Ultrasound Study Research Articles

A rare complication after endoscopic neurolysis of the sciatic nerve: а clinical case

Background: Еndoscopic neurolysis of the sciatic nerve has proven itself as a low traumatic and effective technique of treatment for deep gluteal pain syndrome and sciatic nerve neuropathy. Until now, there have been no publications dedicated to the parietal peritoneum damage after endoscopic sciatic nerve decompression. Clinical case description: A 70-year-old female patient with deep gluteal pain syndrome and sciatic nerve neuropathy on the right side and failure of a conservative treatment. According to the VAS scale, the severity of pain syndrome was 10 cm. The severity of the motor dysfunction, according to the BMRC scale, was 4 points. The severity of the sensitive dysfunction, according to the Seddon scale, was 3 points. The functional activity of the lower limb, according to the LEFS scale, was 48 points. The instrumental investigation of the sciatic nerve included MRI, ultrasound, and ENMG. Endoscopic sciatic nerve decompression was performed in the prone position with saline irrigation using the technique published before. After the surgery, an ultrasound study and a CT scan were performed, which determined the presence of a free fluid in the abdominal cavity, and edema of the right retroperitoneal space. The patient underwent laparoscopy, which revealed the area of the parietal peritoneum damage in the lower floor, with a free saline fluid detected in the abdominal cavity, which was evacuated. The patient was discharged from the hospital on the 10th day after the surgery. 6 months after the surgery, the functional activity of the lower extremity, according to the LEFS scale, was 52 points. Pain syndrome, according to the VAS scale, was 8 cm. The severity of the motor dysfunction, according to the BMRC scale, was 4 points. The severity of the sensitive dysfunction, according to the Seddon scale, was 3 points. The performed surgical endoscopic treatment was rendered ineffective. Conclusion: The method of endoscopic sciatic nerve decompression with saline pumping has a risk of the following complication: damaging the parietal peritoneum, saline penetration into the abdominal cavity, edema of the retroperitoneal space. To decrease the risk of this complication, it is necessary to observe the specific surgical conditions such as: controlled hypotension in a patient and a low pressure in the arthroscopic pump, the time of surgery not exceeding 1 hour, and the saline consumption not exceeding 10 liters. It is also crucial not to perform the dissection and neurolysis too proximal to the piriformis area.

The incidence of ulnar nerve subluxation in patients with ulnar neuropathy at the elbow and healthy control: A clinical, electrodiagnostic, and ultrasonographic study

Abstract Background: Ulnar neuropathy at the elbow is a common presenting disorder in neuromuscular medicine. Patients suffer from paresthesia in the 4/5 finger, pain at the elbow, and weakness and atrophy in advanced cases. Objective: This study aimed to find the incidence of ulnar nerve subluxation in patients with ulnar neuropathy at the elbow. Materials and Methods: This is a case-control study conducted in Al-Sadiq teaching hospital at the period of January 2018–August 2022. It included 84 patients diagnosed with ulnar neuropathy at the elbow by history, clinical examination and electrodiagnostic testing. All patients and control undergo ultrasonographic examination by high-resolution ultrasound looking for ulnar nerve cross-sectional area at 3 points: (1) 7 cm proximal to medial epicondyle, (2) at the medial epicondyle, and (3) at the cubital tunnel 2-3 cm distal to medial epicondyle. Also, dynamic ultrasonographic examination were done looking for subluxation of ulnar nerve behind medial epicondyle during elbow flexion. If ulnar nerve move on the top of medial epicondyle it is considered partial and when it dislocates anteriorly beyond the tip of medial epicondyle it is considered complete subluxation.

Ultrasonographic comparative study between letrazole and clomiphene citrate on endometrial receptivity during induced ovulation

Ultrasonographic comparative study between letrazole and clomiphene citrate on endometrial receptivity during induced ovulation

Pelvic floor ultrasound versus urodynamics in evaluating insensible urinary incontinence: A retrospective study

