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Cheng C, Shen X, Sun J, Fu M, Qian C, Shi L, Yuan L. The Role of Contrast-enhanced Ultrasound in the Femoral Head Perfusion Evaluation: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00302-8. [PMID: 39278802 DOI: 10.1016/j.ultrasmedbio.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 08/04/2024] [Accepted: 08/07/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVES We explored the value of contrast-enhanced ultrasound (CEUS) in evaluating femoral head (FH) perfusion, guiding interventions and follow-up for infants with developmental dysplasia of the hip (DDH) and septic arthritis of the hip (SAH). The aim was to provide robust evidence for clinical assessment. METHODS Ten infants, including 7 with DDH and 3 with SAH, were prospectively enrolled, with their bilateral hips alternately scanned during the CEUS exams. Twenty hips were classified into the case group (n = 11) and the control group (n = 9). Pre- and post-interventional studies were performed in DDH infants requiring interventions. FH perfusion was assessed by the perfusion area ratio (PAR) and quadrant location of microbubble-defect regions. RESULTS In the case group, 25 CEUS studies were conducted, including 11 baseline, 7 follow-up and 7 post-intervention studies. The PAR significantly decreased in the case group (49.79% vs. 100.00%, p < 0.05). The microbubble-defect regions averagely affected 2 quadrants, primarily quadrat No. 3 (30%) and No. 4 (32%). Seven hip abduction angle adjustments were made based on pre-interventional studies, resulting in a significant increase in PAR in post-interventional studies (37.63% vs. 60.24%, p < 0.05). PAR increased in follow-up studies compared to baseline values (45.61% vs. 76.07%, p < 0.05). The inter- and intra-observer reproducibility of PAR measurements were excellent (intraclass correlation coefficient, both 0.97). CONCLUSION CEUS proves to be a promising technique for quantitatively detecting FH perfusion in DDH and SAH infants with high reproducibility. It is valuable for baseline, intra-intervention and follow-up studies, aiming in clinical conditions and therapeutic effect evaluation.
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Affiliation(s)
- Chunyue Cheng
- Department of Ultrasound, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiantao Shen
- Department of Ultrasound, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Sun
- Department of Ultrasound, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Manli Fu
- Department of Ultrasound, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Qian
- Department of Ultrasound, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liqiong Shi
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Yuan
- Department of Ultrasound, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Mick P, Rohner M, Renkawitz T, Lehner B, Geisbüsch A, Tsitlakidis S, Hariri M, Deisenhofer J, Müller M, Doll J. From Benign Lipoma to G3 Liposarcoma: Contrast-Enhanced Ultrasound Reveals Tumor Microperfusion and Indicates Malignancy. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1472-1478. [PMID: 38955624 DOI: 10.1016/j.ultrasmedbio.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/27/2024] [Accepted: 05/31/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE Lipomatous soft tissue tumors (STT), ranging from benign lipomas to malignant liposarcomas, require accurate differentiation for timely treatment. Complementary to MRI, Contrast-enhanced ultrasound (CEUS) is emerging as a promising tool, providing insight into tumor microperfusion in real-time. This study aims to explore the potential of preoperative CEUS in differentiating benign lipomatous tumors from malignant liposarcoma subtypes. METHODS Eighty-seven patients with lipomatous STT scheduled for surgery were enrolled. Clinical and MRI assessments were conducted to obtain general tumor characteristics. CEUS was used for a standardized tumor perfusion evaluation. Perfusion analysis included peak enhancement, rise time, wash-in perfusion index, and wash-out rate, reflecting the perfusion kinetics. Histopathological results were obtained for every STT and compared to perfusion characteristics. RESULTS In total, 48 lipoma, 23 ALT and 11 liposarcoma were identified. Significant differences in tumor microperfusion were demonstrated, with higher perfusion levels indicating higher malignancy (Peak enhancement [a.u.] of Lipoma: 145 ± 238; ALT: 268 ± 368; Liposarcoma: 3256 ± 4333; p (ALT vs. Liposarcoma) < 0.001). A perfusion-based identification of a benign lipoma or ALT versus sarcoma resulted in a positive predictive value of 93%. Patient-related factors (age, gender, BMI, ASA score, smoking status) had no significant impact on the CEUS-based perfusion parameters. CONCLUSION Our study suggests CEUS as a capable non-invasive tool for improving preoperative assessment of lipomatous STT. It can assist in the distinction between benign and malignant STT, accelerating treatment decisions and enhancing patient outcomes. Significant correlations between CEUS-derived parameters and malignancy highlight its risk assessment potential.
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Affiliation(s)
- Paul Mick
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Marie Rohner
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Renkawitz
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Burkhard Lehner
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Geisbüsch
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefanos Tsitlakidis
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Mustafa Hariri
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Deisenhofer
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Michelle Müller
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Doll
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
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Paul M, Robin S, Tobias R, Tilman W, Moritz I, Stefanos T, Mustafa H, Julian D. Contrast-Enhanced Ultrasound Reveals Superior Gluteus Medius Muscle Vitality After Total Hip Arthroplasty in a Minimally Invasive Anterolateral Versus Lateral Surgical Approach. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00266-7. [PMID: 39209559 DOI: 10.1016/j.ultrasmedbio.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Total hip arthroplasty (THA) is essential for treating severe osteoarthritis. With various surgical approaches available, there has been a shift toward techniques that offer quicker recovery and fewer complications. In this study, contrast-enhanced ultrasound was used to evaluate the impact of the minimally invasive anterolateral versus conventional lateral approach in THA on the gluteus medius muscle, focusing on muscle vitality and functional outcomes. METHODS A retrospective, cross-sectional analysis of 64 patients who underwent unilateral THA (26 lateral and 38 anterolateral) was conducted. Muscle strength was measured alongside joint flexibility and patient-reported outcome measures. Contrast-enhanced ultrasound (CEUS) examinations were conducted to visualize gluteus medius microperfusion. CEUS data were analyzed using VueBox 7.1 software and microperfusion parameters were calculated using peak enhancement (PE), wash-in perfusion index (WiPI) and rise time for muscle vitality evaluation. RESULTS Patients from the anterolateral group exhibited higher relative muscle strength in the operated hip compared with the healthy side (96 ± 23% vs. 86 ± 23%, p = 0.048). CEUS revealed superior gluteus medius microperfusion in the anterolateral group (PE 36,300 ± 42,000 arbitrary units [a.u.] vs. 20,400 ± 20,200 a.u., p = 0.024; WiPI 23,600 ± 27,300 a.u. vs. 13,500 ± 13,300 a.u., p = 0.027). A positive Trendelenburg sign was evident in 2 out of 26 patients in the lateral group compared with none in the anterolateral group (χ2 = 0.082), indicating higher rates of gluteal insufficiency in the lateral approach group. CONCLUSION Significantly higher muscle perfusion parameters in the anterolateral group, alongside improved muscle strength recovery, hint at a subtle but important advantage regarding post-operative recovery of the anterolateral approach. These findings support the ongoing trend toward minimally invasive surgical approaches in THA.
