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Thứ Năm, 30 tháng 6, 2016

J U M 7-2016

Selected Abstracts
1.    Abstract 1
2.    Original Research:
Diagnostic Performance of Shear Wave Elastography for Predicting Esophageal Varices in Patients With Compensated Liver CirrhosisJournal of Ultrasound in Medicine July 2016 35:1373-1381; Published Online First May 20, 2016, doi:10.7863/ultra.15.07024
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3.    Abstract 2
4.    Original Research:
Role of Doppler Sonography in Early Detection of Splenic Steal SyndromeJournal of Ultrasound in Medicine July 2016 35:1393-1400; Published Online First May 20, 2016, doi:10.7863/ultra.15.06072
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5.    Abstract 3
6.    Original Research:
Utility of Shear Wave Elastography for Differentiating Biliary Atresia From Infantile Hepatitis SyndromeJournal of Ultrasound in Medicine July 2016 35:1475-1479; Published Online First May 26, 2016, doi:10.7863/ultra.15.08031
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7.    Abstract 4
8.    Original Research:
A Survey of Ultrasound Milestone Incorporation Into Emergency Medicine Training ProgramsJournal of Ultrasound in Medicine July 2016 35:1517-1521; Published Online First June 7, 2016, doi:10.7863/ultra.15.09012
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9.    Abstract 5
10.Original Research:
Correlating the Sonographic Finding of Echogenic Debris in the Bladder Lumen With UrinalysisJournal of Ultrasound in Medicine July 2016 35:1533-1540; Published Online First May 31, 2016, doi:10.7863/ultra.15.09024
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12.Pictorial Essay:
Sonography of Gastrointestinal Tract Diseases: Correlation With Computed Tomographic Findings and EndoscopyJournal of Ultrasound in Medicine July 2016 35:1543-1571; Published Online First June 7, 2016, doi:10.7863/ultra.15.09038
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1.    Abstract 1 of 6Original Research
Diagnostic Performance of Shear Wave Elastography for Predicting Esophageal Varices in Patients With Compensated Liver Cirrhosis
Objectives—The purpose of this study was to investigate the diagnostic performance of shear wave elastography (SWE) for predicting the presence of esophageal varices and high-risk esophageal varices in patients with compensated cirrhosis and to compare it with other nonspecific predictors and according to the presence of splenomegaly.
Methods—Clinical data from 103 patients with compensated cirrhosis who underwent sonography, SWE, and endoscopy were collected consecutively. Liver stiffness was measured by SWE. Comparisons of the accuracy of prediction between groups were made by areas under the receiver operating characteristic curves (AUROCs), and regression analyses were performed for the multiple variables related to the presence of esophageal varices and high-risk varices.
Results—The optimal cutoff values for predicting the presence of esophageal varices and high-risk varices were 13.9 and 16.1 kPa, respectively. The AUROC of liver stiffness for prediction of esophageal varices was significantly higher than the AUROCs of platelet count, spleen diameter, and platelet count/spleen diameter ratio (P = .025; P = .001; P = .027). For predicting esophageal varices in patients without splenomegaly, the AUROC of liver stiffness was higher than that of the platelet count/spleen diameter ratio. In multivariate logistic regression analysis, liver stiffness and the platelet count/spleen diameter ratio were independent predictors of esophageal varices (P < .001; P = .038). For the presence of high-risk varices, only liver stiffness was a statistically significant independent predictor (P = .012).
Conclusions—In patients with compensated cirrhosis, liver stiffness measured by SWE is a new effective noninvasive diagnostic tool for predicting the presence of esophageal varices. It is more accurate than the platelet count/spleen diameter ratio, especially in patients without splenomegaly. In addition, the SWE value was the only effective independent factor for predicting high-risk esophageal varices.
o   cirrhosis
   
   
  

  
o   Received July 10, 2015.
o   Revision received August 11, 2015.
o   Accepted October 7, 2015.
2.    Abstract 2 of 6Original Research
Role of Doppler Sonography in Early Detection of Splenic Steal Syndrome
Objectives—To retrospectively investigate the role of Doppler sonography in the early detection of splenic steal syndrome.
Methods—Fifty cases of splenic steal syndrome after orthotopic liver transplantation were identified. A control group was matched to the splenic steal syndrome group. Information was collected about the clinical presentation, liver enzyme levels, Doppler sonographic results, and follow-up after patients underwent splenic artery embolization.
Results—A persistent hepatic arterial diastolic reversal waveform was observed in 25 patients with splenic steal syndrome versus 0 control patients. The mean hepatic arterial resistive index (RI) values ± SD were 0.95 ± 0.09 in patients with splenic steal syndrome and 0.80 ± 0.10 in control patients (P < .0001). One week after orthotopic liver transplantation, the area under the receiver operating characteristic curve for the RI was 0.884 (95% confidence interval, 0.793–0.975; P = .001) for splenic steal syndrome diagnosis. After splenic artery embolization, there was normalization of the reversal waveform, with an average RI of 0.77 ± 0.11 (P < .0001).
Conclusions—Dynamic changes in the hepatic arterial waveform and RI are keys to detecting splenic steal syndrome with Doppler sonography.
   
