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Thứ Hai, 1 tháng 2, 2016

J U M Feb 2016

1.       Abstract 1 of 7Original Research
Application of Quasistatic Ultrasound Elastography for Examination of Scrotal Lesions
Objectives—The aims of this study were to investigate the value of applying quasistatic ultrasound elastography for examination of scrotal lesions, to investigate the features of normal testes on quasistatic elastography, and to establish whether testicular and epididymal lesions had specific quasistatic elastographic features.
Methods—We screened 1073 patients who underwent color Doppler sonographic examinations of the testes and epididymides in our hospital and performed quasistatic elastography to evaluate their sonographic features. Measurement data were expressed as mean ± SD. For intergroup comparisons, we used paired t tests and independent-samples t tests, withP < .05 considered significant.
Results—Quasistatic elastography did not reveal any testicular or epididymal abnormalities in 625 cases. Seven cases showed testicular torsion; 3 cases showed testicular space-occupying lesions (1 case each of a testicular teratoma, testicular seminoma, and testicular endodermal sinus tumor); 176 cases showed epididymal lesions (138 cases of caudal epididymal inflammatory masses, 37 cases of caput epididymal cysts, and 1 case of an epididymal lymphangioma); and 262 cases showed varicocele. The normal testicular elastographic appearance showed a 3-ring structure: red surrounding bands with a blue edge region and a green central area. The stiffness in cases of testicular torsion, testicular space-occupying lesions, and epididymal lesions was increased, whereas caput epididymal cysts of different diameters appeared either as green, blue-green-red, or “scooped out.” Elastographic results for patients with varicocele were not different from those for normal testes.
Conclusions—Quasistatic elastography can reflect the relative stiffness of the testis and its surrounding tissues, thus providing a novel, reliable, convenient, and noninvasive method for clinical detection of testicular stiffness and related pathologic changes.
o    © 2016 by the American Institute of Ultrasound in Medicine

2.       Abstract 2 of 7Original Research
Ex Vivo Assessment of Sentinel Lymph Nodes in Breast Cancer Using Shear Wave Elastography
Objectives—Axillary lymph node status is one of the important prognostic factors in early-stage breast cancer. Despite the combined use of sonography, fine-needle aspiration, and sentinel lymph node (SLN) dissection, there is a gap between the potential effectiveness of those techniques and current success to determine the axillary lymph node status. The main aim of this study was to evaluate the baseline accuracy of shear wave elastography for differentiation of benign versus malignant SLNs in an ex vivo artifact-free environment.
Methods—Thirty patients with breast cancer scheduled for SLN dissection were enrolled prospectively after informed consent and Institutional Review Board approval were obtained. After dissection, lymph nodes were embedded in ultrasound gel and examined with grayscale sonography and shear wave elastography. Findings were compared to histopathologic results.
Results—A total of 64 SLNs obtained from the 30 patients were evaluated. Twelve of them (18.8%) were metastatic, and 52 (81.2%) were benign. The mean cortical thickness (benign versus metastatic, 1.6 versus 4.4 mm), short-axis length (4.63 versus 7.50 mm), cortical stiffness (10.7 versus 25.5 kPa), and hilar stiffness (7.5 versus 11.3 kPa) were statistically higher in metastatic lymph nodes (P ≤ .02). Area under the receiver operator characteristic curve values for these variables were 0.814, 0.768, 0.786, and 0.759, respectively. Cortical thickness was found to have the highest diagnostic performance, followed by cortical stiffness.
Conclusions—Shear wave elastography can be used with grayscale sonography for evaluation of cases to decide on needle biopsy sampling. However, it cannot be used as a replacement for fine-needle aspiration or SLN dissection.

