Una mirada a la seguridad del ultrasonido en ecotomografía obstétrica / A look at the safety of ultrasound in obstetric echotomography

Resumen Los índices térmico y mecánico son estimadores de riesgo fetal en una ecografía y se deben controlar sus valores minimizando la exposición. Comparamos los valores de los índices térmico y mecánico obtenidos en exámenes ecográficos obstétricos de pacientes gestantes, con el valor recomendado por la comunidad internacional. Se realizó la estimación de estos índices en 421 ecografías obstétricas en 2019. Los valores fueron comparados entre ellos y con el valor recomendado para cada índice y según el modo de visualización (B, Doppler color y Doppler espectral). Del total de la muestra, para el índice térmico en modo Doppler color un 0,24% superó el valor estándar recomendado y en modo Doppler espectral un 2,85%. Para el índice mecánico se sobrepasó el valor recomendado en modo B en un 11,16%, en un 8,08% en modo Doppler color y, por último, en un 0,48% para el modo Doppler espectral. Los índices mecánico y térmico en esta muestra de exámenes ecográficos obstétricos se encuentran en promedio bajo el valor de referencia. Sin embargo, existe un número importante de casos en que se superan las normas, lo que debe ser una voz de alerta para la comunidad médica.

Abstract The thermal and mechanical indices are the best estimators of fetal risk in an ultrasound and their values should be controlled in order to minimize exposure as much as possible. We compared the values of the thermal and mechanical indices obtained in obstetric ultrasound examinations of pregnant patients, with the value recommended by the international community. These indices were estimated in 421 obstetric ultrasounds during 2019. The estimated values were compared with each other and with the recommended value for each index and according to the display mode (B, color Doppler and spectral Doppler). Of the total sample, for the thermal index in color Doppler mode, 0.24% exceeded the recommended standard value and 2.85%. in spectral Doppler mode. For the mechanical index, the recommended value was exceeded in B mode by 11.16%, in 8.08% in color Doppler mode and, finally, by 0.48% for spectral Doppler mode. The mechanical and thermal indices in this sample of obstetric ultrasound examinations are on average below the reference value. However, there is a significant number of cases in which the standards are exceeded, which should be a warning to the medical community.

Evaluation of Masseter Muscle Dimensions Through Ultrasonography / Evaluación de las Dimensiones del Músculo Masetero Mediante Ultrasonido

The objective this study was to determine mean values of masseter muscle thickness in male and female, at rest and contraction, in healthy individuals. At first, 102 questionnaires were distributed between students. Thirty patients were selected, 15 male and 15 female, according to the inclusion criteria, excluding all individuals with symptoms of temporo-mandibular dysfunction or syndromes with craniofacial disorders. Masseter muscle thickness was determined bilaterally, at rest and contraction. As a reference point for the measurement of thickness (axial plane), the posterior prolon gation of the labial commissure was used. Normality values of the masseter muscle in females were 11.75 ± 1,14 mm in contraction and 10.19 ± 1.04 mm in relaxation; and in the male were 13.95 ± 1.62 mm in contraction and 11.64 mm ± 1.68 mm in relaxation. The results obtained are in agreement with those described in the literature. Demonstrating the accuracy and reproductibility of the ultrasound if a protocol is applied, mainly aimed at controlling the pressure applied by the transducer.

El objetivo de este estudio fue determinar los valores medios del grosor del músculo masetero, en reposo y contracción, en hombres y mujeres sanos. Inicialmente se distribuyeron 102 cuestionarios entre los estudiantes. Se seleccionaron 30 pacientes, 15 hombres y 15 mujeres, según los criterios de inclusión, excluyendo a todos los individuos con síntomas de disfunción temporo-mandibular o síndromes con alteraciones craneofaciales. El grosor del músculo masetero se determinó de forma bilateral, en reposo y contracción. Como punto de referencia para la medición del espesor (plano axial), la prolongación posterior de la comisura labial. Los valores de normalidad del músculo masetero en las mujeres fue de 11,75 ± 1,14 mm en contracción y 10,19 ± 1,04 mm en relajación; y en los varones 13,95 ± 1,62 mm en contracción y 11,64 mm ± 1,68 mm en relajación. Los resultados obtenidos coinciden con los descritos en la literatura, señalando la precisión y reproducibilidad del ultrasonido si se aplica un protocolo, principalmente dirigido a controlar la presión aplicada por el transductor.

