Use Of Ultrasound Imaging Research Articles

High-frequency ultrasound in carpal tunnel syndrome: assessment of patient eligibility for surgical treatment.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical) are essential for optimal patient management.AimThe aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment.Material and methodsThe study involved 62 patients (50 women and 12 men, aged 28–70, mean age 55.2) with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confirm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS.ResultsUS examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confirmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm2 (min. 12 mm2, max. 31 mm2). Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%). Increased nerve vascularity on the transverse section was present in 50 patients (80.65%).ConclusionsUltrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy.

Detection of Kidney Abnormalities in Noisy Ultrasound Images

Ultrasound imaging is a widely used and safe medical diagnostic technique, due to its non-invasive nature, low cost and capability of forming real time imaging. Ultrasound imaging uses high-frequency sound to image internal structures by differing reflection signals produced when a beam of sound is projected into the body and bounces back at interfaces between the structures. However the usefulness of ultrasound imaging is degraded by the presence of signal dependant noise known as speckle. The speckle pattern depends on the structure of the image tissue and various imaging parameters. Speckle noise present in ultrasound image affects edges and fine details which limit the contrast resolution and make diagnostic more difficult. There are two main purposes for speckle reduction in medical ultrasound imaging (1) to improve the human interpretation of ultrasound images (2) despeckling is the preprocessing step for many ultrasound image processing tasks such as segmentation and registration. A number of methods have been proposed for speckle reduction in ultrasound imaging.

The use of ultrasound imaging in evaluation of peritonsillar infections.

The objectives of this study were to evaluate safety and patient tolerance of intraoral ultrasound and to evaluate efficacy of intraoral ultrasound in the diagnosis of peritonsillar infections. Prospective single-cohort study involving adult patients (age>18 years) with evaluation consistent with possible peritonsillar abscess. Twenty-four patients were evaluated in the emergency department for peritonsillar infection. Signs and symptoms were recorded including uvular deviation, trismus, and fluctuance. Intraoral ultrasound was performed, and presence or absence of abscess was recorded. Eight patients had a computed tomography (CT) scan. Needle aspiration was performed by the otolaryngology physician in appropriate patients. Presence of purulence confirmed peritonsillar abscess. Intraoral ultrasound was successfully performed on 87.5% (21/24) of patients. The probe could not access the peritonsillar space in 12.5% (3/24) of patients due to trismus. The positive predictive value of ultrasound in diagnosing abscess was 78.6% (11/14). The negative predictive value was 100% (7/7). The specificity was 70% (7/10), and the sensitivity was 100% (11/11). CT scan of the neck was obtained in 8/24 patients and found to be 100% sensitive and specific in diagnosing abscess. Intraoral ultrasound is a sensitive imaging modality at our institution, making it a strong initial imaging choice in patients with peritonsillar infections. Ultrasound can reliably rule out the presence of abscess and make CT of the neck unnecessary in most patients. Although ultrasound is generally well tolerated, diagnosis in patients with severe trismus can be made clinically or with CT scan. Intraoral ultrasound is a useful tool in diagnosing and treating peritonsillar infections when imaging is required. 4.

Use of Ultrasound Imaging in Pelvic Organ Prolapse: an Overview

Pelvic floor ultrasonography has emerged as a procedure that is accurate, easy to perform, cost-effective, and widely available. Numerous studies have been published that demonstrate its potential applications in the assessment of pelvic organ prolapse (POP). Despite the current lack of standardization of techniques and validation studies, use of ultrasound holds promise for aiding the clinician in making surgical decisions and understanding causes of operative failures in POP. Three-dimensional and four-dimensional transperineal and endovaginal ultrasound (3D/4D-TPUS and EVUS) can provide detailed visualization of pelvic floor muscles and soft tissues. Real-time imaging capabilities also allow functional pelvic floor assessment during dynamic maneuvers such as Valsalva or muscle contraction. We provide in this report up-to-date information on the use of ultrasound imaging in POP. Special attention is given to the study of levator ani muscle (LAM) morphology and functionality, which is believed to play an essential role in pelvic organ support.

In situ ultrasound imaging of silk hydrogel degradation and neovascularization.

