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Bm MV, Pakarinen O, Helenius I, Uimonen MM, Ponkilainen VT, Kuitunen I. Why all newborn hip screening programs have same results-a mini review. Eur J Pediatr 2024:10.1007/s00431-024-05539-x. [PMID: 38592484 DOI: 10.1007/s00431-024-05539-x] [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: 12/12/2023] [Revised: 03/08/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
All newborns are screened for developmental dysplasia of the hip (DDH), but countries have varying screening practices. The aim of this narrative mini review is to discuss the controversies of the screening and why it seems that all screening programs are likely to have same outcome. Different screening strategies are discussed alongside with other factors influencing DDH in this review. Universal ultrasound (US) has been praised as it finds more immature hips than clinical examination, but it has not been proven to reduce the rates of late-detected DDH or surgical management. Universal US screening increases initial treatment rates, while selective US and clinical screening have similar outcomes regarding late detection rates than universal US. This can be explained by the extrinsic factor affecting the development of the hip joint after birth and thus initial screening during the early weeks cannot find these cases. Conclusion: It seems that DDH screening strategies have strengths and limitations without notable differences in the most severe outcomes (late-detected cases requiring operative treatment). Thus, it is important to acknowledge that the used screening policy is a combination of values and available resources rather than a decision based on clear evidence.
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Affiliation(s)
- Matias Vaajala Bm
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Oskari Pakarinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ilkka Helenius
- Department of Orthopaedics, New Childrens Hospital, Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mikko M Uimonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Ville T Ponkilainen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Vaughan R, Tjandra D, Patwardhan A, Mingos N, Gibson R, Boussioutas A, Ardalan Z, Al‐Ani A, Gibson PR, Christensen B. Toward transmural healing: Sonographic healing is associated with improved long-term outcomes in patients with Crohn's disease. Aliment Pharmacol Ther 2022; 56:84-94. [PMID: 35343603 PMCID: PMC9313877 DOI: 10.1111/apt.16892] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Transmural healing has emerged as a treatment target in Crohn's disease (CD). We investigated whether transmural healing assessed with intestinal ultrasound (IUS) is associated with improved clinical outcomes in patients with CD in clinical remission. METHODS Patients with CD in clinical remission at baseline (HBI <4) having IUS between August 2017 and June 2020 with at least 6-months' follow-up were retrospectively studied. Time to medication escalation, corticosteroid use and CD-related hospitalisation or surgery were compared by the presence or absence of sonographic healing, defined as bowel wall thickness ≤3 mm without hyperemia on color Doppler, inflammatory fat, or disrupted bowel wall stratification. Factors associated with survival were analyzed by Kaplan-Meier analysis using Cox proportional-hazard model. RESULTS Of 202 consecutive patients (50% male), sonographic inflammation was present in 61%. During median follow-up of 19 (IQR 13-27) months, medication escalation occurred in 52%, corticosteroid use in 23%, hospitalisation in 21%, and CD-related surgery in 13%. Sonographic healing was significantly associated with a reduced risk of medication escalation (p = 0.0018), corticosteroid use (p = 0.0247), hospitalisation (p = 0.0102), and surgery (p = 0.083). On multivariable analysis, sonographic healing was significantly associated with an increased odds of medication escalation-free survival (hazard ratio [HR]:1.94; 95% CI 1.23-3.06; p = 0.004) and corticosteroid-free survival (HR:2.41; 95% CI 1.24-4.67; p = 0.009), but not with hospitalisation or surgery. CONCLUSION In patients with CD in clinical remission, sonographic healing is associated with improved clinical outcomes. Further studies are needed to determine whether sonographic healing should be a treatment target.
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Affiliation(s)
- Rose Vaughan
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Douglas Tjandra
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Ashwin Patwardhan
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Nicholas Mingos
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Robert Gibson
- Department of RadiologyRoyal Melbourne HospitalMelbourneAustralia
| | - Alex Boussioutas
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Zaid Ardalan
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Aysha Al‐Ani
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Peter R. Gibson
- Department of GastroenterologyAlfred Hospital and Monash UniversityMelbourneAustralia
| | - Britt Christensen
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
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Möller K, Dietrich CF, Faiss S, Mutze S, Goelz L. [Alternatives of histological material collection - When and how is histological confirmation by ultrasound (US), computer tomography (CT) or endosonography (EUS) useful?]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:937-958. [PMID: 34781389 DOI: 10.1055/a-1482-9448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Histological classifications of tumorous lesions together with adequate staging are necessary for stage-appropriate and personalized therapies. The indications, technical possibilities, and limitations as well as potential complications of image-guided needle biopsy by ultrasound, computed tomography, and endosonography are described. Which procedure for which organ and which lesion?
