Ultrasound-detectable Pathology Research Articles

Integrating point of care ultrasound into rheumatology practice.

A scenario-based probability approach integrating point of care rheumatology ultrasound (POCRUS) into rheumatology practice has recently been proposed as a teaching methodology to encourage greater awareness of US for practicing clinicians especially with respect to the management of overlapping clinical conditions. This article reviews the rheumatological areas where application of POCRUS substantially enhances clinical reasoning to confirm or exclude target conditions. It highlights the definitions of ultrasound-detected pathologies in rheumatoid arthritis (RA), spondylarthritis, gout and crystal arthritis, osteoarthritis, polymyalgia rheumatica and discusses the added value of POCRUS in diagnosing these conditions. It summarizes advances in predicting giant cell arteritis with sequential application of a probability score and ultrasonography. It discusses the potential for salivary gland ultrasound in the diagnostic workup of suspected Sjogren's syndrome. Other areas for POCRUS application such as in suspected nerve entrapment are reviewed.

Urinary interleukins (IL)-6 and IL-10 in schoolchildren from an area with low prevalence of Schistosoma haematobium infections in coastal Kenya.

Urinary cytokines are gaining traction as tools for assessing morbidity in infectious and non-infectious inflammatory diseases of the urogenital tract. However, little is known about the potential of these cytokines in assessing morbidity due to S. haematobium infections. Factors that may influence the urinary cytokine levels as morbidity markers also remain unknown. Therefore the objective of the present study was to assess how urinary interleukins (IL-) 6 and 10 are associated with gender, age, S. haematobium infections, haematuria and urinary tract pathology and; 2) to assess the effects of urine storage temperatures on the cytokines. This was a cross-sectional study in 2018 involving 245 children aged 5-12 years from a S. haematobium endemic area of coastal Kenya. The children were examined for S. haematobium infections, urinary tract morbidity, haematuria and urinary cytokines (IL-6 and IL-10). Urine specimens were also stored at -20°C, 4°C or 25°C for 14 days before being assayed for IL6 and IL-10 using ELISA. The overall prevalence of S. haematobium infections, urinary tract pathology, haematuria, urinary IL-6 and urinary IL-10 were 36.3%, 35.8%, 14.8%, 59.4% and 80.5%, respectively. There were significant associations between prevalence of urinary IL-6, but not IL-10, and age, S. haematobium infection and haematuria (p = 0.045, 0.011 and 0.005, respectively) but not sex or ultrasound-detectable pathology. There were significant differences in IL-6 and IL-10 levels between urine specimens stored at -20°C and those stored at 4°C (p<0.001) and, between those stored at 4°C and those stored at 25°C (p<0.001). Urinary IL-6, but not IL-10, was associated with children's age, S. haematobium infections and haematuria. However, both urinary IL-6 and IL-10 were not associated with urinary tract morbidity. Both IL-6 and IL-10 were sensitive to urine storage temperatures.

A COMPARISON OF ULTRASOUND-DETECTED PATHOLOGIES IN PERSONS WITH AND WITHOUT KNEE OSTEOARTHRITIS AND THE ASSOCIATIONS WITH PAIN

Purpose: Ultrasound can be performed to evaluate the degree of osteophytes and synovitis in persons with knee OA bedside to patients, without any side effects or contraindications. Few studies have looked at the associations between ultrasound findings and pain, and there is limited knowledge regarding ultrasound as a valid examination to assess OA pathology of the knee. Hence, we aimed to compare the degree of OA changes by ultrasound among people with and without knee OA according to established classification criteria and study the associations between ultrasound findings and pain.