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Affiliation(s)
- Mick Paul
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Schaible Robin
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Renkawitz Tobias
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Walker Tilman
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Innmann Moritz
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Tsitlakidis Stefanos
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hariri Mustafa
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Doll Julian
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
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Kim DS, Jo NG, Lee DW, Ko MH, Seo JH, Kim GW. Ultrasonographic Contrast and Therapeutic Effects of Hydrogen Peroxide-Responsive Nanoparticles in a Rat Model with Sciatic Neuritis. Int J Nanomedicine 2024; 19:3031-3044. [PMID: 38562612 PMCID: PMC10982809 DOI: 10.2147/ijn.s447691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Peripheral nerve damage lacks an appropriate diagnosis consistent with the patient's symptoms, despite expensive magnetic resonance imaging or electrodiagnostic assessments, which cause discomfort. Ultrasonography is valuable for diagnosing and treating nerve lesions; however, it is unsuitable for detecting small lesions. Poly(vanillin-oxalate) (PVO) nanoparticles are prepared from vanillin, a phytochemical with antioxidant and anti-inflammatory properties. Previously, PVO nanoparticles were cleaved by H2O2 to release vanillin, exert therapeutic efficacy, and generate CO2 to increase ultrasound contrast. However, the role of PVO nanoparticles in peripheral nerve lesion models is still unknown. Herein, we aimed to determine whether PVO nanoparticles can function as contrast and therapeutic agents for nerve lesions. Methods To induce sciatic neuritis, rats were administered a perineural injection of carrageenan using a nerve stimulator under ultrasonographic guidance, and PVO nanoparticles were injected perineurally to evaluate ultrasonographic contrast and therapeutic effects. Reverse transcription-quantitative PCR was performed to detect mRNA levels of pro-inflammatory cytokines, ie, tumor necrosis factor-α, interleukin-6, and cyclooxygenase-2. Results In the rat model of sciatic neuritis, PVO nanoparticles generated CO2 bubbles to increase ultrasonographic contrast, and a single perineural injection of PVO nanoparticles suppressed the expression of tumor necrosis factor-α, interleukin-6, and cyclooxygenase-2, reduced the expression of F4/80, and increased the expression of GAP43. Conclusion The results of the current study suggest that PVO nanoparticles could be developed as ultrasonographic contrast agents and therapeutic agents for nerve lesions.
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Affiliation(s)
- Da-Sol Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Nam-Gyu Jo
- Department of Physical Medicine and Rehabilitation, Hansol Convalescence Rehabilitation Hospital, Jeonju, Republic of Korea
| | - Dong-Won Lee
- Department of Bionanotechnology and Bioconvergence Engineering, Jeonbuk National University, Jeonju, Republic of Korea
- Department of Polymer Nano Science and Technology, Jeonbuk National University, Jeonju, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Gi-Wook Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Bionanotechnology and Bioconvergence Engineering, Jeonbuk National University, Jeonju, Republic of Korea
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Bodenbeck EM, Böpple JC, Doll J, Bürkle F, Schmidmaier G, Fischer C. Earlier consolidation and improved knee function of medial open wedge high tibial osteotomy with autologous bone graft. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:371-378. [PMID: 37540246 PMCID: PMC10771360 DOI: 10.1007/s00590-023-03656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Medial knee osteoarthritis can be treated with medial open wedge high tibial osteotomy (OWHTO). We sought to investigate osseous consolidation of the osteotomy with and without autologous bone grafts (ABG) to detect possible benefits of ABG in osseous healing and functional outcome. METHODS In this prospective study, patients without graft transplantation were compared to those receiving ABG after medial OWHTO. They were followed up 6 weeks, 12 weeks, 6 months and 12 months postoperatively. Radiographic progress of consolidation, clinical scores, contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were assessed at each appointment. RESULTS A total of 35 patients were enrolled, 20 without and 15 with graft transplantation. Radiologic evaluation showed a significantly earlier consolidation of the osteotomy gaps (p = 0.012) in patients with ABG, resulting in a significantly higher rate of consolidation 12 months after surgery (60% without bone graft vs. 100% with bone graft, p = 0.006). At 6 weeks as well as 6-month follow-up, a tendency of earlier consolidation with ABG was apparent, but not statistically significant (6 weeks: 50% vs. 80%, p = 0.089; 6 months: 30% vs. 60%, p = 0.097). CEUS and DCE-MRI showed physiological perfusion of the osteotomy gaps in both groups. A tendency to better function and less pain in patients with ABG was recognizable. CONCLUSION In our study, autologous bone grafting evocated earlier osseous consolidation after medial OWHTO and showed a tendency to a better functional outcome.
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Affiliation(s)
- Eva-Maria Bodenbeck
- Center for Orthopaedics, Ultrasound Center, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
| | - Jessica C Böpple
- Center for Orthopaedics, Ultrasound Center, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Julian Doll
- Center for Orthopaedics, Ultrasound Center, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Franziska Bürkle
- Center for Orthopaedics, Ultrasound Center, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopaedics, Ultrasound Center, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopaedics, Ultrasound Center, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
- Shoulder and Elbow Surgery, Arcus Sports Clinic, 75179, Pforzheim, Germany
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Zhang YL, Wu MJ, Hu Y, Ma Q, Wei ZK, Yao QY, Huang YM, Li A. Contrast-enhanced ultrasound guided core needle biopsy for soft tissue tumors: Accuracy and applicability. Eur J Radiol 2023; 168:111114. [PMID: 37778147 DOI: 10.1016/j.ejrad.2023.111114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) guided core needle biopsy (CNB) in diagnosing soft tissue tumors (STTs) and to identify the conventional ultrasonography (US) features of STTs that are recommended for CEUS-guided CNB. MATERIALS AND METHODS A retrospective study was conducted on 123 patients with surgically confirmed STTs. Before surgeries, all subjects underwent CNB under the guidance of US or CEUS. The histopathological results of surgical specimens were considered as the gold standards. A successful biopsy diagnosis was defined as the pathological subtypes obtained by biopsy consistent with the gold standard. The diagnostic yields were compared between the US and CEUS groups, and the diagnostic yields based on various conventional US features of STTs were also compared between the two groups. RESULTS Sixty-seven cases underwent US-guided CNB and fifty-six cases underwent CEUS-guided CNB. The clinical, biopsy, and conventional US characteristics revealed no significant difference between the two groups. The diagnostic yield of the CEUS group was statistically higher than that of the US group (p = 0.011). In the CEUS group, more STTs with the anechoic areas were identified after CEUS examination (p = 0.031). Furthermore, the diagnostic yields based on the conventional US features of STTs, including deep fascia layer (p = 0.010), a maximum diameter ≥5 cm (p = 0.037), rough margin (p = 0.016), heterogeneous echotexture (p = 0.017), and absence of anechoic area (p = 0.013), were significantly different between the two groups, and the CEUS group exhibited higher diagnostic yields. CONCLUSION CEUS-guided CNB was found to be an efficient method for STTs diagnosis. It is particularly recommended for STTs with the following conventional US features, including location in deep fascia layer, a maximum diameter ≥5 cm, rough margin, heterogeneous echotexture, or absence of anechoic area.
