Ultrasound Imaging Examination Research Articles

MÉTODOS DIAGNÓSTICOS PARA O TRATAMENTO DA ENDOMETRIOSE

Endometriosis is an inflammatory disease that affects around 10% to 15% of women of reproductive age and can be asymptomatic or present symptoms of great relevance affecting the woman’s social life. Thus, among the most reported manifestations, chronic abdominal pain, dysmenorrhea, dyspareunia, urinary and/or bowel movements symptoms and infertility stand out. Pelvic ultrasound and magnetic resonance imaging examinations may reveal consistent foci of endometrioma or deep infiltrative endometriosis. However, these imaging tests do not have the specificity necessary for the diagnosis of superficial peritoneal endometriosis. The measurement of the CA-125 marker is the most used laboratory test to investigate the disease. CA-125 is a blood protein that at high levels can be indicative of endometriosis, with a sensitivity of 75% sufficient to indicate the disease. However, the exam that presents a definitive diagnosis of endometriosis characterized by a gold standard procedure is laparoscopy and anatomopathological analysis, which consists of a risky and high-cost procedure, but of great importance in the diagnosis and treatment of the disease. Endometriosis is a chronic, benign and progressive disease, early diagnosis is extremely important to avoid further complications for women, such as highly complex surgery and infertility.

Urethral obstruction in a ram with a periurethral abscess: clinical findings, diagnostic imaging and pathology

BackgroundUrethral obstruction is a common and life-threatening condition in male small ruminants.Case presentationThis case report describes a 3-year old 103 kg Zwartbles breeding ram, presented with the complaint of straining, suspected to have an urethral obstruction. The work-up included clinical examination, laboratory analyses, ultrasound imaging, (contrast) radiography and urine examination. At presentation, blood analysis revealed a respiratory alkalosis, hyperkalaemia and mild azotaemia. On transabdominal ultrasound an enlarged bladder (diameter 11 cm) and free fluid surrounding the right kidney were observed. Treatment of the animal included tube cystostomy, intravenous perfusion, antimicrobial treatment, ammonium chloride and NSAIDs. No indications for urolithiasis were found on ultrasound, radiography, or urine examination. As no improvement was seen despite 16 days of therapy, a contrast radiograph of the urinary tract, as well as reproductive exam were conducted. Positive anterograde urethrogram showed a contrast filled cavitary lesion at the caudal aspect of the pelvic urethra. The reproductive ultrasonography revealed the same large urethral distention or abscess compressing the pelvic urethra, as well as severe testicular degeneration in both testis. The results of the contrast radiograph and the reproductive exam lead to the decision to euthanize the animal, as the animal would not be capable of breeding. Computed tomography was performed post-mortem, which showed close relation between the cavitary lesion and the left bulbourethral gland. Pathology revealed a lymphoplasmacytic to suppurative infection at the level of the urogenital tract, chronic interstitial nephritis and a perirenal to cortical abscess of the right kidney as well as a periurethral abscess. As for the reproductive system, multifocal interstitial inflammatory infiltrates were seen on the entire system. Marked fibrosis and atrophy was seen at the level of the testes and both epididymides.ConclusionsA periurethral abscess should be included in the differential diagnosis for an urethral obstruction in small ruminants. The extensive medical imaging, together with the ante-mortem and post-mortem findings, makes this a good reference case for diagnosticians confronted with urethral problems in a ram.

Qianggan Ruanjian Pill ameliorates liver fibrosis through regulation of the TGF-β1/Smad and PI3K/AKT signalling pathways

