Correlation between portal vein diameter and craniocaudal length of the spleen

A systematic review and meta-analysis of portal vein morphometry in pediatric and adult populations: Drawing the line between normal and abnormal findings

PURPOSE

The morphometry of the hepatic portal vein is of clinical importance, particularly in pre-operative assessments, surgical management, and diagnoses of liver conditions. This systematic review and meta-analysis aimed to characterize the morphometry of the normal portal vein in both pediatric and adult patients.

METHODS

The study, conducted using the PRISMA guidelines and registered with PROSPERO, utilized the MEDLINE, EMBASE, SCOPUS and Web of Science databases up to May 2020, and updated to May 2023. All studies reporting extractable data on diameter, length, and cross-sectional area (CSA) of the main, left, and right portal veins (PV, LPV, RPV, respectively) were included. The AQUA Tool was used to assess the quality of the included studies. Data analysis included subgroup analyses based on geographical location, sex, age, and imaging modality.

RESULTS

A total of 122 studies with 11,637 subjects were eligible for inclusion. Overall, the pooled mean diameter of the PV (PVD) was 10.09 mm (95% CI: 9.56-10.62). Significant differences in diameter were found between pediatric (6.60 mm; 95% CI: 5.38-7.82) and adult (10.72 mm; 95% CI: 10.25-11.19) subjects. Additionally, there was a significantly larger PVD measurement from computed tomography (CT) than other imaging modalities: CT, 13.28 mm (95% CI: 11.71-14.84); magnetic resonance imaging (MRI), 10.50 mm (95% CI: 9.35-11.66) and ultrasound (US), 9.81 mm (95% CI: 9.47-10.16). The mean diameters of the LPV and RPV were 8.27 mm (95% CI: 6.78-9.77) and 8.33 mm (95% CI: 6.70-9.95), respectively. Mean PV length in adults is 48.63 mm (95% CI: 35.63-61.64). Mean CSA of the PV was 1.09 cm2.

CONCLUSIONS

The study obtained aim to improve the understanding of portal vein anatomy, especially with relevance to surgical interventions of the liver in both pediatric and adult patients. Measurements from ultrasound imaging closely approximates the generated pooled PVD mean for pediatric and adult patients. CT imaging, however, significantly exceeded the established 13 mm threshold for adults. For pediatric patients, a threshold of 8 mm is proposed as a diagnostic upper limit for a normal PVD. Although not significant, the PVD decreased from the portal confluence towards its bifurcation.

Subacromial Content to Subacromial Space Ratio in Neutral Position of the Arm as Diagnostic Criteria of Subacromial Impingement Syndrome

Background

Shoulder impingement syndrome is one of the main causes of shoulder disability of working-class individuals. Currently, dynamic sonography of the shoulder is the modality of choice for the evaluation of shoulder impingement syndrome. The ratio of subacromial contents (SAC) and subacromial space (SAS) in neutral arm position could be used as a diagnostic parameter for the subacromial impingement syndrome (SIS), especially in patients who have difficulties in the elevation of their shoulders due to pain. To use the SAC to SAS ratio as a sonographic criterion for the diagnosis of SIS.

Methods

SAC and SAS of 772 shoulders were vertically measured in coronal view with linear transducer 7-14MHz of Toshiba Xario Prime ultrasound unit, while the patient arm was kept in the neutral position. The ratio of both the measurements was calculated, to be used as a diagnostic parameter of the SIS.

Results

The mean SAS was 10.79 ± 1.94 mm and SAC was 7.65 ± 1.43 mm. SAC-to-SAS ratio for normal shoulders was a focused value with narrow standard deviation (0.66 ± 0.03). However, shoulder impingement is confirmed by any value falls out of the range of ratio for normal shoulders. Area under the curve at 95% confidence interval was 96%, while the sensitivity at 95% confidence interval was 99.25% (97.83%-99.85%), and specificity was 80.86% (76.48%-84.74%).

Conclusion

SAC-to-SAS ratio in neutral arm position is a relatively more accurate sonographic technique for the diagnosis of SIS.

