Identificación de las características de los ganglios evaluados en el procedimiento EBUS y su relación con el diagnóstico de malignidad en instituto de alta complejidad en cáncer / Identification of the Characteristics of the Lymph Nodes Evaluated in the EBUS Procedure and their Relationship with the Diagnosis of Malignancy in a Highly Complex Cancer Institute

Introducción: La EBUS ha sido el foco de numerosos estudios destinados a evaluar su utilidad y rendimiento diagnóstico en diversas patologías. Objetivo principal: Identificación de las características ganglionares evaluadas en el procedimiento de Ultrasonido Endobronquial (EBUS) y su relación con el diagnóstico de malignidad en pacientes del Instituto Nacional del Cáncer de Colombia del 1 de enero de 2017 al 31 de marzo de 2021.Métodos: Estudio analítico observacional transversal. La recopilación de datos implicó un muestreo de casos consecutivos no probabilísticos entre individuos que cumplían los criterios de inclusión.Resultados: Un total de 75 pacientes fueron sometidos a EBUS. Se identificaron 6 características ecográficas de los ganglios de la biopsia asociadas a malignidad destacándose los ganglios mayores de 1 cm, márgenes mal definidos, ecogenicidad heterogénea, ausencia de una estructura hiliar central, presencia de signos de necrosis o coagulación y presencia de conglomerado ganglionar. Conclusión: Este estudio caracterizó la frecuencia de los hallazgos en la ultrasonografía endobronquial destacando algunas características ecográficas de los ganglios mediastínicos que podrían predecir patología maligna.

Introduction: The EBUS has been the focus of numerous studies aiming to evaluate its utility and diagnostic performance across various pathologies. Objective: Identification of the node characteristics evaluated in the Endobronchial Ultrasound (EBUS) procedure and their relationship with malignancy diagnosis in patients at the National Cancer Institute of Colombia from January 1st, 2017, to March 31st, 2021. Methods: Observational cross-sectional analytical study. Data collection involved non-probabilistic consecutive case sampling among individuals meeting the inclusion criteria.Results: A total of 75 patients underwent the EBUS procedure. Our findings revealed six predictors of malignancy based on sonographic features of biopsy nodes, including nodes larger than 1 cm, poorly defined margins, heterogeneous echogenicity, absence of a central hilar structure, presence of signs indicating necrosis or coagulation, and the presence of a ganglion conglomerate. Conclusions: This study showed that endobronchial ultrasonography has several sonographic characteristics at the time of evaluating mediastinal nodes that could predict malignant and benign pathology.

Confiabilidad Inter-evaluador en la Medición del Grosor Muscular y el Ángulo de Penación a través de la Evaluación Ecográfica: Estudio entre un Experto y un Kinesiólogo en Formación / Inter-Evaluator Reliability in Measurement of Muscle Thickness and Penance Angle through Ultrasound Evaluation: Comparison Study between an Expert and a Physical Therapist in Training

Existen diversas formas de evaluar el músculo esquelético. Una herramienta que ha ganado relevancia es la evaluación ecográfica. Esta, permite medir el grosor muscular (GM) y el ángulo de penación (AP). Por otra parte, en la formación inicial de los Kinesiólogos es importante realizar el ejercicio de la confiabilidad en la medición en relación al experto. un procedimiento diagnóstico. Así, el objetivo de este estudio es determinar la confiabilidad inter-evaluador en la medición del GM y el AP, a través de la evaluación ecográfica, entre un experto y un kinesiólogo en formación. La capacitación contó de tres fases; el ciclo teórico, el ciclo práctico y el proceso de confiabilidad. Para este último, se realizaron 10 pruebas para cada una de las mediciones GM 1, GM 2 y GM 3 y de AP. La confiabilidad inter-evaluador en la medición de GM es buena a excelente en los tres intentos GM1 (ICC=0,81; p=0,001), GM2 (ICC=0,86; p<0,001), GM3 (ICC=0,88;<0,001). Por su parte, la confiabilidad del AP fue pobre a regular (ICC=0,21; p=0,143. Las conclusiones de esta investigación indican que existe una excelente confiabilidad inter evaluador en la medición de GM. No así, en la medición de AP, por lo que se sugiere incrementar las horas prácticas en el proceso de aprendizaje de esta medida.

SUMMARY: Skeletal muscle can be assessed in a number of different ways. Consequently, ultrasound evaluation has become a relevant diagnostic tool. This procedure allows measuring muscle thickness (MT) and pennation angle (PA). Furthermore, during the initial training of physical therapists it is important in a diagnostic procedure, to exercise reliability in measurement in comparison to the expert. Therefore, the objective of this study is to determine the inter-rater reliability in the measurement of MT and PA, through ultrasound evaluation, between an expert and a physical therapist in training. This training was comprised of three phases: The theoretical cycle, the practical cycle and the reliability process. For the latter, ten different tests were performed for each of the MT 1, MT 2 and MT 3 and PA measurements. Inter-rater reliability in the MT measurement was good to excellent in the three attempts MT1 (ICC=0.81; p=0.001), MT2 (ICC=0.86; p<0.001), MT3 (ICC=0. 88;<0.001). On the other hand, reliability of the PA was poor to fair (ICC=0.21; p=0.143. In conclusion, this research indicates that there is excellent inter-rater reliability in the measurement of MT. This does not however apply to the measurement of PA. It is therefore suggested that practical hours during the learning process of this measure be increased.

