PurposeThere is currently no standardized method for muscle shear wave elastography (SWE). The objective of this study was to investigate the effect of unit of measurement, depth, and probe load on the reliability of muscle SWE. MethodsThe vastus lateralis, biceps femoris, biceps brachii, and abductor digiti minimi muscles were scanned on 20 healthy participants. The SWE readings were measured in shear wave velocity (m/s) and Young's modulus (kPa). Three acquisitions of varying depths were acquired from vastus lateralis. Minimal probe load was compared with the use of a standoff gel layer. Three repeated measurements were acquired to assess reliability using intraclass correlations (ICC). ResultsThe mean elasticity varied across muscle groups and ranged from 1.54 m/s for biceps femoris to 2.55 m/s for abductor digiti minimi (difference=1.01 m/s [95% confidence interval, CI=0.92, 1.10]). Reporting readings in meters per second resulted in higher ICC of 0.83 (0.65, 0.93) in comparison to 0.77 (0.52, 0.90) for kilopascal for the vastus lateralis muscle only. Variance increased proportionally with depth reaching 0.17 (equivalent to 0.82 m/s) at 6 cm. Using a standoff gel decreased ICC to 0.63 (0.20, 0.84) despite similar mean elasticity readings to minimal probe load. ConclusionsDifferent acquisition and technical factors may significantly affect the reliability of SWE in skeletal muscles. Readings acquired in the unit of shear wave velocity (m/s) from depths less than 4 cm using a minimal probe load without a standoff gel yielded the best reliability.
Purpose International guidelines advocate intensive blood pressure (BP) lowering within 6 hours of acute intracerebral hemorrhage (ICH) to a target systolic BP of 130-140 mm Hg, though more intensive lowering may be associated with adverse outcome. Observational studies suggest impaired cerebral autoregulation (CA) following ICH. Transcranial Doppler ultrasonography (TCD), alongside continuous BP monitoring, provides a noninvasive bedside investigation that offers detailed perspectives on physiological perturbations post-acute ICH. This systematic review and meta-analysis focuses on all TCD studies of CA in ICH. Methods MEDLINE, EMBASE, and CENTRAL were searched for studies of hemorrhagic stroke and blood flow measurement. Results Eight studies met inclusion criteria (293 ICH patients); CA was impaired up to 12-days post-acute ICH. Impaired CA was evidenced by reduced transfer function analysis phase and higher mean flow correlation values: these were associated with worsened clinical parameters including ICH-volume and Glasgow Coma Scale. Meta-analysis of CBV demonstrated that, compared to controls, mean CBV was significantly lower in the ipsilateral (49.7 vs 64.8 cm s(-1), Z = 4.26, P < .0001) and contralateral hemispheres following ICH (51.5 vs 64.8 cm s(-1), Z = 3.44, P = .0006). Conclusion Lower mean CBV in combination with impaired CA may have implications for more intensive BP lowering and warrants further studies examining such strategies on cerebral blood flow and its regulatory mechanisms.
Background Epicardial adipose tissue (EAT) is a cardiometabolic risk factor, and its possible relationship with hypertension has been reported previously. Fragmented QRS (fQRS) detected on electrocardiography (ECG) has been demonstrated to be a marker of myocardial fibrosis. In this study, we aimed to investigate the relationship between the thickness of EAT, and presence of fQRS in hypertensive patients. Methods Consecutive patients who were diagnosed with hypertension were included in the study. ECG and transthoracic echocardiography (TTE) were performed to all patients. fQRS was defined as additional R ' wave or notching/splitting of S wave in two contiguous ECG leads. Thickness of EAT was measured by TTE. Results This study enrolled 69 hypertensive patients with fQRS on ECG and 45 hypertensive patients without fQRS as the control group. Age (P = .869), and gender distribution (P = .751) were similar in both groups. Left atrial diameter (P = .012), interventricular septal thickness (P < .001), posterior wall thickness (P < .001), left ventricular ejection fraction (P = .009), left ventricular mass (P = .006), left ventricular mass index (P = .014), left ventricular hypertrophy (P = .003), and EAT thickness (P < .001) were found to be significantly increased in patients with fQRS. In multivariate analysis, among these variables only EAT was observed to be an independent predictor of fQRS (odds ratio:3.306 [95% confidence interval, 0.030-0.118], P = .001). Conclusion A significant association exists between the presence of fQRS and EAT thickness in hypertensive patients. The presence of fQRS, just as EAT thickness, may be used as a cardiometabolic risk factor in hypertensive patients.