Insensible Urinary Incontinence (IUI) is a situation when you complain of urinary incontinence but are unaware of how it occurred. Therefore, it is necessary to apply highly specific diagnostic methods to promote accuracy in the diagnosis of IUI, including pelvic floor ultrasound (PFU) and urodynamic studies (UDS). A total of 41 women with IUI were retrospectively included. Patients were categorized into two groups: the urodynamic urinary incontinence group (UUI group, n=20) and the non-urodynamic urinary incontinence group (NUUI group, n=21), according to the urine leakage during UDS. The baseline clinical characteristics, UDS results, and PFU parameters were collected. Compared with the NUUI group, the UUI group had a smaller maximum cystometric capacity (P=0.008), lower maximum urethral closure pressure (P=0.005), shorter functional urethral length (FUL) (P=0.01), more bladder neck funneling (BNF) (P=0.02), greater BNF depth (P=0.04), and larger BNF area (P=0.01). The area and depth of BNF were negatively correlated with maximum urethral closure pressure (r=-0.42, P=0.01), FUL (r=-0.36, P=0.02 versus r=-0.39, P=0.01), and maximum cystometric capacity (r=-0.35, P=0.03), but positively correlated with maximum urinary flow rate (r=0.33, P=0.04 versus r=0.36, P=0.02). The canonical correlation analysis of the ultrasound parameters and UDS parameters shows that the first pair of canonical variables was statistically significant (r1=0.9, P<0.001). The PFU is associated with UDS in evaluating IUI. It has the advantages of low cost and high comfort, thus should be used as an auxiliary examination for IUI.

Assessment of compression-induced solid stress, fluid pressure and mechanopathological parameters in cancers in vivo using poroelastography

Objective. Compression-induced solid stress (SSc) and fluid pressure (FPc) during ultrasound poroelastography (USPE) experiments are correlated with two markers of cancer growth and treatment effectiveness: growth-induced solid stress (SSg) and interstitial fluid pressure (IFP). The spatio-temporal distributions of SSg and IFP are determined by the transport properties of the vessels and interstitium in the tumor microenvironment. Approach. We propose a new USPE method for the non-invasive imaging of the local cancer mechanical parameters and dynamics of fluid flow. When performing poroelastography experiments, it may be difficult to implement a typical creep compression protocol, which requires to maintain a constant normally applied force. In this paper, we investigate the use of a stress relaxation protocol, which might be a more convenient choice for clinical poroelastography applications. Main results. Based on our finite element and ultrasound simulations study, we demonstrate that the SSc, FPc and their spatio-temporal distribution related parameters, interstitial permeability and vascular permeability, can be determined from stress relaxation experiments with errors below 10% as compared to the ground truth and accuracy similar to that of corresponding creep tests, respectively. We also demonstrate the feasibility of the new methodology for in vivo experiments using a small animal cancer model. Significance. The proposed non-invasive USPE imaging methods may become an effective tool to assess local tumor pressure and mechanopathological parameters in cancers.

Ultra Sonographic Study of Kidney Changes Following Experimental Cryogenic Partial Nephrectomy in a Rabbit Model

Background and Objective: Treatment of some limited kidney neoplasms is a partial kidney resection called a partial nephrectomy. One of the concerns in partial nephrectomy is severe and uncontrolled hemorrhage that sometimes results in kidney removal. Cryosurgery is one of the less invasive methods for the management of small kidney lesions, during which the controlled freezing of unwanted tissues will eventually lead to necrosis and gradual destruction of the lesion.The advantages of the cryosurgery method are easy implementation, no thermal ischemia damage during the operation, and no need to cut and suture the kidney parenchyma. Materials and Methods: In this experimental intervention research, the caudal pole of the left kidney of 9 adult female rabbits was subjected to cryogenic partial nephrectomy through a lateral laparotomy. Rabbits were evaluated by ultrasound on 1, 3, 7, 14, 21, and 28 days after surgery to record and observe the extent of kidney damage and healing in the Sagittal and Dorsal sections. Several parameters, such as kidney length dimensions, size of the caudal cortex, and cranial cortex of the kidney, were measured and recorded. Results: Kidney length on days 1, 21, and 28 was significantly less than day 0. On the 7th day after surgery, 2 separate areas, damaged and frozen necrotic tissue (caudal cortex) and healthy and normal kidney tissue were visible. The size of the caudal cortex from day 14 onwards was significantly less than day 0. The process of significant changes in the caudal cortex of the kidney started from day 14 of surgery and the border between dead and living tissue (Line of Demarcation) was distinguishable as a transition zone. On the 21st day after surgery, both the length of the kidney and the caudal cortex decreased significantly compared to day 0. Gradual loss of the caudal pole of the kidney (caudal cortex, the place where cryosurgery was performed directly) showed the applicability of cryosurgery in surgeries during which the tumor was removed (tumor ablation). On the 28th day after surgery, due to gradual necrosis and the loss of the caudal pole of the kidney, the kidney looked like a bitten apple, and the results of changes in the dimensions of the kidney (caudal cortex and length of the kidney) indicated necrosis of the caudal pole of the kidney, which finally led to the shrinking of the kidney. Conclusion: Ultrasonographic study of kidney injury and healing showed that cryosurgery, in addition to tumor ablation, would also have the ability to remove peripheral tissues (partial nephrectomy).