Desafios do rastreamento do câncer de mama / Challenges of breast cancer screening

A mamografia é o método de eleição para o rastreamento do câncer de mama, sendo o único que demonstra redução de mortalidade na população de risco habitual. A periodicidade de realização e a idade de início do rastreamento mamográfico são um tema controverso na literatura. Entretanto, dados no nosso país apontam para uma porção significativa de neoplasia de mamas em mulheres abaixo dos 50 anos. A Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), a Sociedade Brasileira de Mastologia (SBM) e o Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR) concordam que o rastreamento mamográfico deveria ser realizado, anualmente, por todas as mulheres a partir de 40 anos de idade. No Brasil, há uma distribuição desigual de mamógrafos nas várias regiões. As políticas de rastreamento devem considerar essa desigualdade. A grande maioria dos serviços no Brasil realiza rastreamento oportunístico para o câncer de mama. A implantação de rastreamento organizado por faixa etária e estratificação de risco pode otimizar os custos do sistema público de saúde. Pacientes de alto risco precisam ser rastreadas de forma diferente das pacientes de risco habitual. Essas pacientes precisam ter acesso à ressonância magnética das mamas e também iniciar seu rastreamento em idade mais precoce. O protocolo abreviado da ressonância magnética para rastreamento de pacientes de alto risco para câncer de mama pode melhorar a adesão e o acesso dessas pacientes ao programa de rastreamento. A ultrassonografia das mamas não é método de rastreamento isoladamente. Entretanto, ela tem seu papel como método complementar à mamografia e à ressonância magnética em cenários específicos, bem como em substituição à ressonância magnética em pacientes com contraindicação ao uso desse método. As mamas densas possuem baixa sensibilidade para o rastreamento por mamografia

Ecografía realizada por cirujanos generales más allá de la evaluación enfocada al trauma / Echography Scans Performed by General Surgeons beyond Focused Assessment for Trauma

Introducción: La ecografía es considerada en la actualidad una modalidad de imagen establecida en medicina con múltiples beneficios que se utiliza ampliamente en la práctica quirúrgica. Los cirujanos son entrenados en exploraciones de Evaluación Ecográfica Enfocada para el Trauma. Sin embargo, cada vez adquieren más habilidades para realizar ecografías, tanto al lado de la cama como en el transoperatorio para otras presentaciones quirúrgicas. Objetivo: Exponer el uso de la ecografía realizada por el cirujano general ante el paciente quirúrgico. Métodos: Se realizó una revisión bibliográfica del tema en las bases de datos PubMed, BVS-BIREME y Cochrane. Se consideraron en la búsqueda todo tipo de estudios publicados desde enero de 1958 hasta enero del 2022, a los cuales se tuvo acceso. Los idiomas utilizados en la búsqueda fueron el español y el inglés. Desarrollo: La ecografía realizada por el cirujano general es cada vez más preconizada a nivel mundial, no solo para el trauma sino tanto en afecciones agudas intrabdominales como para aumentar la seguridad durante el transoperatorio. Conclusiones: La ecografía tiene muchas ventajas debido a que es una técnica segura, rápida, no invasiva, portátil y repetible, que brinda imágenes dinámicas en tiempo real relevantes para el manejo del paciente(AU)

Introduction: Echography is nowadays considered an established imaging modality in medicine and with multiple benefits, as well as widely used in surgical practice. Surgeons are trained in focused assessment with echography for trauma. However, they are becoming increasingly skilled in performing echography scans, both at the point of care and in the transoperative setting for other surgical presentations. Objective: To expose the use of echography performed by the general surgeon directly on the surgical patient. Methods: A bibliographic review of the subject was carried out in the PubMed, BVS-BIREME and Cochrane databases. All types of studies published from January 1958 to January 2022, to which access was available, were considered in the search. The languages used in the search were Spanish and English. Development: The echography scan performed by the general surgeon is increasingly advocated worldwide, not only for trauma but also for acute intraabdominal conditions, as well as to increase safety during the transoperative period. Conclusions: Echography has many advantages because it is a safe, fast, noninvasive, portable and repeatable technique that provides real-time dynamic images relevant to patient management(AU)

Biometría fetal en la confirmación de restricciones del crecimiento intrauterino / Fetal Biometrics in Confirming Restrictions of Intrauterine Growth

Introducción: El crecimiento y el desarrollo son fenómenos biológicos que implican aumento de masa celular y diferenciación de forma o función, respectivamente. En beneficio del diagnóstico, se utilizan las bondades del ultrasonido en la evolución biométrica del crecimiento fetal. Objetivo: Determinar mensuraciones biométricas fetales más asociadas a la restricción del crecimiento fetal en infantes que sufrieron restricción del crecimiento intrauterino. Métodos: Se realizó un estudio longitudinal descriptivo y retrospectivo de gestantes captadas en dos áreas de salud del municipio Santa Clara, que terminaron su embarazo entre septiembre del 2013 y octubre del 2018 y cuyos recién nacidos experimentaron restricción del crecimiento. La muestra se clasificó al nacimiento en pequeños y adecuados, según condición trófica y en cada grupo se estudió relación con valores percentilares de variables biométricas en los dos últimos trimestres. Resultados: Predominaron en todas las biometrías y en los dos trimestres los valores por debajo del décimo percentil. En la totalidad de los infantes y durante todo el período fetal, la circunferencia abdominal estuvo por debajo del percentil 10. En las variables largo del fémur y circunferencia cefálica los percentiles más altos se encontraron en el tercer trimestre y desde el segundo en la variable diámetro biparietal, posiblemente relacionado con restricciones asimétricas del crecimiento. Conclusiones: La variable biométrica circunferencia abdominal desde el segundo trimestre es fiable en la detección de restricciones del crecimiento intrauterino y su existencia por debajo del décimo percentil debe servir como certeza de su existencia, aun cuando la condición trófica del recién nacido parezca revelar otra realidad(AU)