Feline testicular ultrasonogram differentiates pre vs. postpubertal and normal vs. disrupted spermatogenesis.

The aims of this study were: to ultrasonograhically describe and compare testicular parenchyma echogenicity and heterogeneity using digital image analysis in: I) prepubertal (PREP), peripubertal (PERI) and mature (MAT) cats; II) Normal and abnormal mature felids. Secondary, the relationships between histomorphological and ultrasonographic attributes of the testes were also determined. I) Fourteen, PREP, PERI and MAT male cats were ultrasonographically examined and then castrated. II) Seven adult cats were ultrasonographically examined before and after a GnRH antagonist administration and then castrated. All the testes were grossly and histomorphometrically assessed. In the frozen digital images of the longitudinal ultrasound sections, 3 regions of interest (ROI, 1 mm2) were selected. Within each ROI the echogenicity and the heterogeneity of the testicular parenchyma were digitally analyzed. In experiment I, testicular volume (0.15 ± 0.0 vs. 0.49 ± 0.1 vs. 1.65 ± 0.1; P < 0.01) and gonadosomatic index (0.04 ± 0.0 vs. 0.05 ± 0.0 vs. 0.08 ± 0.0; P < 0.01), echogenicity (56.54 ± 0.75 vs. 81.87 ± 5.88 vs.94.67 ± 3.62; P < 0.01) and heterogeneity (10.2420 ± 1.3740 vs.13.65 ± 0.65 vs. 14.67 ± 1.49; P < 0.01) augmented throughout PRE, PERI, and MAT. In experiment II, testicular volume (1.00 ± 0.09 vs. 0.85 ± 0.09; P < 0.05), echogenicity (87.74 ± 1.53 vs. 83.32 ± 1.54; P 0.01) but not heterogeneity (14.09 ± 0.26 vs. 14.19 ± 0.29; P > 0.05) decreased in the post GnRH antagonist abnormal testes. For both experiments, testicular volume, seminiferous tubular diameter, percentage of spermatids as the most mature cell type, and luminal/intertubular ratio were highly correlated (P < 0.01) with their echotextural attributes. Computer-assisted image analysis of B mode ultrasonogram appears as a good indicator of pubertal development and mild alterations of spermatogenesis in felids.

Quantitative bidimentional and Doppler ultrasound assessment of the effect of a GnRH antagonist on canine prostatic hyperplasia.

The objectives of this article were: a) To describe the effect of a single administration of the third generation GnRH antagonist, acyline, on canine benign prostatic hyperplasia (BPH) b)To quantitatively compare parenchyma echogenicity, heterogeneity (SD echogenicity) and blood flow in hyperplastic and treated prostate glands. Seven mixed bred dogs, 11.14 ± 0.8 years of age, weighing 8.5 ± 1.4 (3.8-15.6) kg, with BPH were included in this study and administered acyline 330 mg/kg sc (day 0). Then the dogs were examined by B Mode and Doppler ultrasound on days 15, 30 and 60 after treatment. Parenchymal frozen images were digitally analyzed. On day -7, prostatic volume was 1.60-5.36 fold (volume ratio) enlarged in relation to the expected volume. Prostatic volume decreased up to a mean of -38.44% (P < 0.01; range -32.2 to -70.9%) on day 30 to gradually increase towards pretreatment values. A correlation between volume ratio and nadir treatment volume was also found (r = - 0.87; P < 0.05). Mean parenchyma echogenicity (P < 0.01) and heterogeneity (P < 0.01) diminished in all the post treatment evaluations. Pretreatment intraprostatic cysts disappeared at the time point of peak treatment effect. Prostatic arteries RI increased on day 30, being different from day -7 and also from day 60 values (P < 0.05). It was concluded that a single administration of a third generation GnRH antagonist safely decreased prostatic volume and parenchyma and blood flow abnormities associated with canine BPH during 30 days. Monthly administrations of this treatment could represent a rapid, efficient and safe therapeutic option for BPH.