Ethnopharmacological relevanceLiver fibrosis is a critical pathological process in the progression of chronic liver injury, ultimately resulting in cirrhosis, for which currently available therapeutic interventions remain inadequate. Among these, the Qianggan Ruanjian Pill (QGRJP) has emerged as a clinically experienced formula with notable therapeutic efficacy against liver fibrosis. However, the precise underlying mechanisms require further investigation. Aim of the studyIn this study, we investigated the key pathways and target genes of QGRJP that attenuate liver fibrosis and elucidated the underlying mechanisms. Materials and methodsHigh-performance liquid chromatography-mass spectrometry (HPLC-MS) was used to identify the major components of the QGRJP. Mouse models of liver fibrosis were established by injecting olive oil containing 25% carbon tetrachloride (CCl4), which was administered at different doses of QGRJP by gavage. Liver damage and function were assessed using serum biochemical detection, ultrasound imaging, and histopathological examination. The anti-fibrosis effect was assessed using immunohistochemistry, western blotting, and quantitative real-time PCR (qRT-PCR). The in vivo safety of the QGRJP was evaluated using weight monitoring and biopsy. Potential anti-liver fibrosis signalling pathways and key targets of QGRJP were identified using RNA-seq analysis and network pharmacology. The predicted targets and pathways were validated using in vitro and in vivo experiments. ResultsQGRJP significantly ameliorated CCl4-induced liver fibrosis, and its mechanism was correlated with the inhibition of hepatic stellate cell (HSC) activation and the inflammatory response via inhibition of the TGF-β1/Smad and PI3K/AKT pathways, leading to a significant reduction in the expression of collagen and other fibrosis-related proteins. Additionally, no obvious toxic side effects were observed in the major organs of the mice or in activated HSCs (aHSCs). ConclusionThis study demonstrated that QGRJP mitigated liver injury, inflammation, and fibrosis by inhibiting the TGF-β1/Smad and PI3K/AKT signalling pathways.

Coexistence of uterine adenosarcoma and endometrioid endometrial carcinoma: A case report and literature review.

Uterine adenosarcoma coexisting with endometrial carcinoma is a very rare disease. Herein, we reported the case of uterine adenosarcoma coexisting with endometrioid endometrial carcinoma. Transvaginal ultrasound, computed tomography, and magnetic resonance imaging examinations all indicated a space-occupying lesion in the uterine cavity, and initially was considered endometrial carcinoma. Subsequently, total hysterectomy combined with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy were performed. The coexistence of uterine adenosarcoma and endometrioid endometrial carcinoma was histologically confirmed postoperatively. The patient recovered well after surgery and was discharged on postoperative day 7. At a follow-up examination 10 months after surgery, we found no evidence of discomforting symptoms and recurrence or metastasis. Since the coexistence of uterine adenosarcoma and endometrial carcinoma is rare, it is easy to be overlooked the presence of uterine adenosarcoma on imaging or morphology, and thus be misdiagnosed as a more common disease, namely endometrial carcinoma. Observing the cystic structure within the lesion on magnetic resonance imaging is helpful for the diagnosis of uterine adenosarcoma. This article summarizes the imaging characteristics, clinicopathological features, molecular correlation, treatment, and prognosis of the disease.

Teledidactic Versus Hands-on Teaching of Abdominal, Thoracic, and Thyroid Ultrasound—The TELUS II Study

BackgroundThe worldwide COVID-19 pandemic has initiated a change in medical education and the development of new teaching concepts has become inevitable to maintain adequate training.ObjectiveThis pilot study aims to compare teledidactic teaching with traditional face-to-face teaching for abdominal, thoracic, and thyroid ultrasound.DesignConcurrently, a teledidactic and a face-to-face ultrasound course were held. The students completed seven 90-min modules using mobile ultrasound probes (Butterfly IQ). Each module consisted of a lecture, a demonstration of probe guidance, and independent training.ParticipantsA total of thirty medical students took part in the study and were randomly assigned to a teledidactic and a face-to-face group.Main MeasuresAn objective structured assessment of ultrasound skills (OSAUS) was performed as a pre-test and as the final exam and ultrasound images obtained during the exam were evaluated using the brightness mode quality ultrasound imaging examination (B-QUIET) scale.Key ResultsNo significant difference between the two cohorts on the OSAUS final exam was shown (p > 0.05 in all modules). There was a significant difference in the assessment of the images in the focused assessment with sonography for trauma (FAST) (p 0.015) and aorta (p 0.017) modules. Students in the teledidactic group performed better in both modules, scoring 33.59 (± 2.61) out of 44 in the module FAST (face-to-face group 30.95 (± 1.76)) and aortic images averaged 35.41 (± 2.61) points (face-to-face group 32.35 (± 3.08)).ConclusionsA teledidactic course for abdominal and thoracic ultrasound examinations is equally effective to traditional face-to-face teaching in this pilot study. Digital implementation with a portable ultrasound machine could be a great opportunity to promote ultrasound education worldwide and over great distances.