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Affiliation(s)
- Kathleen Möller
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | | | - Siegbert Faiss
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | - Sven Mutze
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany.,Institut für Radiologie, SANA-Klinikum, Berlin, Germany.,Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Leonie Goelz
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany.,Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
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Sprinzl MF, Feist C, Koch S, Kremer WM, Lackner KJ, Weinmann A, Galle PR. Cost evaluation of PAGE-B risk score guided HCC surveillance in patients with treated chronic hepatitis B. BMC Health Serv Res 2021; 21:846. [PMID: 34419018 PMCID: PMC8379870 DOI: 10.1186/s12913-021-06794-6] [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: 10/16/2020] [Accepted: 07/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background The PAGE-B score (Platelet Age GEnder–HBV) selects chronic hepatitis B (cHB) patients showing no relevant 5-year risk for hepatocellular carcinoma (HCC). We, therefore, explored potential cost reduction following the introduction of a PAGE-B tailored ultrasound screening in a single center cohort of cHB patients receiving stable antiviral therapy. Methods cHB patients attending throughout the year 2018 were documented. Patients eligible for PAGE-B score were classified into high (≥18 points), intermediate (10–17 points) and low (≤9 points) HCC risk groups. Patients of the low HCC risk group could postpone HCC screening to reduce HCC screening expenses. Full costs for hepatic ultrasound were assessed. Results Throughout the year cHB patients (n = 607) attended our clinic, which included PAGE-B eligible patients (n = 227, 37.4%) of whom n = 94 (15.8%) were allocated to the low HCC risk group. Sonographic HCC screening during a median exam time of 12.4 min (IQR 9.2–17.2) resulted in total costs of 22.82 Euro/exam. Additional opportunistic expenses caused by patient’s lost earnings or productivity were 15.6–17.5 €/exam and 26.7 €/exam, respectively. Following a PAGE-B tailored HCC screening at our institution annual full costs for cHB patients could be reduced by 15.51%, which equals a cost reduction by 1.91% for our total sonography unit. In comparison, 1.35% up to 7.65% of HBV-infected patients of Caucasian descent could postpone HCC screening according to population-based estimates from Germany. Conclusions PAGE-B risk score adapted screening for HCC is an efficient and cost neutral tool to reduce costs for sonography in Caucasian patients with chronic hepatitis B receiving antiviral treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06794-6.
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Affiliation(s)
- Martin F Sprinzl
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. .,Institute for Laboratory Medicine and Clinical Chemistry, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Christina Feist
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Sandra Koch
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Wolfgang M Kremer
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Karl J Lackner
- Institute for Laboratory Medicine and Clinical Chemistry, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Arndt Weinmann
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Peter R Galle
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
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Evaluation of diagnostic efficacy for localization of parathyroid adenoma in patients with primary hyperparathyroidism undergoing repeat surgery. Langenbecks Arch Surg 2021; 406:1615-1624. [PMID: 33993327 PMCID: PMC8370933 DOI: 10.1007/s00423-021-02191-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/04/2021] [Indexed: 11/05/2022]
Abstract
Purpose Repeat surgery in patients with primary hyperparathyroidism (pHPT) is associated with an increased risk of complications and failure. This stresses the need for optimized strategies to accurately localize a parathyroid adenoma before repeat surgery is performed. However, evidence on the extent of required diagnostics for a structured approach is sparse. Methods A retrospective single-center evaluation of 28 patients with an indication for surgery due to pHPT and previous thyroid or parathyroid surgery was performed. Diagnostic workup, surgical approach, and outcome in terms of complications and successful removement of parathyroid adenoma with biochemical cure were evaluated. Results Neck ultrasound, sestamibi scintigraphy, C11-methionine PET-CT, and selective parathyroid hormone venous sampling, but not MRI imaging, effectively detected the presence of a parathyroid adenoma with high positive predictive values. Biochemical cure was revealed by normalization of calcium and parathormone levels 24–48h after surgery and was achieved in 26/28 patients (92.9%) with an overall low rate of complications. Concordant localization by at least two diagnostic modalities enabled focused surgery with success rates of 100%, whereas inconclusive localization significantly increased the rate of bilateral explorations and significantly reduced the rate of biochemical cure to 80%. Conclusion These findings suggest that two concordant diagnostic modalities are sufficient to accurately localize parathyroid adenoma before repeat surgery for pHPT. In cases of poor localization, extended diagnostic procedures are warranted to enhance surgical success rates. We suggest an algorithm for better orientation when repeat surgery is intended in patients with pHPT.
