Ultrasonography Group Research Articles

Prenatal diagnosis of ectopic kidney: Evaluation of characteristics, additional anomalies and urinary complications

ObjectiveTo assess the characteristics, additional structural anomalies and postnatal urinary outcome of the cases diagnosed with fetal ectopic kidneys in the prenatal period. Study DesignCases having fetal ectopic kidneys, detected from a total of 14,617 pregnant women examined by routine detailed (Group 1) or indicated (Group 2) obstetric ultrasonography (USG) in a tertiary perinatology unit were analyzed. The prevalence of the cases, time of the diagnosis, sidedness of the affected kidney, anatomical location, origins of blood supply, additional urinary or extraurinary anomalies, and urinary complications during the postnatal follow-up period were investigated. ResultsWe have detected 33 fetuses with ectopic kidneys in our cohort. The prevalence of fetal ectopic kidney was 0.22 %, with a median (min.-max.) diagnosis time of 21.3 (17.6–34) weeks. In the group in whom indicated USG was performed, the time of diagnosis was later compared to routine detailed USG (p = 0.04) group. There was no difference in terms of gender [male, (n = 14), female (n = 19), p = 0.38] and the sidedness of the ectopic kidneys (p = 0.38). The location of ectopic kidneys was most frequent in the iliac fossa (n = 20, 60.6 %) and in the lateral pelvic areas (n = 13, 39.3 %). The blood supply origin of ectopic kidneys was the common iliac artery in 22 (66.6 %), whereas the aorta in 11 cases (33.3 %). There was an additional urinary anomaly in 8 cases (24 %), an extraurinary structural anomaly, most commonly cardiac, and/or a soft marker for aneuploidy were presented in 16 cases (48 %). The most common urinary complication in the postpartum period was vesicoureteral reflux (n = 5). ConclusionEctopic kidney in the prenatal period is a rare structural anomaly that can equally affect both genders and both kidneys. Prenatal diagnosis is important for the diagnosis of additional anomalies and follow-up of postnatal complications.

Comparison of Ultrasound-Guided Umbilical Venous Catheter Insertion with Blind Method: A Randomized Controlled Trial

Introduction: Ultrasonography (USG) can be used in neonates to manipulate and place the umbilical catheter in the correct position. Although chest radiograph (CXR) is the gold standard, a noninvasive method like USG without radiation exposure may be an alternative bedside armamentarium to the clinician. The purpose of the study was to evaluate whether USG-guided umbilical venous catheter (UVC) insertion is superior to the conventional method for the successful insertion of UVC. Method: The neonates born between 25 and 42 weeks of gestation requiring parenteral fluids and admission to neonatal intensive care unit (NICU) between September 2020 and November 2022 were randomized in two weight-based strata: ≤1,200 and >1,200 g. USG-guided UVC insertion was done in the intervention group and blind UVC insertion was done in the control group. Results: Out of 112 enrolled neonates, 58 were in the USG-guided group and 54 in the blind group. There was no significant difference in the failure rate between the intervention and control groups (20% versus 29% [RR: 0.69, 95% CI: 0.36–1.33]). The sensitivity and specificity of USG in locating tip position were 97 and 46.8%, respectively. The mean procedure time in USG and blind groups was 8.9 and 8.3 min, respectively (p value 0.56). Conclusion: USG does not reduce the failure rates during the insertion of umbilical catheters. However, being a safe, noninvasive procedure, it can be considered a rescue modality to CXR in NICUs equipped with portable USG for guiding UVC insertion.

Impact of periodic neck ultrasonography on locoregional disease control in surveillance after total thyroidectomy for patients with low- and intermediate-risk papillary thyroid carcinoma: a propensity score-matched study.

This study aimed to evaluate the impact of periodic neck ultrasonography (US) on postoperative surveillance for locoregional disease control of patients with low- and intermediate-risk papillary thyroid carcinoma (PTC) who underwent total thyroidectomy. This retrospective cohort study included patients with PTC who underwent total thyroidectomy and central neck dissection at our institution between January, 2000 and December, 2016. The patients were divided into two groups: the physical examination (PE) group (follow-up by PE without periodic US) and the US group (follow-up by PE with periodic US). Serum thyroglobulin levels were measured periodically in both groups. Propensity score matching was used to rigorously balance the significant variables and assess the 10-year postoperative outcomes between the groups. Of the 189 patients, 150 were included after matching (75 in each group). There were no significant differences between the two groups in terms of background characteristics. The median follow-up period was 127.9 months. There was no significant difference in locoregional relapse-free survival between the PE and US groups (97.0 vs. 98.7%, p = 0.541). The overall survival was 96.7% and 98.7% in the PE and US groups, respectively, with no significant difference (p = 0.364). This study demonstrated that the addition of periodic US to PE for postoperative surveillance of patients with low- and intermediate-risk PTC who underwent total thyroidectomy did not significantly affect locoregional control.

