Ultrasound Examination In Patients Research Articles

Advantages of UltrafastTM ultrasound in the screening for renal artery disease

Aim: Renal artery disease is the most common cause of secondary hypertension worldwide. B-mode and Doppler ultrasound are considered the modalities of choice for the imaging of the renal arteries. However, an adequate examination can be plagued by difficulties in patients with unfavorable anatomy. UltraFastTM ultrasound is faster, performed with higher frame rates, and enables prospective and ret- rospective data analysis with quantification of flow data in the obtained image, so it may be able to resolve some of the difficulties encountered during conventional ultrasound examinations in patients with suspected renal artery disease. Material and methods: Comparison of the duration of conven- tional and UltraFastTM Doppler examinations of segmental renal arteries was performed on 52 young, healthy volunteers. Duration times were summarized using the median and interquartile range, and comparisons between the two methods were performed using the Wilcoxon test for paired samples. Results: The duration of UltraFastTM ultrasound examinations was significantly shorter in comparison to conventional ultrasound for both kidneys and in total (p <0.001, median difference in duration 65 s, median 64% shorter duration of analysis), while both conventional and UltraFastTM ultrasound examina- tions demonstrated consistent velocity measurements with very high correlation (Rho = 0.94, p <0.001). Conclusions: The study provides evidence that UltraFastTM ultrasound is faster than conventional Dop- pler ultrasonography for the assessment of renal artery disease in healthy adults without a history of renal disease. The findings have important implications for clinical practice, as they suggest that Ultra- FastTM imaging could offer a more efficient and time-saving approach to vascular imaging in patients with suspected renal artery disease.

Follow-up ultrasound examination in patients with newly diagnosed giant cell arteritis.

Ultrasound is a standard tool to diagnose giant cell arteritis (GCA). Until now, only few studies investigated the role of ultrasound in the follow-up of GCA. The aim of this study was to assess the changes in the intima media thickness (IMT), total number of affected arteries and provisional OMERACT GCA ultrasonography score (OGUS) in a 12-months follow-up period. Patients with newly diagnosed GCA were prospectively enrolled. Ultrasound examinations of facial, temporal, carotid, vertebral and axillary arteries were performed at baseline, after three, six, nine and 12 months. Changes of IMT, total number of affected arteries, and OGUS values were evaluated. In a subgroup of patients, exams were conducted weekly in the first 100 days. Fifty patients were enrolled, 36 completed the follow-up. Significant reductions in IMT, total number of affected arteries and OGUS were observed. Eighteen patients presented to weekly exams. The mean IMT of the axillary artery normalized after seven days, while IMT of the common temporal artery normalized after 50 days. The mean OGUS values were below one after six months. There were no differences in IMT changes between GCA patients with or without PMR or between those with and without additional tocilizumab treatment. A relapse occurred in 4 patients. At relapse, mean IMT and OGUS were higher as compared with the preceding assessment. No predictive values indicating a relapse were identified. Vascular ultrasound is sensitive to change in GCA. The presence of PMR or treatment with tocilizumab did not affect IMT decrease.

The Value of Ultrasound Diagnostic Imaging of Meniscal Knee Injuries Verified by Experimental and Arthroscopic Investigations.

(1) Introduction: Meniscal knee injuries may develop as the result of trauma or overloading. Ultrasound imaging is an observer-dependent modality, meaning that the assessment of structural damage depends on the investigator's experience.. None of the published papers provides a standardized method for ultrasound examination of knee menisci. The main goal of this study is to realize and standardize ultrasound imaging diagnostics of meniscal knee injuries based on individual features of ultrasound presentation and to evaluate the applicability of this modality in clinical practice. (2) Material and methods: This study consisted of two anatomical parts, including a clinical part that started with clinical examination of 50 patients with suspected meniscal knee injuries. After this we performed ultrasound examinations in patients with positive clinical test results, using sonographic confirmation for inclusion in the next stage. Finally, knee arthroscopy by two physicians in an operating room was performed, with procedures documented through photographs and video recordings, and analytic material obtained from patients in the control group documented similarly. (3) Results: In the clinical part of the study, arthroscopic examination revealed 13 longitudinal injuries (corresponding to 36% of all injuries in the group), 14 multidirectional injuries (corresponding to 28% of all injuries), 3 radial injuries (corresponding to 6% of all injuries), and 20 oblique injuries (corresponding to 40% of all injuries). The analysis of the sensitivity and specificity of the diagnostic test in terms of recognizing actual meniscal injuries on the basis of full-thickness or partial-thickness delamination, meniscal cyst oedema, and articular space stenosis revealed that the presence of at least two of these three characteristics was associated with the sensitivity of 88% and the specificity of 86% relative to the number of actual meniscal injuries as seen in arthroscopic examination. (4) Conclusions: Research results confirm that clinical examination combined with ultrasound imaging is a very efficient tool for evaluation of meniscal injuries.