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Welle R, Seufferlein T, Kratzer W. [Current state of research in abdominal ultrasonography at German university hospitals. A panel study over 20 years]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 59:1059-1067. [PMID: 33348406 DOI: 10.1055/a-1332-2589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The state of research in the field of abdominal ultrasonography has been deficient for years at German university hospitals. Neither research activity nor funding are appropriate given the actual clinical importance of this method. OBJECTIVE In analogy to studies conducted in 1999 and 2009, this study aims to provide a survey into the state of research in the field of abdominal ultrasonography at German university hospitals. It focuses on the topics of research activity, research funding, publication rate and the development of structural conditions. METHODS Chief gastroenterologists from Germany's 34 university hospitals were invited to respond to a postal survey asking about the aforementioned topics. We asked them to forward the survey in case somebody else was responsible for the respective tasks. The response rate was 79 %. RESULTS The amount of hospitals doing research has roughly remained the same with 77 % compared to 74 % in 2009 and 80 % in 1999. On average, however, there are less research projects per department with 3.2 at the moment compared to 3.5 in 1999 and 3.6 in 2009, and research funding has continued to worsen. 75 % of the heads of departments state that they have not received any funding in addition to the usual budget. Funding by producers of ultrasound machines has also reached a low with 11 % compared to 45 % in 2009 and 31 % in 1999. Only public and university funding show a positive trend. The Deutsche Forschungsgemeinschaft (German Research Foundation) is currently not funding any research projects in the field of abdominal ultrasonography. 13 university hospitals provided information about their publication rate in 1999, 2009 and 2019. Whereas the rate had generally remained constant in the previous studies, the annual number of publications has continually increased in the current survey period. 75 % of the publications came from university hospitals that have established or are currently planning to establish interdisciplinary ultrasound centers. The previous studies also showed that more and more hospitals publish in English instead of German. This trend continues. During the survey period, 60 % of publications were both in English and German, 37 % in English and only 3 % exclusively in German. Most publications dealt with clinical and only a few technical or basic research questions. This was also the case in the previous studies. There have been less publications on the use of ultrasound contrast agents in the present survey period. There is also a decline in the number of systematic reviews. Similar to 2009, the impact factor of journals devoted to sonography is increasing and it is growing stronger than that of journals dedicated to radiology. However, only 29 % of the heads of departments agreed that ultrasonography was a field of research that improves your career prospects. CONCLUSIONS The present study did not show a significant improvement of research activity in the field of abdominal ultrasonography. However, an increased publication rate indicates a trend towards high-performing research centers. Research funding remains deficient and has worsened in the past 20 years. The demands made by the previous studies for research funding appropriate to the importance of this clinical method remain.