Ultrasonographic visualization of morphological changes in the tendon tissue of the superficial flexor of the finger in sports horses with tendinopathy

At least one half of population of sport horses during life suffer from superficial digital flexor tendon (SDFT) pathologies, particularly tendinitis and tendinopathies. Etiology of these injuries differs, and their evolution depends on some morphological peculiarities and type of equestrian sport. Success in early detection of preclinical signs of tendinopathy plays a key role in diagnostics and effective treatment in order to preserve athletic potential of a horse. Although in terms of clinical assessment it is not always possible to detect these early pathological changes in tendon tissue without ultrasonography. In this situation elicitation of correlation between morphological and ultrasonic signs seems to be of great importance, because it adds diagnostic and prognostic value of an ultrasound assessment of a patient. Taking into account all mentioned above the aim this study is investigating morphological and ultrasound characteristics of SDFT in middle and distal parts at the cannon and in the area of fetlock joint in normal horses and dressage and show jumping horses with tendinitispathy. In the present study, methods of anatomical preparation and description were used, histological studies were carried out according to the generally accepted methodology, as well as ultrasonographic studies of sports horses using Mindray DС-70 device. Structural features of the SDF tendon were revealed, which explain the chronicity of the pathological process and predispose to incomplete regeneration of the tendon, leading to a deterioration in its functional characteristics and a decrease in the horse's performance. The data obtained deepen the understanding of the etiology and pathogenesis of tendinopathy of the SDFT and allow more detailed interpretation of data obtained by ultrasonographic studies carried out during diagnostic procedures in sport horses, as well as adjusting treatment regimens.

Predictors of Arteriovenous Fistula Maturation among Patients with Severe Obesity

There is an increasing prevalence of obesity among patients who develop end-stage renal disease and require dialysis. While referrals for arteriovenous fistulas (AVFs) among patients with class 2-3 obesity (i.e., body mass index [BMI] ≥ 35) are increasing, it is unclear what type of autogenous access is most likely to mature in this patient population. This study was designed to evaluate factors that impact maturation of AVF among patients with class ≥2 obesity. We retrospectively reviewed AVFs created at a single center from 2016 to 2019 for patients who had undergone dialysis within the same healthcare system. Ultrasound studies were used to evaluate factors that defined functional maturation, including diameter, depth, and volume flow rates through the fistula. Logistic regression models were used to evaluate the risk-adjusted association between class ≥2 obesity and functional maturation. A total of 202 AVFs [radiocephalic (24%), brachiocephalic (43%), and transposed brachiobasilic (33%)] were created during the study period, of which 53 (26%) patients had a BMI >35. Functional maturation was significantly lower among patients with class ≥2 obesity undergoing brachiocephalic (58% obese versus 82% normal-overweight; P=0.017), but not radiocephalic or brachiobasilic AVFs. This was primarily a result of excessive AVF depth in severely obese patients (9.6±4.0mm obese versus 6.0±2.7mm normal-overweight; P<0.001), whereas there was no significant difference found in average volume flow or AVF diameter between groups. In risk-adjusted models, a BMI ≥35 was associated with a significantly lower likelihood of achieving AVF functional maturation (odds ratio: 0.38; 95% confidence interval: 0.18-0.78; P=0.009) after controlling for age, sex, socioeconomic status, and fistula type. Patients with a BMI >35 are less likely to mature AVFs after creation. This principally affects brachiocephalic AVFs and occurs because of increased fistula depth as opposed to diameter or volume flow parameters. These data can help guide decision-making when planning AVF placement in severely obese patients.

Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation

Maternal Serum Angiogenic Profile and Its Correlations with Ultrasound Parameters and Perinatal Results in Normotensive and Preeclamptic Pregnancies Complicated by Fetal Growth Restriction

FGR is a complication of pregnancy in which the fetus does not reach its programmed growth potential due to placental reasons and it is the single largest risk factor of stillbirth. Babies with FGR are at increased risk of mortality and morbidity not only in the perinatal period, but also in later life. FGR presents a huge challenge for obstetricians in terms of its detection and further monitoring of pregnancy. The ultrasound is the gold standard here; apart from assessing fetal weight, it is used to measure Doppler flows in maternal and fetal circulation. It seems that additional tests, like biochemical angiogenic factors measurement would be helpful in diagnosing FGR, identifying fetuses at risk and adjusting the surveillance model. The study aimed to assess the potential relationship between the concentration of sEng, sFlt-1, PlGF, and the sFlt-1/PlGF ratio in maternal serum at delivery and maternal and fetal Doppler flow measurements as well as perinatal outcomes in pregnancies complicated by FGR with and without PE, isolated PE cases and normal pregnancies. The use of angiogenic markers is promising not only in PE but also in FGR. Numerous correlations between ultrasound and Doppler studies, perinatal outcomes and disordered angiogenesis marker levels in maternal serum suggest that biochemical parameters have a great potential to be used as a complementary method to diagnose and monitor pregnancies with FGR. The, PlGF in particular, could play an outstanding role in this regard.

Edge strengthening and phonetic variability in Spanish /l/: an ultrasound study.

Previous research has shown that /l/ in Spanish displays patterns of articulatory variability that are determined by a complex interaction of phonetic, phonological and dialectal factors. In this study, we report the results of an experiment using Ultrasound Tongue Imaging (UTI) that tests /l/-articulations in a dialectal cross-section of Spanish speakers. We show that lengthening of /l/ in phrase-edge contexts is accompanied by articulatory distinctions (e.g. root/dorsum retraction) for some speakers, whereas others produce lengthened realisations of /l/ in these contexts without observable differences in tongue position. We also find acoustic evidence for reduction in utterance-medial intervocalic and preconsonantal environments (duration, intensity, F1 frequency measures are discussed). However, articulatory correlates of reduction are not consistently observed across speakers in these contexts. As well as relating the results to prosodically-driven strengthening and reduction patterns, our findings are of relevance to debates about resyllabification in Spanish. Specifically, we argue that our results cannot be straightforwardly accommodated under phonological analysis assuming that word-final consonants regularly resyllabify across word boundaries prevocalically.

Osteoporosis and Osteopenia – A Rising Healthcare Problem

With Asia housing 75% of humanity, and the proportion of seniors rapidly climbing from 5.3% in 2015 to 9.3% by 2025, Osteoporosis is rapidly becoming a growing medical ailment in this part of the world too [1]. In Pakistan, though clear data on occurrence of hip fractures (osteoporotic) annually is not established, large ultrasound studies suggest that there may be more than 9 million people (7 million women, 2 million men) afflicted with Osteoporosis. It is expected that these estimates may very well cross 12 million by the year 2050 – becoming a major health burden. Low per capita income and high hospital costs further derail the earning capacity. Estimations indicate the population to cross 340 million by the year 2050, and of these 14.9% (50 million) will be over the age 60 years. A five year study from one hospital revealed a 2:1 female to male ratio of hip fracture cases, with 61 years being the average age of patients having osteoporotic fracture. This average age is lower than that reported in North America and Europe but matches data from India. Another study revealed 16% and 34% occurrence of osteoporosis and osteopenia respectively in females of age group 45 to 70 using ultrasound technique. Another study from KPK province estimated the numbers at 29 and 42% respectively. 75% of postmenopausal women from Peshawar seemed to be at risk of osteoporosis on a clinical risk score analysis [2-7].