Introduction: Growth and development are biological phenomenons involving cell mass increase and differentiation of form or function, respectively. For diagnostic purposes, the benefits of ultrasound are used for the biometric evolution of fetal growth. Objective: To determine fetal biometric measurements mostly associated with fetal growth restriction in infants who suffered intrauterine growth restriction. Methods: A descriptive and retrospective longitudinal study was carried out with pregnant women from two health areas of Santa Clara Municipality, who finished their pregnancy between September 2013 and October 2018 and whose newborns experienced growth restriction. The sample was classified at birth into small and adequate, according to trophic condition; and, in each group, the relationship with percentile values of biometric variables in the last two trimesters was studied. Results: Values below the tenth percentile predominated in all biometrics and in the two trimesters. In all infants and during the whole fetal period, abdominal circumference was below the tenth percentile. In the variables femur length and cephalic circumference, the highest percentiles were found in the third trimester; while, from the second trimester on, the same occurred in the variable biparietal diameter, possibly related to asymmetric growth restrictions. Conclusions: The biometric variable abdominal circumference is, from the second trimester on, reliable in the detection of intrauterine growth restrictions; its existence below the tenth percentile should serve as certainty of its existence, even when the trophic condition of the newborn seems to reveal another reality(AU)

La nefroprevención prenatal, un reto en la prevención primaria / Prenatal Kidney Prevention: A Challenge in Primary Care

Por su avanzado desarrollo, la ecografia constituye la prueba de imagen de elección en el diagnóstico de las malformaciones durante la etapa prenatal y, en el caso de la correspondiente al tracto genitourinario, dicha técnica no solo permite el diagnóstico de estas, sino que también ofrece información relacionada con los indicadores de mal pronóstico de la función renal. De ahí que la importancia del diagnóstico prenatal por ultrasonografía de estos defectos radica en la posibilidad de realizar acciones preventivas y educativas encaminadas a disminuir la enfermedad renal terminal en la infancia.1,2) No obstante, dichas acciones se pueden ver entorpecidas debido al desarrollo embriológico del aparato genitourinario en diferentes estadios, a la interacción de factores genéticos, epigenéticos y ambientales durante este, así como a su variada expresión fenotípica.2) De lo antes expuesto se deriva la importancia de realizar acciones preventivas de carácter proactivo, es decir, llevar a cabo acciones que superen la actitud reactiva en los individuos ante los problemas, mediante un trabajo de búsqueda capaz de identificar aquellas situaciones desfavorables que puedan incidir de forma negativa en la calidad de vida y que definan una práctica profiláctica para la reducción de los factores de riesgo.3) Este tipo de acción se facilita, en el nivel primario de salud, a través del trabajo que se realiza con los posibles factores que modifican el riesgo preconcepcional genético. Entonces, en qué situación se sugiere actuar por parte del equipo de salud en la atención primaria, con la finalidad de iniciar la nefroprevención desde la etapa prenatal y así contribuir a amortiguar la aparición de dichas anomalías o defectos capaces de afectar de forma negativa la calidad de vida postnatal al no poderse explicar solamente mediante los factores genéticos. Para comenzar se sugiere cumplimentar a cabalidad las medidas tendientes a disminuir la prematuridad y el bajo peso al nacer mediante la captación precoz y el apropiado seguimiento del embarazo; disminuir la incidencia del embarazo en adolescentes, asegurar una nutrición adecuada de la gestante, así como evitar el uso de drogas teratogénicas (alcohol, warfarina, inhibidores de la enzima de conversión, alquilantes, ácido valproico, comitoína, cocaína, etcétera) que pueden ocasionar malformaciones renales. Deberá realizarse un control cuidadoso de la presión arterial, teniendo cuidado de no usar inhibidores de la encima convertidora de angiotensina en casos de hipertensión arterial. Además, fomentar el diagnóstico y tratamiento temprano y adecuado de la infección urinaria, lo cual constituye otra medida para evitar el parto prematuro.2,4 Todo ello basado en que el recién nacido no forma nuevas nefronas y que la nefrogénesis se extiende hasta las 36 semanas de gestación, por lo tanto, los prematuros nacen con menor número de nefronas, lo cual predispone un mayor riesgo de enfermedades renales futuras y de hipertensión arterial. Asimismo, es más susceptible a infecciones, hipoxia por síndrome de dificultad respiratoria, factores que predisponen a una insuficiencia renal aguda y a lesiones renales seculares. En otro sentido, debemos continuar con la administración de ácido fólico a las potenciales gestantes, lo cual contribuye a disminuir la incidencia de defectos de cierre del tubo neural y, en consecuencia, los casos de mielomeningocele, que es la causa más frecuente de vejiga neurógena. Igualmente, el suplemento de vitamina A, cuya deficiencia ha sido implicada en la génesis de las malformaciones renales.4 Otro acápite importante resulta el diagnóstico y tratamiento de las infecciones durante la gestación, ya que pueden ser potencialmente teratogénicas u ocasionar glomerulopatías (lúes, toxoplasmosis, citomegalovirosis, retrovirosis). La infección por estreptococo grupo B deberá ser adecuadamente pesquisada y tratada eliminando una causa frecuente de sepsis neonatal y la probabilidad de insuficiencia renal aguda secundaria. El diagnóstico prenatal de la uropatía mediante la ecografía bidimensional prenatal (fundamental la ecografía estructural del tercer trimestre) conducirá a una evaluación pronóstica de la función renal y a un tratamiento temprano en caso necesario, evitando así el daño renal secundario.2,4 A modo de conclusión, se puede afirmar que la nefroprevención prenatal en la atención primaria de salud, independiente del origen multifactorial de este tipo de defecto congénito y su asociación a síndromes genéticos, se hace posible y, de esta forma, se contribuye de manera satisfactoria a modificar tanto la incidencia al nacimiento como la prevalencia de estos(AU)

Resultados materno y perinatal de pacientes con diagnóstico prenatal de gastrosquisis en un centro de Medellín / Maternal and perinatal outcomes of patients with prenatal diagnosis of gastroschisis in a center in Medellin