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Affiliation(s)
- Reinhard Welle
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Ulm
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Maaser C, Petersen F, Helwig U, Fischer I, Roessler A, Rath S, Lang D, Kucharzik T. Intestinal ultrasound for monitoring therapeutic response in patients with ulcerative colitis: results from the TRUST&UC study. Gut 2020; 69:1629-1636. [PMID: 31862811 PMCID: PMC7456734 DOI: 10.1136/gutjnl-2019-319451] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Prospective evaluation of intestinal ultrasound (IUS) for disease monitoring of patients with ulcerative colitis (UC) in routine medical practice. DESIGN TRansabdominal Ultrasonography of the bowel in Subjects with IBD To monitor disease activity with UC (TRUST&UC) was a prospective, observational study at 42 German inflammatory bowel disease-specialised centres representing different care levels. Patients with a diagnosis of a proctosigmoiditis, left-sided colitis or pancolitis currently in clinical relapse (defined as Short Clinical Colitis Activity Index ≥5) were enrolled consecutively. Disease activity and vascularisation within the affected bowel wall areas were assessed by duplex/Colour Doppler ultrasonography. RESULTS At baseline, 88.5% (n=224) of the patients had an increased bowel wall thickness (BWT) in the descending or sigmoid colon. Even within the first 2 weeks of the study, the percentage of patients with an increased BWT in the sigmoid or descending colon decreased significantly (sigmoid colon 89.3%-38.6%; descending colon 83.0%-42.9%; p<0.001 each) and remained low at week 6 and 12 (sigmoid colon 35.4% and 32.0%; descending colon 43.4% and 37.6%; p<0.001 each). Normalisation of BWT and clinical response after 12 weeks of treatment showed a high correlation (90.5% of patients with normalised BWT had symptomatic response vs 9.5% without symptomatic response; p<0.001). CONCLUSIONS IUS may be preferred in general practice in a point-of-care setting for monitoring the disease course and for assessing short-term treatment response. Our findings give rise to the assumption that monitoring BWT alone has the potential to predict the therapeutic response, which has to be verified in future studies.
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Affiliation(s)
- Christian Maaser
- Outpatients Department of Gastroenterology, IBD Center, Städtisches Klinikum Lüneburg gGmbH, Luneburg, Niedersachsen, Germany
| | - Frauke Petersen
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg, Germany
| | - Ulf Helwig
- Gastroenterology Practice, Oldenburg, Germany
| | | | - Alexander Roessler
- Medical Department, AbbVie Deutschland GmbH and Co KG, Wiesbaden, Hesse, Germany
| | - Stefan Rath
- Medical Department, AbbVie Deutschland GmbH and Co KG, Wiesbaden, Hesse, Germany
| | - Dorothee Lang
- Medical Department, AbbVie Deutschland GmbH and Co KG, Wiesbaden, Hesse, Germany
| | - Torsten Kucharzik
- Department of Gastroenterology, Stadtisches Klinikum Luneburg gGmbH, Luneburg, Germany
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Grytten J, Skau I, Sørensen R, Eskild A. Does the Use of Diagnostic Technology Reduce Fetal Mortality? Health Serv Res 2018; 53:4437-4459. [PMID: 29349772 PMCID: PMC6232411 DOI: 10.1111/1475-6773.12721] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the effect that the introduction of new diagnostic technology in obstetric care has had on fetal death. DATA SOURCE The Medical Birth Registry of Norway provided detailed medical information for approximately 1.2 million deliveries from 1967 to 1995. Information about diagnostic technology was collected directly from the maternity units, using a questionnaire. STUDY DESIGN The data were analyzed using a hospital fixed-effects regression with fetal mortality as the outcome measure. The key independent variables were the introduction of ultrasound and electronic fetal monitoring at each maternity ward. Hospital-specific trends and risk factors of the mother were included as control variables. The richness of the data allowed us to perform several robustness tests. PRINCIPAL FINDING The introduction of ultrasound caused a significant drop in fetal mortality rate, while the introduction of electronic fetal monitoring had no effect on the rate. In the population as a whole, ultrasound contributed to a reduction in fetal deaths of nearly 20 percent. For post-term deliveries, the reduction was well over 50 percent. CONCLUSION The introduction of ultrasound made a major contribution to the decline in fetal mortality at the end of the last century.
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Affiliation(s)
- Jostein Grytten
- Department of Community DentistryUniversity of OsloOsloNorway
- Department of Obstetrics and GynecologyInstitute of Clinical MedicineAkershus University HospitalLørenskogNorway
| | - Irene Skau
- Department of Community DentistryUniversity of OsloOsloNorway
| | | | - Anne Eskild
- Department of Obstetrics and GynecologyInstitute of Clinical MedicineAkershus University HospitalLørenskogNorway
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Zhu WN. Diagnostic value of contrast-enhanced ultrasound versus magnetic resonance imaging in extrahepatic cholangiocarcinoma. Shijie Huaren Xiaohua Zazhi 2018; 26:796-802. [DOI: 10.11569/wcjd.v26.i13.796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the value of contrast-enhanced ultrasound and magnetic resonance imaging in the diagnosis of extrahepatic cholangiocarcinoma (EHCC).