O-031 The natural history of endometriosis in pregnancy: An ultrasound study of the morphological features of deep endometriosis (DE) and ovarian endometrioma

Abstract Study question What is the impact of pregnancy on the morphological features and behaviour of ovarian endometrioma and deep endometriotic nodules? Summary answer For the majority of women, despite features of decidualization being common in the first and second trimesters, endometrioma and deep nodules will regress during pregnancy. What is known already Deep endometriosis and endometrioma subtypes are thought to affect approximately 5% of women in pregnancy, with about 50% being unaware of their condition. Pregnancy has a major effect on the size and morphological features of endometrioma, with published studies reporting a tendency for cyst regression. Decidualization, a hormonally induced pregnancy-related phenomenon, effects endometriomas and may raise suspicion of an ovarian malignancy. The behaviour of deep endometriosis in pregnancy is poorly understood and there is limited available literature on the subject. Study design, size, duration This was a prospective observational cohort study conducted over three years at a single centre. We included 65 women with a viable eutopic pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis. The study was conducted at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited Endometriosis Centre. Participants/materials, setting, methods All women who participated provided written consent and were invited for surveillance ultrasound examinations at the time of their routine scans in pregnancy. All scans were performed by a single operator to minimise interobserver error. The change in size of endometrioma and nodules were reported as change in their mean diameter. Endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized. Main results and the role of chance Sixty five women were included in the study. Their median age was 34 years (23-44), and the gestation at presentation was 7 + 6 weeks (3 + 6 to 18 + 0). 47/65(72%) were nulliparous, 48/65(74%) had a background of endometriosis and 19/65(29%) conceived following IVF. There were 10/65(15%, 95%CI 7-24) women with endometrioma alone, 28/65(43%, 95%CI 31-55) with nodules alone and the remaining 27/65(42%, 95%CI 30-54) had both. 29/34(85%, 95%CI 73-97) women with endometrioma experienced cyst regression, 2/34(6%, 95%CI 0-14) experienced cyst growth and in 10/34(29%, 95%CI 14-45) there was complete resolution of all cysts. 43/51(84%, 95%CI 74-94) women with nodules experienced nodule regression, 2/51(4%, 95%CI 0-9) experienced nodule growth and in 4/51(8%, 95%CI 0-15) there was complete resolution of all nodules. 5/37(14%, 95%CI 3-25) women who attended postnatal follow-up, experienced complete resolution of all endometriotic lesions during pregnancy . In 10/34(29%, 95%CI 14-45) women with endometrioma and 27/51(53%, 95%CI 39-67) with nodules, a pattern of growth was observed in the first and second trimesters, which preceded regression in later pregnancy. Features of decidualization were observed in 17/34(50%, 95%CI 33-67) women with endometrioma, most commonly in the 1st trimester, and 25/51(49%, 95%CI 35-63) women with nodules, most commonly observed in the 2nd trimester. Limitations, reasons for caution The lack of extended follow-up fails to establish the long-term impact of pregnancy, lactation and postnatal contraception on the behaviour of endometriosis. This study relies on ultrasound alone for the detection of moderate/severe disease with no correlation with laparoscopy. Wider implications of the findings Sonographic changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to reduce unnecessary surgical procedures, associated morbidity to mothers and babies and will help clinicians to counsel women regarding the significance of their condition. Trial registration number The study was registered on Research Registry (Unique identifying number: researchregistry4569).

Point-of-care lung and cardiac ultrasound (LUCAS) study in hip fracture patients: a prospective cohort study.

A clinical conflict often presented with hip fracture patients is whether to proceed with timely surgery or delay surgery until a formal echocardiogram is conducted. This study aimed to assess the impact of incorporating point-of-care lung and cardiac ultrasound (LUCAS) scans as part of the preoperative assessment for hip fracture patients. We recruited 225 consecutive adult patients booked for urgent hip arthroplasty surgery. A LUCAS scan was performed for each patient. The anesthesiologists were asked to provide their anesthetic plans before and after acknowledging the results of the LUCAS scans. The primary endpoint was a composite outcome of changes to the anesthetic plan. The secondary outcomes included anesthesiologists' opinions of the LUCAS scans. One-hundred-ninety-eight patients were included. The majority of LUCAS findings were not severe. A common abnormal finding was hypovolemia (31%). One-hundred-and-six anesthetic management decisions were changed, with 59 of these changes being an escalation of the anesthetic plan, and 47 of these changes being a de-escalation. Eighty-three percent of anesthesiologists agreed that LUCAS affirmed their anesthetic plans and should be an integral part of the perioperative assessment. This study found that LUCAS scans did not significantly alter the anesthetic plan for hip fracture patients. Nevertheless, LUCAS scans can rule out severe cardiopulmonary conditions and allow for both escalation and de-escalation of care. In the setting of early hip surgery, LUCAS presents a viable option in selected patients to address the unmet need to allow for both timely surgery and comprehensive patient evaluation. ClinicalTrials.gov (NCT03275129); registered 8 July 2018.