P–727 Prevalence of ultrasound-detected gynaecological pathology in a One-Stop fertility clinic

Abstract Study question What is the prevalence of abnormal findings on transvaginal ultrasound scan (TVS) in a population of women presenting with subfertility to a One-Stop fertility clinic? Summary answer Two thirds of women in our population had ultrasound-detected pathology. The five commonest pathologies were uterine fibroids, polycystic ovaries, endometriosis, adenomyosis and benign ovarian cysts. What is known already Gynaecological pathology is common in women presenting with subfertility. However, their prevalence varies depending on the age, geography, background health of the population and study design. Few prevalence studies performed in the general female population show definitive associations with subfertility. As imaging techniques become increasingly sophisticated and patient demographics evolve over time, the prevalence of gynaecological pathology is anticipated to change. Understanding their prevalence in a subfertile population would shed light on the burden of disease, providing information about prevention strategies and service priorities. There are no published studies on the prevalence of ultrasound-detected gynaecological pathology in the subfertile population. Study design, size, duration This was a retrospective cross-sectional study of 1558 women presenting to a One-Stop fertility clinic of a university teaching hospital between January 2012 and December 2020. Participants/materials, setting, methods Women who attend the clinic routinely have their demographic data and a detailed clinical history taken prior to a transvaginal ultrasound scan. A clinical examiner trained in transvaginal ultrasonography performs the ultrasound examination in a standardized fashion. Ultrasound features and diagnoses are systematically recorded in an electronic database. We obtained demographic data and details of gynaecological diagnoses from the electronic database. We analysed the data using descriptive statistics and reported our results as proportions. Main results and the role of chance The median age of women at the time of scan was 35 years (range 21–46 years). The mean Body Mass Index was 24.8 kg/m2 (range 16.9–50.4 kg/ m2). The median duration of subfertility was 24 months (range 3–168 months). 472/1558 (30.3%, 95% CI 28.0–32.6) women had normal pelvic scans. The most frequent pathology seen in our population was uterine fibroids (410/1558, 26.3%; CI 24.1–28.6); 10.5% of these fibroids distorted the uterine cavity. Polycystic ovaries were the next most common pathology (363/1558, 23.3%; CI 21.2–25.4), followed by endometriosis (177/1558, 11.4%; CI 9.8–13.0), adenomyosis (160/1558, 10.3%; CI 8.8–11.9) and benign ovarian cysts (122/1558, 7.8%; CI 6.6–9.3). The other abnormalities seen on scan included congenital uterine anomalies (81/1558, 5.2%; CI 4.2–6.4), endometrial polyps (69/1558, 4.4%; CI 3.5–5.6), pelvic adhesions (44/1558, 2.8%; CI 2.1–3.8) and intrauterine adhesions (13/1558, 0.8%; CI 0.5–1.4). Of the 1086 women with abnormal scans, 832 (76.6%, CI 74.0–79.1) had one pathology detected on TVS and 254 (23.4%, CI 20.9–26.0) had more than one pathology detected. Limitations, reasons for caution A limitation of our study was the lack of histological confirmation of the ultrasound findings. Due to our smaller sample size, our prevalence could potentially be overestimated. Wider implications of the findings: The relevance of each pathology to chances of conception requires further examination to avoid under- or overtreating women in their fertility journey. Our findings may provide a background for future correlation studies. Furthermore, a scan quality assessment may be considered if the detection rate is substantially different in similar populations. Trial registration number Not applicable

Phenotyping the shoulder patient based on ultrasound-detected pathologies: a cross-sectional study in general practice.

Shoulder complaints arise from a single pathology or a combination of different underlying pathologies that are hard to differentiate in general practice. Subgroups of pathologies have been identified on the basis of ultrasound imaging that might affect treatment outcomes. Our aim was to validate the existence of different subgroups of patients with shoulder complaints, based on ultrasound-detected pathology, and compare clinical features among them. Profiling shoulder patients into distinct shoulder pathology phenotypes could help designing tailored treatment trials. This was a cross-sectional study in general practice. Data were extracted from 840 first visit patient records at a single diagnostic centre in the Netherlands. Exclusion criteria were age <18 years and previous shoulder surgery. Latent class analysis was used to uncover cross-combinations of ultrasound detected pathologies, yielding subgroups of shoulder patients. The uncovered subgroups were compared for demographic and clinical characteristics. We uncovered four distinct subgroups of patients with shoulder complaints: (i) Frozen shoulder group (11%), (ii) Limited pathology group (44%), (iii) Degenerative pathology group (31%) and (iv) Calcifying tendinopathy group (15%). Group comparisons showed significant differences in demographic and clinical characteristics among subgroups, consistent with the literature. In a general practice population, we uncovered four different phenotypes of shoulder patients on the basis of ultrasound detected pathology. These phenotypes can be used designing tailored treatment trials in patients with shoulder complaints.