Objetivo: Describir los resultados maternos y perinatales de pacientes con diagnóstico prenatal de gastrosquisis atendidos en un centro de referencia obstétrica de Medellín. Método: Estudio observacional, descriptivo y retrospectivo, llevado a cabo en la Clínica Universitaria Bolivariana en fetos con diagnóstico prenatal de gastrosquisis desde el 1 de enero de 2010 hasta el 31 de julio de 2021. Resultados: Se identificaron 54 gestantes con diagnóstico prenatal de gastrosquisis. En el 63% era su primer embarazo y el 27,8% eran adolescentes. La duración promedio de la gestación fue de 35 semanas y 6 días. La cesárea fue la vía más común (98,1%) y la indicación más frecuente fue sufrimiento de asa 66,7%. El 55,6% de los neonatos requirieron más de una intervención quirúrgica para el cierre de la pared abdominal. Las complicaciones más frecuentes fueron anemia (66,7%) e íleo posoperatorio (72,2%). La mortalidad fue del 13%. Conclusiones: Se evidencian algunas características similares a las reportadas en otras series. La mayor presentación fue en primer embarazo, la causa de finalización de la gestación fue sufrimiento de asas (demostrando la importancia del seguimiento ecográfico), y las complicaciones más frecuentes fueron anemia e íleo posoperatorio presentados por la prematuridad. La mortalidad comparada con la de otras instituciones locales fue menor.

Objective: To describe the outcomes of maternal and perinatal in patients diagnosed with prenatal gastroschisis that received medical care at an obstetric reference center in Medellin. Method: Observational, descriptive and retrospective study in fetuses with a prenatal diagnosis of gastroschisis performed in the Clínica Universitaria Bolivariana between January 1st 2010 and July 31st 2021. Results: Were included 54 pregnant women with prenatal diagnosis of gastroschisis. The 63% were their first pregnancy and 27,8% were adolescents. The average duration of gestation was 35 weeks and 6 days. Cesarean section was the most common way of delivery (98,1%) and the most frequent indication was suffering from loop (66,7%). The 55,6% of neonates required more than one surgical intervention for closure of the abdominal wall. The most frequent complications were anemia (66,7%) and postoperative ileus (72,2%). A mortality of 13% was presented. Conclusions: Some characteristics like reported in other series are evident. The greatest presentation was in the first pregnancy, the cause of termination of pregnancy was suffering from loops (demonstrating the importance of ultrasound monitoring) and the most frequent complications were anemia and postoperative ileus presented by prematurity. Mortality, compared to other local institutions, was lower.

Contrast-enhanced ultrasonography with intra-glandular contrast injection can improve the diagnostic accuracy of central compartment lymph node metastasis of thyroid cancer / 南方医科大学学报

OBJECTIVE@#To investigate the value of lymphatic contrast-enhanced ultrasound (LCEUS) with intra-glandular injection of contrast agent for diagnosis of central compartment lymph node metastasis of thyroid cancer.@*METHODS@#From November, 2020 to May, 2022, the patients suspected of having thyroid cancer and scheduled for biopsy at our center received both conventional ultrasound and LCEUS examinations of the central compartment lymph nodes before surgery. All the patients underwent surgical dissection of the lymph nodes. The perfusion features in LCEUS were classified as homogeneous enhancement, heterogeneous enhancement, regular/irregular ring, and non-enhancement. With pathological results as the gold standard, we compared the diagnostic ability of conventional ultrasound and LCEUS for identifying metastasis in the central compartment lymph nodes.@*RESULTS@#Forty-nine patients with 60 lymph nodes were included in the final analysis. Pathological examination reported metastasis in 34 of the lymph nodes, and 26 were benign lymph nodes. With ultrasound findings of heterogeneous enhancement, irregular ring and non-enhancement as the criteria for malignant lesions, LCEUS had a diagnostic sensitivity, specificity and accuracy of 97.06%, 92.31% and 95% for diagnosing metastatic lymph nodes, respectively, demonstrating its better performance than conventional ultrasound (P < 0.001). Receiver-operating characteristic curve analysis showed that LCEUS had a significantly greater area under the curve than conventional ultrasound for diagnosing metastatic lymph nodes (94.7% [0.856-0.988] vs 78.2% [0.656-0.878], P=0.003).@*CONCLUSION@#LCEUS can enhance the display and improve the diagnostic accuracy of the central compartment lymph nodes to provide important clinical evidence for making clinical decisions on treatment of thyroid cancer.

Value of High-Frequency Ultrasound in the Diagnosis of Pronator Teres Syndrome / 中国医学科学院学报

Objective To investigate the clinical value of high-frequency ultrasound in the diagnosis of pronator teres syndrome (PTS). Methods The high-frequency ultrasound was employed to examine and measure the median nerve of the pronator teres muscle in 30 patients with PTS and 30 healthy volunteers (control group).The long-axis diameter (LA),short-axis diameter (SA) and cross-sectional area (CSA) of the median nerve were measured.The receiver operating characteristic curve of the median nerve ultrasonic measurement results was established,and the area under the curve (AUC) was calculated.The diagnostic efficiency of each index for PTS was compared with the surgical results as a reference. Results The PTS group showed larger LA[(5.02±0.50) mm vs.(3.89±0.41) mm;t=4.38,P=0.013],SA[(2.55±0.46) mm vs.(1.70±0.41) mm;t=5.19,P=0.009],and CSA[(11.13±3.72) mm2 vs.(6.88±2.68) mm2;t=8.42,P=0.008] of the median nerve than the control group.The AUC of CSA,SA,and LA was 94.3% (95%CI=0.912-0.972,Z=3.586,P=0.001),77.7% (95%CI=0.734-0.815,Z=2.855, P=0.006),and 78.8% (95%CI=0.752-0.821,Z=3.091,P=0.004),respectively.With 8.63 mm2 as the cutoff value,the sensitivity and specificity of CSA in diagnosing PTS were 93.3% and 90.0%,respectively. Conclusion High-frequency ultrasound is a practical method for diagnosing PTS,and the CSA of median nerve has a high diagnostic value.