LAPORAN KASUS INFEKSI/INFLAMASI TRAKTUS GASTROINTESTINAL BAWAH ABSES PERIANAL DENGAN FISTULA

Perianal abscess with perianal fistula is an infectious-inflammatory disease of the perianal region. This disorder has quite high morbidity and recurrence rates and is treated with surgery. Complete preoperative findings, including anatomy, the connection between the fistula and surrounding structures, and secondary fistulas and abscesses, can be obtained through radiological examination. In this case report, a painful lump that was actively producing pus was found in the perianal area, a perianal ultrasound (USG) and Magnetic Resonance Imaging (MRI) examination was carried out and the diagnosis made was a perianal abscess with fistula. Fistulectomy and abscess drainage were performed.

Holoprosencephaly: The Disease and Its Related Disabilities

AbstractHoloprosencephaly (HPE), the most prevalent developmental anomaly affecting the forebrain in humans, occurs in approximately 1 in 16,000 liveborn neonates, with an incidence reaching 1 in 250 in conceptuses. This condition is distributed worldwide. HPE is etiologically heterogeneous, and its pathogenesis is variable. Environmental, teratogenic, genetic, or metabolic factors can contribute to the development of HPE. Notably, maternal insulin-dependent diabetes mellitus and maternal alcoholism are among the primary causative factors. HPE may be linked to various well-defined multiple malformation syndromes characterized by a normal karyotype, such as Smith–Lemli–Opitz's, Pallister–Hall's, or velocardiofacial syndrome. Alternatively, it can be associated with chromosomal abnormalities. (i.e., Patau's syndrome and, less frequently, Edwards' syndrome or Down's syndrome). The major genes implicated in HPE are SHH, ZIC2, SIX3, and TGIF. The range of HPE is extensive, covering diverse neuropathological phenotypes of varying severity. Three classical types of HPE can be distinguished in increasing order of severity: lobar HPE, characterized by separated right and left ventricles with some continuity across the frontal cortex; semilobar HPE, featuring a partial separation; and the most severe form, alobar HPE, where there is a single brain ventricle and the absence of an interhemispheric fissure. Additionally, there are other variations of HPE, ranging in severity, including the less severe interhemispheric median HPE (also known as middle interhemispheric variant). The phenotypic spectrum of HPE is highly extensive, encompassing severe cerebral malformations to microforms. Children with HPE often encounter numerous medical challenges; among them neurological disorders, craniofacial malformations, endocrine disorders, oral and motor dysfunction, and dysfunction of the autonomic nervous system. Neurologic problems, such as cerebral palsy and seizures, are common. The diagnosis of HPE is typically made prenatally, relying primarily on ultrasound and magnetic resonance imaging examinations. The prognosis for individuals with HPE is largely dependent on its underlying causes. Those with cytogenetic abnormalities, in particular, face a significantly poorer prognosis, with only 2% surviving beyond 1 year.

The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics.

This study aimed to examine the clinical and multimodal ultrasonic characteristics differences between carotid web (CW) and CW with plaque as well as the potential risk factors for stroke caused by CW. We retrospectively enrolled patients diagnosed with CW by CTA or high-resolution MRI (HRMRI) and simultaneously underwent contrast enhanced ultrasound (CEUS) and superb microvascular imaging examinations from January 2015 to October 2022. The CW angle was measured using computer-aided software. The variations between CW and CW with plaque were evaluated, and univariable and multivariable logistic regressions were utilized to identify possible risk predictors for stroke caused by CW. Two hundred ninety-nine patients with an average age of 60.85 (± 8.77) years were included. Sex, age, history of smoking, alcohol, hypertension, diabetes mellitus, homocysteine level, and treatment, as well as web length and thickness, luminal stenosis, location wall, number, CW angle, and CEUS enhancement, were quite different among CW and CW with plaque patients (p < 0.05). The logistic regression analysis showed that web length was an independent predictor of luminal stenosis in CW patients. For patients with CW and plaque, plaque and web thickness, as well as plaque enhancement, were associated with stenosis. Furthermore, luminal stenosis and plaque length were risk factors for symptoms. The multimodal ultrasonic and clinical manifestations of CW and CW with plaque are quite different. Web length is an independent risk factor for carotid artery stenosis in CW patients, whereas luminal stenosis and plaque length were risk factors for symptoms in CW with plaque patients. Exploring the similarities and differences between the carotid web and the carotid web with plaque, based on the stereo-geometric spatial position relationship and hemodynamic changes, may provide further insights into the underlying mechanisms of stroke occurrence caused by the carotid web. 1. Multimodal ultrasonic and clinical manifestations of carotid web and carotid web with plaque are substantially different. 2. A thin triangular endoluminal defect is identified as a typical feature of the web on superb microvascular imaging, and two kinds of typical ultrasonic features of CW with plaque are also identified. 3. Web length is an independent risk factor for carotid stenosis in carotid web patients, whereas luminal stenosis and plaque length are risk factors for symptoms in patients with CW and plaque.

