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Chủ Nhật, 28 tháng 6, 2015

J U M 7-2015

Selected Abstracts 1. Abstract 1 Conditionally Increased Acoustic Pressures in Nonfetal Diagnostic Ultrasound Examinations Without Contrast Agents: A Preliminary Assessment JUM July 2015 34:1-41; doi:10.7863/ultra.34.7.15.13.0001 o Abstract o Full Article o PDF 2. Abstract 2 \Assessment of the Postoperative Appearance of the Rotator Cuff Tendon Using Serial Sonography After Arthroscopic Repair of a Rotator Cuff Tear JUM July 2015 34:1183-1190; doi:10.7863/ultra.34.7.1183 o Abstract o Full Article o PDF 3. Abstract 3 Combination of Virtual Touch Tissue Imaging and Virtual Touch Tissue Quantification for Differential Diagnosis of Breast Lesions JUM July 2015 34:1201-1208; doi:10.7863/ultra.34.7.1201 o Abstract o Full Article o PDF 4. Abstract 4 A Predictive Model for Selecting Malignant Thyroid Nodules in Patients With Nondiagnostic or Indeterminate Fine-Needle Aspiration Cytologic Findings JUM July 2015 34:1245-1251; doi:10.7863/ultra.34.7.1245 o Abstract o Full Article o PDF 5. Abstract 5 6. Original Research: Integrating Sonography Training Into Undergraduate Medical Education: A Study of the Previous Exposure of One Institution’s Incoming Residents JUM July 2015 34:1253-1257; doi:10.7863/ultra.34.7.1253 o Abstract o Full Article o PDF 7. Abstract 6 Sonography of the Optic Nerve Sheath Diameter for Detection of Raised Intracranial Pressure Compared to Computed Tomography: A Systematic Review and Meta-analysis JUM July 2015 34:1285-1294; doi:10.7863/ultra.34.7.1285 o Abstract o Full Article o PDF 8. Abstract 7 The Ultrasound-Only Central Venous Catheter Placement and Confirmation Procedure JUM July 2015 34:1301-1306; doi:10.7863/ultra.34.7.1301 o Abstract o Full Article o PDF o Video 9. Abstract 8 10. Pictorial Essay: Value of Intraoperative Sonography in Pancreatic Surgery JUM July 2015 34:1307-1318; doi:10.7863/ultra.34.7.1307 o Abstract o Full Article o PDF o Videos

1.  Abstract 1 of 8 Online Only Conditionally Increased Acoustic Pressures in Nonfetal Diagnostic Ultrasound Examinations Without Contrast Agents: A Preliminary Assessment The mechanical index (MI) has been used by the US Food and Drug Administration (FDA) since 1992 for regulatory decisions regarding the acoustic output of diagnostic ultrasound equipment. Its formula is based on predictions of acoustic cavitation under specific conditions. Since its implementation over 2 decades ago, new imaging modes have been developed that employ unique beam sequences exploiting higher-order acoustic phenomena, and, concurrently, studies of the bioeffects of ultrasound under a range of imaging scenarios have been conducted. In 2012, the American Institute of Ultrasound in Medicine Technical Standards Committee convened a working group of its Output Standards Subcommittee to examine and report on the potential risks and benefits of the use of conditionally increased acoustic pressures (CIP) under specific diagnostic imaging scenarios. The term “conditionally” is included to indicate that CIP would be considered on a per-patient basis for the duration required to obtain the necessary diagnostic information. This document is a result of that effort. In summary, a fundamental assumption in the MI calculation is the presence of a preexisting gas body. For tissues not known to contain preexisting gas bodies, based on theoretical predications and experimentally reported cavitation thresholds, we find this assumption to be invalid. We thus conclude that exceeding the recommended maximum MI level given in the FDA guidance could be warranted without concern for increased risk of cavitation in these tissues. However, there is limited literature assessing the potential clinical benefit of exceeding the MI guidelines in these tissues. The report proposes a 3-tiered approach for CIP that follows the model for employing elevated output in magnetic resonance imaging and concludes with summary recommendations to facilitate Institutional Review Board (IRB)-monitored clinical studies investigating CIP in specific tissues. o © 2015 by the American Institute of Ultrasound in Medicine Full Article