The feasibility of ultrasonography for the measurement of periodontal and peri-implant phenotype: A systematic review and meta-analysis.

Screening ultrasonography was proposed for monitoring periodontal soft tissues in the early 1960s, owing to its nonionizing, real-time, and cost-effective properties. Studies have provided convincing preliminary evidence for the use of ultrasound (US) in implant dentistry. To assess the feasibility of ultrasonography (US) for measuring the buccal thickness of periodontal and peri-implant tissues. The secondary objective was to evaluate the reliability of US measurements compared to classic techniques, such as CBCT and directly measurements. An electronic literature search was conducted by three independent reviewers through February 2023. The inclusion criteria were articles investigating at least five patients/cadavers with US measurements in periodontal or peri-implant buccal tissues. Compliance with methodological reporting standards and risk of bias was assessed using EULAR and QUADAS-C tools, respectively. Random-effects meta-analysis was conducted, using Bland-Altman analysis. Certainty of the evidence was assessed using GRADE. The final selection included 12 studies examining 458 patients and 13 cadavers, with a total of 226 implants, 1958 teeth and 60 edentulous sites. The body of evidence was assessed as partially compliant with methodological reporting standards for US studies and had an unclear to high risk of bias. Meta-analysis of five comparative studies showed no evidence of clinically significant bias between US and direct measurements (very low certainty), and between US and CBCT (very low certainty) for soft-tissue thickness. Likewise, for bone thickness, there is no evidence of clinically significant bias between US and CBCT (low certainty). Compared to the CBCT and direct measurements, ultrasonography might be a reliable approach for monitoring on periodontal and peri-implant phenotype. However, there is uncertainty about estimates of the actual effect, so further standardized and larger sample size of clinical research is needed.

Evaluating the Effect of Nursing-Performed Point-of-Care Ultrasound on Septic Emergency Department Patients.

Introduction Nursing-performed point-of-care ultrasound (NP-POCUS) studies have been performed on applications such as ultrasound-guided peripheral intravenous line placement and assessing bladder volume. However, research on the use of NP-POCUS in the management of septic patients remains limited. The purpose of this quality improvement study was to investigate how NP-POCUS could impact fluid treatment decisions affecting septic patients in the emergency department (ED)using a focused IVC and lung ultrasound protocol. Methods Nurses received standardized training in POCUS and performed inferior vena cava (IVC) and lung ultrasound scans on septic patients in the ED at predetermined intervals (hours: zero, three, and six). Based on their findings, they were asked to make recommendations on fluid management. Emergency physicians (EPs), both residents and attendings, are providing recommendations for fluid management without the use of ultrasound, which is being compared to the nurse-driven POCUS assessment of fluid management. EPs reviewed the NP-POCUS assessments of patient fluid status to determine nursing accuracy. Results A total of 104 patients were scanned, with a mean age of 60.7 years. EPs agreed with nursing ultrasound assessments in 99.1% of cases. Nursing ultrasound images changed management or increased physician confidence in current treatment plans83.7% and 96.6% of the time, respectively. Before reviewing saved nursing ultrasound images, EPs underestimated fluid tolerance in 37.5% of cases, overestimated fluid tolerance in 26% of cases, and correctly estimated fluid tolerance (within 500 ml) in 36.5% of cases. Throughout resuscitation, IVCs became less collapsible, the number of cases with B-lines was essentially unchanged, and less fluid was recommended. Conclusion This study demonstrated that nurse-performed POCUS is feasible and may have a meaningful impact on how physicians manage septic patients in the emergency department.