Purpose To asses the occurrence of discrepancies between the Doppler waveforms of the left and right umbilical arteries in their paravesical part in fetuses with absent or reversed end‐diastolic flow in the free‐floating umbilical cord. Methods This prospective observational study included pregnant women with fetal growth restriction or twin‐to‐twin transfusion syndrome. Umbilical arterial Doppler waveforms were obtained from both umbilical arteries in their intra‐abdominal paravesical part. Doppler findings were recorded as present end‐diastolic flow (PEDF)/absent end‐diastolic flow (AEDF); AEDF/AEDF; AEDF/reversed end‐diastolic flow (REDF); or REDF/REDF pattern. Results There were 49 fetuses with AEDF or REDF at the free‐floating umbilical cord. Of these, 20 (40.8%) had a discrepancy in Doppler waveforms between the two umbilical arteries, with 14 (28.6%) showing PEDF/AEDF, 17 (34.7%) AEDF/AEDF, 6 (12.2%) AEDF/REDF, and 12 (24.5%) REDF/REDF pattern. Conclusion Doppler waveforms showed discrepancies between the two umbilical arteries in 40.8% of pregnant women with AEDF or REDF in the free‐floating umbilical cord. The presence of end‐diastolic flow in one umbilical artery cannot exclude the possibility of AEDF in the other.
Bicuspid aortic valve (BAV) is a common congenital cardiac malformation, frequently combined with ascending aorta dilation. However, isolated abnormalities of the aortic arch are less frequent in BAV patients. Here, we present a rare case of BAV combined with right‐sided aortic arch aneurysm, aberrant left subclavian artery, and Kommerell's diverticulum, diagnosed by echocardiography and computed tomography angiography. The patient was followed‐up regularly because of the life‐threatening risks of aortic arch aneurysms.
Of the primary cardiac tumors, well‐differentiated papillary mesothelioma (WDPM) is very rare, with only one case report documenting WDPM of the pericardium. We report herein a 17‐year‐old boy who had an abnormal chest X‐ray on a routine college‐entrance examination. A giant cardiac tumor was detected by echocardiography. The neoplasm was partially resected, and histopathological examination revealed a WDPM. The patient recovered without any complication.
Objectives The purpose of this study was to evaluate the reproducibility of stomach position grading in congenital diaphragmatic hernia (CDH) as proposed by Cordier et al and Basta et al after standardization of the methods at our center. Methods We collected sonographic images from 23 fetuses with left‐sided CDH at our center from 2010 to 2018. Nine operators (one maternal fetal medicine expert and eight sonographers) reviewed the selected images and graded the stomach position according to the methods of Cordier et al and Basta et al. We assessed the interoperator agreement with Fleiss's kappa statistics. Results Overall agreement amongst all operators was moderate for both methods proposed by Cordier et al (k = 0.60, SE 0.07, 95% CI 0.47‐0.73, P < .0001) and Basta et al (k = 0.60, SE 0.06, 95% CI 0.47‐0.73, P < .0001). Interoperator agreement was moderate for grade 3 with the method by Cordier et al (k = 0.45, SE 0.09, 95% CI 0.27‐0.64, P < .0001) and fair for grade 4 with the method by Basta et al (k = 0.33, SE 0.08, 95% CI 0.18‐0.49 P < .0001). Conclusions Our study demonstrates a fair to moderate interoperator agreement of the stomach position grading methods proposed in the literature after standardization of the methods at our center. Further multicenter studies are needed to confirm our results.
The detection of multiple cardiac tumors during fetal echocardiography allowed us to make the diagnosis of tuberous sclerosis complex in the mother and establish the reason of her first epileptic seizures.
Purpose To evaluate the accuracy and reproducibility of a new fully automated fast three‐dimensional (3D) transthoracic echocardiography (TTE) software for the simultaneous assessment of left atrial (LA) volumes and LA ejection fraction (EF), left ventricular (LV) volumes, LV mass, and LVEF, and to compare the results obtained with a cardiac magnetic resonance (CMR) reference. Methods We included retrospectively 56 patients (46 men; mean age 63 ± 13 years) in sinus rhythm who had had comprehensive 3D TTE and CMR examinations within 24 hours. Results Despite a slight underestimation of LV and LA volumes, LVEF and LAEF were similar using CMR or 3DTTE (58% ± 16% vs 58% ± 12%; P = .65 and 45% ± 14% vs 46% ± 15%; P = .38, respectively) in the total population. Despite significant correlation between TTE and CMR measurements (r = 0.78; P < .001), 3D TTE underestimated LV mass (bias = −27 ± 35 g). Conclusion 3D TTE using a new‐generation fully automated software is a fast and reproducible imaging modality for simultaneous extensive quantification of left heart chambers size and function in routine practice. Potential underestimation of LA volume and LV mass, and of LVEF in patients with LVEF <50%, should be taken into consideration.