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Affiliation(s)
- Ying-Lun Zhang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meng-Jie Wu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Hu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Ma
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zong-Kai Wei
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qi-Yu Yao
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Min Huang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Ao Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Mick P, Holz Z, Renkawitz T, Bülhoff M, Deisenhofer J, Hariri M, Fischer C, Doll J. Contrast-Enhanced Ultrasound-Assessed Supraspinatus Muscle Perfusion Indicates Better Tissue Vitality and Outcome After Supraspinatus Tendon Repair and Subacromial Decompression. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2371-2377. [PMID: 37596153 DOI: 10.1016/j.ultrasmedbio.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE Supraspinatus tendon (SSP) tears are a frequent indication for shoulder surgery. Therapy options include physiotherapy, tendon repair and less invasive surgical options like subacromial decompression (SAD). The selection of the most appropriate treatment depends on the specific characteristics and needs of each patient subgroup. Typically, physically active patients are candidates for tendon repair, while a conservative approach is preferred for individuals with severe muscle degeneration or low physical demands. The goal of this study was to assess the impact of contrast-enhanced ultrasound (CEUS)-assessed SSP muscle perfusion on post-operative shoulder function and tendon healing in patients undergoing SSP repair or SAD, thereby enhancing personalized therapy for SSP tendon tears. METHODS Two cohorts of patients with SSP tendon tears were treated either by SAD or tendon repair. Pre-operative and 6-month post-operative SSP muscle perfusion was quantified using CEUS and investigated as a surrogate for tissue vitality. The magnetic resonance imaging-derived parameters fatty infiltration and tendon retraction and established shoulder function scores were assessed pre- and post-operatively. RESULTS Thirty-five SSP repair patients were compared with 20 SAD patients. Pre-operative perfusion was comparable in the SAD and SSP repair cohorts when a re-tear occurred (wash-in perfusion index = 103.8 ± 124.0 vs. 114.6 ± 155.0, p = 0.83), while being significantly higher among patients with an intact repair (103.8 ± 124 vs. 325.4 ± 388.6, p = 0.006). Below-median pre-operative muscle perfusion was associated with lower post-operative shoulder function (Constant score: 59 ± 28 vs. 78 ± 19, p = 0.012). CONCLUSION CEUS can visualize SSP muscle perfusion as a surrogate for tissue vitality and tendon healing, which is associated with better post-operative shoulder function.
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Affiliation(s)
- Paul Mick
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoe Holz
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Renkawitz
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Bülhoff
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Deisenhofer
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Mustafa Hariri
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Julian Doll
- Department for Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany.
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Xing G, Wang J, Jiang W, Ge N, Zhu Y, Wang Y. Value of Multimodality Ultrasound in Quantitative Evaluation of the Intra-compartmental Pressure and Perfusion Pressure in Acute Compartment Syndrome in a Rabbit Model. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1837-1844. [PMID: 37268554 DOI: 10.1016/j.ultrasmedbio.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/23/2023] [Accepted: 04/21/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of the work described here was to investigate the feasibility of using multimodality ultrasound in quantitative evaluation of the intra-compartmental pressure (ICP) and perfusion pressure (PP) changes in acute compartment syndrome (ACS). METHODS Infusion technique was used to increase the ICP of the anterior compartment of 10 rabbits from baseline to 20, 30, 40, 50, 60, 70 and 80 mmHg. The anterior compartment was evaluated with conventional ultrasound, shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS). The shape of the anterior compartment, shear wave velocity (SWV) of the tibialis anterior (TA) muscle and CEUS parameters of the TA muscle were measured. RESULTS When the ICP exceeded 30 mmHg, the shape of the anterior compartment did not expand significantly with increasing ICP. There was a strong correlation between the SWV of TA muscle and measured ICP (ρ = 0.927). Arrival time (AT), time to peak (TTP), peak intensity (PI) and area under the curve (AUC) were significantly correlated with PP (AT, ρ = -0.763; TTP, ρ = -0.900; PI, ρ = 0.665; AUC, ρ = 0.706), whereas mean transit time (MTT) was not. CONCLUSION Multimodality ultrasound can be used to quantitatively evaluate ICP and PP and, thus, could provide more information for the rapid diagnosis and monitoring of ACS.
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Affiliation(s)
- Guanghui Xing
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Jing Wang
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Wenli Jiang
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Naiqiao Ge
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Yaqiong Zhu
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China
| | - Yuexiang Wang
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing 100853, China.
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Chen SY, Wang YW, Chen WS, Hsiao MY. Update of Contrast-enhanced Ultrasound in Musculoskeletal Medicine: Clinical Perspectives - A Review. J Med Ultrasound 2023; 31:92-100. [PMID: 37576422 PMCID: PMC10413398 DOI: 10.4103/jmu.jmu_94_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 08/15/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) uses an intravascular contrast agent to enhance blood flow signals and assess microcirculation in different parts of the human body. Over the past decade, CEUS has become more widely applied in musculoskeletal (MSK) medicine, and the current review aims to systematically summarize current research on the application of CEUS in the MSK field, focusing on 67 articles published between January 2001 and June 2021 in online databases including PubMed, Scopus, and Embase. CEUS has been widely used for the clinical assessment of muscle microcirculation, tendinopathy, fracture nonunions, sports-related injuries, arthritis, peripheral nerves, and tumors, and can serve as an objective and quantitative evaluation tool for prognosis and outcome prediction. Optimal CEUS parameters and diagnostic cut off values for each disease category remain to be confirmed.