#4659 PREVALENCE OF LIVER STEATOSIS MEASURED BY MULTIFREQUENCY BIOIMPEDANCE IN PATIENTS WITH CKD

Abstract Background and Aims The increase in visceral fat is one of the factors that contribute to the increased cardiovascular risk associated with CKD. There are few data on the prevalence of hepatic steatosis in patients with CKD. The Maltron multifrequency BIA offers us the possibility of evaluating it. The purpose of this study was to determine the prevalence of hepatic steatosis by means of multifrequency bioimpedance and to correlate it with its presence by ultrasound or CT in patients with CKD on Advanced CKD(ACKD) and HD. Methods We carried out a study of body composition with BIA in 315 patients, analyzing with the Maltron monitor Bioscan i-touch8 the determination of hepatic steatosis and its classification into 4 stages of involvement (normal, mild, moderate, moderately-severe and severe steatosis. We also correlated with ultrasound studies that had In order to see coincidence, we also obtained data from 9 patients without CKD.We established global steatosis prevalence and in CKD and HD and correlated with GOT,GPT,GGT,MIS, waist/height ratio, mass-fat and BMI. Results 315 patients evaluated for CKD 151 (48%) and HD 163 (52%), 67.9% men aged 70.79 ± 12.87 years (sig difference between CKD and HD (72.4 ± 2.7) vs 69.2 ±14.3) p0.023. Globally we found healthy liver in 37.9% and steatosis in 61.3% appearing mild-13.4%, moderate 11.8%, light-high 11.4% and high 24.5%. We observed healthy liver in 35.1% in ACKD vs 40.5% in HD. We did not find significant differences between liver enzyme values between healthy liver and steatosis at a global level. We established correlation/coincidence between ultrasound/CT and BIA in 72 patients. We found a healthy liver BIA-ECHO correlation in 43 cases (93.4%), steatosis by BIA coincides with ECHO in 41.6%. If we combine healthy liver + mild steatosis by BIA, the BIA-Echo healthy liver coincides in 92.7% and steatosis in 50%. Establishing cut-off points for BMI, % fat mass and waist/height index using COR curves, we obtain areas-under-the-curve 0.828, 0.738 and 0.853 respectively, being Waist-height index (WC 0.6) with better sensitivity 80% and specificity 71, 3%. If we determine the area of fat mass with another tool, we see AUC 0.838 with 72.3% specificity and 91.3% sensitivity to detect normal liver. Conclusion 1) A high prevalence of hepatic steatosis due to IAB appears in patients with CKD greater in CKD than in HD. 2) There is a good correlation with ECO for a healthy liver and there are parameters that correlate well in a healthy liver diagnosis. 3) Specific studies of Ultrasound-BIA are needed to validate the diagnosis of steatosis.

#5088 ARTIFICIAL INTELLIGENCE APPLIED TO VASCULAR DOPPLER ULTRASOUND MODELS FOR PREDICTING UNDERDEVELOPMENT OF VASCULAR ACCESS IN NEPHROLOGY

Abstract Background and Aims The vascular access of choice for hemodialysis patients is the arteriovenous fistula (AVF). There is a high rate of early primary failure and loss of primary AVF patency. Monitoring of vascular access is essential for early diagnosis of complications and prolonging survival. Models based on Artificial Intelligence (AI) and Machine Learning (ML) can be used for this. Method Retrospective descriptive study of the Vascular Doppler Ultrasound (VDU) in adults carried out since January 2019 to January 2022 in our AVF follow-up nephrology clinic. We analyze the results and create AI-based AVF underdevelopment prediction models. We included clinical, demographic and ultrasound variables. Patients were undergoing AVF post-surgery follow-up (VDU by protocol at 3-4 weeks after AVF surgery) or were referred to the clinic with signs of AVF dysfunction. The insufficient development of the vascular access is established as an objective variable. SPSS 20 Statistical Package. Automated Learning Analysis (ML) with Orange ML and BigML. Results 243 VDU were performed. Of the total, 139 (57%) were follow-up post-surgical VDU per protocol and 104 (43%) were AVF dysfunction VDU. Using supervised ML Analysis techniques with random sampling of 80% of the instances for Training and 20% for Test, we obtain prediction models for the underdevelopment (UD) attribute of FAV: Decision tree algorithm, Area under the curve (AUC) 89%, Classification accuracy (CA) 90%, Precision 90%. Random Forest Algorithm (RF) (AUC) 95%, (CA) 86%, Accuracy 81%. Near Neighbor Algorithm (K-NN) (AUC) 88%, CA 82%, Accuracy 78%. Convolutional Neural Networks (NNC) (AUC) 82%, CA 74%, Accuracy 60%. Algorithm with unsupervised technique of clustering in k-Means 3 clusters are obtained. The variables that best correlate with the objective variable are access flow, vein diameter, resistance index (RI) proximal, (RI) distal, and diameter of the anastomosis. Conclusion The vascular ultrasound systematized by the nephrologist facilitates the early diagnosis of complications that lead to early intervention. Analysis of the data with techniques (ML) can facilitate early diagnosis AVF poor development requiring close monitoring or intervention. The development of a nephrology clinic for monitoring vascular access could avoid invasive and unnecessary procedures for the patient.