  

o   sonography
   
3.    Abstract 3 of 6Original Research
Utility of Shear Wave Elastography for Differentiating Biliary Atresia From Infantile Hepatitis Syndrome
Objectives—The purpose of this study was to investigate the potential utility of shear wave elastography (SWE) for diagnosis of biliary atresia and for differentiating biliary atresia from infantile hepatitis syndrome by measuring liver stiffness.
Methods—Thirty-eight patients with biliary atresia and 17 patients with infantile hepatitis syndrome were included, along with 31 healthy control infants. The 3 groups underwent SWE. The hepatic tissue of each patient with biliary atresia had been surgically biopsied. Statistical analyses for mean values of the 3 groups were performed. Optimum cutoff values using SWE for differentiation between the biliary atresia and control groups were calculated by a receiver operating characteristic (ROC) analysis.
Results—The mean SWE values ± SD for the 3 groups were as follows: biliary atresia group, 20.46 ± 10.19 kPa; infantile hepatitis syndrome group, 6.29 ± 0.99 kPa; and control group, 6.41 ± 1.08 kPa. The mean SWE value for the biliary atresia group was higher than the values for the control and infantile hepatitis syndrome groups (P < .01). The mean SWE values between the control and infantile hepatitis syndrome groups were not statistically different. The ROC analysis showed a cutoff value of 8.68 kPa for differentiation between the biliary atresia and control groups. The area under the ROC curve was 0.997, with sensitivity of 97.4%, specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 96.9%. Correlation analysis suggested a positive correlation between SWE values and age for patients with biliary atresia, with a Pearson correlation coefficient of 0.463 (P < .05).
Conclusions—The significant increase in liver SWE values in neonates and infants with biliary atresia supports their application for differentiating biliary atresia from infantile hepatitis syndrome.
   
o   infant
   
  

  
o   sonography
4.    Abstract 4 of 6Original Research
A Survey of Ultrasound Milestone Incorporation Into Emergency Medicine Training Programs
Objectives—With the introduction of the Emergency Medicine Milestone Project in 2013, residencies now assess emergency ultrasound (US) skills at regular intervals. However, it is unclear how programs are implementing the emergency US milestones and assessing competency. With the use of the milestone tool, a survey was distributed to emergency US educators to determine when programs are providing emergency US education, when residents are expected to attain competency, and whether the milestones reflect their expectations of trainees.
Methods—We conducted a prospective cross-sectional survey study distributed electronically to designated emergency US experts at 169 programs. Participants were queried on education and competency evaluation within the context of the milestones by designating a postgraduate year when the 5 milestone levels were taught and competency was expected. Survey findings were reported as percentages of total respondents from descriptive statistics.
Results—Responses were received from 53% of programs, and 99% were familiar with the milestones. Most programs provide level 1 (88%) and 2 (85%) instruction during postgraduate year 1. Most programs expect level 1 competency before residency (61%) and expect mastery of level 2 by the end of postgraduate year 1 (60%). Sixty-two percent believe the milestones do not accurately reflect their expectations, citing insufficient minimum scan numbers, lack of specificity, and unattainable level 5 requirements.
Conclusions—There is substantial variability in the frequency and methods of competency evaluation using the emergency US milestones. However, most responders agree that residents should obtain level 2 competency by postgraduate year 1. Variation exists regarding what year and what skills define level 3 or greater competency.
o   milestones
   
   

5.    Abstract 5 of 6Original Research
Correlating the Sonographic Finding of Echogenic Debris in the Bladder Lumen With Urinalysis
Objectives—The purpose of this study was to determine the significance of urinary bladder debris detected by sonography.
Methods—We conducted a retrospective analysis of urinalysis results in age-matched patients with and without bladder debris detected by transabdominal sonography. Patients were recruited from a radiology database search for bladder sonograms either with words suggesting echogenic debris or by a clinical history suggesting an infectious course. The sonograms were randomized and read by a single radiologist, who was blinded to case versus control. The urinalysis and sonographic results were analyzed by the Fisher exact test.
Results—There was no statistically significant correlation between the finding of debris on sonography and the frequency of abnormal urinalysis results, regardless of the quality of debris (layering versus floating). The only variable that was significantly associated with abnormal urinalysis results was a clinical history suggesting infection.
Conclusions—A urinalysis should not be routinely recommended to work up the finding of urinary bladder debris on sonography.
   
o   sediment
   
o   sonography
   
o   urinalysis
6.    Abstract 6 of 6Pictorial Essay
Sonography of Gastrointestinal Tract Diseases
Correlation With Computed Tomographic Findings and Endoscopy
Sonographic evaluation of the gastrointestinal (GI) tract may be difficult because of overlying intraluminal bowel gas and gas-related artifacts. However, in the absence of these factors and with the development of high-resolution scanners and the technical experience of radiologists, sonography can become a powerful tool for GI tract assessment. This pictorial essay focuses on sonographic findings of GI tract lesions compared with endoscopic, computed tomographic, and magnetic resonance imaging findings. Neoplastic and non-neoplastic diseases and postoperative complications are illustrated, and the distinctive sonographic characteristics of these entities are highlighted.
   
  
o   sonography


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