Correlation between endometriosis and migraine features: Results from a prospective case-control study.

Endometriosis and migraine frequently coexist, but only a limited number of studies have focused on their mutual association. The aim of our study was to investigate, in untreated women with comorbid endometriosis/adenomyosis and migraine, the correlation between headache features and endometriotic subtypes and their possible relationship with pain severity and disease disability. Fifty women affected by endometriosis/adenomyosis and migraine matched (1:2) with 100 patients with endometriosis alone and 100 patients with only migraine were recruited and underwent pelvic ultrasound imaging and neurological examination. Severe adenomyosis, posterior and anterior deep infiltrating endometriosis (p = 0.027, p = 0.0031 and p = 0.029, respectively) occurred more frequently in women with migraine. Dysmenorrhea was the most commonly reported symptom in women with endometriosis and migraine and the mean VAS scores of all typical endometriotic symptoms were significantly higher in the presence of comorbidity. Women with both migraine and endometriosis reported significant higher pain intensity (p = 0.004), higher monthly migraine days (p = 0.042) and increased HIT 6-scores (p = 0.01), compared with those without endometriosis. Our results demonstrated that the co-occurrence of migraine in untreated women with endometriosis is associated with more severe gynecological infiltrations and correlated with increased pain intensity and disease disability.Trial Registration: Protocol number 119/21.

Design, synthesis and anti-hepatic fibrosis activity of novel diphenyl vitamin D receptor agonists

Hepatic fibrosis poses a significant threat to human health due to excessive extracellular matrix (ECM) deposition leading to liver function damage. Ligand-activated vitamin D receptor (VDR) has been identified as an effective target for hepatic fibrosis, reducing ECM by inhibiting hepatic stellate cell (HSC) activation. Here, a series of novel diphenyl VDR agonists have been rationally designed and synthesized. Among these, compounds 15b, 16i, and 28m showed better transcriptional activity compared to sw-22, which was previously reported to be a potent non-secosteroidal VDR modulator. Moreover, these compounds exhibited outstanding efficacy to inhibit collagen deposition in vitro. In models of CCl4-induced and bile duct ligation-induced hepatic fibrosis, compound 16i showed the most significant therapeutic effect by ultrasound imaging and histological examination. Moreover, 16i was able to repair liver tissue by reducing the expression levels of fibrosis genes and serum liver function indexes without causing hypercalcemia in mice. In conclusion, compound 16i is a potent VDR agonist with significant anti-hepatic fibrosis action both in vitro and in vivo.

Imaging Diagnosis of Testicular Lymphoma in Young Male Patient: Incidental Finding in Ultrasonography

BACKGROUND: Ultrasonography is a common diagnostic procedure in patients with testicular abnormalities. Primary testicular lymphoma (PTL) is rarely discovered and is more common among elderly populations. CASE PRESENTATION: This case describes a young male patient with a history of painless testicular enlargement. Ultrasonography reveals an incidental finding of hypoechoic echo structural mass and increased vascularity using color Doppler ultrasonography. The further pathological examination discovered the findings indicative of a non-Hodgkin, diffuse, and large B-cell lymphoma. These distinctive features should be helpful in suggesting a diagnosis of PTL on imaging. CONCLUSION: PTL is a rare and aggressive extranodal NHL. Despite its low incidence, it is an extremely rare testicular cancer at a young age. Careful ultrasound imaging examination should be applied in patients with testicular enlargement. The presence of hypoechoic echostructural and an increase in vascularity should be considered for the possibility of a diagnosis of primary testicular tumor.

Modified B-QUIET scoring of kidney images acquired by veterinary students in live canines with versus without sequential practice on ultrasound phantoms.

