Evaluation of the effectiveness of artificial intelligence for ultrasound guided peripheral nerve and plane blocks in recognizing anatomical structures.

BACKGROUND: We aimed to assess the accuracy of artificial intelligence (AI) based real-time anatomy identification for ultrasound-guided peripheral nerve and plane block in eight regions in this prospective observational study. METHODS: After obtaining ethics committee approval and written informed consent from 40 healthy volunteers (20 men and 20 women, between 18 and 72 years old), an ultrasound device installed with AI software (Nerveblox, SmartAlfa, Turkey) were used to scan regions of the cervical plexus, brachial plexus, pectoralis (PECS), rectus sheet, femoralis, canalis adductorius, popliteal, and ESP by three anesthesiology trainees. During scanning by a trainee, once software indicates 100 % scan success of associated anatomic landmarks, both raw and labeled ultrasound images were saved, assessed, and validated using a 6-point scale between 0 and 5 by two expert validators. Evaluation scores of the validators for each block were compared according to demographics (gender, age, and BMI) and block type exists. RESULTS: The scores were not different except ESP, femoralis, and cervical plexus regions between the experts. The mean scores of the experts for the PECS, popliteal and rectus sheath were significant between males and females (p < 0.05). In terms of BMI, significant differences in the scores were observed only in the canalis adductorius, brachial plexus, and ESP regions (p < 0.05). CONCLUSIONS: Ultrasound guided AI-based anatomy identification was performed in commonly used eight block regions by the trainees where AI technology can successfully interpret the anatomical structures in real-time sonography which would be valuable in assisting anesthesiologists.

Comparison of the Efficiency of Radiofrequency and Microwave Ablation Methods in the Treatment of Benign Thyroid Nodules.

RATIONALE AND OBJECTIVES: To compare the efficacy of two thermal ablation techniques (radiofrequency vs microwave ablation) in the treatment of benign thyroid nodules. MATERIALS AND METHODS: A total of 80 patients with 80 nodules underwent thermal ablation of thyroid nodules with either radiofrequency ablation (RFA) (23 females and 14 males; mean age 41 ± 9years) or microwave ablation (MWA) (28 females and 15 males; mean age 45 ± 11years). Ultrasound assessments were made at the 1st, 3rd, 6th, and 12th months after the ablation procedure. RESULTS: The mean initial volume of the nodules (RFA: 15.6 mL [min 2.5-max 74]; MWA: 40 mL [min 2-max 205]) was statistically significantly different (P < .001). The following were the volume reduction rates of nodules at 1, 3, 6, and 12months, respectively: after RFA: 46.8 ± 13.5%, 62.9 ± 13.6%, 71.6 ± 11.9%, and 77.9 ± 10.3%. After MWA: 38.7 ± 12.5%, 54 ± 15.3%, 59.6 ± 12.5%, and 65 ± 11.3%. For all months, volume reduction rates in the RFA group were significantly higher than those in the MWA group (P < .05). One patient treated by RFA reported an abscess formation and another patient treated by RFA had a self-limiting hematoma, who recovered without any further treatment. Also, in the MWA group, one patient had abscess formation and another patient had transient recurrent nerve paralysis, who recovered with appropriate treatment. CONCLUSION: Both methods are effective in treating benign thyroid nodules; however, RFA provides a better volume reduction.

A real-time anatomy identification via tool based on artificial intelligence for ultrasound-guided peripheral nerve block procedures: an accuracy study.

We aimed to assess the accuracy of an artificial intelligence (AI)-based real-time anatomy identification software specifically developed to ease image interpretation intended for ultrasound-guided peripheral nerve block (UGPNB). Forty healthy participants (20 women, 20 men) were enrolled to perform interscalene, supraclavicular, infraclavicular, and transversus abdominis plane (TAP) blocks under ultrasound guidance using AI software by anesthesiology trainees. During block practice by a trainee, once the software indicates 100% scan success of each block associated anatomic landmarks, both raw and labeled ultrasound images were saved, assessed, and validated using a 5-point scale by expert validators. When trainees reached 100% scan success, accuracy scores of the validators were noted. Correlation analysis was used whether the relationship (r) according to demographics (gender, age, and body mass index: BMI) and block type exist. The BMI (kg/m2) and age (year) of participants were 22.2 ± 3 and 32.2 ± 5.25, respectively. Assessment scores of validators for all blocks were similar in male and female individuals. Mean assessment scores of validators were not significantly different according to age and BMI except for TAP block, which was inversely correlated with age and BMI (p = 0.01). AI technology can successfully interpret anatomical structures in real-time sonography while assisting young anesthesiologists during UGPNB practice.