Utilidad para médicos no radiólogos de la clasificación tirads y las características ecográficas de los nódulos tiroideos / Usefulness for non radiologist physicians of tirad classification and ecographic characteristics of thyroid nodules

Dada la mayor accesibilidad a la ecografía tiroidea, se diagnostican más nódulos de forma incidental aumentando su prevalencia al 65% en las tres últimas décadas. Todo ello ha supuesto un aumento de punciones innecesarias. El objetivo de nuestro estudio es identificar la utilidad de la clasificación TIRADS y de las características ecográficas de los nódulos tiroideos para establecer la probabilidad de malignidad de los mismos y seleccionar aquellos sospechosos para realizar la punción y aspiración con aguja fina (PAAF). Se encontró una relación estadísticamente significativa entre la malignidad y nódulo sólido, hipoecogenicidad, márgenes irregulares y microcalcificaciones. Sin embargo, no se encontró relación estadísticamente significativa entre malignidad y número de nódulos, tamaño nodular, diámetro craneocaudal y vascularización central. Asimismo, un 26.1% de los nódulos TIRADS-2 (todos ellos microcarcinomas), un 30% de los TIRADS-3 y un 54 % de los TIRADS-4 fueron malignos (p 0.027). Tanto el TIRADS como las características ecográficas aisladas son útiles para identificar nódulos sugerentes de malignidad.

Owed to the easier accessibility to thyroid ecography, more incidental nodules are discovered reaching their prevalence the 65 % of population in the last three decades. All of it has resulted in a growth of unnecessary fine needle aspirations (FNA). Our study objective is to identify the TIRADS classification utility and the nodules sonographic characteristics to establish their probability of malignancy and to select those suspicious susceptible of FNA. We found a statistically significant relationship between malignancy and solid nodule, hypoechogenicity, irregular margins and microcalcifications. However we didn´t find a relation between malignancy and number, size, shape (taller than wide) and central vascularity. With respect to TIRADS classification, 26,1% of TIRADS-2 (all of them microcarcinomas), 30% of TIRADS-3 and 54% of TIRADS-4 were malignant (p: 0,027). Both of them, TIRADS and individual sonographic characteristics are useful to identify nodules suspicious of malignancy.

Índice Ventricular De Levene Y Mensuración Del Tercer Ventrículo En Neonatos Ecuatorianos Mediante Ecografía Cerebral / Levene Ventricular Index And Measurement Of The Third Ventricle In Ecuadorian Neonates By Means Of Cerebral Ultrasound

Resumen Introducción: La aplicación del ultrasonido en la evaluación cerebral del neonato posibilita la mensuración de estructuras cerebrales. Objetivo: El objetivo de este trabajo es obtener las medidas del III ventrículo y del índice de Levene en un grupo de recién nacidos ecuatorianos, con la finalidad de determinar valores de normalidad que puedan ser utilizados en el trabajo diario del servicio de neonatología. Métodos: Se seleccionó un grupo de neonatos sin alteraciones neurológicas. A través de la fontanela anterior se determinó el índice de Levene. La mensuración del diámetro del III ventrículo se realizó a través de la ventana craneal temporal. Resultados: Se incluyeron en el estudio 66 pacientes con edad post menstrual de 37 semanas (rango 27-42 semanas), predominó el sexo masculino. El peso promedio al nacer fue de 2554 gramos. El valor medio del diámetro del III ventrículo es de 1,5 mm, rango entre 0,5 mm - 3,8 mm. El índice de Lindergaard promedio fue de 12,7 mm (8,2-27 mm). Tanto el diámetro del tercer ventrículo como el índice ventricular se vieron afectados por el peso al nacer. En relación con el momento del parto no existió diferencia significativa en el tamaño ventricular. Conclusiones: Comparado con los resultados de otras series nuestro estudio ofrece parámetros diferentes.