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Affiliation(s)
- Shao-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wei Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
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Doll J, Neide A, Mick P, Brunnemer U, Schmidmaier G, Fischer C. Functional outcome and CEUS-assessed deltoid muscle vitality after fracture-specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma. J Orthop Res 2023; 41:489-499. [PMID: 35662238 DOI: 10.1002/jor.25392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/29/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023]
Abstract
Functional outcome after reverse-shoulder-arthroplasty (RSA) in proximal humerus fractures (PHF) depends on deltoid muscle integrity and successful reattachment of the tuberosities for best possible recovery of rotator-cuff function. In this monocentric, prospective, randomized, controlled trial we investigated whether a reverse-fracture-prosthesis (RFP) with a metaphyseal fenestrated stem achieved superior shoulder and muscle function compared to a common reverse-prosthesis (RP) design for patients with PHF. Our hypothesis was that patients with RFP may achieve a superior healing rate of the greater tuberosity (GT) compared to patients receiving RP, which translates to significantly higher clinical outcome and functional scores as well as differences in deltoid muscle microperfusion. Forty-four patients with PHF were randomized preoperatively to one of the prosthesis types in RSA between 2018 and 2020 (22 with RFP and 22 with RP) and prospectively assessed 6 months after surgery. We assessed osteointegration of the GT with radiographs 1 day and 6 months postoperatively and examined shoulder function and patient satisfaction by using established shoulder scores. A contrast-enhanced ultrasound (CEUS) examination of both shoulders was performed to quantify intramuscular blood flow and evaluate vitality of the deltoid muscle. None of the functional and psychosocial scores or radiographs and ultrasound examinations showed significant differences between the RSA designs. The constant-Murley score (p = 0.384) and active anterior-elevation-abduction, and external rotation were comparable between the RFP and RP group. Similar healing rates of the GT were observed (p = 0.655). CEUS-assessed deltoid microperfusion revealed equivalent muscle vitality for both groups (p = 0.312). Level of evidence: Level II; Randomized Controlled Trial; Treatment Study. Clinical significance: The radiographic evaluation for the investigation of the GT healing rate indicates that the proclaimed benefits of the fracture prosthesis with fenestration design might not be as great as expected.
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Affiliation(s)
- Julian Doll
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Arndt Neide
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Mick
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulf Brunnemer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany.,ARCUS Clinics, Pforzheim, Germany
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Mick P, Kunz P, Fischer C, Gross S, Doll J. CEUS-assessed supraspinatus muscle perfusion improves after tendon repair and predicts anatomical and functional outcome: A 1-year prospective pilot study. J Orthop Res 2023; 41:426-435. [PMID: 35460536 DOI: 10.1002/jor.25349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
Rotator cuff tear including SSP (Supraspinatus) tendon tears are a very common and often painful condition with several therapeutic options such as tendon repair. Reflected by the high retear rates, the preoperative selection of patients suitable for surgery or conservative treatment, which often yields comparable results, remains difficult. Using contrast-enhanced ultrasound (CEUS), it is possible to quantify the SSP muscle perfusion as a surrogate parameter for its vitality and healing capabilities. In this study, we enrolled 20 patients who underwent an SSP repair for a preoperative and two postoperative (6 months and 1 year) clinical and sonographic exams including CEUS. Along with functional improvement (p < 0.001, Constant score), we found a significant increase in CEUS-assessed muscle perfusion after tendon repair (p < 0.001). Furthermore, weak preoperative muscle perfusion was associated with a higher risk of a retear (χ2 = 0.045) and a moderate trend toward lower postoperative shoulder function that did not reach significance (r = 0.435; p = 0.055, DASH score). If confirmed in larger studies, CEUS might be a valuable additional diagnostic method for a precise selection of patients who most likely profit from a tendon repair and those who can be treated conservatively with an equally good outcome.
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Affiliation(s)
- Paul Mick
- Center for Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Pierre Kunz
- Shoulder and Elbow Surgery, Catholic Hospital Mainz, Mainz, Germany
| | | | | | - Julian Doll
- Center for Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
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12
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Yan M, Li R, Hu D, Zhao P. Detection of Subchondral Bone Microcirculatory Perfusion in Adults with Early Osteonecrosis of the Femoral Head Using Contrast-Enhanced Ultrasound: A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:635-644. [PMID: 36336550 DOI: 10.1016/j.ultrasmedbio.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to quantitatively assess subchondral bone microcirculation perfusion in adults with early osteonecrosis of the femoral head (ONFH) using contrast-enhanced ultrasound (CEUS) and to evaluate its correlation with the Association Research Circulation Osseous (ARCO) stage. We investigated 97 adult patients with definite ONFH by imaging a total of 155 hips, performing CEUS, storing images of CEUS processes at different ARCO stages and generating CEUS time-intensity curves (TICs) to obtain perfusion parameters. Differences in CEUS parameters at different ARCO stages were analyzed, and correlations were explored. A logistic regression model was constructed by incorporating the meaningful CEUS indicators. The CEUS parameters time to peak (TTP), peak intensity (PI), enhanced intensity (EI), ascending slope (AS), descending slope (DS) and area under the receiver operating characteristic curve (AUC) were significantly different in ARCO stage Ⅰ compared with stage ⅢA, and the same results were obtained in stage Ⅱ compared with stage ⅢA. However, there were no significant differences between stages Ⅰ and Ⅱ. The MTT (mean transit time) assay was not significantly different between the different stages. The receiver operating characteristic curve analysis of TTP, PI, EI, AS, DS and AUC in stages Ⅰ and ⅢA had a certain diagnostic efficacy, similar to the results in stages Ⅱ and ⅢA. The diagnostic performance of DS was less accurate in stages Ⅰ and ⅢA, while the diagnostic performance of TTP was less accurate in stages Ⅱ and ⅢA. ARCO stage was independently and negatively correlated with TTP and DS and independently and positively correlated with PI, EI, AS and AUC. The MTT assay was not correlated with ARCO stage. Logistic regression models containing statistically significant TTP, EI and AUC values were constructed, and all three values were closely related to the ARCO stage. In patients with different ARCO stages of ONFH, CEUS can effectively assess subchondral bone perfusion of the femoral head and is expected to become an effective imaging method for the diagnosis of early ONFH.