Convolutional neural network for automated segmentation of the liver and its vessels on non-contrast T1 vibe Dixon acquisitions

We evaluated the effectiveness of automated segmentation of the liver and its vessels with a convolutional neural network on non-contrast T1 vibe Dixon acquisitions. A dataset of non-contrast T1 vibe Dixon liver magnetic resonance images was labelled slice-by-slice for the outer liver border, portal, and hepatic veins by an expert. A 3D U-Net convolutional neural network was trained with different combinations of Dixon in-phase, opposed-phase, water, and fat reconstructions. The neural network trained with the single-modal in-phase reconstructions achieved a high performance for liver parenchyma (Dice 0.936 ± 0.02), portal veins (0.634 ± 0.09), and hepatic veins (0.532 ± 0.12) segmentation. No benefit of using multi-modal input was observed (p = 1.0 for all experiments), combining in-phase, opposed-phase, fat, and water reconstruction. Accuracy for differentiation between portal and hepatic veins was 99% for portal veins and 97% for hepatic veins in the central region and slightly lower in the peripheral region (91% for portal veins, 80% for hepatic veins). In conclusion, deep learning-based automated segmentation of the liver and its vessels on non-contrast T1 vibe Dixon was highly effective. The single-modal in-phase input achieved the best performance in segmentation and differentiation between portal and hepatic veins.

Flow Resistance Analysis of Clinically Significant Portal Hypertension in Patients with Liver Cirrhosis

Cirrhosis-induced clinically significant portal hypertension (CSPH) is a fatal disease. Early detection of CSPH is vitally important to reduce the patients' mortality rate. In this study, combined with three-dimensional image construction technology and computational fluid dynamics (CFD), an image-based flow resistance analysis was proposed. The flow resistance analysis was performed for nine cirrhosis patients with CSPH and ten participants without liver diseases, respectively. The results showed that the flow resistance coefficient of the portal vein system in CSPH patients was significantly lower than that in the control group (0.97 ± 0.11 Pa/(mL/s) for CSPH patients; 1.80 ± 0.40 Pa/(mL/s) for the control group; P = 0.028). In contrast, although main portal vein dilation was found in CSPH patients, the cross-sectional area enlargement was not statistically significant (186.01 ± 57.48 mm² for CSPH patients; 166.26 ± 33.74 mm² for the control group; P = 0.39). The research outcomes indicated that the flow resistance analysis was more sensitive than the commonly used vessel size measurement in the detection of CSPH. In summary, we suggest using flow resistance analysis as a supplementary noninvasive method to detect cirrhosis patients with CSPH.

Interobserver agreement on the sonographic severity grading of shoulder impingement syndrome

BACKGROUND

Shoulder impingement syndrome is the painful entrapment of the soft tissues between the acromion and the humeral head. The severity of shoulder impingement could be graded according to the limitation of shoulder joint moment. The reliability of sonographic findings in the grading of shoulder impingement severity grading is required to be evaluated by the consistency of findings between the observers.

PURPOSE

To assess the interobserver agreement in the sonographic severity grading of shoulder impingement syndrome with the help of a ratio between acromion-to-greater tuberosity distance in the abduction and neutral arm position.

MATERIAL AND METHODS

Patients were examined by two independent observers in the coronal approach with neutral arm position. Acromion-to-greater tuberosity distance was measured in abduction and neutral shoulder position. The ratios of the distances in the abduction and neutral position were calculated to grade the severity of shoulder impingement syndrome.

RESULTS

A total of 78 shoulders were included in this study. A strong agreement was found for the grading of shoulder impingement severity grading between the two independent observers with Kappa value of 0.94. And correlation between the results of the two observers for the severity grading of shoulder impingement syndrome was significant at 0.01 level.

CONCLUSION

Severity grading of the shoulder impingement syndrome was performed based on the ratio of acromion-to-greater tuberosity distance in abduction and neutral arm position. However, the sonographic findings were consistent and a strong interobserver agreement was seen in this sonographic severity grading.

Sonographic Evaluation of Various Causes of Female Infertility: A Literature Review

Objective:

Female infertility may be a commonly encountered problem that presently accounts for a great percentage of women seeking gynecologic services. A systematic review was preformed to evaluate the most common cause of infertility, using sonography.

Materials and Methods:

A search was executed with Google Scholar, PubMed, NCBI, and Medscape databases, from 2001 to 2020. Two investigators independently reviewed and assessed those studies for eligibility. The data were tabulated in a Microsoft Excel sheet. The Statistical Package for the Social Sciences (SPSS), version 24 software was used to evaluate the data.

Results:

Out of 70 studies, the contributing factors, detected with sonography, for infertility were as follows: polycystic ovarian syndrome (PCOS), 44.9%; fibroids, 43.6%; endometriosis, 33.3%; polyps, 29.5%; adhesions, 29.5%; pelvic inflammatory disease, 23.1%; ovarian cysts, 23.1%; congenital anomalies, 20.5%; and adenomyosis, 11.5%.

Conclusion:

The most common cause of infertility, detected with sonography, was PCOS, and the least contributor to infertility was adenomyosis.