Factors related to non-alcoholic fatty liver disease in obese children.

BACKGROUND/AIMS: The incidence of non-alcoholic fatty liver disease has been increasing parallel to obesity in the pediatric age group. This study aimed to analyze the factors that are related to non-alcoholic fatty liver disease in obese children. METHODS: 101 obese children and 68 non-obese controls were included in the study. Liver steatosis was investigated by ultrasonography. The subjects were divided into three groups: 53 obese patients with fatty liver (Group I), 48 obese patients without steatosis (Group II), and 68 controls without steatosis (Group III). Group I was further divided into those with Grade 1 steatosis (44 patients, Group Ia) and higher grades of steatosis (9 patients, Group Ib). The relationships of body mass index, serum ALT, lipids, leptin, and insulin resistance index with steatosis were analyzed. RESULTS: 52.4% of obese children had fatty liver and 13.8% had high ALT levels. Additionally, all patients with elevated ALT levels were seen to have liver steatosis by ultrasonography. Leptin and insulin resistance index levels were higher in obese groups than controls; however, the difference disappeared when these levels were adjusted for body mass index. ALT levels were higher in Group I (31.5+/-30.2) than Group II (18.0+/-7.1) and Group III (14.5+/-5.2) (p<0.05). Group Ib showed higher VLDL and ALT levels than Group Ia (p<0.05). Multiple regression analysis revealed that body mass index was the most important determinant of liver steatosis, while body mass index and VLDL were the determinants of higher ALT levels. CONCLUSIONS: We suggest that body mass index and VLDL are the most important determinants of non-alcoholic fatty liver disease and elevated ALT levels in obese children. The contribution of leptin to this process could not be determined in our findings.

Vascular endothelial growth factor and carotid intima-media thickness in patients with Behçet's disease.

There is morphologic evidence of subclinical atherosclerosis in Behçet's disease (BD) patients obtained by high-resolution B-mode ultrasonography (US). Vascular endothelial growth factor (VEGF) is a potent angiogenetic factor and a marker for endothelial dysfunction. VEGF could contribute to the pathological events in BD. VEGF could also be an important factor in the progression of atherosclerosis. In this study, we investigated whether there is correlation between intima-media thickness (IMT) of the carotid arteries and serum VEGF levels in BD patients and healthy controls. Twenty-one patients with BD (male/female: 15/6, mean age: 35.8 +/- 8.6 years) were individually matched to control subjects on the basis of age (within 3 years) and sex. Carotid IMT of the subjects was measured by high-resolution B-mode US. Mean IMT values of common carotid arteries were 0.86 +/- 0.18 mm for patients with BD, and 0.57 +/- 0.14 mm for healthy controls (p < 0.001). Mean VEGF levels were 130.41 +/- 58.28 pg/ml for patients with BD and 82.69 +/- 25.03 pg/ml for healthy controls (p < 0.001). There was no correlation between VEGF levels in the control group and in the BD group, but there was a significant correlation between VEGF levels and mean carotid IMT in the whole group (r = 0.317, p < 0.05). In conclusion, elevation of VEGF appears as a feature of the inflammatory reaction during the course of BD, not a direct determinant of subclinical atherosclerosis. On the other hand, the significant correlation between carotid IMT and serum VEGF levels in the whole group suggests that association between VEGF levels and carotid IMT warrants further investigation with larger sample sizes.

Morphologic evidence of subclinical atherosclerosis obtained by carotid ultrasonography in patients with Behcet's disease.