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Affiliation(s)
- Meijun Yan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruoyu Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Die Hu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ping Zhao
- Department of Ultrasound, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
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13
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Zhu M, Xu H, Chen Y, Peng Y. Multimodal ultrasonography findings of extramammary granular cell tumors: Two case reports. Front Oncol 2023; 13:1136770. [PMID: 37020870 PMCID: PMC10067867 DOI: 10.3389/fonc.2023.1136770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/10/2023] [Indexed: 04/07/2023] Open
Abstract
Extramammary masses are infrequently encountered in breast examinations. They may occur in the chest wall and axilla as neighbors of the breast. It is important to determine the nature of the lesion. However, some benign tumors, such as granular cell tumors (GCTs), also show malignant characteristics, which leads to misdiagnosis. To the best of our knowledge, multimodal ultrasound features of GCT have not been elucidated. We report two cases of women with GCTs encountered upon breast cancer screening; the tumor was not located in breast tissue. The first patient was a 37-year-old woman who presented with a slow-growing mass in the right breast and the GCT was located in the pectoralis major muscle. The second patient was a 52-year-old woman who presented with a palpable left axillary mass and the GCT was located in the axilla. Mammography failed to detect the masses in the two patients upon breast cancer screening. However, two-dimensional ultrasonography revealed a solid heterogeneous hypoechoic mass. Shear wave elastography showed that the masses had an increased hardness compared with the surrounding tissue. Further contrast-enhanced ultrasonography showed that the contrast patterns of the two masses were different. In case one, contrast-enhanced ultrasonography showed an inhomogeneous annular high enhancement, and the dynamic curve showed rapid enhancement and regression. In case two, contrast enhanced ultrasound showed slight enhancement around the lesion but no enhancement inside. Postoperative pathology confirmed that the GCT was benign in both cases. The patients showed no signs of recurrence at the 2-year follow-up. Here, we report two cases and present the multimodal ultrasonography findings of this tumor for the first time. Radiologists and surgeons should be aware of these imaging manifestations and include them in their differential diagnoses.
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Affiliation(s)
- Meng Zhu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Huan Xu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yujuan Chen
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yujuan Chen, ; Yulan Peng,
| | - Yulan Peng
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yujuan Chen, ; Yulan Peng,
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14
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Bürkle F, Doll J, Neide A, Gantz S, Tsitlakidis S, Fischer C. New perspectives for investigating muscular perfusion response after dietary supplement intake: an exploratory, randomized, double-blind, placebo-controlled crossover trial in healthy young athletes using contrast-enhanced ultrasound (CEUS). J Int Soc Sports Nutr 2022; 19:397-416. [PMID: 35859621 PMCID: PMC9291664 DOI: 10.1080/15502783.2022.2097018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Various dietary supplements have been reported to enhance muscular perfusion in athletes practicing resistance training, especially through modulation of nitric oxide signaling. Objectives The aim of this study was therefore to investigate selected ‘NO-boosting’ supplements in a real-life setting i) to generate novel hypotheses and perfusion estimates for power calculation in view of a definitive trial and ii) to assess the feasibility of the study design with particular focus on the use of contrast-enhanced ultrasound (CEUS) for perfusion quantification. Methods Thirty young male athletes (24 ± 4 years) regularly practicing resistance training were enrolled in this three-arm, placebo(PL)-controlled crossover trial with ingestion of two commercially available supplements: an amino acid combination (AA) (containing 3 g of L-arginine-hydrochloride and 8 g of L-citrulline-malate) and 300 mg of a specific green tea extract (GTE). After intake, CEUS examinations of the dominant biceps brachii muscle were performed under resting conditions and following standardized resistance exercising. Quantitative parameters of biceps perfusion (peak enhancement, PE; wash-in perfusion index, WiPI) and caliber were derived from corresponding CEUS video files. Additionally, subjective muscle pump was determined after exercise. Results For PE, WiPI, and biceps caliber, the standard deviation (SD) of the within-subject differences between PL, AA, and GTE was determined, thereby allowing future sample size calculations. No significant differences between PL, AA, and GTE were observed for biceps perfusion, caliber, or muscle pump. When comparing resting with post-exercise measurements, the increase in biceps perfusion significantly correlated with the caliber increase (PE: r = 0.266, p = 0.0113; WiPI: r = 0.269, p = 0.0105). Similarly, the biceps perfusion correlated with muscle pump in the post-exercise conditions (PE: r = 0.354, p = 0.0006; WiPI: r = 0.350, p = 0.0007). A high participant adherence was achieved, and the acquisition of good quality CEUS video files was feasible. No adverse events occurred. Conclusion Based on our novel examination protocol, CEUS seems to be feasible following higher-load resistance exercising and may be used as a new method for high-resolution perfusion quantification to investigate the effects of pre-exercise dietary supplementation on muscle perfusion and related muscle size dynamics.
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Affiliation(s)
- Franziska Bürkle
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Doll
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Arndt Neide
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Simone Gantz
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefanos Tsitlakidis
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
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15
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Preoperative contrast-enhanced ultrasound (CEUS) of long bone nonunions reliably predicts microbiology of tissue culture samples but not of implant-sonication. Orthop Traumatol Surg Res 2022; 108:102862. [PMID: 33610855 DOI: 10.1016/j.otsr.2021.102862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Bacterial infection in the context of fracture repair remains a severe complication in trauma surgery and may result in long bone nonunion. Since treatment options for aseptic and infected nonunions vary greatly, diagnostic methods should ideally differentiate between these two entities as accurately as possible. Recently, contrast-enhanced ultrasound (CEUS) has been introduced as a preoperative imaging technique to evaluate hypervascularity at the fracture site as sign of bacterial infection. HYPOTHESIS Preoperative CEUS predicts results of microbiological evaluation obtained either by culture of tissue samples or by analyzing the sonication fluid following removal and sonication of the implant. PATIENTS AND METHODS Over the course of 6 months, 26 patients with long bone nonunions were included in this study. Patients' clinical data were evaluated. Tissue samples were collected intraoperatively and examined by standard microbiological techniques. The sonication method was applied to removed implants. Additionally, 1-3 days before surgery, CEUS was performed to determine hypervascularity at the nonunion site as a possible parameter for infection. RESULTS Culture of tissue samples indicated infection in 50% of cases and implant sonication in 57.7% of cases. However, there was merely a fair agreement (κ=0.231) between these two diagnostic methods. CEUS predicted results of tissue culture reliably (sensitivity 92.3% and specificity 100%), whereas implant sonication showed no significant correlations with results from CEUS. Hypertrophic and atrophic nonunions were evaluated separately to determine possible differences in vascularity. We found that contrast peak enhancement of CEUS was similar in atrophic and hypertrophic nonunions with positive culture of tissue samples. Both differed significantly from culture negative cases (p=0.0016 and 0.0062). Results of implant-sonication positive or negative cases in atrophic and hypertrophic nonunions, however, were less clear and could be misleading. DISCUSSION We were able to confirm CEUS as a valuable preoperative diagnostic tool that reliably predicts microbiology of tissue culture samples, but not of implant sonication. LEVEL OF EVIDENCE I; diagnostic study.