METHODS Forty-six patients with extrahepatic cholangiocarcinoma (ECHH group) diagnosed at our hospital from January 2015 to December 2017 were enrolled. Forty-six patients with extrahepatic bile duct stones (CBDS group) and 46 patients with pancreatic head carcinomas or duodenum papilla disease (PD group) were also included. All patients underwent B-mode ultrasonography (BUS), CEUS, and MRI. Using the pathological diagnosis as the "gold standard", the receiver operating characteristic (ROC) curves were plotted to compare the diagnostic efficacy (including diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value) of the three examination methods for EHCC.
RESULTS There was no significant difference between CEUS and MRI in the arterial phase (χ2 = 1.105, P = 0.602). CEUS showed low enhancement in 86.96% and 100.00% of patients in the portal phase and delayed phase, respectively, which were significantly higher than those of MRI (13.04% and 13.04%, respectively; χ2 = 50.261, 70.769; P = 0.000, 0.000). The ROC curve analysis showed that the area under the curve (AUC) of MRI and CEUS for the diagnosis of EHCC was higher that of BUS (0.924, 0.897 vs 0.690). The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of BUS for EHCC were significantly lower than those of CEUS (χ2 = 0.175, 0.066, 11.467, 37.260, 6.328; P = 0.000, 0.010, 0.001, 0.000, 0.012) and MRI (χ2 = 0.227, 0.098, 13.378, 41.170, 9.082; P = 0.000, 0.002, 0.000, 0.000, 0.003). There was no significant difference in the diagnostic efficacy of CEUS and MRI for EHCC (χ2 = 0.464, 0.383, 0.000, 0.001, 0.334; P = 0.496, 0.536, 1.000, 0.972, 0.563).
CONCLUSION CEUS has high value in the diagnosis of EHCC and can be used as an important complement to MRI.
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Affiliation(s)
- Wei-Nian Zhu
- Department of Ultrasound, Changxing Traditional Chinese Medicine Hospital, Changxing 313100, Zhejiang Province, China
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Dietrich CF, Tana C, Caraiani C, Dong Y. Contrast enhanced ultrasound (CEUS) imaging of solid benign focal liver lesions. Expert Rev Gastroenterol Hepatol 2018; 12:479-489. [PMID: 29658347 DOI: 10.1080/17474124.2018.1464389] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultrasound is well accepted worldwide for imaging of the liver. Absences of radiation exposure, low cost and large diffusion are some of the advantages that make this technique the first to be used in the assessment of focal liver lesions (FLL). Areas covered: Contrast enhanced ultrasound (CEUS) has been introduced more than twenty years ago, and its detection rate is comparable to that of contrast enhanced magnetic resonance imaging (CEMRI) and contrast enhanced computed tomography (CECT). In this narrative review, we discuss the main CEUS features of benign liver lesions and controversies in published results including the gold standard chosen and the quality and knowledge of the preferred techniques. Expert commentary: CEUS is safe and allows an immediate evaluation of the nature of FLL. CEUS permits differentiation between malignant and benign FLL in healthy liver parenchyma by analysing the arterial, portal venous and late phases. CEMRI and CECT are reliable to characterize FLL but higher costs, radiation exposure, nephrotoxicity (in particular for CECT) and absence of real time imaging limit the appropriate evaluation of FLL. Therefore CEUS can be preferred in most clinical situations, and when results are unclear or suggestive for malignant FLL, biopsy and histological examination can be directly initiated avoiding unnecessary additional imaging.