Subclinical atherosclerosis can be demonstrated by measuring the intima-media thickness (IMT) of the carotid arteries by high-resolution B-mode ultrasonography (US). Endothelial injury appears a key event in the atherogenesis. Endothelial cell activation and/or injury are the characteristic features of Behçet's disease (BD). In this study, we investigated morphologic evidence of subclinical atherosclerosis in the BD patients by using high-resolution B-mode US. Thirty-four patients with BD without arterial involvement (male/female 21/13; mean age 34.6+/-8.5 years) were individually matched to control subjects on the basis of age (within 2 years) and sex. Subjects with diabetes mellitus, hypertension, evidence of myocardial infarction or cerebrovascular disease, and patients on long-term steroids (i.e., >6 months) were excluded from the study. Mean IMT values of the right carotid arteries were 0.81+/-0.17 mm for patients with BD, and 0.54+/-0.13 mm for healthy controls (P<0.001). Mean IMT values of the left carotid arteries were 0.82+/-0.16 mm for patients with BD, and 0.55+/-0.12 mm for healthy controls (P<0.001). The overall prevalence of carotid atherosclerotic plaques was higher among the patients than the controls [prevalence of plaques were 17.6% (6/34) in BD patients and 0% in healthy controls, P<0.05]. In conclusion, our data indicate morphologic evidence of subclinical atherosclerosis in patients with BD.

Doppler and gray-scale ultrasound evaluation of morphological and hemodynamic changes in liver vascualture in alcoholic patients.

OBJECTIVE: The aim of this study is to search sonographically for morphological and hemodynamic changes in hepatic and splanchnic vasculature of alcoholic patients having no signs of hepatic damage, and compare these with normal healthy subjects. METHODS: Thirty alcohol-dependent patients and 30 control subjects with no alcohol problem or hepatic impairment were included in the study. All patients were evaluated by gray-scale and spectral Doppler ultrasound. The diameter of the portal vein, portal venous velocity, peak systolic and end diastolic velocities of hepatic and superior mesenteric arteries were assessed. RI, PI and systolic/diastolic velocity ratios were also calculated. RESULTS: Portal vein cross-sectional area was greater in alcoholic patients compared to control group (P = 0.0012). Portal vein velocity, hepatic artery peak systolic and end diastolic velocity, superior mesenteric artery peak systolic and end diastolic velocity were significantly greater in alcoholic patients than in control group (P < or = 0.001). No statistically significant difference was detected between other parameters evaluated. CONCLUSION: In alcohol-dependent patients, some hemodynamic and morphologic changes occur in hepatic and splanchnic circulation, even before the signs of hepatic damage develop. These changes can be detected by means of Doppler and gray-scale sonogrsphy.

Characterization of hyperechoic focal liver lesions: quantitative evaluation with pulse inversion harmonic imaging in the late phase of levovist.

OBJECTIVE: The aim of this study was to evaluate hyperechoic focal liver lesions with pulse inversion harmonic imaging in the late phase of SH U 508A (Levovist; Schering AG, Berlin, Germany) and to determine whether quantitative evaluation improves the characterization of the lesions. METHODS: Twenty-six patients with hyperechoic liver lesions were enrolled in this study. Pulse inversion harmonic imaging was performed before and after administration of Levovist. Scan data were digitally stored, and each lesion was analyzed with a personal computer-based quantification package. All lesions were confirmed by histologic or triphasic spiral computed tomographic examinations. The intensity was measured in decibels in regions of interest drawn within the lesion and surrounding liver parenchyma. The lesion-liver ratios were than calculated. After contrast agent administration, a ratio equal to or greater than 1 was presumed benign, whereas a ratio of less than 1 was considered malignant. RESULTS: Nine malignant (7 metastases, 1 hepatocellular carcinoma, and 1 cholangiocarcinoma) and 17 benign (14 hemangioma, 1 focal nodular hyperplasia, 1 focal fatty change, and 1 inflammatory pseudotumor) hyperechoic lesions were quantitatively evaluated. All malignant (n = 9) and 2 benign lesions (1 hemangioma and 1 inflammatory pseudotumor) had ratios of less than 1. In 15 of 17 benign lesions, the ratios were equal to or greater than 1. The intensity ratios calculated for benign and malignant lesions showed a statistically significant difference (P < .05). CONCLUSIONS: Pulse inversion harmonic imaging with quantitative evaluation facilitates the differential diagnosis of hyperechoic focal liver lesions. A lesion-liver ratio equal to or greater than 1 predicts a benign nature, assuming that malignant lesions show a ratio of less than 1.