Ultrasound (US) is a useful technique to monitor morphological and functional changes of biomaterial implants without sacrificing the animal. Contrast-enhanced ultrasound (CEUS) along with two-dimensional (2D) US were used to characterize the biodegradation and neovascularization of silk protein (8 wt%) hydrogel implants in rats. Cylinder-shaped silk hydrogel plugs were implanted into the space between the hind limb thigh muscles in Wistar rats (n = 6). The increase of echogenicity in 2D US revealed tissue-ingrowth-accompanied gel degradation over 18 weeks. The shape and size of the implanted gels remained qualitatively unchanged until week 15, as confirmed by Bland and Altman analysis and visualization of retrieved samples. Using CEUS, neovascularization was monitored by the presence of microbubbles in the gel area, and the dynamic vascularization process was indicated by the contrast enhancement values, which showed a relatively low level (< 5 dB) during weeks 1-8 and significantly increased levels (around 20 dB at week 15 and > 35 dB at week 18), suggesting that major vascularization had occurred in the gel implants by this time point. Histological and scanning electron microscopic analysis of explants revealed time-dependent increases in the pore size of the gel matrix, the presence of endothelial and red blood cells and the number of blood vessels in the gel implants, indicating that degradation and vascularization did occur in silk gel implants during the time period. The present study demonstrates the use of US imaging for monitoring of in vivo degradation and vascularization of silk implants in a non-destructive way. Copyright © 2015 John Wiley & Sons, Ltd.

Novel use of ultrasound imaging to decode activity of forearm muscles for upper extremity prosthetic control

With the recent developments in the electro-mechanical design of upper extremity prosthetics, the need for more advanced control strategies for such prosthetics has increased. Current commercially available prostheses based on myoelectric control have limited functionality, which leads to many amputees abandoning use. Myoelectric control using surface electrodes has a number of limitations, such as low signal to noise ratio and lack of specificity for deep muscles. To address these limitations, and enable more intuitive dexterous control, we propose a new strategy for sensing muscle activity based on real-time ultrasound imaging. Ultrasound imaging of the forearm muscles was performed on six healthy volunteers and a transradial amputee using a Sonix RP system with a 5–14 MHz linear array transducer. Images were analyzed to map muscle activity based on the changes in the ultrasound echogenicity of the contracting muscles during different complex movements, and used to control a virtual prosthetic hand. Individual digit movement could be decoded with 97% accuracy, and 15 different complex grasps could be decoded with 87% accuracy. In a transradial amputee, we were able to differentiate between seven different movements. These preliminary results demonstrate the feasibility of using ultrasound imaging for control of upper extremity prostheses.

Regenerative medicine injection techniques for the hip pathology

Hip pain is a common complaint that can have both intra-articular and extra-articular origins. Three common causes of hip pain are hip osteoarthritis, iliopsoas tendinopathy, and gluteus medius tendinopathy. Current treatment plans range from conservative measures to surgical replacement. Traditionally, minimally invasive approaches with the use of corticosteroid and local anesthetic injections have served to manage symptoms of pain without altering disease progression. In addition, these agents have been associated with deleterious effects on bone, tendon, and cartilage health. Emerging regenerative medicine techniques are becoming increasingly popular for the management of hip pain, as they have been shown to improve clinical outcomes and potentially alter disease progression. Some of these techniques, such as injection of platelet-rich plasma, mesenchymal stem cells, and percutaneous needle fenestration, have been shown to promote healing of damaged tissue. These techniques are often augmented by the use of ultrasound imaging, which greatly increases ease and accuracy. This article reviews ultrasound-guided regenerative orthopedic injections specifically for hip joint osteoarthritis, gluteus medius tendinopathy, and iliopsoas tendinopathy.