Global sonication of the human intracranial space via a jumbo planar transducer

Contrary to conditioning a Focused Ultrasound (FUS) beam to sonicate a localized region of the human brain, the goal of this investigation was to explore the prospect of distributing homogeneous ultrasound energy over the entire brain space with a large cranium-wide ultrasound beam. Recent ultrasound preclincal studies utilizing large or whole brain stimulation regions create a demand for expanding the treatment envelope of transcranial pulsed-low intensity ultrasound towards Global Brain Sonication (GBS) for potential human investigation. Here, we conduct ultrasound field characterizations when transmitting pulsed ultrasound through human skull specimens using a 1–3 piezocomposite planar transducer operating at 464 kHz with an active single-element surface of 30 × 30 cm. Through computational simulation and hydrophone scanning methodology, ultrasound wave behavior and dose homogeneity in the brain space were evaluated under various trajectories of sonication using the planar transducer. Clinically relevant pulse parameters used for transcranial therapeutic ultrasound applications were used in the experiments. Simulations and empirical testing revealed that dose homogeneity and acoustic intensity over the brain space are influenced by sonication trajectory, skull lens effects, and acoustic wave reflections. The transducer can emit a spatial peak pulse average intensity of 4.03 W/cm2 (0.24 MPa) measured in the free-field at 464 kHz with electrical power of 1 kW. The simulation showed that approximately 99 % of the cranial volume was exposed with <30 % of the maximum external acoustic intensity being transmitted into the skull. The transmission loss across all sonication trajectories is similar to previously reported FUS studies. A marker for GBS dose homogeneity is introduced to score the ultrasound pressure field uniformity in the intracranial space. Results of this study identify the initial challenges of exposing the entire human brain space with ultrasound using a large cranium-wide sonication beam intended for global brain therapeutic modulation.

#3423 DIAGNOSTIC SIGNIFICANCE MAGNETIC RESONANCE IMAGING IN CHRONIC HEART FAILURE OF VARIOUS GENESIS

Abstract Background and Aims Based on a comparative assessment of radiological, ultrasound, clinical and laboratory studies, to determine the diagnostic significance of cardio-MRI. Method We analyzed echocardiographic and magnetic resonance imaging of the heart in 40 patients who were examined and treated in the cardiology departments of the Republican Medical Specialized Scientific and Practical Center for Therapy and Medical Rehabilitation. The information content of the use of instrumental research methods in patients with chronic heart failure was evaluated. Information on demographic characteristics, including age, gender, education, occupation, was collected from doctors visits using a standard questionnaire. Results The average age of patients was 57 years. 40% of the surveyed were made up of men. When studying risk factors for the disease, 49% of all patients had arterial hypertension, 18% had type 2 diabetes mellitus, 21% of patients were active smokers, and 11% had a family history of risk of cardiovascular disease. 36% of patients had a history of myocardial infarction, percutaneous coronary interventions. The mean LV EF was 42% and the mean right ventricular EF (RVEF) was 48%. In patients with CHF of ischemic origin, in the vast majority of cases, the results of echocardiographic and MRI examinations of the heart were comparable. The conducted MRI of the heart had an additional informative value in case of doubtful ECG and EchoCG data, as well as in differential diagnosis. The results of MRI were more accurate in determining the etiology of myocardial hypertrophy, in particular hypertrophic cardiomyopathy. Conclusion The diagnostic value of cardio-MRI showed great diagnostic value in the diagnosis of ischemic damage and non-coronary diseases of the myocardium.