Evaluation of Extrathyroidal Extension of Papillary Thyroid Microcarcinoma With Three-Dimensional Tomographic Ultrasound Imaging / 中国医学科学院学报

Objective To evaluate extrathyroidal extension (ETE) in papillary thyroid microcarcinoma (PTMC) with three-dimensional tomographic ultrasound imaging (3D-TUI). Methods A total of 97 thyroid nodules of 79 patients with PTMC treated in PUMC Hospital from February 2016 to January 2018 were included in this study.Two ultrasound experts performed independent blinded assessment of the relationship between thyroid nodules and thyroid capsule by two-dimensional ultrasound (2D-US) and 3D-TUI.The results of 2D-US and 3D-TUI in evaluating ETE were compared with intraoperative findings and postoperative histological and pathological results. Results Among the 97 nodules,54 (55.7%) nodules had ETE.The diagnostic sensitivity (68.5% vs.37.0%;χ2=10.737,P=0.002),accuracy (74.5% vs.56.7%;χ2=6.686,P=0.015),and area under the receiver operating characteristic curve[0.761 (95%CI=0.677-0.845) vs.0.592 (95%CI=0.504-0.680);Z=3.500,P<0.001] of 3D-TUI were higher than those of 2D-US.However,3D-TUI and 2D-US showed no significant difference in the specificity (84.1% vs.81.4%;χ2=0.081,P=0.776),negative predictive value (67.9% vs.50.7%;χ2=3.645,P=0.066),or positive predictive value (84.1% vs.71.4%;χ2=1.663,P=0.240). Conclusion Compared with 2D-US,3D-TUI demonstrates increased diagnostic efficiency for ETE of PTMC.

Advances in Molecular Targeted Ultrasound Contrast Agents / 中国医学科学院学报

In real-time ultrasound,molecular targeted contrast agent is introduced into the blood circulation through peripheral intravenous injection to enhance the imaging signal of target lesions after binding to the corresponding intravascular receptors,which can realize early diagnosis,staging of diseases,assessment of treatment response,and targeted treatment.In addition,molecular targeted ultrasound contrast agents provide a platform for the delivery of drugs and genes via microbubbles,and nanoscale contrast agents can be infiltrated through vascular endothelium into the interstitial space of the lesion for imaging or treatment.The available studies of molecular targeted ultrasound contrast agents mainly focus on the preclinical trials.Some clinical trials have been conducted in humans and preliminarily confirm the safety and feasibility of targeted ultrasound contrast agents.The molecular targeted ultrasound contrast agents enjoy a broad prospect in clinical application.

Abdominal ultrasound in amazonian manatee (Trichechus inunguis) (Natterer, 1883) / Ultrassonografia abdominal em peixe boi amazônico (Trichechus inunguis (Natterer, 1883)

Morphophysiological species researches are fundamental, and diagnostic imaging is an excellent technique, already used in wild animals, with great application, not invasive and provide real-time information of each body. Amazonian manatees are on the list of endangered animals classified in the vulnerable category and knowledge of the normal pattern of ultrasound anatomy of organs and tissues is important for the maintenance and well-being of captive specimens contributing to reintroduction actions. The objective of the study was to standardize the examination technique and describe the ultrasound findings of the liver, gallbladder, stomach, urinary bladder and the subcutaneous tissue of the abdominal region in Trichechus inunguis, in order to contribute with the anatomical and sonographic knowledge and assist in the diagnosis and prognosis diseases. The study used 18 animals to describe the normal sonographic anatomy in the abdominal cavity of the Amazonian manatee. During abdominal scan, it was possible to visualize the features of the liver, gallbladder, stomach, urinary bladder obtained satisfactory results in this study. Therefore, other structures were not primarily identified by the reduced time, lots of fat and gases in intestines of animals.

Pesquisas morfofisiológicas em espécies selvagens são fundamentais, e o diagnóstico por imagem é uma excelente técnica, já usada e com grande aplicação, não invasiva e que fornece informações em tempo real de cada órgão. Peixes-boi-amazônico encontram-se na lista de animais ameaçados de extinção classificados na categoria vulnerável e o conhecimento do padrão normal da anatomia ultrassonográfica de órgãos e tecidos é importante para a manutenção e bem-estar de espécimes em cativeiro contribuindo para ações de reintrodução. O objetivo deste estudo foi padronizar a técnica de exame e descrever os achados ultrassonográficos do fígado, vesícula biliar, estômago, vesícula urinária e o tecido subcutâneo da região abdominal em Trichechus inunguis, de modo a contribuir com o conhecimento anátomo-sonográfico e auxiliar no diagnóstico e prognóstico de doenças. O estudo utilizou 18 animais para descrever a anatomia ultrassonográfica normal na cavidade abdominal de peixe-boi amazônico. Durante a varredura abdominal foi possível visualizar as características dos órgãos obtendo resultados satisfatórios neste estudo, concluindo ser uma técnica eficiente para avaliação de determinados órgãos abdominais em peixe-boi amazônico. Entretanto, outras estruturas não foram identificadas principalmente pelo tempo reduzido, muita gordura e gases nos intestinos dos animais.