Abstract Introduction: The application of ultrasound in the brain evaluation of the neonate allows the measurement of brain structures. Objective: To obtain the sizes of the third ventricle and the ventricular index of Levene in a group of Ecuadorian neonates without neurological alterations. To establish normal ranges that can be used in the daily work of the neonatology service. Methods: A group of neonates without neurological alterations was studied. Through the anterior fontanelle, the Levene index was determined. The third ventricle's diameter was seized through the temporal cranial window. Results: Sixty-six patients of 37 weeks' gestational age at birth (range 27-42 weeks), predominantly male and an average weight at birth of 2554 grams, were included. The third ventricle's mean diameter was 1.5 mm (range: 0.5 mm - 3.8 mm). The average Lindergaard index was 12.7 mm (8.2-27 mm). Both, the diameter of the third ventricle and the ventricular index were affected by the birth weight of newborns. Regarding the moment of delivery, there was no significant difference in ventricular size. Conclusions: Compared with the results of other series, our study offers different parameters.

Ecotomografía renal como estudio inicial de malformaciones urológicas en niños hospitalizados por infección del tracto urinario / Renal ecotomography as initial study in hospitalized children for presenting urinary tract infection

La Infección del Tracto Urinario (ITU) es una de las patologías infecciosas más frecuentes en pediatría. Como factores de riesgo más relevantes se encuentran el reflujo vesicoureteral y las malformaciones urogenitales. El estudio con imágenes es imprescindible para detectar posibles anomalías del tracto urinario, demostrando la ecografía la mejor correlación costo-beneficio. Objetivo: Describir las características y resultados de las ecografías renales y vesicales de pacientes hospitalizados por ITU en el Hospital San Martín de Quillota (HSMQ) en el año 2014. Material y métodos: Estudio descriptivo; estudio de casos, se incluyó a niños hospitalizados en el servicio de pediatría del HSMQ durante el año 2014, ingresados con diagnóstico de ITU. Resultados: Ingresos por ITU: 99 pacientes, excluyéndose 27 casos con un número total de 72 pacientes; de estos, 71 % fueron de sexo femenino, 76% lactantes. Del total de ecografías, 55% resultaron normales, 3 1% compatibles con Pielonefritis Aguda (PNA) y 14% con alteración anatómica, siendo lo más frecuente el doble sistema pielocalicial. Discusión: Hubo similitud entre la información entregada por la literatura de un 12 a 15% de ecografías alteradas y un 14% en este estudio.

The Urinary Tract Infection (UTI) is one of the most common infectious diseases in children. Vesicouretral reflux and urogenital malformations are amongst the most significant risk factors. The imagenological studies are essential to detect possible anatomical or functional urological abnormalities. Within them, renal ultrasound (US) has the best cost-benefit relation. Objective: Describe the characteristics and results of renal and vesical ultrasound done on patients hospitalized in Hospital San Miguel de Quillota (HSMQ) during 2014, diagnosed with UTI. Material and methods: Descriptive study, cases study includes hospitalized children under the diagnose of UTI in the Pediatric Service of HSMQ during 2014. Results: 99 patients entered with the diagnose of UTI, 27 cases were excluded,with 72 patient which met the inclusion criteria:71% of them were female and 76% were infants. From the total of US, 55% were normal, 3 1% showed acute pyelonephritis (APN) and 14% anatomical abnormalities, where duplicated collecting system was the highest frequency condition. Discussion: There were similar results in literature that showed 12-15% of altered ultrasound compared to 14% obtained in this study.