 2. Abstract 2 of 8 Original Research Assessment of the Postoperative Appearance of the Rotator Cuff Tendon Using Serial Sonography After Arthroscopic Repair of a Rotator Cuff Tear Objectives—The purpose of this study was to evaluate serial changes in sonographic findings of a rotator cuff tendon after rotator cuff repair. Methods—Sixty-five arthroscopically repaired rotator cuff tears (43 full-thickness tears and 22 partial-thickness tears) were retrospectively included in this study. Serial sonographic examinations were performed at 5 weeks, 3 months, and 6 months after surgery. The sonographic findings of the repaired tendon were assessed for a recurrent tear, tendon thickness, morphologic tendon characteristics, vascularity, and bursitis at each time point. Results—Four recurrent tears occurred within 3 months of surgery. The postoperative tendon thickness decreased from 5 weeks to 6 months after surgery (P = .001). There were significant changes in the morphologic tendon characteristics, including the echo texture, fibrillar pattern, and surface irregularity of the repaired tendon, from 5 weeks to 6 months after surgery (P under .001). Additionally, subacromial-subdeltoid bursitis and the vascularity of the repaired tendon decreased postoperatively over time. Conclusions—Serial sonography after arthroscopic rotator cuff repair was useful for monitoring the postoperative changes in a repaired tendon. The morphologic appearance of the repaired tendon and peritendinous soft tissue changes improved over time and nearly normalized within 6 months of surgery. o arthroscopic tendon repair o musculoskeletal ultrasound o rotator cuff o sonography o Received August 6, 2014. o Revision received August 27, 2014. o Accepted September 22, 2014. o © 2015 by the American Institute of Ultrasound in Medicine Full Article

 3.Abstract 3 of 8 Original Research Combination of Virtual Touch Tissue Imaging and Virtual Touch Tissue Quantification for Differential Diagnosis of Breast Lesions Objectives—Breast cancer is the second leading cause of death from cancer in women, and early detection is the key to successful treatment. Unfortunately, even with technological advances, the specificity of imaging modalities is still low. Therefore, we evaluated the value of a newly developed noninvasive technique, acoustic radiation force impulse imaging, for differentiating benign versus malignant breast lesions. Methods—We prospectively examined 141 breast lesions in 122 patients. All lesions were classified according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography, BI-RADS for sonography, and Virtual Touch tissue imaging (VTI; Siemens Medical Solutions, Mountain View, CA) pattern. Internal and marginal shear wave velocity (SWV) values for the lesions were noted. The sensitivity, specificity, accuracy, and positive and negative predictive values for VTI and Virtual Touch tissue quantification (VTQ; Siemens Medical Solutions) were calculated. Results—The marginal SWV values were statistically higher in malignant lesions (mean ± SD, 5.41 ± 1.37 m/s) than benign lesions (2.91 ± 0.88 m/s; P under .001). When the SWV cutoff level was set at 4.07 m/s, and the higher of the internal and marginal values was adopted, the combination of VTI and VTQ showed 95.1% sensitivity, 99.0% specificity, and 97.8% accuracy. Conclusions—Breast Imaging Reporting and Data System category 4 lesions are the main focus of research for early detection of breast cancer. Unfortunately, BI-RADS category 4 assessment covers a wide range of likelihood of malignancy (2%–95%). This wide range reflects the necessity for a more specific imaging modality. The combination of VTI and VTQ could increase the diagnostic performance of conventional sonography. o acoustic radiation force impulse imaging o breast cancer o breast ultrasound o shear wave velocity o Virtual Touch tissue imaging o Virtual Touch tissue quantification o Received August 8, 2014. o Revision received September 10, 2014. o Accepted October 3, 2014. o © 2015 by the American Institute of Ultrasound in Medicine Full Article

 4. Abstract 4 of 8 Original Research A Predictive Model for Selecting Malignant Thyroid Nodules in Patients With Nondiagnostic or Indeterminate Fine-Needle Aspiration Cytologic Findings Objectives—The management of nodules with nondiagnostic or indeterminate fine-needle aspiration cytologic findings remains challenging. This study evaluated the clinical differences, conventional sonographic findings, elastographic findings, and cytologic findings for predicting thyroid malignancy. Methods—A total of 167 patients with a nondiagnostic or indeterminate thyroid fine-needle aspiration cytologic findings were enrolled in this study. The clinicopathologic and sonographic data from the patients were analyzed retrospectively to determine the independent predictive factors for thyroid malignancy. Then a scoring system was designed on the basis of statistically significant predictors. Results—Fine-needle aspiration cytologic findings, Thyroid Imaging Reporting and Data System categorization, and elastographic findings were independent predictive factors for thyroid cancer on multivariate analysis. The index points were statistically significant, with a score higher than 3 favoring malignant nodules with sensitivity of 79.37%, specificity of 85.85%, a positive predictive value of 76.9%, and a negative predictive value of 87.3%. Conclusions—For patients with nondiagnostic or indeterminate fine-needle aspiration cytologic findings, our scoring system for prediction of thyroid malignancy can be another choice. We suggest surgery for nodules with index points higher than 3. For nodules with index points of 3 or lower, observation and regular follow-up are recommended. o cytopathology o fine-needle aspiration o head and neck ultrasound o sonography o thyroid cancer o thyroid nodules o Received July 18, 2014. o Revision received August 7, 2014. o Accepted October 16, 2014. o © 2015 by the American Institute of Ultrasound in Medicine Full Article