Ultrasound diagnosis of causalgia causes in the late stages after inguinal hernioplasty: clinical case

Diagnosis of complications after inguinal hernioplasty is of great importance in modern clinical practice. The main method of examination for this category of patients is ultrasound. Pain syndrome in the late stages after inguinal hernioplasty might be a consequence of various complications, which require differential diagnosis. One of the cases might be causalgia, in which the physical data are not always specific. Ultrasound examination of the abdominal wall was performed in 4 patients who underwent inguinal hernioplasty with complaints of pain in the area of surgical intervention. The performed examination revealed the signs of local edema and hypervascularization at the locations of metal staples fixing the mesh implant in the abdominal wall. Ultrasound examination of patients with causalgia allows to reveale the signs of local aseptic inflammation of tissues.

Could pelvic floor sonography be a standalone method for excluding genuine stress urinary incontinence in women?

Determine whether introital pelvic floor sonography with transvaginal probe (PFS-TV) can be an independent method in the diagnosis of genuine stress urinary incontinence (SUI) and to create a ultrasonographic diagnostic model to objectify diagnostic process. The study involved 315 patients with a history of urinary incontinence problems. Based on the clinical examination and urodynamic examination, the final diagnosis was made. Patients were divided into two groups. Group I included women with SUI and Group II included patients without SUI (OAB and no-UI). Each patient underwent PFS-TV at rest and during straining. The groups were compared in terms of ultrasound parameters. Patients from both groups differed statistically in a significant way (p < 0.05) in terms of mean distance between the lower edge of the pubic symphysis at rest 19 mm vs 22 mm (Group I vs Group II) and during straining (D1 and D2) 22 mm vs 26 mm, the average value of the γ angle (at rest (γ1) 37.5° vs 40° and during straining (γ2) and 66° vs 58.5°, average difference value of angle γ during straining and at rest (γ2-γ1) 29° vs 14°, and frequency of urethral funneling 89% vs 17%. Two parameters studied during PFS-TV were included in the logistic regression model used to exclude the stress component of urinary incontinence. Diagnostic test parameters of model were sensitivity 86.6%, specificity 90.4%, accuracy 93.1%. PFS-TV makes it possible to exclude the stress component of urinary incontinence. The developed logistic regression model allows for the objectification of the results of ultrasound examination in patients with urinary incontinence.

Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review.

Shoulder disorders are very common in clinical practice. Among several other pathologies, calcific tendinopathy of the rotator cuff tendons is frequently observed during the ultrasound examination of patients with painful shoulder. The deposition of hydroxyapatite calcium crystals should not be considered as a static process but rather a dynamic pathological process with different/possible patterns of migration. In this paper, we have illustrated how and where these calcium depositions can migrate from the rotator cuff tendons to the peri-articular soft tissues. We have also tried to discuss the issue from the clinical side, i.e., how these particular conditions might impact the specific diagnosis, appropriate rehabilitation plan or interventional approach for optimal functional recovery.

The roles and mechanisms of miR-26 derived from exosomes of adipose-derived stem cells in the formation of carotid atherosclerotic plaque.