Automated Telehealth System for Fetal Growth Detection and Approximation of Ultrasound Images

Abstract One of the most profound use of ultrasound imaging is fetal growth monitoring. Conventionally, physicians will perform manual measurements of several parameters of the ultrasound images to draw some conclusion of the fetal condition by manually annotating the fetal images on the ultrasound device interface. However, performing manual annotation of fetal images will require significant amount of time considering the number of patients an obstetrician can have. In this paper, an integrated automatic system for fetal growth monitoring and detection is proposed. This system will be able to automatically measuring the parameters of fetal head, abdomen, femur, and humerus. In addition to automated image detection, we also propose an integrated telehealth monitoring system to provide better access of ultrasound monitoring for patients that lives in rural areas. A new approach of fetal image detection is also proposed by using AdaBoost.MH boosting algorithm that is combined with an improved efficient Hough Transform for detecting ellipse-like organs such as head and abdomen. Experiments of the method are tested on real ultrasound image dataset. The detection was applied on 2D ultrasound images to perform fetal object measurement to approximate the Head Circumference (HC) and Biparietal Diameter (BPD), Femur Length (FL), and Humerus Length (HL).

Ultrasound guided Deep Vein cannulation: "Perpendicular Insertion Technique (PIT)", an edge over "Conventional Insertion Technique (CIT)".

Introduction:The use of ultrasound imaging before or during vascular cannulation greatly improves first-pass success and reduces complications, but this skill must then be combined with manual dexterity to perform the three dimensional (3D) procedure of placing a catheter into the deep veins while analyzing the 2D images. Hence this study is an attempt to still decrease the above mentioned limitation of guided deep vein cannulation by slight modification in the insertion technique.Aims and objectives:Aims to compare the ultrasound guided deep vein cannulation by conventional insertion technique(CIT) v/s ultrasound guided perpendicular insertion technique (PIT). Main comparison parameters here are number of attempts required, time taken for successful insertion, vessel counter puncture, arterial puncture and other known mechanical complications of deep venous cannulation.Material and method:Prospective, non randomized cross sectional study, done over 200 patients in two arms. Data-analysed by epi2k and state-9 software.Results:Total number of insertions were 64 by CIT v/s 136 by the PIT. Mean of number of attempts required were 1.918 with the CIT v/s 1.106 for the PIT method. Mean of time of cannulation was 78.62 + 18 sec with CIT while it was 66.98 + 12 sec for PIT and this was statistically significant(P = 0.041). Incidence of vessel counter-puncture was much lower in PIT as compared to CIT (6.1 % v/s 16.2%). 5.9% cannulation done by CIT had arterial puncture v/s 0.8% with the PIT. Not a single episode of any other mechanical complications with either of the method.Conclusion:USG guided perpendicular method is less time consuming, less number of attempts are required and there are less chances of arterial picture or vessel counter puncture.

Usefulness of US imaging in overhydrated nephropathic patients

Achievement of a normal hydration status is one of the major targets of hemodialysis. It is based on the estimation of "dry weight", the term used to define normal body fluid content. The concept of dry weight in hemodialysis patients is clinically undisputed, but it is not always easy to achieve in this population. Assessment of hydration status by clinical evaluation is imprecise and often unreliable. Measurement of the inferior vena cava (IVC) diameter has been shown to reflect individual fluid status. The relationship between variation in IVC diameter before and after hemodialysis session and weight loss has been investigated. Ultrasound (US) measurement of the IVC diameter is considered a valid measure of the hydration status and is routinely used in hemodialysis patients. Moreover, a relationship between IVC diameter, respiratory activity and hydration status, evaluated by considering both plasma volume and central venous pressure, has been demonstrated. In conclusion, assessment of hydration status based on blood pressure and central venous pressure can be considered reliable only in patients without signs of heart failure.

Vocal fold paresis: etiology, clinical diagnosis and clinical management.

Recent papers on incidence of unilateral paresis in general and for specific causes; techniques to assist clinical diagnosis; computer and animal modeling leading to new assessment tools; and studies on the effectiveness of clinical management. There is much interest in being able to assess unilateral paresis in patients both pre and post-thyroidectomy. Because the gold standard for defining the presence of paresis is by laryngeal electromyography, which is not routinely available, much interest has been placed in finding other measures that correlate with electromyographic findings, including use of ultrasound imaging and high-speed videoendoscopy. Paresis is also being seen as an underlying factor in other voice disorders, such as reflux and presence of granulomas. Animal modeling is providing insights into the mechanisms that will help our understanding of vocal fold asymmetry. The development of trial injections to determine if more permanent interventions will provide good outcomes is an important step in good patient care. Randomized clinical trials need to be completed to provide level 1 evidence for the efficacy of treatments. Centers that have access to laryngeal electromyography need to lead the way in developing assessment tools and treatment trials for patients with paresis.