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Clevert DA, Jung EM, Weber MA, Lerchbaumer MH, Willinek W, Fischer T. Concepts in the Establishment of Interdisciplinary Ultrasound Centers: The Role of Radiology. ROFO-FORTSCHR RONTG 2022; 194:1322-1332. [PMID: 35850139 DOI: 10.1055/a-1853-7443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Ultrasound (US) is widely used as a fast and cost-efficient first-choice imaging technique without relevant side effects for a variety of diagnostic tasks. Due to technical advances, more complex and sophisticated methods such as color-coded duplex ultrasound, image fusion, contrast-enhanced ultrasound (CEUS), and ultrasound-guided interventions have become increasingly important in diagnostic algorithms. METHOD This study presents an overview of all aspects regarding the establishing of an interdisciplinary US center based on five representative examples in Germany. These aspects include topics of ultrasound education, research, economics, and administration. RESULTS The goal of an interdisciplinary US center is to bundle the use of equipment, staff, rooms, and infrastructure resources (optimization of equipment availability and use of new techniques) to expand the range of examinations, to promote resident training, and to boost continuing medical education of residents. This should result in better patient care and has additionally improved patient care while considering the added value for the participating institutions involved. Interdisciplinary US centers allow a reduction of the number of US devices needed in a hospital and more efficient use of available equipment through bedside time optimization by central organization within interdisciplinary management. The focused application of special US techniques such as CEUS or image fusion for complex, difficult interventions as well as the training and education of younger colleagues in using these techniques is centrally organized by experts and can be improved through the multidisciplinary experience available. CONCLUSION Organizational structures, sharing of materials, and standardization of diagnostic reports facilitate and accelerate cooperation with the referring specialty. KEY POINTS · Interdisciplinary US centers foster clinical collaboration, research, and jointly organized, standardized training.. · Economic aspects include optimization of available equipment, use of the latest US techniques, and centralization of organizational structures.. · Common terminology and standardized reporting increase the satisfaction of referring doctors. CITATION FORMAT · Clevert DA, Jung EM, Weber M et al. Concepts in the Establishment of Interdisciplinary Ultrasound Centers: The Role of Radiology. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1853-7443.
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Affiliation(s)
- Dirk Andre Clevert
- Institut für Klinische Radiologie, Campus Grosshadern, Klinikum der Universität München Großhadern, München, Germany
| | - Ernst Michael Jung
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Germany
| | - Marc-André Weber
- Universitätsmedizin Rostock, Diagnostische und Interventionelle Radiologie, Rostock, Germany
| | - Markus Herbert Lerchbaumer
- Department of Radiology, ChariteCentrum 6 Diagnostische und interventionelle Radiologie und Nuklearmedizin, Berlin, Germany
| | - Winfried Willinek
- 3. Center for Radiology, Neuroradiology, Sonography and Nuclear Medicine, Krankenhaus der Barmherzigen Brueder, Trier, Germany.,Radiology, University of Bonn, Germany
| | - Thomas Fischer
- Department of Radiology, ChariteCentrum 6 Diagnostische und interventionelle Radiologie und Nuklearmedizin, Berlin, Germany
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Abstract
Physiologic bone healing involves numerous parameters, such as microstability, fracture morphology, or tissue perfusion, to name just a few. Slight imbalances or a severe impairment of even one of these factors may, as the figurative weakest link in the chain, crucially or completely inhibit the regenerative potential of a fractured bone. This review revisits the physiology and pathophysiology of fracture healing and provides an insight into predispositions, subtypes, diagnostic tools, and therapeutic principles involved with delayed fracture healing and nonunions. Depending on the patients individual risk factors, nonunions may develop in a variety of subtypes, each of which may require a slightly or fundamentally different therapeutical approach. After a detailed analysis of these individual factors, additional diagnostic tools, such as magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, sonography, or contrast-enhanced ultrasonography, may be indicated to narrow down the most likely cause for the development of the nonunion and therefore help find and optimize the ideal treatment strategy.
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Affiliation(s)
- Paul Mick
- Center for Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
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18
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Doll J, Fischer C. [Contrast-enhanced ultrasound in the diagnostics of non-unions]. Unfallchirurg 2022; 125:107-112. [PMID: 34997249 DOI: 10.1007/s00113-021-01129-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
Non-union represents a severe complication and a major socioeconomic challenge in orthopedics and trauma surgery. Timely and reliable diagnostics are obligatory to be able to carry out the treatment of non-unions in a patient-specific and efficient manner. Contrast-enhanced ultrasound (CEUS) is an important interface between clinical signs, imaging investigations and the results of the paraclinical diagnostics, e.g. C‑reactive protein (CRP) and leukocyte count. It can display the microperfusion inside the non-union gap in real time and provide valuable information for exclusion of an infection or on the healing progress after revision surgery. An establishment of this diagnostic modality in routine orthopedic trauma surgery contributes to optimization of the treatment of non-unions.
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Affiliation(s)
- Julian Doll
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Christian Fischer
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland.
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Rossmann T, Reissig LF, Pfisterer WK, Grisold W, Weninger WJ, Meng S. Angiosomes of the Ulnar Nerve at the Elbow: A Cadaver Trial Using Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3393-3402. [PMID: 34479732 DOI: 10.1016/j.ultrasmedbio.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/12/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Abstract
Three major arteries supplying the ulnar nerve in the cubital tunnel are commonly known. However, their vascular territories (angiosomes) have not been described yet. Contrast-enhanced ultrasound was used to identify the angiosomes of posterior ulnar recurrent artery, inferior ulnar collateral artery and superior ulnar collateral artery in 20 fresh, non-frozen human body donors. The arteries were cannulated, and physiologic blood flow was simulated. Contrast agent was applied in each vessel in a randomized sequence, and the length of the contrast-enhancing ulnar nerve segment was measured by a radiologist blinded to the sequence. The angiosome of the posterior ulnar recurrent artery overlaps both other angiosomes. It fully covers the cubital tunnel in 63.6% of specimens. In addition, collateral flow via nerve and muscle branches of the arterial anastomotic network around the elbow (rete articulare cubiti) partly maintains the intra-neural blood flow in the absence of a vascular pedicle. The posterior ulnar recurrent artery is the dominant nutrient vessel of the ulnar nerve in the cubital tunnel. A potential watershed zone exists proximal to the Osborne ligament. Knowledge of these angiosomes may advance surgery of the ulnar nerve in the cubital tunnel.
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Affiliation(s)
- Tobias Rossmann
- Division of Anatomy, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Lukas F Reissig
- Division of Anatomy, Medical University of Vienna, Vienna, Austria
| | | | - Wolfgang Grisold
- Neurology Consultancy Unit, Division of Anatomy, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Meng
- Division of Anatomy, Medical University of Vienna, Vienna, Austria; Department of Radiology, Hanusch Hospital, Vienna, Austria.