Ultrasound phantoms are training tools that can help students learn basic ultrasound principles. The purpose of this prospective cohort design study was to determine whether preclinical veterinary students in a curriculum with more phantom training sessions acquire better-quality ultrasound images of kidneys in live canines compared with students in a curriculum without sequential phantom training sessions. In clinical skills labs, 132 second-year (2VM) and 130 third-year (3VM) veterinary students obtained sagittal and transverse images of the left kidney of healthy, student-owned dogs. Images were graded on proper identification/orientation, technique, and image anatomy using a modified Brightness Mode Quality Ultrasound Imaging Examination Technique, a modified standardized ultrasound interpretation scale. A two-sample t-test was used to compare 2VM and 3VM performance. 2VM students were inaugural members of a redesigned curriculum and had previously participated in eight clinical skills labs involving hands-on ultrasound practice using phantoms and live animals prior to this study. The 3VM students were the final members of the prior curriculum and had previously participated in a single ultrasound lab using phantoms and a single ultrasound lab using live animals. For Identification/Orientation categories, 2VM students acquired slightly but statistically significantly better transverse images (P=0.04). There were no significant differences between identification/orientation tasks for sagittal images or for technique and image anatomy categories. The findings indicate that future studies assessing more sensitive evaluation tools and serial evaluation of students may be beneficial in monitoring student competency and assist in evaluating the role of phantoms in ultrasound training in the veterinary curriculum.

Robotic Abdominal Wall Repair with Endoscopic Adductor Lengthening: A Minimally Invasive Approach for Core Muscle Injuries

Groin pain is a common complaint in sports medicine practices but can be a challenge to accurately diagnose given the expanse of differentials. In the athlete, groin pain may be caused by a core muscle injury, also known as sports hernia or athletic pubalgia. These injuries most frequently occur in young males who participate in explosive and rotationally demanding activities such as soccer, football, and ice hockey, which generate large forces across the trunk and hip joint. These injuries are becoming more frequently diagnosed, in part, due to the utilization of diagnostic modalities, such as dynamic ultrasound and magnetic resonance imaging (MRI) and sensitive physical examination tests, such as the cross-body sit-up and squeeze test. When conservative management fails, surgical intervention is a good option for the athletes who desire to return to play. Surgical options include both open and laparoscopic techniques to repair abdominopelvic defects with or without attention to adductor pathology. The purpose of this article is to present a technique for minimally invasive robotic abdominal wall repair with endoscopic adductor lengthening for core muscle injuries.

Interaction of basic diseases and low red blood cell count as critical murderer of wound infection after osteosarcoma resection: Wound infection after osteosarcoma resection.

Background:Surgical wound infection is one of the common complications in patients after osteosarcoma resection. It is imperative to grasp the risk factors comprehensively. Therefore, this study aimed to explore the risk factors of wound infection and deeply analyze the correlation between risk factors and wound infection.Methods:The study subjects were 101 patients who underwent osteosarcoma resection between April 2018 and August 2021. The diagnosis of postoperative wound infection was confirmed by postoperative observation of the incision, ultrasound imaging, and pathogenic examination. This study included a series of potential factors, mainly laboratory examination indicators and patients’ general information. The statistical methods had Pearson Chi-square test, Spearman-rho correlation test, multifactorial linear regression model, logistic regression analysis, and receiver operating characteristic (ROC) curve.Results:Pearson Chi-square test and Spearman correlation test showed that red blood cell (RBC) count (P = .033) and basic diseases (P = .020) were significantly correlated with a surgical wound infection after osteosarcoma resection. Logistic regression analysis manifested that basic disease (OR = 0.121, 95% CI: 0.015‐0.960, P = .046) and RBC (OR = 0.296, 95% CI: 0.093‐0.944, P = .040) have a clear correlation with whether the patients have surgical wound infection after osteosarcoma resection. And the interaction of basic diseases and RBC could diagnose the surgical wound infection sensitively and accurately (AUC = 0.700, P = .014, 95% CI = 0.564‐0.836) via the ROC analysis.Conclusion:Patients with basic diseases and low RBC were risk factors for surgical wound infection after osteosarcoma resection.