The Use of Ultrasound Imaging in Dermatology

The Use of Ultrasound Imaging in Dermatology

Examining suprasegmental and morphological effects on constriction degree with ultrasound imaging

Two case studies of ultrasound imaging use tongue shape differences to investigate whether suprasegmental influences affect the articulatory implementation of otherwise equivalent phonemic sequences. First, we examine whether word-medial and word-final stop codas have the same degree of constriction (e.g., "blacktop" vs. "black top"). Previous research on syllable position effects on articulatory implementation have conflated syllable position with word position, and this study investigates whether each prosodic factor has an independent contribution. Results indicate that where consistent differences are found, they are due not to the prosodic position but to speaker-specific implementation. Second, we examine whether morphological status influences the darkness of American English /l/ in comparing words like "tallest" and "flawless." While the intervocalic /l/s in "tall-est" and "flaw-less" are putatively assigned the same syllabic status, the /l/ in "tallest" corresponds to the coda /l/ of the stem "tall" whereas that of "flawless" is the onset of the affix "-less." Results indicate that /l/ is darker—the tongue is lower and more retracted—when corresponding to the coda of the stem word. Data in both studies were analyzed with smoothing spline ANOVA, an effective statistical technique for examining differences between whole tongue curves.

Incorporación de la ecografía en Dermatología

Incorporación de la ecografía en Dermatología

Outcome of appendicectomy in children performed in paediatric surgery units compared with general surgery units

Appendicectomy for acute appendicitis in children may be performed in specialist centres by paediatric surgeons or in general surgery units. Service provision and outcome of appendicectomy in children may differ between such units. This multicentre observational study included all children (aged less than 16 years) who had an appendicectomy at either a paediatric surgery unit or general surgery unit. The primary outcome was normal appendicectomy rate (NAR). Secondary outcomes included 30-day adverse events, use of ultrasound imaging and laparoscopy, and consultant involvement in procedures. Appendicectomies performed in 19 paediatric surgery units (242 children) and 54 general surgery units (461 children) were included. Children treated in paediatric surgery units were younger and more likely to have a preoperative ultrasound examination, a laparoscopic procedure, a consultant present at the procedure, and histologically advanced appendicitis than children treated in general surgery units. The unadjusted NAR was significantly lower in paediatric surgery units (odds ratio (OR) 0.37, 95 per cent confidence interval 0.23 to 0.59; P < 0.001), and the difference persisted after adjusting for age, sex and use of preoperative ultrasound imaging (OR 0.34, 0.21 to 0.57; P < 0.001). Female sex and preoperative ultrasonography, but not age, were significantly associated with normal appendicectomy in general surgery units but not in paediatric surgery units in this adjusted model. The unadjusted 30-day adverse event rate was higher in paediatric surgery units than in general surgery units (OR 1.90, 1.18 to 3.06; P = 0.011). When adjusted for case mix and consultant presence at surgery, no statistically significant relationship between centre type and 30-day adverse event rate existed (OR 1.59, 0.93 to 2.73; P = 0.091). The NAR in general surgery units was over twice that in paediatric surgery units. Despite a more severe case mix, paediatric surgery units had a similar 30-day adverse event rate to general surgery units. Service provision differs between paediatric and general surgery units.

Ultrasound use in the pediatric airway: the time has come.

Advancements in ultrasonography and increasing familiarity with its use in the operating room (vascular access and regional neural blockade) suggest its feasibility as an adjunct in pediatric airway evaluation and intervention. We report 3 cases demonstrating the usefulness of ultrasound techniques in this setting. We show key elements of airway anatomy, noninvasive observation of vocal cord motion, and percutaneous periglottic steroid injection via the cricothyroid membrane in 3 different patients. This report reveals the possible usefulness of ultrasound imaging in clinical anesthesia care, specifically airway management, in children.