Precocidade sexual em bovinos Nelore avaliada por ultrassonografia testicular / Sexual precocity in Nelore bovines evaluated by testicular ultrasonography

The present study aimed to evaluate if there are differences in testicular parenchyma echogenicity between pre-pubescent and pubescent animals at the same age. Ultrasound examinations were performed in longitudinal and transversal planes of the testicles of 111 healthy Nelore bovines, at the ages of nine, 13 and 15 months. The EIV software calculated the echogenicity of the testicular parenchyma, which ranged from 0 (anechoic) to 100% (hyperechoic). Animals that had reached puberty at 15 months of age presented higher testicular echogenicity than the animals that had not reached puberty at the same age. These results suggest that testicular ultrasonography can be used as a predictor of sexual precocity.(AU)

Precocidade sexual em bovinos Nelore avaliada por ultrassonografia testicular / Sexual precocity in Nelore bovines evaluated by testicular ultrasonography

The present study aimed to evaluate if there are differences in testicular parenchyma echogenicity between pre-pubescent and pubescent animals at the same age. Ultrasound examinations were performed in longitudinal and transversal planes of the testicles of 111 healthy Nelore bovines, at the ages of nine, 13 and 15 months. The EIV software calculated the echogenicity of the testicular parenchyma, which ranged from 0 (anechoic) to 100% (hyperechoic). Animals that had reached puberty at 15 months of age presented higher testicular echogenicity than the animals that had not reached puberty at the same age. These results suggest that testicular ultrasonography can be used as a predictor of sexual precocity.(AU)

Análise dos achados ecográficos em nódulos de hiperplasia pseudoangiomatosa do estroma mamário diagnosticados por core biópsia / Analyzing the ecographic features of pseudoangiomatous stromal hyperplasia masses diagnosed by core biopsy

Objetivos: Descrever os aspectos ecográficos em nódulos de hiperplasia pseudoangiomatosa do estroma mamário, classificando-os segundo o BI-RADS®. Métodos: Foi realizado um estudo retrospectivo, de 2009 a 2010, da base de dados do nosso serviço (UD diagnóstico por imagem) para identificar nódulos evidenciados na ecografia mamária, com diagnóstico histopatológico confirmado de hiperplasia pseudoangiomatosa do estroma mamário, por meio de core biópsia orientada por ultrassonografia, com agulha de 16 gauge. Foram identificadas 16 pacientes com lesões ecográficas que tinham hiperplasia pseudoangiomatosa do estroma mamário como diagnóstico. Resultados: O fator determinante para a classificação em categorias 4a e 4b, segundo o léxico BI-RADS® para ultrassonografia, foi as margens não-circunscritas, que estavam presentes em 93,3% das lesões, as demais características ecográficas das lesões foram compatíveis com lesões benignas. Conclusão: Nódulos ecográficos de hiperplasia pseudoangiomatosa do estroma mamário podem apresentar características ecográficas que sejam determinantes para a realização de biópsias, mesmo sabendo-se que esta patologia tem curso tipicamente benigno.

Objectives: To describe the ecographic features of pseudoangiomatous stromal hyperplasia masses, classifying them according to the BI-RADS® lexicon. Methods: A retrospective review was performed during the period from 2009 to 2010, using the database of our service (UD diagnóstico por imagem), in order to find ecographic masses with pseudoangiomatous stromal hyperplasia diagnosis, which were performed with 16-gauge core biopsy ultrasound guided. We identified 16 patients with ecographic masses diagnosed with pseudoangiomatous stromal hyperplasia. Results: The most important finding that changes the classification of the BI-RADS® was noncircumscribed margins, which were foundin 93.3% of the lesions, other ultrasound characteristics found were benign features. Conclusion: Pseudoangiomatous stromal hyperplasiamasses may present ecographic findings that support biopsy indication; although it is known that it is a benign pathology.