Contrast-enhanced ultrasound guided core needle biopsy for soft tissue tumors: Accuracy and applicability

ObjectiveTo evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) guided core needle biopsy (CNB) in diagnosing soft tissue tumors (STTs) and to identify the conventional ultrasonography (US) features of STTs that are recommended for CEUS-guided CNB. Materials and methodsA retrospective study was conducted on 123 patients with surgically confirmed STTs. Before surgeries, all subjects underwent CNB under the guidance of US or CEUS. The histopathological results of surgical specimens were considered as the gold standards. A successful biopsy diagnosis was defined as the pathological subtypes obtained by biopsy consistent with the gold standard. The diagnostic yields were compared between the US and CEUS groups, and the diagnostic yields based on various conventional US features of STTs were also compared between the two groups. ResultsSixty-seven cases underwent US-guided CNB and fifty-six cases underwent CEUS-guided CNB. The clinical, biopsy, and conventional US characteristics revealed no significant difference between the two groups. The diagnostic yield of the CEUS group was statistically higher than that of the US group (p = 0.011). In the CEUS group, more STTs with the anechoic areas were identified after CEUS examination (p = 0.031). Furthermore, the diagnostic yields based on the conventional US features of STTs, including deep fascia layer (p = 0.010), a maximum diameter ≥5 cm (p = 0.037), rough margin (p = 0.016), heterogeneous echotexture (p = 0.017), and absence of anechoic area (p = 0.013), were significantly different between the two groups, and the CEUS group exhibited higher diagnostic yields. ConclusionCEUS-guided CNB was found to be an efficient method for STTs diagnosis. It is particularly recommended for STTs with the following conventional US features, including location in deep fascia layer, a maximum diameter ≥5 cm, rough margin, heterogeneous echotexture, or absence of anechoic area.

Real-time ultrasound-guided versus landmark-guided subclavian vein catheterization in the intensive care unit: a prospective randomized study

Abstract Background The subclavian vein (SCV) is an alternative to the internal jugular vein when it is difficult to locate, such as in patients with hypovolemia or obesity. Ultrasonography (USG) guidance for SVC cannulation has evolved, resulting in fewer complications and higher first-pass success rates. This study aimed to compare the effectiveness and safety of SCV cannulation with USG- and landmark-guided techniques. Methods In this prospective randomized interventional controlled study, 80 patients admitted to the intensive care unit between July 2022 and October 2022 were randomly assigned to the landmark method group (LM group) and USG group. In the LM group, SCV cannulation was performed using the traditional landmark technique, whereas in the USG group, it was performed using USG guidance. The primary objective of this study was to evaluate the ease of subclavian central venous cannulation in critically ill patients using the 2 techniques. The secondary objectives were to compare the success rate of cannulation between these 2 techniques, evaluate the number of attempts, assess cannulation failure, and assess mechanical complications. Results The first-pass success rates were 70% and 92.5% in the LM and USG groups, respectively (P < 0.001). The average numbers of attempts in the LM and USG groups were 1.275 (±0.520) and 1.075 (±0.266), respectively (P = 0.034). The average procedure durations were 7.45 (±1.10) and 8 (±0.933) minutes in the LM and USG groups (P = 0.018), respectively. The rates of complications in both groups were not statistically significant. Conclusion The USG guidance for SCV cannulation has an advantage over landmark-guided methods in a critical care setting. The SCV is a good alternative to internal jugular vein cannulation. The average time to cannulation was longer in the USG group than in the LM group, which can decrease with the frequent use of USG and increasing operator experience. Clinical trials This study was registered in the Clinical Trials Registry-India (CTRI Trial No. CTRI/2022/07/043694, dated May 7, 2022).