Primary cardiac tumors are rare, but papillary fibroelastoma (PFE) is reportedly the most common form, which usually occurs on the left‐side valves of the heart. However, PFE involving the tricuspid and pulmonary valves has also been documented. Although PFE is benign and seldom associated with valvular dysfunction, the associated embolic complications may lead to serious consequences. Most patients with PFE lack specific clinical symptoms and the diagnosis is incidental. Surgical resection is the mainstay treatment for PFE in order to prevent the occurrence of embolic complications. In this report, we present a case of a rare asymptomatic PFE of the pulmonary valve, which was incidentally noted during a routine examination with transthoracic echocardiography (TEE). There was neither valvular dysfunction nor hemodynamic change. The PFE was surgically removed, and the diagnosis was further confirmed with histopathology.
ABSTRACT Purpose Maternal ocular sonography offers a window into cerebrovascular and intracranial pressure changes in pregnancy. This study aimed to determine the Doppler velocimetric variables of the ophthalmic artery, and the mean diameter of the optic nerve sheath (ONSD), in an Australian cohort of healthy pregnant women. Methods A prospective observational cohort study of healthy women with uncomplicated singleton pregnancies in the third trimester was undertaken in a tertiary maternity service. A single prenatal ultrasonographic examination was performed on all participants, with a postnatal examination performed on a subgroup with uncomplicated deliveries. Results Fifty women were examined at a mean gestation of 35 weeks. The mean ± SD Doppler variables in the ophthalmic artery were peak systolic velocity (PSV) 41.89 ± 13.13 cm/s, second peak velocity 20.63 ± 8.97 cm/s, end diastolic velocity 9.29 ± 5.13 cm/s, pulsatility index 1.97 ± 0.53, resistive index 0.78 ± 0.07, peak ratio (second peak velocity/PSV) 0.49 ± 0.12, while the mean ONSD was 4.34 ± 0.4 mm. None of these variables had a demonstrable relationship with gestation or mean arterial pressure (MAP), nor did the sheath diameter have a relationship with any of the Doppler variables. Conclusions The ocular sonographic variables observed in this population are similar to those reported in other cohorts. No clear relationship could be identified in this cohort between ophthalmic artery Doppler variables and the ONSD, and between each of these variables and gestation or MAP.
Primary cardiac lymphoma (PCL) is a very rare kind of primary heart tumor, belonging to non‐Hodgkin's lymphoma whose major pathological type is diffuse large B‐cell lymphoma. The common symptoms include heart failure, pericardial effusion, and malignant arrhythmias. Early diagnosis and treatment of PCL are of great importance due to its merely 7‐month median survival period. Here, we report a 48‐year‐old male patient in whom both atria were involved and had to undergo palliative surgery because of severe clinical symptoms.
Objectives Evaluate the time taken to visualize the internal jugular vein and carotid arteries, and subjective image quality assessed on a 0–100 visual analogic scale, on an ultrasound model using either traditional ultrasound gel or normal saline. Methods Twenty‐two anesthesiology residents and twenty anesthesiology faculty were blinded and randomized into four separate groups using gel and saline as a conduction medium, in different sequences. Results Subjective image quality was 12.2 ± 4.2 better with gel than with saline (P < 0.01). Image acquisition time did not differ significantly between the two mediums. There was no significant difference in subjective image quality or time to image acquisition between faculty and residents. Conclusions Internal jugular vein and carotid artery identification time using ultrasonography were similar between gel and saline as conduction mediums. The difference in subjective image quality did not appear clinically relevant. Better image quality resulted in less time taken to identify the structures, as expected. We conclude that saline may be an effective alternative medium to gel for vessel imaging and access guidance. Further study in a clinical setting is warranted.
