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Thứ Tư, 5 tháng 8, 2015

J U M 8-2015

Selected Abstracts
Original Research:Ultrasound Education—A Multimodal Educational Approach in the Predoctoral Setting: A Pilot Study JUM August 2015 34:1437-1443; doi:10.7863/ultra.34.8.1437
Original Research:Musculoskeletal Sonography for Evaluation of Anatomic Variations of Extensor Tendon Synovial Sheaths in the   August 2015 34:1445-1452; doi:10.7863/ultra.34.8.1445
Original Research:Ultrasound-Guided Intratendinous Injections With Platelet-Rich Plasma or Autologous Whole Blood for Treatment of Proximal Hamstring Tendinopathy: A Double-Blind Randomized Controlled Trial  JUM August 2015 34:1455-1463; doi:10.7863/ultra.34.8.1455
Original Research: Sonographic Features of Superficial-Type Nodular Fasciitis in the Musculoskeletal System JUM August 2015 34:1465-1471; doi:10.7863/ultra.34.8.1465
Case Series: Sonographic Findings of Subcutaneous Sarcoidosis in 3 Cases JUM August 2015 34:1485-1488; doi:10.7863/ultra.34.8.1485
Case Series: Sonographic Findings in Fetal Renal Vein Thrombosis JUM August 2015 34:1509-1514; doi:10.7863/ultra.34.8.1509
1.       Abstract 1 of 6 Original Research
Head and Neck Ultrasound Education—A Multimodal Educational Approach in the Predoctoral Setting
A Pilot Study
Objectives—With the increased implementation of ultrasound in medical education, it is important to continually improve instructional methods. In this study, we demonstrate that by augmenting the traditional methods of instructor demonstration and student practice on a healthy volunteer with additional modalities, such as didactic presentation, simulated pathologic cases, and simulated procedures, students gain a more comprehensive understanding of and confidence in ultrasound technique and pathology.
Methods—A multimodal curriculum was developed and applied to head and neck ultrasound sessions of our institution’s Ultrasound Symposium. Participants were asked to fill out surveys rating each instructional modality as well as preinstructional and postinstructional confidence. The survey results were divided into a group of first- and second-year medical students who had previous ultrasound training and a group of third- and fourth-year students who were ultrasound “naïve.”
Results—The survey showed that the first- and second-year student group (n = 8) had an average preinstructional confidence of 4.14/10 compared to 1.44/10 in the third- and fourth-year student group (n = 9) (P = .003). Following the instructional sessions, the students’ confidence increased respectively to 8.14/10 and 7.78/10 (P= .53), showing a 4.00 (96%) increase in the first- and second-year group and a 6.34 (440%) increase in the third- and fourth-year group. The combined results of all student teaching modality ratings showed that instructor demonstration was rated the highest (9.47) and computerized simulation lowest (8.25).
Conclusions—Overall, our study shows that multimodal ultrasound instruction was beneficial in increasing both ultrasound-trained and ultrasound-naïve medical students’ confidence in head and neck ultrasound.
o    © 2015 by the American Institute of Ultrasound in Medicine
2.       Abstract 2 of 6 Original Research
Musculoskeletal Sonography for Evaluation of Anatomic Variations of Extensor Tendon Synovial Sheaths in the Wrist
Objectives—The purpose of this article is to show the anatomic variations of extensor tendon synovial sheaths in the wrist.
Methods—Videos from 157 patients that were available in the electronic database were reviewed. Sonography showed involvement of 186 tendon sheaths.
Results—We describe our center’s experience with most tendon variants described in the literature and show the sonographic appearance of the most frequent ones.
Conclusions—Sonography is an accepted, safe, and efficient method for evaluating conditions characterized by effusion into the synovial sheaths of the wrist extensor tendons. Knowledge of anatomy and anatomic abnormalities of these sheaths is essential for diagnosis and for correct ultrasound-guided injection therapy or, less frequently, planning a surgical approach.
o    © 2015 by the American Institute of Ultrasound in Medicine
3.       Abstract 3 of 6  Original Research
Ultrasound-Guided Intratendinous Injections With Platelet-Rich Plasma or Autologous Whole Blood for Treatment of Proximal Hamstring Tendinopathy
A Double-Blind Randomized Controlled Trial
Objectives—To compare the effects of ultrasound-guided platelet-rich plasma (PRP) and whole blood (WB) injections in patients with chronic hamstring tendinopathy.
Methods—In a prospective double-blind randomized controlled trial, PRP or WB was injected under ultrasound guidance into the proximal hamstring tendon in a cohort of patients with clinically suspected hamstring tendinosis. Questionnaires were administered before injection and 2, 6, and 12 weeks and 6 months after injection. Pain and function outcomes were measured via the Modified Harris Hip Score (MHHS), Hip Outcome Scores for activities of daily living (ADL) and sport-specific function, and International Hip Outcome Tool 33 (IHOT-33). Diagnostic ultrasound was used to compare preinjection and 6-month postinjection tendon appearances.
Results—The WB group showed greater improvements in pain and function over the PRP group before 12 weeks, whereas the PRP group showed improved outcomes over WB at 6 months. None of these between-group outcome measures, except 6-week IHOT-33, showed statistical significance. Comparing preinjection and 6-month scores, the PRP group showed significant improvements in ADL (P = .018) and IHOT-33 (P = .28) scores, whereas the WB group showed no significant improvements from baseline. The WB group showed significantly decreased pain with 15-minute sitting (P= .008) at 6 months. Ultrasound imaging showed no significant differences between PRP and WB group tendon appearances.
Conclusions—Both PRP and WB groups showed improvements in all outcome measures at 6 months. The PRP group showed significant improvements in 6-month ADL and IHOT-33 scores. The WB group reached significance in 15-minute sitting pain. No significant between-group differences were observed at any time point.
o    © 2015 by the American Institute of Ultrasound in Medicine
4.       Abstract 4 of 6 Original Research
Sonographic Features of Superficial-Type Nodular Fasciitis in the Musculoskeletal System
Objectives—We evaluated the sonographic features of superficial-type nodular fasciitis in 9 pathologically proven cases.
Methods—Review of the radiology and pathology databases yielded 14 cases of histologically proven superficial-type nodular fasciitis, which was defined as nodular fasciitis located in the subcutaneous fat layer or outer muscle fascia between the subcutaneous fat layer and muscle. Sonograms were available in 9 patients. Two musculoskeletal radiologists retrospectively reviewed all cases in consensus. Imaging features evaluated included the fasciitis location in the body, size, relationship with the fascia, echogenicity, vascularity, and location of the center.
Results—There were 4 male and 5 female patients. The mean age was 35 years (range, 8–49 years). The masses ranged in size from 0.8 to 2 cm, with 90% measuring less than 1.8 cm. Five masses developed in the forearm (4 cases) or elbow (1 case). Six masses were located in the subcutaneous fat layer, and 3 masses were in the fascia. Seven masses were in direct contact with the outer muscle fascia, whereas 2 masses were indistinctly in contact with the fascia. These masses showed a hypoechoic background with echogenic foci or peripheral hyperechoic nodules. In all 3 of the masses within the fascia, the findings were similar to those of neurogenic tumors. The vascularity of the masses was variable, but most (7 of 9 cases) showed no substantial vascularity. All masses had centers of less than half the thickness of the subcutaneous fat layer.
Conclusions—Superficial-type nodular fasciitis is often located in the deep subcutaneous fat near the muscle fascia, has a hypoechoic appearance with echogenic foci or peripheral hyperechoic nodules, and quite often does not show internal vascular flow. If a superficial soft tissue mass has the above findings, superficial-type nodular fasciitis should be included in the differential diagnosis.