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Doll J, Waizenegger S, Schmidmaier G, Weber MA, Fischer C. Contrast-Enhanced Ultrasound: A Viable Diagnostic Tool in Predicting Treatment Failure after Non-union Revision Surgery for Upper- and Lower-Limb Non-unions. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3147-3158. [PMID: 34433520 DOI: 10.1016/j.ultrasmedbio.2021.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Non-unions remain a major complication in the treatment of long-bone fractures and affect quality of life considerably. Both early detection and treatment of non-unions are essential to secure subsequent fracture union. Sufficient vascularization plays a key role in the healing process. The aim of this prospective study was to quantify the microperfusion within non-unions by means of contrast-enhanced ultrasound (CEUS) as early as 12 wk after non-union surgery and to examine the prognostic capability of CEUS in predicting treatment failure. Among 112 patients who had undergone non-union surgery, consolidation within 36 mo was achieved in 89 patients ("responders"), whereas 23 patients showed persistent non-unions ("non-responders") and required further surgery. CEUS quantification parameters such as peak enhancement, wash-in area under the curve and wash-in perfusion index revealed significantly higher perfusion levels in "responders" compared with "non-responders" (p < 0.05). Receiver operator characteristic curve analysis revealed that persistent fracture non-unions could be predicted with a sensitivity/specificity of 88.7%/72.2% in lower-limb non-unions and a sensitivity/specificity of 66.7%/100.0% in upper-limb non-unions. CEUS is a suitable diagnostic tool in predicting treatment failure as early as 12 wk after non-union surgery and should be integrated into the clinical routine when deciding on revision surgery at an early stage.
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Affiliation(s)
- Julian Doll
- Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Heidelberg, Germany.
| | - Stefan Waizenegger
- Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Fischer
- Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Heidelberg, Germany; Arcus Sports Clinic, Pforzheim, Germany
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21
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Dietrich CF, Abramowicz JS, Chammas MC, Chou YH, Condous G, Kim SH, Nolsøe CP, Vinayak S, Jenssen C. World Federation for Ultrasound in Medicine and Biology (WFUMB) Policy Document Development Strategy - Clinical Practice Guidelines, Position Statements and Technological Reviews (on behalf of the WFUMB publication committee and Executive Bureau). ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2779-2781. [PMID: 34119356 DOI: 10.1016/j.ultrasmedbio.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/10/2021] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Affiliation(s)
| | | | | | - Yi-Hong Chou
- World Federation for Ultrasound in Medicine and Biology (WFUMB)
| | - George Condous
- World Federation for Ultrasound in Medicine and Biology (WFUMB)
| | - Seung Hyup Kim
- World Federation for Ultrasound in Medicine and Biology (WFUMB)
| | | | - Sudhir Vinayak
- World Federation for Ultrasound in Medicine and Biology (WFUMB)
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Prada F, Vetrano IG, Gennari AG, Mauri G, Martegani A, Solbiati L, Sconfienza LM, Quaia E, Kearns KN, Kalani MYS, Park MS, DiMeco F, Dietrich C. How to Perform Intra-Operative Contrast-Enhanced Ultrasound of the Brain-A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2006-2016. [PMID: 34045096 DOI: 10.1016/j.ultrasmedbio.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 06/12/2023]
Abstract
Intra-operative ultrasound has become a relevant imaging modality in neurosurgical procedures. While B-mode, with its intrinsic limitations, is still considered the primary ultrasound modality, intra-operative contrast-enhanced ultrasound (ioCEUS) has more recently emerged as a powerful tool in neurosurgery. Though still not used on a large scale, ioCEUS has proven its utility in defining tumor boundaries, identifying lesion vascular supply and mapping neurovascular architecture. Here we propose a step-by-step procedure for performing ioCEUS analysis of the brain, highlighting its neurosurgical applications. Moreover, we provide practical advice on the use of ultrasound contrast agents and review technical ultrasound parameters influencing ioCEUS imaging.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA; Focused Ultrasound Foundation, Charlottesville, VA, USA.
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio G Gennari
- Department of Neuropediatrics, MR Research Center, University Children's Hospital, Zurich, Switzerland
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Luigi Solbiati
- Division of Radiology, Humanitas Research Hospital, Rozzano, Italy
| | | | - Emilio Quaia
- Radiology Institute, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA
| | - M Yashar S Kalani
- University of Oklahoma School of Medicine, St. John's Neuroscience Institute, Tulsa, OK, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, USA
| | - Christoph Dietrich
- Department of Internal Medicine, Caritas Krankenhaus Bad Mergentheim, Bern, Switzerland
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Doll J, Streblow J, Weber MA, Schmidmaier G, Fischer C. The AMANDUS Project PART II-Advanced Microperfusion Assessed Non-Union Diagnostics with Contrast-Enhanced Ultrasound (CEUS): A Reliable Diagnostic Tool for the Management and Pre-operative Detection of Infected Upper-Limb Non-unions. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:478-487. [PMID: 33342619 DOI: 10.1016/j.ultrasmedbio.2020.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
The management of upper-limb non-unions can be challenging, especially when infection is existent. Thus, pre-operative detection of infection plays a relevant role in non-union treatment. This study investigated in a large cohort the diagnostic potential of contrast-enhanced ultrasound (CEUS) as stand-alone method for differentiating between aseptic and infected upper-limb non-unions. Osseous perfusion of 50 upper-extremity non-unions (radius/ulna, n = 20; humerus, n = 22; clavicle, n = 8) was prospectively assessed with CEUS before revision surgery. The perfusion was quantified via time-intensity curves and peak enhancement (in arbitrary units). Significant perfusion differences between aseptic and infected non-unions could be detected (peak enhancement, p < 0.001). The sensitivity and specificity for the detection of infected upper-limb non-unions were 80% and 94.3% (cutoff peak enhancement: 130.8 arbitrary units). CEUS reliably differentiates between aseptic and infected upper-limb non-unions. Consequently, CEUS should be integrated into the daily diagnostic routine algorithm to plan non-union revision surgery more precisely as a single- or multi-step procedure.