Ultrasound parameters of pelvic organs and their age-related changes in a cohort of asymptomatic postmenopausal women: A community-based study.

To describe the ultrasound parameters of pelvic organs and their age-related changes in a cohort of asymptomatic postmenopausal women and to describe the prevalence of ultrasound-detected pathologies in a Sri Lankan population. A large community-based longitudinal study using a randomly selected sample of postmenopausal women who have never used hormone replacement therapy. Uterine, endometrial and ovarian measurements at pelvic ultrasonography as described by the International Endometrial Tumor Analysis and the International Ovarian Tumor Analysis groups. A total of 815 postmenopausal women were approached and all volunteered to participate. This included women between the ages of 45 and 74 years with a median (interquartile range (IQR)) of 62.0 (10.0) years. The median (IQR) uterine volume was 18.1 (17) ml, while the median (IQR) of right and left ovarian volumes were 17.3 (22.9) ml and 18.2 (21.5) ml. Both uterine and ovarian volumes showed an age-related decline (p < 0.01). Furthermore, the ovarian volumes demonstrated an increase in size with a higher body mass index (p < 0.03 for left and p < 0.01 for right, respectively). Median (IQR) endometrial thickness among the population was 3.0 (1.0) mm and there was no age-related change observed. Sixty-one women had an ultrasound-detected gynaecological pathology with a prevalence of 7.5% (95% confidence interval (CI) 5.6-9.5). This study aimed at describing ultrasound parameters of pelvic organs among postmenopausal women of Sri Lanka was able to provide the reference values for uterine and ovarian volume among asymptomatic postmenopausal women. Both uterine and ovarian volumes demonstrated an age-related decline, whereas the endometrial thickness does not seem to relate to the age.

Ultrasound Features of the Posterior Tibialis Tendon and Peroneus Brevis Tendon Entheses: Comparison Study Between Healthy Adults and Those With Inflammatory Arthritis.

Limited literature exists on the sonographic appearance of the posterior tibialis tendon (PTT) and the peroneus brevis tendon (PBT) entheses. We determined the anatomic features and best imaging techniques of normal PTT and PBT using musculoskeletal ultrasound and compared these findings to subjects with inflammatory arthritis. Adult subjects were enrolled as healthy controls (HCs), rheumatoid arthritis (RA) patients, or spondyloarthropathy (SpA) patients. Bilateral PTT and PBT entheses were imaged longitudinally, comparing 2 angles of insonation: perpendicular to the skin surface and 45° cephalad. Images were scored on semiquantitative scales assessing pathology. A total of 78 subjects were enrolled (37 HC, 21 RA, and 20 SpA). Complete enthesis visualization was achieved more frequently in the perpendicular than in the cephalad view for the PBT (76.3% versus 58.7%), but more frequently in the cephalad view for the PTT (58.0% versus 19.6%). RA and SpA subjects had higher rates of PTT fiber disruption (P < 0.001), PTT tenosynovial effusion (P < 0.001), and Doppler signal (P < 0.001) than HCs. No significant differences existed at the PBT enthesis. In multivariate analysis, RA and SpA subjects were found to be 5.1 times (P < 0.001) and 3.6 times (P < 0.001) more likely to exhibit ultrasound-detected pathology, respectively, than HCs. The perpendicular transducer aim is optimal for imaging the PBT, while the cephalad transducer orientation was more effective for evaluation of the PTT. Unlike distal PBT imaging, PTT imaging distinguished healthy and disease states, with both RA and SpA patients showing features of PTT enthesopathy. Distal PTT imaging is a useful technique for musculoskeletal ultrasound.