Comparison of Accuracy of Ultrasound Measurement of Subglottic Diameter Versus Conventional Age Based Formula for Estimating Endotracheal Tube Size for Pediatric Surgical Patients- A Prospective Randomized Controlled Study

Introduction: The main aim of this study is to determine if ultrasonography (USG) based measurement of subglottic diameter is the best size predictor for endotracheal tube (ETT) in pediatric surgical cases over age-based formula with micro cuff tube. Also, to test reintubation percentage and post-operative complications in children. Methodology: This research is double-blind randomized control study with 68 children undergoing elective surgery requiring general anaesthesia with micro cuff tube. They were divided into 2 groups i.e. ETT size by USG (group U) and ETT size by age-based formula group A) (with 34 children in each. Both groups ETT measurement was calculated by independent Samples t-test, and correlation of both groups with actual ET Tube was measured by Pearson’s correlation coefficient. Reintubations or post-op complications was measured by Chi-squared test. Results: Mean age of group A and U are 5.65 ± 2.77 and 5.97 ± 2.77 respectively. Mean weights were from 13.5±2.06 kgs to 27±4.63kgs. Statistical significance with a P-value (P=0.0460) is observed in group U whereas no significance was seen in group A. A strong positive correlation (R=0.960) between USG-estimated ETT size and actual ETT size is observed. The difference in reintubations and post-op complications in group U were statistically significant with P < 0.002. Conclusion: The present study concludes that the sub glottis diameter measured by USG is a good predictor for correct size of micro cuff endo tracheal tube in children.

Comparative effectiveness of different hepatocellular carcinoma screening intervals or modalities: a systematic review and meta-analysis.

Current guidelines recommend hepatocellular carcinoma (HCC) screening in high-risk populations. However, the ideal HCC screening interval and screening modality have not been determined. This study aimed to compare the screening efficacy among different modalities with various intervals. PubMed and other nine databases were searched through June 30, 2021. Binary outcomes were pooled using risk ratio (RR) with 95% confidence intervals (CIs). Survival rates were also pooled using RR with 95% CIs because most eligible studies only provided the number of survival patients instead of hazard ratio. In all, 13 studies were included. Two random controlled trials (RCTs) and six cohort studies compared screening intervals for ultrasonography (US) screening and found no significant differences between shorter (3- or 4-month) and longer (6- or 12-month) screening intervals in terms of early HCC proportion, HCC significant mortality, 1-year survival rate; screening at 6-month interval significantly increased the proportion of early HCC (RR = 1.17, 95% confidence interval [CI]: 1.08-1.26) and prolonged the 5-year survival rate (RR = 1.39, 95% CI: 1.07-1.82) relative to the 12-month interval results. Three other RCTs and two cohort studies compared different screening modalities in cirrhosis or chronic hepatitis B, which indicated no statistical differences in the proportion of early HCC (RR = 0.89, 95% CI: 0.40-1.96) and HCC mortality (RR = 0.69, 95% CI: 0.23-2.09) between the biannual US and annual computed tomography (CT screening). Biannual US screening showed a lower proportion of early HCC than biannual magnetic resonance imaging (MRI) (RR = 0.60, 95% CI: 0.37-0.97) and biannual US combined with annual CT (RR = 1.31, 95% CI: 1.13-1.51) screening. The proportion of early HCC in the contrast-enhanced US group was slightly higher than that in the B-mode US (RR = 1.08, 95% CI: 1.00-1.23) group. The evidence suggests that 6 months may be the best HCC screening interval for US screening. The effectiveness of CT and MRI is better than US during same screening intervals. However, MRI and CT are more expensive than US, and CT also can increase the risk of radiation exposure. The selection of CT or MRI instead of US should be carefully considered. No. CRD42020148258 at PROSPERO website ( https://www.crd.york.ac.uk/PROSPERO/ ).

Impact of Ultrasonography on Chest Compression Fraction and Survival in Patients with Out-of-hospital Cardiac Arrest.