This study explored the serum concentrations of miR-26 in patients with carotid atherosclerosis (CAS) and defined the roles and mechanisms of miR-26 derived from the exosomes of adipose-derived stem cells (ADSC-exos). The carotid artery width was diagnosed by ultrasound examination in patients with different degrees of CAS. The serum levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) in patients were detected by biochemistry. The serum levels of miR-26 were determined by quantitative polymerase chain reaction (qPCR). A model of CAS in ApoE-/- mice fed with a rich-fat diet was established to analyze the regulatory effects of serum miR-26 on blood lipids in mice. Adipose mesenchymal stem cell lines transfected with miR-26 were established. The regulatory relationship between the expression levels of inflammatory factors, including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-1β, and the expression levels of miR-26 in the supernatant of each group of cells was determined by qPCR. The ADSC-exos were extracted from ADSCs and injected into model mice through the tail vein. The therapeutic effect of ADSCs expressing miR-26 on model mice was evaluated by detecting the levels of inflammatory factors and blood lipids in the serum of the mice. The degree of atherosclerosis (AS) was positively associated with the intima-media thickness (IMT) of the carotid artery. The serum levels of miR-26 in patients were inversely correlated with the levels of blood lipids (TC, TG, and LDL-C), and positively correlated with HDL-C levels. Similarly, in the CAS mouse model, the serum levels of miR-26 were inversely correlated with the levels of blood lipids (TC, TG, and LDL-C), and positively correlated with HDL-C level. In ADSCs transfected with miR-26, the miR-26 expression in the cell supernatant was negatively regulated by the expression of inflammatory factors, TNF-α, IL-6, and IL-1β, in the cell supernatant. ADSC-exos expressing miR-26 has positive effects on correcting blood lipids and inflammatory factors in the mouse model of CAS. miR-26 has an active role in CAS and may be a novel target for the treatment of CAS in the future.

Protocol of bedside ultrasound examination for heart failure (ConCOrD – CONgestion, Cardiac and multiORgan Dysfunction)

The purpose of this article is to discuss an algorithm for bedside ultrasound examination in patients with heart failure, which consisting of three blocks: assessment of morphofunctional cardiac pathology, detection of hypertension in the heart chambers, and the presence of congestion. This protocol is based on the point-of-care ultrasound methodology and is designed for use by doctors of clinical non-ultrasound specialties. The protocol is presented in two variations: extended (for expert cardiological assessment) and short for emergency examination. The article provides brief information about the diagnosis, terminology, and classification of heart failure according to modern clinical guidelines.

Preventive ultrasound diagnosis of deep vein thrombosis of the lower extremities in patients with COVID-19

Aim: The aim of the study was to determine the risk group for detecting early signs of thrombus formation in the veins of the lower extremities during preventive ultrasound examination in patients with COVID-19. Materials and methods: The study included three groups of patients who were in intensive care units for COVID-19, of which 50 with acute venous thrombosis, 50 with venostasis in the veins of the lower extremities, and 50 patients without vein pathology, which constituted the control group. All patients were determined the level of D-dimer, fibrinogen and underwent duplex ultrasound scanning examination of the veins of the lower extremities. Results: A close correlation was established between the presence of venous thrombosis and the levels of D-dimer and fibrinogen (2.33, 4.66, p=0.0001). According to the data obtained, in the examined patients values ​​>=2.33 µg/ml for D-dimer is a sign of thrombus formation with 87.76% sensitivity and 97% specificity. For fibrinogen values 0. ​​>=4.64 g/L are indicative of thrombus formation with 83.67% sensitivity and 83.00% specificity. The two studied parameters D-dimer (AUC area = 0.9458) and fibrinogen (AUC area = 0.9024) were a very high-quality classifier model. Conclusion: The results of this study make it possible to form risk groups for the development of deep vein thrombosis (DVT) and to carry out timely prevention of this pathology. In patients with COVID-19 with severe respiratory failure and elevated levels of D-dimer (more than 2.33 mg/l) and fibrinogen (more than 4.64 g/l) duplex ultrasound is indicated.

Pelvic Congestion syndrome - common, but underdiagnosed disease of women

Introduction: Pelvic congestion syndrome is defined as the presence of varicose changes in the ovarian veins and venous plexuses associated with chronic pelvic pain syndrome. The main problem with pelvic congestion syndrome is the low awareness of medical staff about this syndrome and the resulting very low recognition. &#x0D; State of knowledge: Pelvic congestion syndrome is an important cause of chronic pelvic pain. The diagnosis is based on imaging examination with ultrasound as a first-line choice and correlation with clinical presentation. The aetiology is multifactorial and may result from a combination of genetic predisposition, anatomical abnormalities, hormonal, mechanical factors with venous wall weakness, reverse blood flow and hypertension. The incidence is strongly related to the number of pregnancies. &#x0D; Conclusions: Pelvic congestion syndrome is one of the possible causes of chronic pelvic pain, thus differential diagnosis should necessarily include venous insufficiency during interviewing, clinical and ultrasound examination of patients. Among several treatment methods, intravascular embolization is a minimally invasive, effective and safe, currently recognised as a method of choice in treatment.