Diagnóstico prenatal ecográfico de catarata en un caso de toxoplasmosis congénita, Quindío (Colombia) / Prenatal ultrasound diagnosis of cataracts in a case of congenital toxoplasmosis, Quindío, Colombia

Introducción: el diagnóstico de catarata por ecografía prenatal es un hallazgo poco frecuente y se ha reportado aún con menor frecuencia en casos de infecciones congénitas. El presente reporte describe un caso de catarata congénita durante una infección por Toxoplasma en el embarazo. Los estudios prenatales y posnatales confirmaron la etiología. Metodología: estudio de caso y revisión de literatura. Se hizo búsqueda en PubMed de MEDLInE con los términos sin restricción: “ultrasonido”, “ultrasonografía”, “cataratas” y “prenatal”. Resultados: se hallaron 43 referencias. Sólo uno de los documentos reportaba hallazgo de catarata por ecografía prenatal en toxoplasmosis congénita. Conclusión: la búsqueda cuidadosa de compromiso ocular durante el estudio ecográfico en la toxoplasmosis adquirida durante el embarazo debería ser un componente clave del estudio ecográfico durante esta infección.

Introduction: it is not usual to diagnose cataracts by prenatal ecography and this has been even less frequently reported in cases of congenital infection. The present report describes a case of congenital cataract caused by toxoplasma infection during pregnancy. Prenatal and post-natal studies confirmed the aetiology. Methodology: a case study was prepared and a review of the pertinent literature was made. The search was made in MEDLInE/PubMed using terms without restriction: “ultrasound”, “ultrasonography”, “cataracts” and “prenatal”. Results: forty-three references were found. Only one of the documents reported a cataract being found by prenatal ecography in a case of congenital toxoplasmosis. Conclusion: the careful search for ocular commitment during ecographic study of toxoplasmosis acquired during pregnancy should be a key component of ecographic study during this infection.

Diagnostico ecográfico de acretismo placentario / Ultrasound diagnosis of placental accreta

El acretismo placentario consiste en la adherencia anormal de la placenta a una decidua defectuosa o al miometrio, conduciendo a una demora en el alumbramiento o a la retención placentaria, asociada además a una hemorragia postparto que puede requerir o no histerectomía. Hoy, gracias al mejor entendimiento y conocimiento de los factores de riesgo y al mejoramiento de las pruebas diagnosticas, la mayoría de los casos de placenta acreta puede y deben ser diagnosticados durante el embarazo. La valoración de la morfología y localización placentaria es parte de la evaluación ultrasonográfica obstétrica de rutina, lo cual permite el diagnóstico antenatal de la localización anómala de la placenta y su posible invasión a las demás capas de la estructura uterina. El diagnóstico temprano, hace posible la preparación adecuada y correcta para el momento del parto y sus complicaciones.

The accreta of placenta is the anormal adherence of placenta to a deficient deciduas or to myometrum, leading to a delay in placenta expulsion or to placenta retention. It is associated to a post partum blooding which sometimes can corrected only with hysterectomy. Currently because the better understanding of risk factors and improved diagnostic tests, most of patients with placenta accreta could be diagnosticed throughout pregnancy. Evaluation of morphology and location of placenta form part of routine ecography obstetric assessment, which allow prenatal diagnostics of abnormal position of placenta and the possible invasion to other uterine layers. The early diagnostics make possible patients have an adequate and correct preparation for the partum and prevent its complications.

Estudio ecográfico de cáncer de vesícula biliar. Correlación con casos clínicos. Revisión de la literatura / Image study of gallbladder carcinoma. Clinical Correlation and review of the literature

Presentamos tres casos de pacientes femeninos que acuden al servicio de imagenología para la realización de exámenes ecográficos de hígado y vías biliares.Recordamos que la vesícula biliar es una bolsa cerrada, en forma de pera, que descansa bajo la superficie inferior del hígado. La fosa vesicular se encuentra en el plano de la fisura interlobular que separa a los lóbulos hepáticos derecho e izquierdo. El cáncer de vesícula biliar es poco común, pero el carcinoma es el tumor maligno más frecuente y su tipo histológico habitual es en un 90% de los casos, un adenocarcinoma. No obstante en la vesícula biliar se han descrito carcinomas: epidermoides y mixtos, y sarcomas.

We present three cases of female patients admitted to our service where liver and bile duct ecography is done.The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. Cancer of the gallbladder is uncommon. The most frequent type of tumor is andenocarcinoma but others have been described such as epidermoid carcinoma and sarcomas.