Whether ultrasonography (US) contributes to delays in chest compressions and hence a negative impact on survival is uncertain. In this study we aimed to investigate the impact of US on chest compression fraction (CCF) and patient survival. We retrospectively analyzed video recordings of the resuscitation process in a convenience sample of adult patients with non-traumatic, out-of-hospital cardiac arrest. Patients receiving US once or more during resuscitation were categorized as the US group, while the patients who did not receive US were categorized as the non-US group. The primary outcome was CCF, and the secondary outcomes were the rates of return of spontaneous circulation (ROSC), survival to admission and discharge, and survival to discharge with a favorable neurological outcome between the two groups. We also evaluated the individual pause duration and the percentage of prolonged pauses associated with US. A total of 236 patients with 3,386 pauses were included. Of these patients, 190 received US and 284 pauses were related to US. Longer resuscitation duration was observed in the US group (median, 30.3 vs 9.7 minutes, P<.001). The US group had comparable CCF (93.0% vs 94.3%, P=0.29) with the non-US group. Although the non-US group had a better rate of ROSC (36% vs 52%, P=0.04), the rates of survival to admission (36% vs 48%, P=0.13), survival to discharge (11% vs 15%, P=0.37), and survival with favorable neurological outcome (5% vs 9%, P=0.23) did not differ between the two groups. The pause duration of pulse checks with US was longer than pulse checks alone (median, 8 vs 6 seconds, P=0.02). The percentage of prolonged pauses was similar between the two groups (16% vs 14%, P=0.49). When compared to the non-ultrasound group, patients receiving US had comparable chest compression fractions and rates of survival to admission and discharge, and survival to discharge with a favorable neurological outcome. The individual pause was lengthened related to US. However, patients without US had a shorter resuscitation duration and a better rate of ROSC. The trend toward poorer results in the US group was possibly due to confounding variables and nonprobability sampling. It should be better investigated in further randomized studies.

Adding MRI as a Surveillance Test for Hepatocellular Carcinoma in Patients with Liver Cirrhosis Can Improve Prognosis.

Gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) can detect early stages of hepatocellular carcinoma (HCC). However, the survival benefit of Gd-EOB-DTPA-enhanced MRI in the surveillance of patients with cirrhosis has not yet been determined. We explored whether the intermittent replacement of ultrasonography (USG) with Gd-EOB-DTPA-enhanced MRI during HCC surveillance improved the clinical outcomes of patients with cirrhosis. We performed a retrospective cohort study of 421 HCC patients who were newly diagnosed during surveillance. Of these patients, 126 (29.9%) underwent surveillance based on Gd-EOB-DTPA-enhanced MRI and USG (USG+MRI group). The patients (295, 70.1%) who did not undergo MRI during surveillance were referred to as the USG group. In the USG+MRI group, 120 (95.2%) of 126 patients were diagnosed with early-stage HCC, whereas 247 (83.7%) of 295 patients were diagnosed with early-stage HCC in the USG group (P = 0.009). The significantly longer overall survival and time to progression in patients in the USG+MRI group compared to the unmatched cohort USG group was consistently observed by inverse probability weighting and propensity score-matched analysis. Gd-EOB-DTPA-enhanced MRI combined surveillance improved the detection of early-stage HCC and clinical outcomes such as overall survival and the time to progression in patients with cirrhosis.

Does Diagnostic Laparoscopy Still Have a Role in the Evaluation of Right Iliac Fossa Pain Versus Imaging Techniques or Experience?

Background Right iliac fossa (RIF) pain is the most common cause of emergency surgical presentation, and a significant number of patients are eventually diagnosed with acute appendicitis. Typically, appendicitis is a clinical diagnosis, and it is prudent to take the patient to theatre for an early diagnostic laparoscopy (DL) to prevent complications as a result of acute appendicitis with the caveat it may lead to an increased number of negative appendectomies. The primary objective of this study was to ascertain the efficacy of DL in tackling RIF pain. The secondary objective was to compare the results among the diagnostic versus imaging groups (negative appendectomy rate, postoperative complications, and length of stay). Methodology The data were collected retrospectively for patients presenting with RIF pain in the surgical unit of the Royal Oldham Hospital between April 2017 and March 2019. The electronic database was utilized to identify all patients who underwent appendicectomy during this period. Patients were divided into two groups, group one had DL as their primary operation, and group two had imaging prior to surgery. Group two was further subdivided into computed tomography (CT) and ultrasonography (USG). Data included blood results, imaging reports, intraoperative findings, length of stay (LOS), postoperative complications, and histopathology results. The data were analysed using an Excel sheet and SPSS version 27 (IBM Corp., Armonk, NY, USA). Results A total of 340 patients were identified. Group one had 165 (48.53%) and group two had 175 (51.47%) patients. Most surgeries were carried out by middle-grade doctors (80.95%). Comparison with the histopathology report revealed that the negative appendectomy rate was 20% in group one, 3.8% in the CT group, and 27.5% in the USG group. The average length of stay was 2 ± 1.38 days in the diagnostic group and 3 ± 2.7 and 3 ± 0.8 days in subsequent groups. Conclusions This study shows that DL is a valuable first option when trained surgeons are available for tackling RIF pain, particularly in the young age group where it can reduce the risk of radiation exposure, decrease LOS, and avoid complications because of perforation.