Analysis of Ultrasound Parameters in Pregnant Women with Retrochorial Hematoma

The purpose of the study was to determine the parameters of ultrasound examination in patients with retrochorial hematoma in the early stages of pregnancy. Materials and methods. Ultrasound examination was performed in 210 women in the early stages of pregnancy to study the features of the echographic parameters of embryo development during the formation of retrochorial hematoma. The main group consisted of 100 pregnant women with signs of early termination and diagnosed retrochorial hematoma. The comparison group consisted of 80 pregnant women with the threat of early termination, but without retrochorial hematoma. The control group included 30 conditionally healthy women with a physiological course of pregnancy. All groups were comparable in age and parity. During ultrasound scanning in the first trimester, the localization of the fetal egg, its size, thickness and echogenicity of the chorion, the diameter of the yolk sac and the echogenicity of its walls were evaluated, attention was paid to the location, volume, and duration of hematoma manifestation. Results and discussion. Pregnant women with the threat of termination at the time of examination had clinical signs of threatening miscarriage. In the women of the main group with the formation of retrochorial hematoma in the first trimester, a certain clinical picture was observed: in 85.0% of cases – pain syndrome, in 71.0% – increased uterine tone and in 42.0% of cases – episodes of bloody discharge. In patients of the comparison group with the threat of termination of pregnancy, but without the formation of retrochorial hematoma, the incidence of pain syndrome was 86.3%, increased uterine tone – 77.5%, bleeding from the genital tract – 46.3%. Pregnant women with retrochorial hematoma have a higher incidence of pathology of extraembryonic formations (chorion, yolk sac). Prognostically unfavorable ultrasound signs are the formation of a retrochorial hematoma up to 6 weeks, a delay in coccygeal-parietal size of the embryo for more than 7 days, corporeal localization and a large volume of hematoma, a violation of uterine blood flow. Normal uterine blood flow was observed in all women of the control group. In patients of the comparison group, blood flow disorders were recorded in 29 (37.2%) women (p=0.000). In the main group of patients with retrochorial hematoma, uterine blood flow disorders were noted in 60 (60.0%) women (p=0.000). Conclusion. Pregnant women with retrochorial hematoma in the first trimester have a higher incidence of pathology of extraembryonic formations (chorion, yolk sac). Prognostically unfavorable ultrasound signs are the formation of a retrochorial hematoma up to 6 weeks, a delay in coccygeal-parietal size of the embryo for more than 7 days, corporeal localization and a large volume of hematoma, a violation of uterine blood flow

Specificity and Sensitivity of Lung Ultrasound Examination in Patients with COVID-19 Induced Pneumonia

The coronavirus infection (COVID-19) is characterized by a high incidence of pneumonia. Extensive damage, high mortality associated with COVID-19 make the rapid bedside diagnosis and dynamic monitoring of the volume and nature of lung tissue damage a challenge. Lung ultrasound examination can be used as a tool to answer it.The objective: to compare the signs detected by lung computed tomography and ultrasound and to assess the sensitivity and specificity of ultrasound in the diagnosis of pneumonia induced by COVID-19.Subjects and Methods. The observational prospective clinical study included 388 patients aged 18–75 years old; they had a confirmed diagnosis of pneumonia caused by COVID-19 or suspected COVID-19. Lung ultrasound was performed within 24 hours after computed tomography (CT) of the chest organs. During CT, pathological signs, infiltration and consolidation of the lungs were visualized which were documented by lung segments. Lung ultrasound was performed according to the Russian Protocol, ultrasound signs of B-lines and consolidation were also documented based on the projection of lung segments on the chest wall. The distributions of variables was analyzed, described and summarized. The sensitivity and specificity of ultrasound methods were evaluated on the basis of ROC analysis according to CT gold standard.Results. Bilateral involvement was found in 100% of cases. Typical CT signs of pneumonia caused by coronavirus infection were ground-glass opacity of the pulmonary parenchyma, thickened pleura, consolidation, interstitium, reticular induration, and cobblestone appearance. With ultrasound examination of the lungs and pleura, the detected signs corresponded to CT signs. B lines (multifocal, discrete or merging) and consolidation of various volumes of lung tissue were most common during ultrasound. The sign of consolidation was detected less frequently versus infiltration (p &lt; 0.001). The sensitivity of lung ultrasound in the diagnosis of lung lesions was 95.3%, and the specificity was 85.4%, the area under the curve was 0.976 with a confidence interval of 0.961–0.991 (p &lt; 0.001).Conclusion. The use of lung ultrasound during the COVID-19 pandemic makes it possible to identify, assess the volume and nature of lung damage. Lung ultrasound demonstrated accuracy comparable to CT of the chest organs in detecting pneumonia in patients with COVID-19.