Diagnostic value of ACR TI-RADS combined with three-dimensional shear wave elastography in ACR TI-RADS 4 and 5 thyroid nodules / 中华医学杂志(英文版)

BACKGROUND@#Three-dimensional shear wave elastography (3D-SWE) is a promising method in distinguishing benign and malignant thyroid nodules. By combining with conventional method, it may further improve the diagnostic value. The study aimed to assess the diagnostic value of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.@*METHODS@#All nodules were examined by conventional ultrasonography, ACR TI-RADS classification, and 3D-SWE examination. Conventional ultrasonography was used to observe the location, size, shape, margin, echogenicity, taller-than-wide sign, microcalcification, and blood flow of thyroid nodules, and then ACR TI-RADS classification was performed. The Young's modulus values (3D-C-Emax, 3D-C-Emean, and elastography standard deviation [3D-C-Esd]) were measured on the reconstructed coronal plane images. According to the receiver operating characteristic (ROC) curve, the best diagnostic efficiency among 3D-C-Emax, 3D-C-Emean, and 3D-C-Esd was selected and the cut-off threshold was calculated. According to the surgical pathology, they were divided into benign group and malignant group. And appropriate statistical methods such as t -test and Mann-Whitney U test were used to compare the difference between the two groups. On this basis, 3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.@*RESULTS@#Of the 112 thyroid nodules, 62 were malignant and 50 were benign. The optimal cut-off value of three-dimensional maximum Young's modulus in coronal plane (3D-C-Emax) was 51.5 kPa and the area under the curve (AUC) was 0.798. The AUC, sensitivity, specificity, and accuracy of conventional ACR TI-RADS were 0.828, 83.9%, 66.0%, and 75.9%, respectively. The AUC, sensitivity, specificity, and accuracy of combined ACR TI-RADS were 0.845, 90.3%, 66.0%, and 79.5%, respectively. The difference between the two AUC values was statistically significant.@*CONCLUSIONS@#Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS. The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements. It can be used as an effective method in the diagnosis of thyroid nodules.

Multiparametric ultrasound for the assessment of testicular lesions with negative tumoral markers / 亚洲男科学杂志(英文版)

The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound (mpUS; grayscale US, color Doppler US, strain elastography, and contrast-enhanced US) in the assessment of testicular lesions with negative tumoral markers. MpUS imaging data, patient age, serum tumor markers, scrotal pain, cryptorchidism, and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019. Histologic results or follow-up examinations were used as the reference standard. In total, 83 lesions from 79 patients were included in the analysis. Fifty-six patients were finally diagnosed with benign tumors, and 23 patients were ultimately diagnosed with malignant tumors. Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups. Stepwise multivariate logistic regression analysis showed that lesion diameter (odds ratio [OR] = 1.072, P = 0.005), vascularization on color Doppler US (OR = 4.066, P = 0.001), and hyperenhancement during the early phase (OR = 6.465, P = 0.047) were significant independent risk factors for malignancy; however, when compared with neoplastic lesions, pain (OR = 0.136, P < 0.001), absence of vascularization on color Doppler US (OR = 1.680, P = 0.042), and nonenhancement during the late phase (OR = 3.461, P = 0.031) were strongly associated with nonneoplastic lesions. MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis, which may avoid inappropriate radical orchiectomy.

Multiresolution discrete optimization registration method of ultrasound and magnetic resonance images based on key points / 生物医学工程学杂志

The registration of preoperative magnetic resonance (MR) images and intraoperative ultrasound (US) images is very important in the planning of brain tumor surgery and during surgery. Considering that the two-modality images have different intensity range and resolution, and the US images are degraded by lots of speckle noises, a self-similarity context (SSC) descriptor based on local neighborhood information was adopted to define the similarity measure. The ultrasound images were considered as the reference, the corners were extracted as the key points using three-dimensional differential operators, and the dense displacement sampling discrete optimization algorithm was adopted for registration. The whole registration process was divided into two stages including the affine registration and the elastic registration. In the affine registration stage, the image was decomposed using multi-resolution scheme, and in the elastic registration stage, the displacement vectors of key points were regularized using the minimum convolution and mean field reasoning strategies. The registration experiment was performed on the preoperative MR images and intraoperative US images of 22 patients. The overall error after affine registration was (1.57 ± 0.30) mm, and the average computation time of each pair of images was only 1.36 s; while the overall error after elastic registration was further reduced to (1.40 ± 0.28) mm, and the average registration time was 1.53 s. The experimental results show that the proposed method has prominent registration accuracy and high computational efficiency.

Reinforcing the valuable role of gastric ultrasound for volume and content assessment: an observational study

Abstract Background Pulmonary aspiration is one of the most important complications in anesthesiology. Assessment of gastric content by ultrasound is a good method to quantify gastric volume and to determine the risk of intraoperative pulmonary aspiration. The aim of this study is to determine the accuracy of the gastric ultrasonography in the qualitative analysis of gastric content, mainly in the analysis of small amounts of liquid content. Methods Gastric ultrasound was performed to 36 patients before upper gastrointestinal endoscopy (UGI), making two longitudinal scans at the epigastric level, one in supine position and the other in right lateral decubitus position, measuring two diameters and the area of the gastric antrum and assessing the content characteristics determining whether it was an empty stomach or contained fluid or solid content. Subsequently, the ultrasound findings were compared with UGI findings. Results Gastric areas were analyzed by the trace and the lengths of the craniocaudal and anteroposterior axes concluding that there are no significant differences between the two methods. No statistically significant difference was found between UGI and US assessment technics. No statistically significant difference was found between the estimated volume by UGI and US. Conclusions Though our study has some limitations, qualitative analysis of gastric content using ultrasound followed by endoscopy enabled the conclusion that there are no differences in the qualitative assessment regarding these two techniques, supporting the important role of point-of-care gastric ultrasound (POCGUS) in the assessment of pulmonary aspiration risk by the anesthesiologist in the perioperative period.