Children and adolescent patients with goiter and normal thyroid function: US findings related to underlying autoimmune thyroid diseases.

This study was conducted to investigate and compare thyroid ultrasonography (US) findings in children and adolescents with goiter and normal thyroid function with positive or negative thyroid autoimmunity. From 2000 to 2020, we reviewed initial thyroid US images in 33 autoimmune thyroid diseases (AITDs) patients and 52 nonAITD patients. Our review of the images focused on thyroid parenchymal hypoechogenicity and heterogeneous echopattern subdivided into 2 groups according to severity: hypoechogenicity 1 and 2 (HO1 and HO2) and heterogeneity 1 and 2 (HE1 and HE2). HO1 and HE1 were observed more frequently in the nonAITD group (86.5% and 42.3%, respectively), while HO2 and HE2 were observed more frequently in the AITDs group (36.4% and 81.8%, respectively). More patients in the AITDs group showed change of both US groups and thyroid function state within the follow-up periods than in nonAITD group (33.3% and 5.77%, respectively). Children and adolescent AITDs patients showed more severe parenchyma hypoechogenicity and heterogeneous echopattern compared with nonAITD patients with goiter and normal thyroid function.

A randomized-controlled clinical trial comparing the effects of steroid phonophoresis and therapeutic ultrasound in carpal tunnel syndrome.

In this study, we aimed to compare the efficacy of ultrasonography (US) and steroid phonophoresis (PH) treatments in patients with idiopathic carpal tunnel syndrome (CTS). Between January 2013 and May 2015, a total of 46 hands of 27 patients (5 males, 22 females; mean age: 47.3+13.7 years; range, 23 to 67 years) with idiopathic mild/moderate CTS without tenor atrophy or spontaneous activity in abductor pollicis brevis were included. The patients were randomly divided into three groups. The first group was ultrasound (US) group, the second group was PH group, and the third group was placebo US group. Continuous US with a frequency of 1 MHz, an intensity of 1.0 W/cm2 was used in the US and the PH groups. The PH group received 0.1% dexamethasone. Placebo group received a frequency of 0 MHz, an intensity of 0 W/cm2 US. Treatments were administered for five days a week, a total of 10 sessions. All patients also wore night splints during treatment. The Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire consisting of two parts, namely the Symptom Severity Scale and Functional Status Scale), grip strength, and electroneurophysiological evaluations were compared before the treatment, after the treatment, and three months later. All clinical parameters improved in all groups after treatment and at three months, except for the grip strength. Recovery in the sensory nerve conduction velocity between palm and wrist was seen in US group at three months after the treatment; however, recovery in the sensory nerve distal latency between the second finger and palm was seen in PH and placebo groups after treatment and at three months after the treatment. The results of this study suggest that splinting therapy combined with steroid PH, placebo or continuous US is effective for both clinical and electroneurophysiological improvement; however, electroneurophysiological improvement is limited.

Comparative study of ultrasound assisted versus conventional surface landmark guided technique for combined spinal epidural anaesthesia in patients with increasaed body mass index and difficult surface anatomy of lower back and spinal deformity