Clinical epidemiological survey of primary liver cancer in Yunnan province from 2005 to 2014

Objective: To investigate the clinical characteristics and changing trends of primary liver cancer in Yunnan province from 2005 to 2014, in order to provide theoretical basis for the prevention and treatment of liver cancer in this region. Methods: A retrospective survey was used to select inpatient cases of liver cancer who were initially diagnosed and treated in our hospital from 2005 to 2014 with simple random sampling. Patients socio-demographic and clinicopathological characteristics were extracted by a unified and standardized questionnaire, and the data were statistically analyzed. Results: A total of 1000 cases with liver cancer were included, aged (53.2±11.2) years, with a male-to-female ratio of 5.99/1.00. There was no significant change in the gender and age composition ratio of patients in the past 10 years. The proportion of patients with lower education level (primary or junior high school) were increased from 21.8% to 23.4%, and the proportion of patients with relatively higher education level were decreased from 58% to 38.2% (P<0.001). Smokers and non-smokers patients were decreased and increased from 58.8% to 44.4%, and 41.2% to 55.6% (P<0.001). The proportion of drinker patients were decreased from 46.4% to 35.2%. The proportion of patients with advanced liver cancer (stage C and D) were increased, while the proportion of patients with stage A and B showed a downward trend (P<0.001). The proportion of HBsAg-positive patients showed an upward trend, that is, rising from 69% in 2005 to 82% in 2014 (P=0.043). The proportion of HBeAg-positive patients showed a steady trend (P=0.008). The use rate of ultrasound examination in patients with liver cancer were decreased from 91.0% to 58.0% (P=0.001), while the use rate of computed tomography (CT), MRI, and PET/CT examinations were increased from 81.0% to 84.0% (P=0.05), 0 to 22% (P<0.001), and 0 to 3% (P=0.026) between 2005 to 2014. The proportion of surgical patients were increased (P=0.005), but the proportion of interventional patients did not change significantly (P=0.590). Surgery and interventional therapy were the most common treatment methods, and the proportion of patients treated with surgery over the past 10 years showed an upward trend (P=0.005), while the proportion of interventional therapy remained at a high level with no significant change (P=0.590). Conclusion: In Yunnan province, the incidence of liver cancer increases with age, and the proportion of male with liver cancer is almost six times that of women. Moreover, the low positive rate of alpha-fetoprotein levels and advanced clinical stage in this region are presently the main challenges against the liver cancer prevention and treatment. The application scope of CT, magnetic resonance imaging, PET-CT and other examination methods has gradually expanded, but the treatment methods are still mainly surgery and interventional therapy.

Multicenter Study of ACR Ultrasound LI-RADS Visualization Scores on Serial Examinations: Implications for Surveillance Strategies.

BACKGROUND. The American College of Radiology Ultrasound LI-RADS includes the visualization score as a subjective measure of examination quality and the expected level of sensitivity. Whether a single suboptimal visualization score warrants a change in surveillance strategy is unknown. OBJECTIVE. The purpose of this study is to determine the relative stability of visualization scores on serial surveillance ultrasound examinations in patients at risk for HCC. METHODS. This retrospective study included patients at risk for HCC who underwent at least two HCC surveillance ultrasound examinations at one of three institutions between January 2017 and November 2020. The frequencies of the score remaining unchanged after variable numbers of preceding examinations with the given score were determined. A mixed-effects logistic model was fitted to identify factors associated with a repeat score of C (denoting severe limitations) versus a change to score A (indicating no or minimal limitations) or score B (denoting moderate limitations). RESULTS. A total of 3169 patients underwent at least two ultrasound examinations, yielding a total of 9602 examinations. A total of 8030 examinations (83.6%) were assigned score A; 1378 (14.4%), score B; and 194 (2.0%), score C. The frequency of score A was 88%, 91%, and 93% after one, two, and three consecutive prior examinations with score A, respectively. The frequency of score B was 45%, 48%, and 55% after one, two, and three consecutive prior examinations with score B. The frequency of score C was 42%, 67%, and 80% after one, two, and three consecutive prior examinations with score C. Among 109 examinations with score C in 91 patients with an available follow-up examination, no factor (including age, sex, severe steatosis, advanced cirrhosis, ascites, body mass index, and a change in the ultrasound machine, sonographer, or radiologist) was significantly associated with repeat score C (all p > .05). Although not statistically significant, presence of severe steatosis and presence of advanced cirrhosis had the highest odds ratios (2.88 and 2.38, respectively) for repeat score C in multivariable analysis. CONCLUSION. Only 42% of patients with visualization score C on a single surveillance examinations have score C on follow-up examinations; however, after two or more score C examinations, the chance of future score C substantially increases. CLINICAL IMPACT. The findings may inform decisions regarding alternative surveillance strategies in patients with visualization score C on ultrasound. This decision should consider the number of previous examinations with score C.