Ultrasonographic Diagnosis for Tenosynovitis of Extensor Carpi Ulnaris

We investigated the usefulness of ultrasound imaging and treatments for tenosynovitis of the extensor carpi ulnaris (ECU), based on clinical findings. Ultrasonography for diagnostic imaging of ECU tenosynovitis has not been previously reported. This study included 29 patients who were diagnosed as having ECU tendinitis and underwent ultrasonography. The short-axis view ultrasound images were characterized by an oval hyperechoic area in the ECU tendon from the distal to the peripheral end of the ulna on the affected side in all patients and a hypoechoic area suggesting a thickened synovial membrane of the tendon sheath around the ECU tendon. Patients with the most pronounced findings showed the greatest resistance to conservative therapy. Ultrasound images can be an indicator for differentiating ECU tendinitis from other diseases and determining therapeutic strategies. In cases with ulnar-sided wrist pain without these characteristic ultrasound imaging findings, injury of the triangular fibro cartilage complex should be suspected.

Role of diagnostic imaging in the diagnosis of acute appendicitis: a comparison between ultrasound and computed tomography

Acute appendicitis is the most common cause of acute abdomen requiring emergency surgery. In particular, it affects patients older than 20 years and diagnosis is challenging in this patient subset. The radiologic methods (ultrasound and computed tomography) play a key role in the identification, characterization and staging of the disease as well as optimal timing of surgery. The aim of our study is to assess the usefulness of ultrasound imaging in the diagnosis of acute appendicitis and in a retrospective analysis of 54 ultrasound and computed tomography exams performed in the emergency department.

Internal Carotid Artery Variations in Velocardiofacial Syndrome Patients and Its Implications for Surgery

Medially displaced internal carotid arteries in velocardiofacial syndrome carry a risk during pharyngeal flap surgery. This study was designed to evaluate the frequency of medially deviated internal carotid arteries in both velocardiofacial syndrome patients and the general pediatric population and to assess the minimum distance to the pharyngeal walls to define the potential risk of internal carotid artery injury during pharyngeal surgery. Twenty-three consecutive patients with velocardiofacial syndrome who underwent posterior pharyngeal flap surgery and 21 control subjects who did not have velocardiofacial syndrome but who underwent oropharynx magnetic resonance imaging were reviewed. Medial deviation of at least one internal carotid artery was documented in 10 velocardiofacial syndrome patients (43.5 percent), compared with three patients (14.3 percent) in the control group (p=0.034). The mean±SD minimum distance to the posterior pharyngeal wall was 3.78±1.86 mm in velocardiofacial syndrome patients and 9.17±2.94 mm in the control group (p=0.014). Only one patient had significant medial dislocation of the internal carotid artery, and the closest distance from the pharyngeal wall was 0.86 mm. In velocardiofacial syndrome patients, medial dislocation of the internal carotid artery was common, and the minimum distance to the pharyngeal wall was short compared with the control group. However, in most of the authors' patients, the course of the cervical portion of the internal carotid artery is irrelevant to pharyngeal flap surgery. The authors conclude that preoperative vascular imaging study is not cost-effective in velocardiofacial syndrome patients but that intraoperative use of ultrasound imaging is still valuable for the purpose of planning pharyngeal flap surgery. Risk, II.

Ultrasound and dermatology: basic principles and main applications in dermatologic research

Ultrasound imaging has been increasingly used in dermatologic research over the past four decades. This paper aims to review its use as a disease severity and treatment efficacy assessment tool, with emphasis on the past five years. Quantitative parameters such as skin thickness, overall echogenicity, echogenicity distribution, dermal–subcutaneous interface length or area are used. The authors review skin aging, cellulite, striae, fillers, scleroderma, hypertrophic scar, wounds and psoriasis studies, and discuss correlation between sonographic findings and clinical assessment and/or validated scores. Data are still insufficient to support ultrasound imaging use as an unique efficacy assessment method in a trial, but favor that it is a valuable adjuvant assessment tool that brings objectiveness to subjective clinical assessment. Further studies and technology improvement will expand its applications in dermatology.