 5. Abstract 5 of 8 Original Research Integrating Sonography Training Into Undergraduate Medical Education A Study of the Previous Exposure of One Institution’s Incoming Residents Objectives—Sonography is a crucial and versatile tool within the field of medicine. Recent advancements in technology have led to increased use of point-of-care sonography. We designed a survey to assess prior point-of-care sonography training among incoming interns at an academic teaching hospital. Methods—In 2012 and 2013, we surveyed incoming interns (n = 154 and 145, respectively) regarding point-of-care sonography training received during medical school. The survey questions included formal didactic sessions, bedside instruction, and the use of simulation technology. Results—One-fourth (26.3% in 2012 and 23.4% in 2013) of responding interns reported having never done an ultrasound scan at the bedside. In 2012 and 2013, 55.0% and 55.6% of respondents reported never having done an ultrasound scan in a simulation center, respectively. Interns agreed that sonography education should be provided during medical school. On average, interns disagreed with the statement that sonography should be taught in residency only. There was no significant difference in the sex or general previous experience with sonography across both intern classes. Conclusions—Point-of-care sonography is inconsistently taught in medical school. The interns in our study also thought that sonography education should begin in medical school, and sonography should be taught by using simulation and at the bedside. o graduate medical education o intern o medical education o point-of-care sonography o sonography training o ultrasound education o undergraduate medical education o Received July 7, 2014. o Revision received September 3, 2014. o Accepted October 8, 2014. o © 2015 by the American Institute of Ultrasound in Medicine Full Article


 6. Abstract 6 of 8 Original Research Sonography of the Optic Nerve Sheath Diameter for Detection of Raised Intracranial Pressure Compared to Computed Tomography A Systematic Review and Meta-analysis Objectives—The diagnosis of raised intracranial pressure (ICP) is important in many critically ill patients. The optic nerve sheath is contiguous with the subarachnoid space; thus, an increase in ICP results in a corresponding increase in the optic nerve sheath diameter. The objective of this study was to assess the diagnostic accuracy of sonography of the optic nerve sheath diameter compared to computed tomography (CT) for predicting raised ICP. Methods—We searched PubMed, EMBASE, and the Cochrane database from 1986 to August 2013 and performed hand searches. Two independent reviewers extracted data. Study quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. We calculated κ agreement for study selection and evaluated clinical and quality homogeneity before the meta-analysis. Results—From 1214 studies, we selected 45 for full review. Twelve studies with 478 participants were included (κ = 0.89). Ocular sonography yielded sensitivity of 95.6% (95% confidence interval [CI], 87.7%–98.5%), specificity of 92.3% (95% CI, 77.9%–98.4%), a positive likelihood ratio of 12.5 (95% CI, 4.16–37.5), and a negative likelihood ratio of 0.05 (95% CI, 0.02–0.14). Average quality according to the QUADAS tool was 7.4 of 11. There was moderate to high heterogeneity based on the prediction ellipse area and variance logit of sensitivity (2.1754) and specificity (2.6720). Conclusions—Ocular sonography shows good diagnostic test accuracy for detecting raised ICP compared to CT: specifically, high sensitivity for ruling out raised ICP in a low-risk group and high specificity for ruling in raised ICP in a high-risk group. This noninvasive point-of-care method could lead to rapid interventions for raised ICP, assist centers without CT, and monitor patients during transport or as part of a protocol to reduce CT use. o emergency department o emergency ultrasound o intracranial pressure o optic nerve sheath o point-of-care ultrasound o Received July 15, 2014. o Revision received August 8, 2014. o Accepted October 19, 2014. o © 2015 by the American Institute of Ultrasound in Medicine Full Article

 7. Abstract 7 of 8 Technical Innovation The Ultrasound-Only Central Venous Catheter Placement and Confirmation Procedure The placement of a central venous catheter remains an important intervention in the care of critically ill patients in the emergency department. We propose an ultrasound-first protocol for 3 aspects of central venous catheter placement above the diaphragm: dynamic procedural guidance, evaluation for pneumothorax, and confirmation of the catheter tip location. o central venous access o central venous catheter placement o contrast-enhanced ultrasound o emergency ultrasound o iatrogenic pneumothorax o Received September 22, 2014. o Revision received October 9, 2014. o Accepted October 24, 2014. o © 2015 by the American Institute of Ultrasound in Medicine Full Article

 8. Abstract 8 of 8 Pictorial Essay Value of Intraoperative Sonography in Pancreatic Surgery The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease.1–8 Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care—the surgeon’s scalpel—can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct or other vital structures. o gastrointestinal ultrasound o inflammation o intraoperative o neoplastic o neuroendocrine tumors o pancreas o Received July 10, 2014. o Revision received August 8, 2014. o Accepted September 23, 2014. o © 2015 by the American Institute of Ultrasound in Medicine Full Article

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