Assessment of the risks of changes in brachiocephalic vessels according to ultrasound examination of patients with obstructive sleep apnea

Introduction. In the medical literature, there is not enough work on the impact of obstructive sleep apnea (OSA) on the development of atherosclerosis of the brachiocephalic arteries and venous dysgemenia. For the purpose of early diagnosis of vascular complications, further study of extracranial vessels in patients with OSA is necessary.Aim. To study the chances of changes in brachiocephalic vessels by ultrasound examination in patients with obstructive sleep apnea.Materials and methods. A survey was carried out of 88 patients. The results of anthropompetry, polysomnography and ultrasound examination of brachiocephalic vessels were evaluated.Results and discussion. New data were obtained on the severity of macroangiopathy, an increase in the peak systolic blood flow velocity in the internal jugular veins, and an increase in the diameters of the vertebral veins in patients with sleep apnea. It was also found that in patients with OSA, the chances of having a wide diameter of the common carotid artery (CCA) on both sides and the internal carotid artery on the left are more than 3 times higher, the probability of thickening of the intima-media complex in the area of the CCA and its bifurcation is more than on the left 3.5 times and the chances of macroangiopathy are 3 times higher in comparison with the examined patients without apnea.Conclusion. Timely assessment of the entire spectrum of pathological changes in the brachiocephalic vessels in patients with OSA will make it possible to diagnose early signs of atherosclerotic lesions of the arteries, venous dysfunction at the extracranial level.

Keep up with progress-Ultrasound education requires change.

Despite increasing use of ultrasound imaging even beyond the circle of radiologists, low priority is given to student training. Until today, integration of ultrasound into clinical education at medical schools still lags far behind, and a curricular structure is oftentimes missing or implemented half-heartedly on a voluntary basis. Main reasons for not having ultrasound integrated are lack of time and poor funding. Finally, residents feel inadequately prepared for daily professional practice. For patient safety and satisfaction, however, it is highly desirable that ultrasound becomes second nature to the next generations of physicians, as the stethoscope already is.1 At our university hospital, we recently developed and implemented a multidisciplinary curriculum that integrates ultrasound as a compulsory part into medical education directly from start to finish. The curriculum follows a spiral course with four levels of training in which learning activities are repeated with continuously growing complexity. Competency-centred “probe-in-the-hand” courses are held in small groups of maximum six learners. Students start to practice ultrasonography by scanning each other, attending training in skills labs and, finally, deepen experience in clinical settings. Students should prepare self-determinedly for courses using learning videos available on the university's in-house network and on publicly available e-learning platforms. On the first training level, during preclinical education, ultrasonography is closely linked to anatomy dissection- and physiology courses. With this vertical integration, basic sciences are put into context and vice versa, clinical aspects are introduced into early medical training. At the same time, specific psychomotor skills are introduced. On the second level, in the third year of medical education, students apply point-of-care ultrasound in peers, skills lab simulations and ultrasound phantoms. The skills lab will be available during semester breaks to provide the opportunity to practice outside scheduled courses. On the third level, during advanced clinical education, students select a compulsory elective ultrasound course in a specialty of their choice, held at five consecutive dates following the concept of work-based learning. This allows students to direct their own learning and to focus on their preferred specialty. From then on, they conduct ultrasound examinations in patients. During the final year, students successively adapt skills and knowledge to growing medical experience. Now they are expected to use ultrasound with a large degree of independence and confidence. Entrustable professional activities are specified and assessed concomitantly. The longitudinal curriculum might serve as an inspiring example, however, with built-in flexibility according to requirements of each medical school and changing conditions. Incidental effects including enhancement of self-determined learning and mutual benefits regarding learning success in involved disciplines are expected. Costs and time can be saved by e-learning and appointment of student tutors. As participating departments share benefits arising from integration of ultrasound, they may contribute to the costs proportionally. In the interest of both patients and students, with an eye to the future, medical schools are encouraged to remove initial obstacles and tackle full and early integration of ultrasound into their curricula.