Palpatory method is traditionally used in clinical practice to locate the puncture site of combined spinal epidural (CSE) block, but locating the puncture site accurately in obesity and patients with difficult landmark or spinal deformity is usually difficult. For a successful CSE block, the puncture site must be accurately identified. The goal of this study was to see how ultrasonography (USG) affected the success rate of CSE puncture in these patients.This prospective randomized study included 100 patients requiring CSE (needle through needle technique) of American Society of Anaesthesiologists (ASA) grade I/II, age 18-60years, obese (BMI upto 35 kg/m2), patients with difficult landmark, spinal deformity and were randomly assigned to one of two groups: Ultrasound assisted group (USG) (n=50) or Surface landmark group (SLG) (n=50). The primary outcome was to compare the first-pass needle success rate for establishing CSE, with secondary outcomes including the number of needle puncture attempts, time to establish landmarks (t1), time to complete CSE (t2), total procedure time (t), block associated pain and complications.The USG group had a significantly greater first pass needle success rate (92%) than the SLG group (60%) p&amp;#60;0.001. The number of attempts to accomplish CSE in the USG group was lower than in the SLG group (p = 0.001). The USG group had a longer t1 (1.50±0.42) minutes than the SLG group (0.80±0.28), p&amp;#60;.0001. The USG group had a shorter t2 (1.60±0.45) than the SLG group (3.37±1.25) minutes (p &amp;#60;0.001). Block associated pain score was less in USG group as compared to SLG group (p=0.0003).Preprocedural USG improves first pass needle success rate and reduces the number of needle puncture attempts, decrease the procedural time thus lowering the risk of trauma, block associated pain, and discomfort to the patient.

Breast Imaging Findings of Microcalcifications in Ductal Carcinoma in Situ and Their Correlations with Pathological and Biological Features

Background: Mammography (MMG) is the primary screening tool for breast cancer, as microcalcifications are the most common MMG finding in ductal carcinoma in situ (DCIS). The use of high-frequency transducers facilitates the visualization of calcifications on ultrasonography (USG), especially in patients with dense breasts and cancer symptoms. Although a correlation has been reported between the imaging features of DCIS and pathological features, few studies have focused on multiple imaging modalities. Objectives: To evaluate the correlation of DCIS microcalcifications in breast imaging with pathological and biological features. Patients and Methods: The MMG and USG findings of 125 lesions detected in 123 patients, diagnosed with pure DCIS, were retrospectively reviewed according to the breast imaging-reporting and data system (BI-RADS). The USG and comparable MMG findings of microcalcifications were divided into three groups: group 1 (MMG negative, USG negative), group 2 (MMG positive, USG negative), and group 3 (MMG positive, USG positive). The pathological findings (nuclear grade and comedo necrosis) and biological features [estrogen (ER) positive group, human epidermal growth factor receptor 2 (HER2) positive group, triple negative group, and Ki-67 index] were compared with the MMG and USG features using Chi-square test. Results: Microcalcifications were observed on MMG in 83 (66.4%) DCIS lesions. Positive microcalcifications on MMG were significantly associated with a high nuclear grade (P = 0.001) and comedo necrosis (P = 0.001). Positive microcalcifications on MMG were significantly associated with ER negativity (P = 0.023), HER2 positivity (P = 0.002), and increased Ki-67 index (P = 0.001). There were 62 lesions (49.6%) without microcalcifications on USG (group 1 and group 2), while there were 63 (50.4%) lesions with microcalcifications on USG (group 3). Positive microcalcifications on MMG were significantly associated with ER-negative group (P = 0.023), HER2-positive group (P = 0.002), and increased Ki 67 index (P = 0.001). Conclusion: Based on the present results, DCIS microcalcifications detected via imaging were significantly associated with poor prognostic pathological factors, such as a high nuclear grade and comedo necrosis, as well as poor prognostic biological factors, including ER negativity, HER2 positive group, and a high Ki-67 index.

Augmented reality in laparoscopic liver resection evaluated on an ex-vivo animal model with pseudo-tumours.

The aim of this study was to assess the performance of our augmented reality (AR) software (Hepataug) during laparoscopic resection of liver tumours and compare it to standard ultrasonography (US). Ninety pseudo-tumours ranging from 10 to 20mm were created in sheep cadaveric livers by injection of alginate. CT-scans were then performed and 3D models reconstructed using a medical image segmentation software (MITK). The livers were placed in a pelvi-trainer on an inclined plane, approximately perpendicular to the laparoscope. The aim was to obtain free resection margins, as close as possible to 1cm. Laparoscopic resection was performed using US alone (n = 30, US group), AR alone (n = 30, AR group) and both US and AR (n = 30, ARUS group). R0 resection, maximal margins, minimal margins and mean margins were assessed after histopathologic examination, adjusted to the tumour depth and to a liver zone-wise difficulty level. The minimal margins were not different between the three groups (8.8, 8.0 and 6.9mm in the US, AR and ARUS groups, respectively). The maximal margins were larger in the US group compared to the AR and ARUS groups after adjustment on depth and zone difficulty (21 vs. 18mm, p = 0.001 and 21 vs. 19.5mm, p = 0.037, respectively). The mean margins, which reflect the variability of the measurements, were larger in the US group than in the ARUS group after adjustment on depth and zone difficulty (15.2 vs. 12.8mm, p < 0.001). When considering only the most difficult zone (difficulty 3), there were more R1/R2 resections in the US group than in the AR + ARUS group (50% vs. 21%, p = 0.019). Laparoscopic liver resection using AR seems to provide more accurate resection margins with less variability than the gold standard US navigation, particularly in difficult to access liver zones with deep tumours.