A Randomized Study of b3 Agonists versus Anticholinergics Administration in Patients with Multiple Sclerosis and Lower Urinary Tract Dysfunction

Abstract Introduction and Objective: Multiple sclerosis (MS) is the most frequent autoimmune demyelinating disease of the central nervous system usually affecting lower urinary tract function. In the present study, we compare the efficacy and safety of either a b3 agonist (mirabegron) or anticholinergics in treating MS patients with lower urinary tract dysfunction (LUTD) and assess the LUTD symptom improvement. Evidence Acquisition: A multi-center, single-blinded, comparative study was designed, including MS patients with LUTD. Patients were administered either mirabegron or anticholinergics in combination with standard MS treatment. All cases underwent clinical examination and completed urination diaries and validated questionnaires (Neurogenic Bladder Symptom Score and MS International Quality of Life). Furthermore, urine test analysis, as well as abdominal ultrasound imaging examination, was performed. Data on several clinical and imaging parameters were collected between the two groups at the first visit and after 3 months of treatment. Evidence Synthesis: A total of 61 patients with LUTD participated in the survey. An improvement regarding LUTD was noted in all patients. However, no statistical difference was recorded between the mirabegron and the anticholinergic group. Medical treatment was well tolerated, and no patient discontinued medication due to side effects. Conclusions: Both mirabegron and anticholinergic therapy can be administered for LUTD in MS patients. In terms of drug efficacy, no statistical difference was noted between the two cohorts at 3 months.

Clinical Value of Contrast-Enhanced Ultrasound in Breast Cancer Diagnosis.

Breast cancer (BC) ranks first in morbidity and mortality among female malignant tumors worldwide. This study is aimed at clarifying clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis and differentiation of BC. A total of 108 BC patients admitted to our hospital from January 2019 to December 2021 were enrolled. All patients underwent conventional color Doppler ultrasound and CEUS imaging examination. All ultrasound images were analyzed by a senior (5+ years) sonographer. The lesion location, echo, size, and color Doppler flow imaging (CDFI) blood flow distribution of benign and malignant BC were assessed. The transverse and longitudinal diameters of malignant BC presented significant elevation compared with the control group (P < 0.05). CEUS is more reliable than conventional ultrasound in the differentiation of benign and malignant breast lesions, and CEUS has the best reliability. The comparison of CEUS observation indicators between benign and malignant groups demonstrated that CEUS enhancement patterns (time and intensity) and morphological features (lesion boundary, shape, range, homogeneity, and filling defect) presented statistical significance (P < 0.01). Irregular shape and range expansion were high-specificity indicators (all >90.00%); fast-forward, high enhancement, clear boundary, and range expansion were high-sensitivity (all >90.00%); and fast-forward, high enhancement, and clear boundary were low-specificity indicators (all <50.00%); moderate sensitivity is as follows: homogeneous enhancement and range expansion (all >80.00%). The area under curve of CEUS (0.735 ± 0.053) presented elevation relative to conventional ultrasound (0.901 ± 0.024), with statistical significance (Z1 = 2.462, P < 0.05). Relative to conventional ultrasound, the specificity and positive predictive value of CEUS presented elevation (P < 0.05). In conclusion, in the differentiation of benign and malignant breast lesions, CEUS has better diagnostic accuracy and reliability than conventional ultrasound. The diagnostic advantages of CEUS are to elevate the diagnostic specificity and positive predictive value and reduce the misdiagnosis rate.

The Necessity of Magnetic Resonance Imaging in Congenital Diaphragmatic Hernia.

This is a retrospective study investigating the relationship between ultrasound and magnetic resonance imaging (MRI) examinations in congenital diaphragmatic hernia (CDH). CDH is a rare cause of pulmonary hypoplasia that increases the mortality and morbidity of patients. Inclusion criteria were: patients diagnosed with CDH who underwent MRI examination after the second-trimester morphology ultrasound confirmed the presence of CDH. The patients came from three university hospitals in Bucharest, Romania. A total of 22 patients were included in the study after applying the exclusion criteria. By analyzing the total lung volume (TLV) using MRI, and the lung to head ratio (LHR) calculated using MRI and ultrasound, we observed that LHR can severely underestimate the severity of the pulmonary hypoplasia, even showing values close to normal in some cases. This also proves to be statistically relevant if we eliminate certain extreme values. We found significant correlations between the LHR percentage and herniated organs, such as the left and right liver lobes and gallbladder. MRI also provided additional insights, indicating the presence of pericarditis or pleurisy. We wish to underline the necessity of MRI follow-up in all cases of CDH, as the accurate measurement of the TLV is important for future treatment and therapeutic strategy.

Small Demyelination of the Cortex May Be a Potential Marker for the Right-to-Left Shunt of the Heart.