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Affiliation(s)
- Julian Doll
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jan Streblow
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany; Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
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Macrì F, Angileri V, Russo T, Russo MT, Tabbì M, Di Pietro S. Evaluation of Bone Healing Using Contrast-Enhanced Ultrasonography in Non-Operative Treatment of Tibial Fracture in a Puppy Dog. Animals (Basel) 2021; 11:ani11020284. [PMID: 33498663 PMCID: PMC7912655 DOI: 10.3390/ani11020284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 01/21/2023] Open
Abstract
Simple Summary This report describes the clinical presentation of a tibial fracture in a young dog. treated with a conservative approach and subjected to X-ray, B-mode, Color Doppler and contrast-enhanced ultrasound (CEUS) examinations during the bone healing, in order to assess hemodynamic changes during fracture healing. This report showed the application of CEUS in controlling the fracture healing process. Abstract A 10-month-old mixed-breed male dog was presented with an oblique tibial fracture. The dog was treated with a Robert Jones-like bandage as a conservative approach, and was subjected to X-ray, B-mode, Color Doppler and contrast-enhanced ultrasound (CEUS) examinations during the fracture healing, in order to assess bone hemodynamic changes. B-mode, Power Doppler and CEUS examinations of the fracture gap were performed at 7, 20, 35, and 50 days post-trauma. Quantitative analysis of CEUS and perfusion parameters were obtained. On CEUS, a steep incline in signal numbers was visible in fracture gap at 7 days with peaks at 35 days, after which the vascularization decreases gradually over the next days. In this study, CEUS provided important information on the early stages of the callus formation and on the healing of neighboring tissues, allowing recognition of a correct bone healing. Moreover, the number of vascular signals on CEUS was greater than that on Doppler images on the same day. This report showed the application of CEUS in controlling the fracture healing process. CEUS could be a method of monitoring the remedial processes, assessing the tibial fracture perfusion characterized by low-velocity, small-volume blood flows.
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Affiliation(s)
- Francesco Macrì
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 98168 Messina, Italy; (F.M.); (M.T.)
| | | | - Teresa Russo
- Veterinary Practitioner, 98077 Santo Stefano di Camastra, Italy;
| | | | - Marco Tabbì
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 98168 Messina, Italy; (F.M.); (M.T.)
| | - Simona Di Pietro
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 98168 Messina, Italy; (F.M.); (M.T.)
- Correspondence: ; Tel.: +39-090676-6758
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25
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Progress of Interfacial Polymerization Techniques for Polyamide Thin Film (Nano)Composite Membrane Fabrication: A Comprehensive Review. Polymers (Basel) 2020; 12:polym12122817. [PMID: 33261079 PMCID: PMC7760071 DOI: 10.3390/polym12122817] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/12/2023] Open
Abstract
In this paper, we review various novel/modified interfacial polymerization (IP) techniques for the fabrication of polyamide (PA) thin film composite (TFC)/thin film nanocomposite (TFN) membranes in both pressure-driven and osmotically driven separation processes. Although conventional IP technique is the dominant technology for the fabrication of commercial nanofiltration (NF) and reverse osmosis (RO) membranes, it is plagued with issues of low membrane permeability, relatively thick PA layer and susceptibility to fouling, which limit the performance. Over the past decade, we have seen a significant growth in scientific publications related to the novel/modified IP techniques used in fabricating advanced PA-TFC/TFN membranes for various water applications. Novel/modified IP lab-scale studies have consistently, so far, yielded promising results compared to membranes made by conventional IP technique, in terms of better filtration efficiency (increased permeability without compensating solute rejection), improved chemical properties (crosslinking degree), reduced surface roughness and the perfect embedment of nanomaterials within selective layers. Furthermore, several new IP techniques can precisely control the thickness of the PA layer at sub-10 nm and significantly reduce the usage of chemicals. Despite the substantial improvements, these novel IP approaches have downsides that hinder their extensive implementation both at the lab-scale and in manufacturing environments. Herein, this review offers valuable insights into the development of effective IP techniques in the fabrication of TFC/TFN membrane for enhanced water separation.
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Young GM, Krastins D, Chang D, Lam J, Quah J, Stanton T, Russell F, Greaves K, Kriel Y, Askew CD. Influence of cuff‐occlusion duration on contrast‐enhanced ultrasound assessments of calf muscle microvascular blood flow responsiveness in older adults. Exp Physiol 2020; 105:2238-2245. [DOI: 10.1113/ep089065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Grace Marie Young
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Sunshine Coast Hospital and Health Service Sunshine Coast Health Institute Birtinya Queensland Australia
| | - Digby Krastins
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Sunshine Coast Hospital and Health Service Sunshine Coast Health Institute Birtinya Queensland Australia
| | - David Chang
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Jeng Lam
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Jing Quah
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Tony Stanton
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Fraser Russell
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
| | - Kim Greaves
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Yuri Kriel
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
| | - Christopher David Askew
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Sunshine Coast Hospital and Health Service Sunshine Coast Health Institute Birtinya Queensland Australia
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
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Abstract
BACKGROUND Non-union is defined as an insufficiently consolidated fracture in which healing without a surgical intervention is no longer foreseeable. Several underlying predispositions and factors have to be taken into account in order to optimize the diagnostics, classification and surgical treatment of this complex and challenging pathology. OBJECTIVE As the patient-specific optimized treatment sometimes pursues different goals depending on the specific subtype of non-union, an agreement on the most important parameters within the framework of a standardized classification is of crucial importance. In addition to established diagnostic algorithms, this article also describes modern radiologic diagnostic methods. MATERIAL AND METHODS In addition to the clinical examination, the diagnostics of non-union are mainly based on radiological imaging using X‑ray or computed tomography. Complex fracture morphology or uncertainty, particularly regarding the infection status and perfusion of non-union, can be an indication for an extension of the diagnostics using contrast-enhanced ultrasound (CEUS) or dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). CONCLUSION A practicable and precise classification of the different types of non-union can only be successful based on a focussed diagnostic procedure using radiologic and functional diagnostic tools, which guide the surgeon in establishing the optimal treatment. This also includes modern functional imaging examinations, such as CEUS and DCE-MRI.
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Affiliation(s)
- Christian Fischer
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
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28
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[General fracture principles and imaging characteristics]. Radiologe 2020; 60:477-486. [PMID: 32415316 DOI: 10.1007/s00117-020-00694-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the process of fracture healing, two different types (direct and indirect) are observed, which can be distinguished by radiologic imaging. If a fracture insufficiently consolidates without further treatment, regardless of the duration of prior treatment, it is referred to as a "non-union". This occurs in about 10% of long bone fractures. AIM The aim of this article is to provide an overview of the classification of fractures, an explanation of fracture healing and non-unions as well as their radiologic characteristics. METHODS The diagnosis of fractures is based on physical examination and x‑ray with a minimum of two planes. If a soft tissue defect or complex fracture is suspected, a CT or MRI should be considered. For the treatment of non-unions, it might be helpful to expand the diagnostics to a CEUS (contrast-enhanced ultrasound) or DCE-MRI (dynamic contrast-enhanced magnetic resonance imaging). CONCLUSION Non-unions represent a severe limitation for the patient's quality of life and are often associated with a long period of suffering. In recent years, CEUS has been shown to be a useful and precise method for the diagnosis and assessment of non-unions and as a surrogate parameter for fracture consolidation.
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