Factors associated with positive thrombus findings at ultrasonography in COVID-19 ward patients who underwent imaging for suspected deep vein thrombosis under prophylactic anticoagulation

ObjectiveThe incidence of deep vein thrombosis (DVT) is increased in patients with coronavirus disease 2019 (COVID-19) and its presence is associated with worse outcomes. Ultrasound examination of patients with COVID-19 with a suspected DVT is challenging owing to concerns with disease transmission; the timely initiation of therapeutic anticoagulation is essential. This study aimed to identify patient factors associated with positive thrombus findings at ultrasound examination in patients with COVID-19 who underwent imaging for suspected DVT. MethodsPatients who did not require intensive care unit treatment and who underwent ultrasound imaging for suspected DVT between March and December 2020 were included retrospectively. Patient demographics, comorbidities, modified Well’s score, and d-dimer results on the day of ultrasound examination were recorded. Parameters for a higher likelihood of a positive DVT result were determined by comparing patients with confirmed DVT on ultrasound examination and patients with negative ultrasound findings. To determine a cut-off for d-dimer levels, a receiver operating characteristic curve was constructed. The sensitivity and specificity of the determined high-risk factors in the prediction of positive ultrasound results were calculated. ResultsA positive history for DVT (25% vs 4%; P < .001), thrombophilia (9% vs 2%; P = .048), immobilization (53% vs 23%; P = .001), and a Well’s score ≥ 2 (50% vs 21%; P = .001) were more frequent in patients with DVT. The mean d-dimer levels were higher in patients with DVT (3871 ± 1805 vs 2075 ± 1543; P < .001). The presence of either thrombophilia or a d-dimer level of >2020 had a sensitivity of 93% and a specificity of 64%. The presence of either thrombophilia, a d-dimer level of >2020, or a Well’s score of ≥2 had a sensitivity of 100% and a specificity of 51%. ConclusionsPatients with COVID-19 with a d-dimer of >2020, a positive history for thrombophilia, and a Well’s score of ≥2 should undergo a timely ultrasound examination. The high risk of DVT should be remembered for all hospitalized patients with COVID-19.

Potential of sonography in diagnosis of tongue tumors

Purpose of the study. An analysis of sonography potential in the primary diagnosis and clinical staging of tongue cancer.Patients and methods. The study included 18 patients aged 40–70 years with tongue tumors. The majority accounted males – 14 (77.7 %). Women were represented by 4 (22.2 %) examinees. Ultrasound examinations were performed using expert-class ultrasound systems with broadband linear multifrequency transducers. Transoral examination with linear transducers required tumor location in the anterior and lateral parts of the oral tongue. During ultrasound examinations we evaluated: tumor shape, tumor invasion depth; tumor sizes – width and thickness; tumor echogenicity and structure; tumor vascularization in Doppler modes. The results were compared with the data of histological examination.Results. Transoral ultrasound examination of patients with tongue cancer allows clear visualization of the tumor and assessment of it’s spread. The study showed that the round shape of tongue tumors prevailed in 13 (72.2 %) patients, the tumor echo structure in 10 (55.5 %) was heterogeneous, the contours were even and clear in the majority of patients – 13 (72.2 %), all tumors showed a reduced acoustic density, the depth of invasion ranged from 2 to 6 mm in 8 (44.4 %) patients and exceeded 6 mm in 6 (33.3 %) patients, which corresponded to stages III and IV of the diseas. Doppler ultrasonography recorded intense intratumoral blood flow in 100 % of cases. In 8 (44.4 %) cases, metastatic lesions of the cervical lymph nodes were observed.Conclusion. Transoral ultrasound diagnosis of tongue cancer is a highly informative, safe and modern method providing surgeons with information that helps in choosing the scope of surgical treatment and in determining the disease prognosis at the preoperative stage. The accuracy of the method was 87 %, the sensitivity was 85 %, and the specificity was 86.2 %.