o    © 2016 by the American Institute of Ultrasound in Medicine

3.       Abstract 3 of 7Original Research
Renal Cell Carcinomas
Sonographic Appearance Depending on Size and Histologic Type
Objectives—Prior studies have demonstrated that approximately 10% of malignant renal cell carcinomas are as echogenic as angiomyolipomas on sonography. However, a recent presentation suggested that small (<1-cm also="" always="" angiomyolipomas="" are="" as="" be="" benign="" carcinoma="" carcinomas="" cases="" cell="" confirm="" corresponding="" detected="" echogenic="" entities.="" examined="" hyperechoic="" masses="" may="" o:p="" of="" on="" or="" other="" our="" own="" renal="" some="" sonography.="" sonography="" that="" therefore="" to="" we="" with="">
Methods—Institutional Review Board approval and Health Insurance Portability and Accountability Act compliance were maintained for this retrospective review of 91 pathologically proven cases of renal cell carcinoma, with corresponding sonography. Tumors were first differentiated by histologic cell type (clear cell, papillary, and chromophobe). Tumors were then stratified according to 2 size group parameters, falling into those that were 3 cm or larger and those that were smaller than 3 cm in diameter, with the less than 3-cm group further subdivided into 2 cm or smaller and greater than 2 cm. Tumor echogenicity was graded on a 5-point scale with respect to the renal parenchyma.
Results—Forty-six tumors (51%) were 3 cm in diameter or smaller, and most were found to be either isoechoic (35%) or mildly hyperechoic (26%) to the surrounding renal parenchyma. Of tumors smaller than 2 cm, most were either mildly hyperechoic (29%) or as hyperechoic as renal sinus fat (very hyperechoic; 29%). Tumors larger than 3 cm were found most often to be either isoechoic (49%) or mildly hyperechoic (33%), with only 4% found to be very hyperechoic.
Conclusions—The sonographic appearances of renal cell carcinomas include a small population that are very hyperechoic on sonography and thus could potentially be misdiagnosed as angiomyolipomas.
o    © 2016 by the American Institute of Ultrasound in Medicine

4.       Abstract 4 of 7Original Research
Diagnostic Accuracy of SuperSonic Shear Imaging for Staging of Liver Fibrosis
A Meta-analysis
Objectives—The purpose of this study was to assess the performance of SuperSonic shear imaging (SuperSonic Imagine SA, Aix-en-Provence, France) for diagnosis of liver fibrosis.
Methods—Literature databases were searched to identify relevant studies from inception to February 28, 2015. Sensitivity, specificity, and other information were extracted from the studies. Pooled data were calculated by a bivariate mixed-effects binary regression model. Subgroup and sensitivity analyses were performed. Publication bias was tested by funnel plots.
Results—Twelve studies were included in this meta-analysis and reported on 1635 patients. The pooled sensitivity and specificity were 0.78 (95% confidence interval [CI], 0.69–0.85) and 0.95 (95% CI, 0.75–0.99), respectively, for fibrosis stages F≥1, 0.84 (95% CI, 0.81–0.86) and 0.81 (95% CI, 0.74–0.87) for F≥2, 0.89 (95% CI, 0.85–0.93) and 0.84 (95% CI, 0.77–0.89) for F≥3, and 0.88 (95% CI, 0.82–0.91) and 0.86 (95% CI, 0.81–0.90) for F=4. The areas under the summary receiver operating characteristic curves were 0.87 (95% CI, 0.84–0.90) for F≥1, 0.85 (95% CI, 0.81–0.88) for F≥2, 0.93 (95% CI, 0.91–0.95) for F≥3, and 0.93 (95% CI, 0.90–0.95) for F=4. No significant publication bias was found.
Conclusions—SuperSonic shear imaging could be used for staging of liver fibrosis. Especially, it has high diagnostic accuracy for severe fibrosis and cirrhosis.
o    © 2016 by the American Institute of Ultrasound in Medicine