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Affiliation(s)
- Christoph F Dietrich
- a Department of Internal Medicine 2 , Caritas Krankenhaus , Bad Mergentheim , Germany.,b Ultrasound Department , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Claudio Tana
- c Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department , University-Hospital of Parma , Parma , Italy
| | - Cosmin Caraiani
- d Department of Radiology , University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Yi Dong
- e Department of Ultrasound , Zhongshan Hospital, Fudan University , Shanghai , China
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Use of Intestinal Ultrasound to Monitor Crohn's Disease Activity. Clin Gastroenterol Hepatol 2017; 15:535-542.e2. [PMID: 27856365 DOI: 10.1016/j.cgh.2016.10.040] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We performed a multicenter study to determine whether transabdominal bowel wall ultrasonography, a noninvasive procedure that does not require radiation, can be used to monitor progression of Crohn's disease (CD). METHODS We performed a 12-month prospective, noninterventional study at 47 sites in Germany, from December 2010 through September 2014. Our study included 234 adult patients with CD who experienced a flare, defined as Harvey-Bradshaw index score of ≥7. All patients received treatment intensification, most with tumor necrosis factor antagonists. Ultrasound parameters and clinical data were assessed at baseline and then after 3, 6, and 12 months. The primary endpoint was the change in ultrasound parameters within 12 months of study enrollment. RESULTS All patients included had bowel wall alterations either within the terminal ileum and/or segments of the colon. After 3 and 12 months, ultrasonographic examination showed significant improvements of nearly all ultrasound parameters, including reductions in bowel wall thickening or stratification, decreased fibrofatty proliferation, and increased signals in color Doppler ultrasound (P < .01 for all parameters at months 3 and 12). Median Harvey-Bradshaw index scores decreased from 10 at baseline to 2 after 12 months. Improvement in bowel wall thickness correlated with reduced levels of C-reactive protein after 3 months (P ≤ .001). CONCLUSIONS In a multicenter prospective study, we found that ultrasonographic examination can be used to monitor disease activity in patients with active CD. Bowel ultrasonography seems to be an ideal follow-up method to evaluate early transmural changes in disease activity, in response to medical treatment. German Clinical Trials Register: drks.de/DRKS00010805.
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Plentz RR, Boozari B, Malek NP. [Guideline compliant diagnostics of hepatocellular carcinoma]. Radiologe 2015; 54:660-3. [PMID: 24981446 DOI: 10.1007/s00117-014-2651-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer death worldwide. The incidence continues to rise and only a detailed surveillance of patients with chronic liver disease can allow an early assessment. Diagnosis is made by imaging techniques, such as contrast-enhanced ultrasound (CEUS), computed tomography (CT), magnetic resonance imaging (MRI) and also histopathological examination of biopsy material. The determination of the tumor marker alpha fetoprotein (AFP) is no longer established for early detection but can be used as a supplement in addition in HCC history progressio.
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Affiliation(s)
- R R Plentz
- Abteilung Innere Medizin I, Medizinische Universitätsklinik, Otfried-Mueller-Str. 10, 72076, Tübingen, Deutschland
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Jung A, Schlag C, Becker V, von Delius S, Lersch C, Jeliazkova P, Herner A, Bajbouj M, Schuster T, Meining A. Endosonography For Right-sided and Acute Upper Intestinal Misery: the EFRAIM study: A prospective, randomized, controlled, blinded study. United European Gastroenterol J 2014; 1:329-34. [PMID: 24917980 DOI: 10.1177/2050640613498589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/28/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Acute upper abdominal pain is a frequent symptom leading to hospital admission. OBJECTIVE To determine whether a primary intra- and extraluminal diagnostic approach enabled by endoscopic ultrasound is as effective as a conventional diagnostic algorithm of transabdominal ultrasound followed by oesophagogastroduodenoscopy. METHODS A total of 240 patients who presented with acute right-sided and/or upper abdominal pain were prospectively recruited. Exclusion criteria were chronic pain, malignancy, prior abdominal surgery, bleeding, peritonitis, and elevated liver enzymes or lipase as defined 3-times higher than upper reference value. All patients underwent first transabdominal ultrasound and were then randomized (1 : 1) to either endoscopy followed by endoscopic ultrasound or vice versa. Patients and respective examiners were blinded to prior findings. RESULTS A total of 223 patients were included. Endoscopic ultrasound provided a higher diagnostic yield than the combination of transabdominal ultrasound and endoscopy (62.3 vs. 50.7%; p = 0.001). For mucosal/intraluminal lesions, we observed a very good agreement between both endoscopic modalities (kappa 0.89). The agreement for pancreatic and biliary causes was good between both ultrasound modalities (kappa 0.66). CONCLUSIONS Due to its high diagnostic yield, endoscopic ultrasound as a primary diagnostic modality appears to be a valuable option in patients with acute upper abdominal pain.
