Spleen and Liver Stiffness Evaluation by ARFI Imaging: A Reliable Tool for a Short-Term Monitoring of Portal Hypertension?

Background: Assessment of hepatic venous pressure gradient (HVPG) is the most reliable, though invasive method for evaluation of portal hypertension. Non-invasive, elastography-based techniques are well established in diagnosis, but not in monitoring of portal hypertension. The aim of our prospective study was to determine the value of acoustic radiation force impulse (ARFI) elastography technique of the liver and spleen in diagnosis and monitoring of portal hypertension. Methods: We prospectively assessed portal hypertension by HVPG and corresponding elastography of the liver and spleen in 31 patients with liver cirrhosis and an indication for primary prophylaxis by non-cardio selective beta-blockers. Investigations were performed at baseline and a follow-up visit after 6-8 weeks. To address the known large variability of values for spleen elastography, well-defined corresponding areas in the spleen were used for baseline and follow-up elastography. Sensitivity, specificity, and AUC-ROC values for both spleen and liver elastography monitoring of portal hypertension were calculated. Results: Liver but not spleen elastography significantly correlated with HVPG results and was suitable for initial evaluation of portal hypertension. However, changes in HVPG results did not show any correlation with alterations of ARFI values from baseline to follow-up visits both for liver and spleen elastography. Spleen stiffness results were not homogeneous across the whole organ differing significantly between the upper, hilar, and bottom placed investigation areas. Conclusions: In this prospective study ARFI-based assessment of liver elastography showed itself suitable for initial assessment but not for monitoring of portal hypertension. Spleen elastography was not appropriate for both, evaluation and monitoring of portal hypertension. A possible explanation for this new data that are in some contrast to previously published results is the degree of portal hypertension in our study, a comparatively short follow-up period, and well-defined investigation areas for spleen elastography in repetitive ARFI investigations. This trial is registered with NCT03315767.

Diagnostic accuracy of MRI with MRCP and B-Mode-sonography with elastography of the pancreas in patients with cystic fibrosis: a point-to-point comparison.

OBJECTIVE: For patients with cystic fibrosis, the imaging of the pancreas is of crucial importance for the early detection of pancreatic carcinoma. Comparative studies between Magnetic Resonance Imaging (MRI) and sonographic pancreas sonography are not yet available. The aim of the study was to compare MRI, sonography and point-shearwave elastography (pSWE). A total of 19 patients were included (10 male, 9 female; age 29.7 ± 14.3 years) in the study. Ultrasonography with pSWE and contrast enhanced MRI with MRCP were performed. RESULTS: Significant differences between measurements of pancreatic body were registered in MRI with 1.4 ± 0.6 cm vs 1.0 ± 0.4 cm in ultrasound (p = 0.049), however not for pancreatic head and tail. In 10/19 patients (52.6%) pancreatic parenchyma did not show in MRI because of complete lipomatous transformation, but could be detected in ultrasound. pSWE-values showed no significant differences between the full and partial fatty transformation in pancreatic head (p = 0.968), body (p = 0.657) and tail (p = 0.840). pSWE-values did not correlate with measured signal intensity in T1w flash (p = 0.930, r = 0.025) and T2w HASTE sequences (p = 0.152, r = - 0.375). In patients with CF ultrasound is superior to MRI for displaying full fibro-fatty parenchymal transformation, pancreatic duct. Ultrasound elastography did not provide additional clinical relevant information.

[Implementation of ultrasound education in the medical degree curriculum - the Ulm model]. / Implementierung der Ultraschallausbildung in das Kerncurriculum des Medizinstudiums ­ das Ulmer Modell.

Ultrasound is the most commonly used diagnostic method in everyday clinical practice aside from conventional radiography. For prospective physicians, there is a gap between the increased requirements in everyday clinical practice and the skills acquired thus far, especially when dealing with sonography. In this work, we would like to present the structure of our sonography course and its implementation in the Ulm core curriculum of medical studies. The sonography course is based on two pillars. The Sonography Seminar (Pillar 1) has a lecturer who regularly conveys interdisciplinary theoretical content, fundamentals and possible fields of application for sonography during 13 appointments of 45 minutes. The internship (Pillar 2) consists of four appointments of two hours each. The groups of four students are supervised by a student tutor. In addition to the technical basics and an introduction to the device customer, the organ systems liver, gallbladder and biliary tract, kidneys and adrenal glands, spleen, pancreas, abdominal vessels and lymph nodes are mediated. The focus is on the realistic exercises with high-end ultrasound equipment used in small groups with a final practical test. The structure and procedure of the course was evaluated as being very positive by the students.

Point shear wave elastography of the pancreas in patients with cystic fibrosis: a comparison with healthy controls.

PURPOSE: Manifestations of cystic fibrosis in the pancreas are gaining in clinical importance as patients live longer. Conventional ultrasonography and point shear wave elastography (pSWE) imaging are non-invasive and readily available diagnostic methods that are easy to perform. The aim of this study was to perform conventional ultrasonography and obtain pSWE values in the pancreases of patients with cystic fibrosis and to compare the findings with those of healthy controls. METHODS: 27 patients with cystic fibrosis (13 women/14 men; mean age 27.7 ± 13.7 years; range 9-58 years) and 60 healthy control subjects (30 women/30 men; mean age 30.3 ± 10.0 years; range 22-55 years) underwent examinations of the pancreas with conventional ultrasound and pSWE imaging. RESULTS: Patients with cystic fibrosis have an echogenic pancreatic parenchyma. We found cystic lesions of the pancreas in six patients. pSWE imaging of the pancreatic parenchyma gave significantly lower shear wave velocities in patients with cystic fibrosis than in the control group (1.01 m/s vs 1.30 m/s; p < 0.001). CONCLUSIONS: Using pSWE imaging in vivo, we have shown that the pancreas is considerably softer in patients with cystic fibrosis than in a healthy control population.