5.       Abstract 5 of 7Original Research
Performance of 2-Dimensional Ultrasound Shear Wave Elastography in Liver Fibrosis Detection Using Magnetic Resonance Elastography as the Reference Standard
A Pilot Study
Objectives—To investigate the correlation between 2-dimensional (2D) ultrasound shear wave elastography (SWE) and magnetic resonance elastography (MRE) in liver stiffness measurement and the diagnostic performance of 2D SWE for liver fibrosis when imaging from different intercostal spaces and using MRE as the reference standard.
Methods—Two-dimensional SWE was performed on 47 patients. One patient was excluded from the study. Each of the remaining 46 patients underwent same-day MRE for clinical purposes. The study was compliant with the Health Insurance Portability and Accountability Act and approved by the Institutional Review Board. Informed consent was obtained from each patient. Two-dimensional SWE measurements were acquired from the ninth, eighth, and seventh intercostal spaces. The correlation with MRE was calculated at each intercostal space and multiple intercostal spaces combined. The performance of 2D SWE in diagnosing liver fibrosis was evaluated by receiver operating characteristic curve analysis using MRE as the standard.
Results—The 47 patients who initially underwent 2D SWE included 22 female and 25 male patients (age range, 19–77 years). The highest correlation between 2D SWE and MRE was from the eighth and seventh intercostal spaces (r = 0.68–0.76). The ranges of the areas under the receiver operating characteristic curves for separating normal or inflamed livers from fibrotic livers using MRE as the clinical reference were 0.84 to 0.92 when using the eighth and seventh intercostal spaces individually and 0.89 to 0.90 when combined.
Conclusions—The results suggest that 2D SWE and MRE are well correlated when SWE is performed at the eighth and seventh intercostal spaces. The ninth intercostal space is less reliable for diagnosing fibrosis with 2D SWE. Combining measurements from multiple intercostal spaces does not significantly improve the performance of 2D SWE for detection of fibrosis.
o    \© 2016 by the American Institute of Ultrasound in Medicine

6.       Abstract 6 of 7Original Research
Integration of Ultrasound in Medical Education at United States Medical Schools
A National Survey of Directors’ Experiences
Objectives—Despite the rise of ultrasound in medical education (USMED), multiple barriers impede the implementation of such curricula in medical schools. No studies to date have surveyed individuals who are successfully championing USMED programs. This study aimed to investigate the experiences with ultrasound integration as perceived by active USMED directors across the United States.
Methods—In 2014, all allopathic and osteopathic medical schools in the United States were contacted regarding their status with ultrasound education. For schools with required point-of-care ultrasound curricula, we identified the USMED directors in charge of the ultrasound programs and sent them a 27-question survey. The survey included background information about the directors, ultrasound program details, the barriers directors faced toward implementation, and the directors’ attitudes toward ultrasound education.
Results—One-hundred seventy-three medical schools were contacted, and 48 (27.7%) reported having a formal USMED curriculum. Thirty-six USMED directors responded to the survey. The average number of years of USMED curriculum integration was 2.8 years (SD, 2.9). Mandatory ultrasound curricula had most commonly been implemented into years 1 and 2 of medical school (71.4% and 62.9%, respectively). The most common barriers faced by these directors when implementing their ultrasound programs were the lack of funding for faculty/ equipment (52.9%) and lack of time in current medical curricula (50.0%).
Conclusions—Financial commitments and the full schedules of medical schools are the current prevailing roadblocks to implementation of ultrasound education. Experiences drawn from current USMED directors in this study may be used to help programs starting their own curricula.
o    © 2016 by the American Institute of Ultrasound in Medicine

7.       Abstract 7 of 7Original Research
Medical Student Core Clinical Ultrasound Milestones
A Consensus Among Directors in the United States
Objectives—Many medical schools are implementing point-of-care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point-of-care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point-of-care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed.
Methods—An initial list of 205 potential clinical ultrasound milestones was developed through a literature review. An expert panel consisting of 34 USMED directors across the United States was used to produce consensus on clinical ultrasound milestones through 2 rounds of a modified Delphi technique, an established anonymous process to obtain consensus through multiple rounds of quantitative questionnaires.
Results—There was a 100% response rate from the 34 USMED directors in both rounds 1 and 2 of the modified Delphi protocol. After the first round, 2 milestones were revised to improve clarity, and 9 were added on the basis of comments from the USMED directors, resulting in 214 milestones forwarded to round 2. After the second round, only 90 milestones were found to have a high level of agreement and were included in the final medical student core clinical ultrasound milestones.
Conclusions—This study established 90 core clinical milestones that all graduating medical students should obtain before graduation, based on consensus from 34 USMED directors. These core milestones can serve as a guide for curriculum deans who are initiating ultrasound curricula at their institutions. The exact method of implementation and competency assessment needs further investigation.
o    © 2016 by the American Institute of Ultrasound in Medicine


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