Investigation on the effectiveness of abdominal hollowing home-exercises using a portable ultrasound: Randomized controlled trial

We used a 3-arm randomized control trial to investigate whether abdominal hollowing (AH) home exercise using pocket-sized ultrasonography (US)—miruco (AH with miruco group)—was more effective than conventional AH home exercise using abdominal palpation and or also a wait-and-see approach (control group) to improve isolated control of the transversus abdominis (TrA) muscle during AH. We randomized 60 participants with low back pain into the three groups equally. Primary outcome measures for the US group were percentage of change in TrA thickness and excursion of the edge of the TrA fascia during AH when the thickness of the internal or external oblique muscles increased. Score on the Oswestry Disability Index (ODI) was a secondary outcome measure. The intervention period was 1 week, followed by 1 week without intervention. As a result, we found no statistically significant interaction effect (P > .05) in changes of the primary outcome measures from baseline for each follow-up period. The AH with miruco group had a statistically lower ODI (P = .036) than did the control group after the intervention. Results indicate a limited benefit for use of the miruco in AH home exercise to improve isolated control of the TrA muscle during AH.

English

BACKGROUND Imaging plays a major role in the diagnosis and management of patients with urolithiasis. Non-Contrast Computed Tomography (NCCT) is generally accepted as the gold standard, but there are concerns over higher radiation exposure from NCCT to the patient population. Our prospective study compared the diagnostic accuracy of plain X-ray KUB (Kidney, Ureter, Bladder) and USG (Ultrasonography) with NCCT in the evaluation of patients with ureteric colic. METHODS This study conducted from December 2018 to January 2020 in the Department of Urology, Vijayanagar Institute of Medical Sciences, and attached Hospital. 230 patients with ureteric colic were evaluated for ureteric calculi with x-ray KUB, USG (Ultrasonography) abdomen and pelvis and NCCT (Non-Contrast Computed Tomography) KUB region. RESULTS Out of 230 patients, 168 (73 %) were males and 62 (26.9 %) were females. Ages of the study population ranged from 18 to 55 yrs. 198 of the 230 patients were confirmed to have ureteric calculus, with lower ureteric calculus 97 (48.9 %), upper ureteric 65 (32.8 %), middle ureteric 29 (14.6 %), and multiple 7 (3.5 %). X-ray and USG (Ultrasonography) group yielded a sensitivity of 86.3 %, a specificity of 87.5 %, positive predictive value 97 %, and negative predictive value 51 %. While On NCCT (Non-Contrast Computed Tomography), a total of 192 patients (96 %) demonstrated ureterolithiasis of the 198 patients confirmed to have ureteric calculi (Table 2). X-ray and USG group yielded a sensitivity of 96.9 %, specificity of 93.6 %, positive predictive value 98.9 %, and negative predictive value 83 %. CONCLUSIONS Combination of x-ray KUB and USG, and NCCT were found to be excellent imaging modalities for the detection of ureteric calculi. X-ray KUB and USG can be used as the first investigation of choice for patients with ureteric colic and for follow up of patients after treatment. KEYWORDS Ureteric Colic, Ureterolithiasis, Ultrasonography

Ultrasonography-Based Radiomics of Screening-Detected Ductal Carcinoma In Situ According to Visibility on Mammography.