Diagnostic accuracy of vascular ultrasound in patients with suspected giant cell arteritis (EUREKA): a prospective, multicentre, non-interventional, cohort study.

Temporal artery biopsy is considered the diagnostic gold standard for giant cell arteritis, despite approximately 39% of patients who are negative for the condition by biopsy subsequently being given a clinical diagnosis of giant cell arteritis. We aimed to assess the diagnostic accuracy of ultrasound examination in patients with suspected giant cell arteritis. In this prospective, multicentre, non-interventional, cohort study (evaluation of ultrasound's role in patients suspected of having extracranial and cranial giant cell arteritis; EUREKA), we consecutively recruited patients aged 50 years or older, with clinically suspected giant cell arteritis from three Danish hospitals (South West Jutland Hospital in Esbjerg, Silkeborg Regional Hospital, and Rigshospitalet, Glostrup). Participants had a bilateral ultrasound of the temporal, facial, common carotid, and axillary arteries. Ultrasounds were done by ultrasonographers who were systematically trained in vascular ultrasound using appropriate equipment and settings. Participants then had a temporal artery biopsy within 7 days of initiation of corticosteroid treatment. A blinded ultrasound expert assessed all ultrasound images. Ultrasound vasculitis was defined in cranial arteries as a homogeneous, hypoechoic, intimamedia complex thickness and a positive compression sign and as a homogeneous intimamedia complex of 1 mm in thickness or wider in the axillary arteries and of 1·5 mm thickness or wider in the common carotid artery. Participants were followed up at 6 months. During this 6 month period, clinicians were able to collect data from all clinical examinations to enable a full clinical diagnosis at 6 months. Clinical diagnosis was based on the expert opinion of the treating rheumatologist. The diagnostic criterion standard was diagnosis confirmed after 6 months of follow-up. We used logistic regression analyses to calculate the odds ratio and 95% CI of ultrasound as a predictor for giant cell arteritis. Between April 1, 2014, and July 31, 2017, 118 patients were screened for inclusion, of whom 106 had both ultrasound examinations and an eligible temporal artery biopsy and were included in the intention-to-diagnose population. The mean age was 72·7 years (SD 7·9), 63 (59%) participants were women, and 43 (41%) were men. Temporal artery biopsy was positive in 46 (43%) of 106 patients, and 62 (58%) of 106 patients had a clinically confirmed diagnosis of giant cell arteritis at 6 months (temporal artery biopsy sensitivity 74% [95% CI 62-84], specificity 100% [95% CI 92-100]). Cranial artery ultrasound was positive in all patients who had a positive temporal artery biopsy, and seven (58%) of 12 patients who were positive by ultrasound and negative by temporal artery biopsy were confirmed to have large-vessel giant cell arteritis via other imaging methods. The sensitivity of ultrasound diagnosis of giant cell arteritis was 94% (84-98) and specificity was 84% (70-93). Logistic regression analysis confirmed that ultrasound was the strongest baseline predictor for a clinically confirmed diagnosis of giant cell arteritis at 6 months (crude odds ratio 76·6 [95% CI 21·0-280·0]; adjusted for sex and age 141·0 [27·0-743·0]). Vascular ultrasound might effectively replace temporal artery biopsy as a first-line diagnostic method in patients suspected of having giant cell arteritis when done by systematically trained ultrasonographers using appropriate equipment and settings. The Institute for Regional Research at Hospital of Southwest Jutland, Esbjerg, Denmark.

Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure.

Chronic heart failure is one of the common causes of hospitalization and death. Pulmonary congestion is the common disease feature of patients with chronic heart failure, which could be correctly diagnosed by lung ultrasound. Efficacy of lung ultrasound‐guided pulmonary congestion management for patients with acute heart failure is well documented, however, more evidence is needed to establish the clinical value of pulmonary congestion detection by lung ultrasound examination in patients with chronic heart failure. This review summarized current evidence related to the use and clinical value of pulmonary congestion assessment by lung ultrasound in patients with chronic heart failure, aiming to provide new suggestions on promoting the widespread use of lung ultrasound in patients with chronic heart failure to improve the quality of life and outcome of patients with chronic heart failure.