Desafíos del cirujano general en la realización de la ecografía en la evaluación del trauma / Challenges of the General Surgeon in the Performance of Trauma Assessment Ultrasound

Introducción: El trauma es la pandemia que cada año cobra muchas vidas, los avances tecnológicos no han podido detenerla, sin embargo, estos han ayudado en la evaluación más efectiva de los pacientes. La ecografía realizada por médicos no radiólogos se ha convertido en una herramienta necesaria en la evaluación del paciente traumatizado. Objetivo: Describir los conocimientos que debe adquirir el cirujano general para realizar ecografía en la evaluación del trauma. Método: Se realizó una revisión bibliográfica del tema en las bases de datos PubMed, BVS-BIREME y Cochrane. Se describió los elementos que tiene que conocer el cirujano general para realizar ecografía en la evaluación del trauma. Se consideraron en la búsqueda todo tipo de estudios publicados desde enero de 1971 hasta diciembre de 2019 a los cuales se tuvo acceso y se realizó la evaluación de la validez interna de la evidencia, así como de su calidad global. Los idiomas utilizados en la búsqueda fueron el español e inglés. Desarrollo: La mayoría de los estudios aceptan a la ecografía como herramienta de evaluación en el trauma y su utilización sistemática por médicos no radiólogos. Conclusiones: Los principios básicos de la ecografía en el trauma tienen que ser parte de las herramientas de un cirujano general del siglo xxi. Los errores más frecuentes, responden a la no realización sistemática y a la falta de entrenamiento. Cada vez son menos las contraindicaciones de la ecografía en el trauma, pero sí es marcada la dependencia del operador(AU)

Introduction: Trauma is the pandemic that every year claims many lives; technological advances have not been able to stop it, but have contributed with the more effective assessment of patients. Ultrasound performed by non-radiologists physicians has become a necessary tool in the assessment of the trauma patient. Objective: To describe the knowledge that the general surgeon should acquire to perform ultrasound for assessing trauma. Methods: A bibliographic review of the subject was carried out in the PubMed, BVS-BIREME and Cochrane databases. The elements that the general surgeon must know in order to perform ultrasound in the assessment of trauma were described. The search considered all types of studies published from January 1971 to December 2019 and that could be accessed; the internal validity of the evidence was assessed, together with its overall quality. The languages used in the search were English and Spanish. Development: Most studies accept ultrasound as an assessment tool in trauma and its systematic use by non-radiologist physicians. Conclusions: The basic principles of ultrasound in trauma have to be part of the tools of a general surgeon of the twenty-first century. The most frequent errors are due to lack of systematic use and lack of training. Contraindications of ultrasound in trauma are progressively less frequent, but there is a marked dependence on the person who operates(AU)

Diagnóstico de roturas del manguito rotador por ecografía y resonancia magnética: ¿la morfología acromial influye en los resultados? / Ultrasound and magnetic resonance imaging diagnosis for rotator cuff tears: does acromial morphology affect the results?

INTRODUCCIÓN Actualmente no existen estudios que evalúen la concordancia entre la ecografía (ECO) y la resonancia magnética (RM) observando parámetros como el índice acromial (IA) y el ángulo crítico (AC) para roturas del manguito rotador (MR). Se considera que la mayor cobertura de la huella por un IA o AC incrementados podría afectar la adecuada visualización del MR en estudios de ECO al interponerse entre el complejo tendíneo y el transductor ecográfico. OBJETIVO Estimar la concordancia de la ECO y la RM en el diagnóstico de pacientes con roturas del MR confirmadas por artroscopia con IA y AC mayores al promedio normal (0.7 y 35°, respectivamente). Secundariamente, determinar si la concordancia diagnóstica es comparable entre tipos de rotura (espesor completo o parciales). MATERIALES Y MÉTODOS Estudio retrospectivo de una serie consecutiva de 100 pacientes con roturas totales o parciales del MR confirmadas por artroscopia. RESULTADOS La edad media del grupo de estudio fue de 55,7 ± 10,5 años. La media del IA fue de 0,77 ± 0,08, y la del AC, de 37,42° ± 5,88°. La concordancia entre la ECO y la RM y el IA fue > 0,7 de 56,7% (K = 0,27; p = 0,01); y < 0,7 de 35,7% (K = 0,01; p = 0,46), respectivamente. Y la concordancia entre la ECO y la RM y el AC fue > 35° de 61,5% (K = 0,32; p = 0,001); y < 35° de 33,3% (K = -0,00; p = 0,52), respectivamente. CONCLUSIÓN La concordancia diagnóstica de la ECO comparada con la de la RM, en pacientes con roturas del MR confirmada por artroscopia y con IA y AC mayores al promedio normal, fue justa. La concordancia diagnóstica de la ECO comparada con la RM, en pacientes con IA y AC menores al promedio normal, fue pobre. La capacidad diagnóstica fue similar entre la ECO y la RM para roturas parciales y totales.

INTRODUCTION Currently, there are no studies that evaluate the agreement between ultrasound (US) and magnetic resonance imaging (MRI) scans in rotator cuff (RC) tears by the observation of parameters such as the acromial index (AI) and critical shoulder angle (CSA). We hypothesize that the greater coverage of the footprint by increased AI or CSA could affect the proper visualization of the RC in US scans by its interposition between the tendinous complex and the US transducer. OBJETIVE To estimate the agreement between US and MRI in the diagnosis of patients with RC tears confirmed by arthroscopy and with AI and CSA greater than the normal average values (0.7 and 35° respectively). The secondary objective is to determine if the diagnostic agreement is comparable regarding different types of tear (partial and complete). MATERIALS AND METHODS A retrospective study of a consecutive case series of 100 patients with partial or complete RC tears confirmed by arthroscopy. RESULTS The mean age of the study group was of 55.7 10.5 years. The mean AI was of 0.77 0.08, and the mean CSA was of 37.42° 5.88°. The agreement regarding the US, the MRI and the AI was > 0.7 of 56.7% (K » 0.27; p » 0.01); and < 0.7 of 35.7% (K » 0.01; p » 0.46) respectively. And the agreement regarding the US, the MRI and the CSA was > 35° of 61.5% (K » 0.32; p » 0.001); and < 35° of 33.3% (K »-0.00; p » 0.52) respectively. CONCLUSION The diagnostic agreement of the US compared with the MRI, in patients with RC tears confirmed by arthroscopy and with AI and CSA greater than the normal average values was fair. The diagnostic agreement of the US compared with the MRI, in patients with AI and CSA lower than the normal average values was poor. The diagnostic performance of the IS and MRI was similar for partial and complete tears.