Migraine is a common clinical primary headache with unclear aetiology. In recent years, studies have shown that migraine is related to right-to-left shunts (RLS), and some patients with migraine have white matter lesions. However, the relationship among the three is unclear. To explore the characteristics of white matter lesions (WMLs) in migraine patients with right-to-left shunts and to predict the presence of right-to-left shunts through magnetic resonance imaging (MRI) characteristics in patients with migraine, we conducted a retrospective study. We enrolled 214 patients who were diagnosed with migraines in an outpatient clinic from January 2019 to December 2021. All of them had completed contrast transcranial Doppler ultrasound (cTCD) and magnetic resonance imaging (MRI) examination. Through the inclusion and exclusion criteria, 201 patients were finally included. The patients were grouped according to the presence of WMLs and were compared by age, sex, hypertension, diabetes, RLS, and other characteristic data. We observed the MRI fluid attenuation inversion recovery sequence (FLAIR) image and compared the differences in WMLs between the RLS-positive group and the RLS-negative group. There were 71 cases and 130 cases of migraine with and without WMLs, respectively. A statistically significant difference in near-cortical WMLs with RLS in migraine patients was observed (p = 0.007). Logistic regression analysis was adjusted by age, sex, duration of migraine, and severity. Migraine with aura and family history identified the RLS status as the sole determinant for the presence of near-cortical WMLs (OR = 2.69; 95%CI 1.386–5.219; p = 0.003). Near-cortical white matter lesions in migraine patients are related to RLS, especially in the blood supply area of the anterior cerebral artery. This small demyelination of the near-cortical WMLs may be a potential marker for the right-to-left shunt of the heart. Transcranial Doppler ultrasonography may help finding more RLS in migraineurs with near-cortical WMLs.

Comparison of the Efficacy of Systemic Versus Local Steroid Treatment in Idiopathic Granulomatous Mastitis: A Cohort Study

IntroductionSteroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis. Materials and methodsThis prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period. ResultsMedian doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P < 0.001). The recurrence rates were similar in both groups (P > 0.05). ConclusionsLocal steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate.

P185 Patients' and clinicians' perspectives on the clinical utility of the Rheumatoid Arthritis Foot Disease Activity Index

Abstract Background/Aims Although patient-reported outcome measures (PROMs) are recommended in clinical practice, their application in primary care is limited. The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) is a validated PROM for assessing foot disease activity in rheumatoid arthritis (RA). This qualitative study aims to understand the clinical utility of the RADAI-F5 as a management tool for foot disease in RA. Methods Adult RA patients and rheumatologists, physiotherapists and podiatrists routinely involved in treating RA patients were recruited through convenience sampling. Recruitment continued until data saturation had been achieved. A 60-minute, semi-structured, one-on-one Microsoft Teams interview with participants was conducted. Interviews involved open-ended questions to explore barriers and facilitators to the clinical application of the RADAI-F5. These interviews were audio-recorded and transcribed verbatim, with each participant verifying the transcript to establish rigour and credibility. The transcripts were coded using Nvivo12, and inductive thematic data analysis was conducted to identify emerging themes. Results Eight RA participants: 7 females; mean [standard deviation, SD] age 52.4 [9.5], mean [SD] disease duration 16.1 [16.4] and eight clinicians; mean [SD] age 46.75 [5.3], mean [SD] years of clinical experience of 19.5 [2.21] participated. The RADAI-F5 has four key themes that support its clinical utility. These were as follows: ‘need for the RADAI-F5' because patients felt that feet were ignored during routine consultations and clinicians felt the need for a foot PROM that is accurate, short and quick to complete in clinical practice; ‘promoting patient-clinician communication' because it can identify areas of concern that may be under-recognized by clinicians; ‘guiding management' as implementing the RADAI-F5 could assist in the screening, monitoring foot disease status, and guiding future interventions; and ‘patient involvement,' since the tool may trigger patients to be more involved in their foot health self-management. Three themes were identified as potential barriers to implementation; ‘practical difficulties, including lack of time during appointments; ‘lack of validity', as clinicians were hesitant to use the RADAI-F5 until its validity is established further with the use of ultrasound imaging and clinical examination; and, ‘lack of an electronic database', since there is currently no electronic system for reporting RADAI-F5 results. Conclusion The results of this study suggest that the RADAI-F5 has significant potential as a clinical tool to aid foot disease management in RA. However, some barriers to implementation may need to be overcome to enable widespread uptake in rheumatology clinics. Disclosure A. Hoque: None.