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Affiliation(s)
- Andreas Jung
- Technischen Universität München, München, Germany
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15
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Dietrich C, Schreiber-Dietrich D, Nürnberg D. Abdominelle Sonographie. DER GASTROENTEROLOGE 2013; 8:341-356. [DOI: 10.1007/s11377-013-0766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
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Friedrich-Rust M, Klopffleisch T, Nierhoff J, Herrmann E, Vermehren J, Schneider MD, Zeuzem S, Bojunga J. Contrast-Enhanced Ultrasound for the differentiation of benign and malignant focal liver lesions: a meta-analysis. Liver Int 2013; 33:739-55. [PMID: 23432804 DOI: 10.1111/liv.12115] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/06/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND International guidelines of Ultrasound recommend the performance of contrast-enhanced ultrasound (CEUS) as the first method of choice after conventional ultrasound for the diagnostic work-up of focal liver lesions. However, these recommendations are based on the results of multiple single studies and only few large multicentre studies. AIMS The rationale of the present systematic review and meta-analysis was to assess the overall sensitivity and specificity of CEUS for the diagnosis of malignant liver lesions. METHODS Literature databases were searched up to March 2012. Inclusion criteria were evaluation of CEUS, assessment of sensitivity and specificity of CEUS for the diagnosis of malignant liver lesions. The meta-analysis was performed using the random-effects model based on the DerSimonian Laird method. Quality analyses were carried out to assess sources of heterogeneity. RESULTS A total of 45 studies with 8147 focal liver lesions were included in the analysis. Overall sensitivity and specificity of CEUS for the diagnosis of malignant liver lesions was 93% (95%-CI: 91-95%) and 90% (95%-CI: 88-92%) respectively. Significant heterogeneity was found between studies. However, subanalysis revealed no significant difference when evaluating studies using histology for all liver lesions, when comparing high-quality and low-quality studies, and blinded vs non-blinded studies. CONCLUSION The results of this meta-analysis support the international recommendations on CEUS for the diagnostic work-up of focal liver lesions selecting patients who need further diagnostics.
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Affiliation(s)
- Mireen Friedrich-Rust
- Department of Internal Medicine 1, J.W.Goethe-University Hospital, Frankfurt, Germany.
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Hinz T, Voth H, Ahmadzadehfar H, Hoeller T, Wenzel J, Bieber T, Schmid-Wendtner MH. Role of high-resolution ultrasound and PET/CT imaging for preoperative characterization of sentinel lymph nodes in cutaneous melanoma. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:30-36. [PMID: 23122637 DOI: 10.1016/j.ultrasmedbio.2012.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/29/2012] [Accepted: 08/29/2012] [Indexed: 06/01/2023]
Abstract
The purpose of our study was the comparison of high-resolution ultrasound (HRUS) and positron emission tomography combined with computerised tomography (PET/CT) in the preoperative characterization and identification of subclinical nodal metastases focusing on sentinel lymph nodes (SLN) in melanoma patients. Patients with cutaneous melanoma (CM) who received sentinel lymph node biopsy at the Department of Dermatology and Allergy, University of Bonn, between January 2009 and January 2011 had been evaluated with a retrospective computer-aided search concerning preoperative staging procedures. A combination of PET/CT and HRUS had been performed preoperatively in 20 of 123 patients. A total of 59 SLNs had been removed in those 20 patients followed by histopathologic examination. HRUS correctly identified two of 17 positive SLNs whereas PET/CT imaging identified none. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HRUS were 11.8 % (95 % confidence interval [CI] = 3.3-34.3), 100 % (95 % CI = 91.6-100.0), 100.0 % (95 % CI = 34.2-100.0), and 73.7 % (95 % CI = 61.0-83.3), respectively. On the basis of this limited study cohort, HRUS had a better value than PET/CT in preoperative identification of positive SLNs, suggesting a possible diagnostic superiority of HRUS in general characterization of peripheral nodal disease in CM.
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Affiliation(s)
- Torsten Hinz
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
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