Ultrasound-detected pathologies cluster into groups with different clinical outcomes: data from 3000 community referrals for shoulder pain

BackgroundUltrasound is increasingly used to evaluate shoulder pain, but the benefits of this are unclear. In this study, we examined whether ultrasound-defined pathologies have implications for clinical outcomes.MethodsWe extracted reported pathologies from 3000 ultrasound scans of people with shoulder pain referred from primary care. In latent class analysis (LCA), we identified whether individual pathologies clustered in groups. Optimal group number was determined by the minimum Bayesian information criterion. A questionnaire was sent to all patients scanned over a 12-month period (n = 2322). Data collected included demographics, treatments received, current pain and function. The relationship between pathology-defined groups and clinical outcomes was examined.ResultsLCA revealed four groups: (1) bursitis with limited inflammation elsewhere (n = 1280), (2) bursitis with extensive inflammation (n = 595), (3) rotator cuff tears (n = 558) and (4) limited pathology (n = 567). A total of 777 subjects (33%) completed questionnaires. The median (IQR) duration post-ultrasound scan was 25 (22–29) months. Subsequent injections were most common in groups 1 and 2 (groups 1–4 76%, 67%, 48% and 61%, respectively); surgery was most common in group 3 (groups 1–4 23%, 21%, 28% and 16%, respectively). Shoulder Pain and Disability Index scores were highest in group 3 (median 48 and 30, respectively) and lowest in group 4 (median 32 and 9, respectively). Patients in group 4 who had surgery reported poor outcomes.ConclusionsIn a community-based population, we identified clusters of pathologies on the basis of ultrasound. Our retrospective data suggest that these groups have different treatment pathways and outcomes. This requires replication in a prospective study to determine the value of a pathology-based classification in people with shoulder pain.

The impact of Schistosoma japonicum infection and treatment on ultrasound-detectable morbidity: a five-year cohort study in Southwest China.

BackgroundUltrasonography allows for non-invasive examination of the liver and spleen and can further our understanding of schistosomiasis morbidity.Methodology/Principal FindingsWe followed 578 people in Southwest China for up to five years. Participants were tested for Schistosoma japonicum infection in stool and seven standard measures of the liver and spleen were obtained using ultrasound to evaluate the relationship between schistosomiasis infection and ultrasound-detectable pathology, and the impact of targeted treatment on morbidity. Parenchymal fibrosis, a network pattern of the liver unique to S. japonicum, was associated with infection at the time of ultrasound (OR 1.40, 95% CI: 1.03–1.90) and infection intensity (test for trend, p = 0.002), adjusting for age, sex and year, and more strongly associated with prior infection status and intensity (adjusted OR 1.84, 95% CI: 1.30–2.60; test for trend: p<0.001 respectively), despite prompt treatment of infections. While declines in parenchymal fibrosis over time were statistically significant, only 28% of individuals with severe parenchymal fibrosis (grades 2 or 3) at enrollment reversed to normal or grade 1 within five years. Other liver abnormalities were less consistently associated with S. japonicum infection.Conclusions/SignificanceParenchymal fibrosis is an appropriate measure of S. japonicum morbidity and can document reductions in disease following control efforts. Other ultrasound measures may have limited epidemiological value in regions with similar infection levels. Because severe fibrosis may not reverse quickly following treatment, efforts to reduce exposure to S. japonicum should be considered in combination with treatment to prevent schistosomiasis morbidity.

SHORT REPORT: EVALUATION OF HEPATIC FIBROSIS IN PERSONS CO-INFECTED WITH SCHISTOSOMA MANSONI AND HUMAN IMMUNODEFICIENCY VIRUS 1

To investigate whether infection with human immunodeficiency virus 1 (HIV-1) affects fibrosis development in patients infected with Schistosoma mansoni, we evaluated schistosomiasis-induced pathology in the livers of Kenyan patients co-infected with HIV-1. Compared with persons with schistosomiasis alone (n = 58), there were no significant differences in distribution of ultrasound-detectable pathology in persons with HIV-1 co-infection (n = 23). Similarly, serum aspartate aminotransferase levels were not significantly different in HIV-1+ individuals. Hepatic fibrosis was associated with significantly decreased CD4+ T cell counts, even in the absence of HIV-1 infection. These data suggest that HIV-1 co-infection does not significantly alter the proportion of patients experiencing schistosomiasis-induced fibrosis, but pathology associated with S. mansoni infections leads to CD4+ T cell reductions and thereby may exacerbate the effects of HIV-1 in co-infected individuals.