Ductal carcinoma in situ (DCIS) has different prognostic factors according to the detection modality. The purpose of this study was to compare parameters from a radiomic analysis of ultrasonography (US) images for DCIS detected on screening mammography (MMG) and US and detected on screening US only. A total of 154 surgically confirmed DCIS visible on US were included. Regions of interest were drawn onto US images of DCIS, and texture analysis was performed. Lesions were classified into those detected by both US and MMG (the US-MMG group) and those detected by US only (the US group). Analysis parameters were compared between the US-MMG group and the US group. Ninety-six lesions were included in the US-MMG group and 58 lesions in the US group. Energy, entropy, maximum, mean absolute deviation, range, SD, and variance were significantly higher in the US-MMG group than the US group. Kurtosis, skewness, and uniformity were significantly lower in the US-MMG group than the US group. Among the 22 gray-level cooccurrence matrix parameters, 18, 21, 22, 20, and 21 parameters were significantly different between the 2 groups in 0, 45, 90, and 135 degrees and the average value. Among the 11 gray-level run-length matrix parameters, 6, 6, 7, 7, and 6 parameters were significantly different in 0, 45, 90, and 135 degrees and the average value. Inverse variance and gray-level nonuniformity were the most different features between the 2 groups. Screening-detected DCIS showed different radiomic features according to the detection modality.

Continued value of the serum alpha-fetoprotein test in surveilling at-risk populations for hepatocellular carcinoma.

Because of the known limitations of ultrasonography (US) alone, we re-evaluated whether complimentary testing for serum alpha-fetoprotein (AFP) is helpful in surveilling for hepatocellular carcinoma (HCC) in high-risk populations. We included, from a hospital-based cancer registry, 1,776 asymptomatic adults who were surveilled biannually with the AFP test and US and eventually diagnosed with HCC between 2007 and 2015. Based on the screening results, these patients were divided into three groups: AFP (positive for AFP only; n = 298 [16.8%]), US (positive for US only; n = 978 [55.0%]), and AFP+US (positive for both; n = 500 [28.2%]). We compared the outcomes of the three groups, calculating the survival of the AFP group both as observed survival and as survival corrected for lead-time. In terms of tumor-related factors, the separate AFP and US groups were more likely to have early stage HCC and to receive curative treatments than the combined AFP+US group (Ps<0.05). The AFP group had significantly better overall and cancer-specific survival than the AFP+US group after adjusting for covariates (adjusted hazard ratios [HRs] 0.68 and 0.62, respectively). In analyses correcting for lead-time in the AFP group (doubling time 120 days), the respective adjusted HRs for the AFP group were unchanged (0.74 and 0.67), but they were no longer significant after additional adjustment for tumor stage and curative treatment (0.87 and 0.81). HCC cases detected by the AFP test without abnormal ultrasonic findings appear to have better survival, possibly as a result of stage migration and the resulting cures. Complementary AFP surveillance, together with US, could be helpful for at-risk patients.

Utility of real-time image fusion technology in ultrasonography-guided fiducial marker implantation for stereotactic body radiation therapy for liver tumors.

Ultrasonography (US) is useful when implanting fiducial markers in the liver. However, the implant position is sometimes lost. Recently, real-time image fusion technology (Volume Navigation [V-navi]; GE Healthcare, Milwaukee, WI, USA) has been introduced as a technique for using images from different modalities, and its utility for fiducial marker implantation has been hypothesized. To evaluate the utility of US-guided fiducial marker implantation in the liver using V-navi compared to conventional US. We retrospectively reviewed 35 patients who underwent fiducial marker implantation for stereotactic body radiation therapy of liver tumors in 2013-2018. To avoid artifacts obscuring the tumor, the target point of implantation was set 10 mm cranial or caudal to the tumor. Marker implantation was then performed using US alone (US group, n = 24) or V-navi with computed tomography (CT) or magnetic resonance imaging (V-navi group, n = 11). Postprocedural CT was evaluated to determine technical success, distances between marker and either tumor surface or target point, and whether marker-induced artifacts obscured the tumor. Complications were also evaluated. Results were compared between groups. Technical success was obtained in 33 patients. Distance between the tumor and marker showed no significant difference between groups. Distance between target point and marker was shorter in the V-navi group (P = 0.0093). Tumor-obscuring artifacts were seen in 12 patients (V-navi group, n = 1; US group, n = 11; P = 0.055). The only complication was minor bleeding in the US group (n = 1). V-navi appears useful for US-guided fiducial marker implantation in the liver compared with conventional US.