidence intervals (CIs). Cohen's κ coefficient was determined as a measurement of the level of agreement. Four hundred sixty-nine patients (404 adult and 65 pediatric) ranging in age from 1–97 y were enrolled at two different hospitals. Seven hundred six examinations, both US and X-ray, were performed in 634 suspected fractures in adults (age ≥18 y) and 72 in children. On physical examination, swelling, localized hematoma and functional limitation were found in 64.61%, 34.97% and 53.52, respectively. The sensitivity of US examination was 93.89% (CI: 89.74%–96.49%) for all patients and 94.30% (CI: 89.77%–96.98%) and 91.67% (CI: 76.41%–97.82%) in adult and pediatric groups, respectively. Specificity was 94.13% (CI: 91.53–95.99), 94.56% (CI: 91.89–96.41) and 88.89% (CI: 73.00–96.38) for the whole group, adults and children, respectively. The positive predictive value was 88.48% (CI: 83.62%–92.08%), 88.35% (CI: 82.97%–92.24%) and 89.19% (CI: 73.64%–96.48%) for the whole group, adults and children, respectively. The negative predictive value was 96.98% (CI: 94.86%–98.27%), 97.43% (CI: 95.31%–98.64%) and 91.43% (CI: 75.81%–97.76%) in the three groups, respectively. Cohen's κ coefficient revealed high agreement of 0.87 for both the whole group and adult patients and 0.81 for pediatric patients. We found that POCUS has significant diagnostic accuracy in evaluating fracture compared with plain radiography, with excellent sensitivity, specificity and positive and negative predictive values.

Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage.

Cross-sectional study of 75 consecutive patients presenting with acute symptomatic posterior vitreous detachment (ASPVD) and vitreous hemorrhage was conducted at University Eye Clinic, University Hospital "Sveti Duh", Zagreb, Croatia. To check ultrasound reliability in detecting retinal tears in patients with ASPVD, transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6wk period. In 13 (17%) patients membranous lesion with ultrasound characteristics of retinal tear was detected. Ophthalmoscopy confirmed the diagnosis in 8/13 patients. In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear. Sensitivity of ultrasound examination was 100%, specificity 92%, positive predictive value 62% and negative predictive value 100%. Ultrasound proved to be a reliable and accurate method for detection of retinal tears in ASPVD. Given the high sensitivity and negative predictive value, negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.

Multiparametric magnetic resonance imaging in the diagnosis of local recurrence of prostate cancer in patients after radical prostatectomy

Prostate cancer (PC) is the most common cancer among men. The risk of local recurrence of PC after radical prostatectomy (RP) remains significant. Multiparametric magnetic resonance imaging (mpMRI) is an effective method of local PC recurrence detection in the prostatic bed in patients after RP. Sensitivity of ultrasound examination and other radiological methods for detecting a small-sized relapse is very poor. Use of mpMRI in improving diagnostic accuracy in local relapse detection of PC after RP is of current importance, primarily in patients suitable for salvage radiation therapy.

OP28.11: The influence of methodology of counting malformations on the sensitivity of ultrasound examination

<scp>OP</scp>28.11: The influence of methodology of counting malformations on the sensitivity of ultrasound examination

La place de l’échographie de contraste dans la détection du carcinome hépatocellulaire

The incidence of the hepatocellular carcinoma (HCC) is increasing in Occident, as well as in France. Primary prevention is the only solution for early detection. The combination of ultrasound (US) and αFP each 4 to 6 months dosage has many limitations.The sensitivity of US examination is rather poor (less than 70% for lesions below 2 cm in diameter) and serum αFP values remainnormal in almost 50% of HCC. US contrast agents (USCAs) with perfluorocarbon gases increase the backscattered signals during all phases of the liver transit, including arterial, portal and delayed phases. Hepatocellular lesions exhibit a specific kinetics with strong enhancement during arterial phase, and rapid wash-out during portal and delayed phases. USCAs increase the detection of HCCs and allow characterization of additional focal lesions found in cirrhotic livers (regenerative and dysplastic nodules, haemangiomas…). Indeed, regenerative nodules contrast uptake is synchronous to the surrounding parenchyma, and usually disappear during portal and delayed phases. However, US in cirrhosis remains a difficult examination, with limitations due to limited access to sub-diaphragmatic localization, attenuation of the ultrasound beam and shortness of the arterial phase.

Efficacy of routine fetal ultrasound screening for congenital heart disease in normal pregnancy.

Second trimester routine ultrasound evaluation of the fetal heart by means of the four-chamber view has been proposed for prenatal detection of cardiac anomalies. The aim of this study was to evaluate the efficacy of this procedure. A prospective follow-up study on 6922 scanned fetuses was performed. Pregnant women without known risk factors who were scheduled for a routine fetal ultrasound examination between 16 and 24 weeks gestation were invited to participate. Follow-up until 6 months postpartum was available for 5660 subjects (81.8%), of whom 5319 fulfilled all eligibility criteria. by comparing the prenatal diagnosis to the postnatal diagnosis, we obtained sensitivity, specificity, and predictive value (positive and negative). A total of 80 cases of congenital malformations were diagnosed during the study: 44 cases of congenital heart disease, 40 cases of noncardiac malformations, and a combination of the two in 4 cases. The fetal four chamber-view examination was considered abnormal in 7 women who were subsequently referred for extensive fetal ultrasound examination. Two proved to be carrying an affected fetus. Similarly, prenatal referral of 14 women because of suspected noncardiac malformations yielded 12 such cases. The fetal four chamber-view examination had a sensitivity of 4.5% (95% CI, 0.6% to 15%). Sensitivity for noncardiac anomalies was 30% (95% CI, 16.6% to 46.5%). Overall sensitivity of ultrasound examination was 16.3% (95% CI, 2.09% to 48.8%). Specificity and negative predictive value were high (>98%). The positive predictive value was low with wide CIs. These results suggest that the current mode of routine prenatal ultrasound screening for congenital malformations is inefficient, particularly for cardiac anomalies.

Magnetic resonance imaging in pregnancy: study of fetal cerebral malformations.

This paper reports 15 examinations by magnetic resonance imaging (MRI) performed in pregnant women whose fetuses had cerebral malformations identified by sonography. In all the cases the fetuses were immobilized by ultrasound-guided intravenous or intramuscular curarization. The diagnoses by MRI and ultrasound differed only in one case where an occipital meningocele had first been suggested. No cerebral abnormalities were demonstrated in this case by the MRI study, and this was confirmed at birth. In the remaining 14 cases, MRI confirmed the ultrasound diagnosis of cerebral malformation. In four of these cases, MRI added some additional information to the ultrasound diagnosis of ventriculomegaly by detecting agenesis of the corpus callosum in two fetuses, one Chiari malformation and one triventricular hydrocephalus. Another two ultrasound diagnoses of microcephaly actually proved to be semilobar holoprosencephaly with MRI. In the following cases, the MRI diagnoses concurred with those of ultrasound, and was therefore used unnecessarily despite providing further anatomical details of the lesions: two cases of agenesis of the corpus callosum, one case of anencephaly, a cystic hygroma of the neck, an alobar holoprosencephaly, a Dandy-Walker malformation and a mild isolated hydrocephalus associated with diaphragmatic hernia. In one case of iniencephaly, sonography offered closer approximation to the correct diagnosis. The results obtained unequivocally confirm the high sensitivity of ultrasound examinations in the prenatal screening of cerebral malformations and show that MRI proves to be complementary in uncertain cases or when more accurate anatomical detail is required.