Purpose Lung ultrasound (LUS) at the point‐of‐care is a new method that is increasingly used in neonatology. The aim of this study was to determine the utility of the addition of LUS prior to the interhospital transport of neonates with respiratory failure. Methods LUS was performed on 50 newborns with respiratory failure prior to transport to a tertiary neonatal intensive care unit. We analyzed the performance of LUS for diagnosing the cause of respiratory failure, the concordance between LUS, chest X‐ray (CXR) and final clinical diagnosis, and the impact of LUS on clinical decision making before transport. Results LUS sensitivity for the diagnosis of respiratory distress syndrome was 91.3% (95%CI: 70.5‐98.5%), and specificity was 92.6% (95%CI: 74.2‐98.7%), whereas sensitivity and specificity of CXR were 69.6% (95%CI: 47.0‐85.9%) and 81.5% (95%CI: 61.2‐92.9%), respectively. For the recognition of pneumothorax (PTX) LUS had a sensitivity of 83.3% (95%CI: 36.5‐99.1%) and a specificity of 100% (95%CI: 89.9‐100%). For CXR, sensitivity was 16.7% (95%CI: 0.01‐63.5%) and specificity was 97.7% (95%CI: 86.4‐99.9%). The agreement between LUS and CXR in diagnosing the cause of respiratory failure was substantial (κ of 0.57 [95%CI: 0.40‐0.74]) and the agreement between LUS and the final clinical diagnosis was very good (κ of 0.86 [95%CI: 0.74‐0.98]). In 42% of the patients, a LUS examination prior to transport indicated the need for endotracheal tube repositioning or PTX decompression. Conclusion LUS may be a reliable imaging technique for differentiating the causes of respiratory failure before neonatal transport. Use of LUS may optimize the care of infants during transport.
Ultrasound is the imaging method of choice in gynecology. The quality and diagnostic accuracy of ultrasound depends on the skills of the individual performing the scan. Evaluation of ultrasound practice has received limited attention. A video recording device was connected to an ultrasound machine in gynecology clinics in a teaching hospital. To minimize the observer effect, all staff were notified through email in advance. Data were collected over a 3-week period. Anonymous recordings of both patients and user were compared with current guidelines, and practice was categorized as: compliant, partially compliant, or non-compliant. Observations (n = 43) were categorized and the results described as percentage frequencies (%). Image optimization was compliant in 23.3% of recorded observations, 11.6% was partially compliant, and 65.1% was noncompliant. The study also found that global examination on gynecology was 20.9% compliant, 18.6% partially compliant, and 60.47% noncompliant. Images were annotated in appropriately 41.9% of instances, and 25.6% of end-users examined bladder, vagina, and cervix when indicated. The pilot evaluation showed that ultrasound practice among end-users did not reflect current guidelines, suggesting a need for improvement. Accuracy and performance of ultrasound examination remains highly operator-dependent although video evaluation can be an effective tool for assessing such skills.
Solitary fibrous tumors (SFTs) rarely occur in the head and neck area. Imaging findings are nonspecific, and immunohistochemical (IHC) analysis is necessary for a definitive diagnosis. We report the case of a patient with a mass in the submandibular region that was initially diagnosed as basal cell adenoma. After excision and IHC examinations, a SFT was diagnosed.
The purpose of this case series is to evaluate the diagnostic potential of contrast-enhanced ultrasound (CEUS) in patients with clinically suspected pulmonary embolism (PE), suspicious pleural lesions, and negative computed tomography pulmonary angiogram (CTPA). Between January 2017 and January 2018, we examined patients with an intermediate or a high-risk Wells score and a negative CTPA with lung B-mode ultrasound (LUS). In a total of six patients, pleural defects were identified and further examined by CEUS. Nonenhancing lesions or those with inhomogeneous enhancement were considered to be suspicious for an embolic event and biopsied for histological validation. The data analysis was retrospective. In LUS, the lesions had an average size of 2.4 cm (range 2-3 cm). Five were hypoechoic and one was complex. The shape was wedge shaped (n = 5) or round (n = 1), and the number was solitary (n = 4) or multiple (n = 2) with dorsobasal localization (n = 6). Three lesions were nonenhancing, and three had an inhomogeneous enhancement with areas with complete absence of enhancement. The histological examination showed pulmonary infarction in all six cases, and in one patient also cells of a lung carcinoma. Our case series demonstrates the diagnostic potential of CEUS for detecting peripheral pulmonary infarction in patients with clinically suspected PE and negative CTPA scan regarding PE. A histological validation or a narrow follow-up might be warranted in some cases.
We describe two cases of intracranial cystic lesions associated with acrocallosal syndrome. These fetal anomalies were detected on antenatal sonography and confirmed postnatally. Imaging findings include corpus callosum agenesis with interhemispheric cysts and craniofacial anomalies associated with polydactyly. Identifying the above imaging features is of importance to plan management and provide supportive care that may be required.