o    © 2015 by the American Institute of Ultrasound in Medicine
5.       Abstract 5 of 6  Case Series
Sonographic Findings of Subcutaneous Sarcoidosis in 3 Cases
Subcutaneous sarcoidosis occurs infrequently among cases of cutaneous sarcoidosis. To our knowledge, few studies have described the sonographic characteristics of subcutaneous sarcoidosis. Here we report the sonographic characteristics of 3 cases of this condition. Our results revealed 4 features: (1) an irregular hypoechoic appearance, (2) heterogeneous echogenicity, (3) perilesional hyperechoic changes, and (4) abnormal Doppler signals. Sonography is a rapid, simple, and noninvasive procedure that is useful for initial evaluation of granulomatous lesions such as subcutaneous sarcoidosis.
o    © 2015 by the American Institute of Ultrasound in Medicine
6.       Abstract 6 of 6  Case Series
Sonographic Findings in Fetal Renal Vein Thrombosis
We present the sonographic findings of fetal renal vein thrombosis in a series of 6 patients. The mean gestational age at diagnosis was 31.2 weeks. Four cases were unilateral, and 2 were bilateral. The most common findings were renal enlargement and intrarenal vascular calcifications, followed by increased renal parenchymal echogenicity. Inferior vena cava thrombosis was found in 4 patients and common iliac vein thrombosis in 2. Fetal renal vein thrombosis is an uncommon diagnosis with characteristic sonographic findings. The presence of these findings should prompt Doppler interrogation of the renal vein and inferior vena cava to confirm the diagnosis.

o    © 2015 by the American Institute of Ultrasound in Medicine

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