Uso de protocolos de examen radiográfico para la evaluación diagnóstica de la osteogénesis imperfecta / Use of radiographic examination protocols for diagnostic evaluation of osteogenesis imperfecta

RESUMEN La osteogénesis imperfecta (OI), también conocida como enfermedad de los huesos de cristal, es una enfermedad rara, causada principalmente por mutaciones en los genes COL1A1 y COL1A2. Aunque el 85-90% de los eventos son causados por mutaciones en el propio colágeno, las formas recesivas pueden ser el resultado de otros defectos. Dado que pueden ocurrir hallazgos similares entre la OI y otras enfermedades, es necesario un diagnóstico diferencial para una adopción más rápida de los tratamientos apropiados. Debido a la necesidad constante de exámenes, estos pacientes tienen más probabilidades de tener complicaciones por la radiación ionizante, por lo que es muy importante cumplir estrictamente con todos los requisitos de protección radiológica. OBJETIVO Verificar la existencia de protocolos de imagen utilizados en el diagnóstico de la OI y describir las técnicas radiográficas involucradas en el proceso. METODOLOGIA Se trata de un estudio cualitativo en el que se utilizaron las revistas PubMed, BIREME, CAPES y ScienceDirect, con el objetivo de verificar la presencia de investigaciones dirigidas a la creación de protocolos de imagen para auxiliar el diagnóstico de la OI. CONSIDERACIONES FINALES: Si bien ha demostrado ser de gran utilidad, debido a los riesgos a los que están expuestos los pacientes con OI, el uso de herramientas que liberan radiaciones ionizantes debe ser monitoreado constantemente. Por lo tanto, los protocolos deben revisarse para que, incluso con una reducción de la dosis, no se pierda la resolución y el detalle de la imagen.

ABSTRACT: The osteogenesis imperfecta (OI), also known as brittle bone disease, is a rare disease, mainly caused by mutations in genes COL1A1 and COL1A2. Although 85-90% of events are caused by mutations in collagen itself, the recessive forms may be the result of other defects. Since similar findings may occur between OI and other diseases, a differential diagnosis is required for faster adoption of appropriate treatments. Due to the constant need for tests, these patients are more likely to have complications due to ionizing radiation, so it is very important to strictly comply with all radiological protection requirements. OBJETIVO To verify the existence of imaging protocols used in the diagnosis of OI and to describe the radiographic techniques involved in the process. METHODOLOGY This is a qualitative study in which PubMed, BIREME, CAPES y ScienceDirect databases were used, with the objective of verifying the presence of research aimed at the creation of imaging protocols to assist in the diagnosis of OI. FINAL CONSIDERATIONS Although it has proved very useful, because of the risks to which patients with OI are exposed, the use of tools that release ionizing radiation should be monitored constantly. With this, the protocols should be reviewed so that even with a dose reduction, the resolution and detail of the image are not lost

Mensuración ecográfica del complejo nervio óptico-vaina en la hipertensión intracraneal / Ultrasonographic imaging of the optic nerve-sheath complex in intracranial hypertension

Objetivo: Determinar la relación entre el grosor del complejo nervio óptico-vaina, mensurado por ecografía y la hipertensión intracraneal. Métodos: Se realizó un estudio observacional descriptivo y longitudinal en 144 órbitas de 72 pacientes con diagnóstico clínico de hipertensión intracraneal. Una vez alcanzada la mejoría clínica, se les practicó ultrasonido orbitario al inicio del diagnóstico, el cual permitió mensurar la vaina meníngea, el nervio óptico, el complejo nervio óptico-vaina y la altura de la papila. Resultados: En la totalidad de los casos el grosor inicial de la vaina fue ≥ 3 mm, el del complejo nervio óptico-vaina > 5 mm, y la altura de la papila > 0,8 mm, mientras que el del nervio óptico no superó los 3 mm. Tras alcanzar la mejoría clínica se demostró disminución de todas estas variables, con excepción del nervio óptico, cuyo diámetro casi no se modificó. Algunas diferencias evidenciadas entre la primera y la segunda medición ecográfica fueron estadísticamente significativas. Conclusión: Por tanto, este proceder se ratifica como parte del monitoreo neurológico integral en pacientes con hipertensión intracraneal sospechada o confirmada(AU)

Objective: To determine the relationship between the thickness of the optic nerve- sheath complex as measured by ultrasound and intracranial hypertension. Methods: A descriptive and longitudinal observational study was performed in 144 orbits of 72 patients with a clinical diagnosis of intracranial hypertension. Once clinical improvement was achieved, orbital ultrasound was performed at the beginning of the diagnosis, which allowed measuring the meningeal sheath, the optic nerve, the optic nerve-sheath complex and the height of the papilla. Results: In all cases the initial thickness of the sheath was ≥ 3 mm, that of the optic nerve-sheath complex > 5 mm, and the height of the papilla > 0.8 mm, while that of the optic nerve did not exceed 3 mm. After reaching clinical improvement, a decrease in all these variables was demonstrated, with the exception of the optic nerve, whose diameter was almost unchanged. Some differences between the first and second ultrasound measurements were statistically significant. Conclusion: Therefore, this procedure is ratified as part of the full neurological monitoring in patients with suspected or confirmed intracranial hypertension(AU)