Shoulder Ultrasound could help Diagnose Diabetes.

Shoulder ultrasound could help diagnose diabetes

By Kate Madden Yee, AuntMinnie.com staff writer

November 19, 2018 -- Brightness on ultrasound in the shoulder's deltoid muscle could be an indicator of diabetes or prediabetes, according to a study to be presented at the upcoming RSNA 2018 meeting in Chicago.

The results may help clinicians diagnose diabetes earlier, according to lead author Dr. Steven Soliman, a musculoskeletal radiologist from Henry Ford Hospital in Detroit.

The [U.S. Centers for Disease Control and Prevention (CDC)] states that prediabetes affects an astonishing 84.1 million adults, or nearly 34% of the adult U.S. population," Soliman said in a statement released by the RSNA. "Ninety percent of these people are completely unaware of their prediabetic status and are at a high risk of developing type 2 diabetes."

Musculoskeletal ultrasound is often used to diagnose shoulder pain, and over the course of his practice, Soliman has noticed a pattern in which patients who have a bright deltoid muscle on ultrasound are also diabetic or prediabetic. He and colleagues conducted a study to determine if this brightness could predict the disease.

The study included 124 shoulder ultrasound scans from patients with type 2 diabetes and 13 from people with prediabetes; diabetes was confirmed via hemoglobin A1c level measurements. The study also included 49 ultrasound scans from nondiabetic obese patients, with obesity determined by body mass index. Two musculoskeletal radiologists blinded to the diabetic status of the patients reviewed the images and categorized them as normal, suspected diabetic, or diabetic; a third reader arbitrated cases in which the other two radiologists disagreed.

Of the 137 diabetic ultrasound scans included in the study, 31 (22.6%) were categorized as normal, 36 (26.2%) as suspected diabetic, and 70 (51.2%) as definitely diabetic. Brightness in the deltoid muscle on ultrasound had a positive predictive value for diabetes of 89%. It was also an effective predictor of prediabetes: Of the 13 prediabetic ultrasound scans reviewed, the readers categorized all as either "suspected diabetic" or "definite diabetic."

"We weren't surprised that we had positive results because the shoulder muscle on patients with diabetes looked so bright on ultrasound, but we were surprised at the level of accuracy," Soliman said in the RSNA release.

Shoulder images show reversal of the rotator cuff-to-deltoid gradient. Image A shows the normal gradient of the deltoid muscle to the supraspinatus tendon. Image B shows reversal of the normal gradient in a type 2 diabetic patient. D = deltoid, S = supraspinatus, and H = humerus. Image courtesy of RSNA.

Why the deltoid muscle is bright on ultrasound in diabetic or prediabetic patients isn't completely understood, but the researchers theorized that it's because of low levels of glycogen in the muscle, which can be depleted in people with the disease.

"It could be that this appearance in people with diabetes and prediabetes is related to the known problems with glycogen synthesis in their muscles because of their insulin abnormalities," Soliman said.

SIÊU ÂM GIÁP NHIỀU DẪN TỚI TĂNG XUẤT ĐỘ K GIÁP

NEW YORK (Reuters Health) - Patients in areas of the U.S. where thyroid ultrasound has increasingly been used for initial imaging are more likely to be diagnosed with thyroid cancer, with the greatest increase among adults over 65, new research suggests.

"We found that over time, there has been an increase in the use of thyroid ultrasound as initial imaging. After controlling for time and demographics, area-level use of thyroid ultrasound as initial imaging was associated with area-level thyroid-cancer incidence, including incidence of localized papillary thyroid cancer with tumor 1 cm or smaller," . We need to be able to distinguish the few patients who have high-risk thyroid cancer and may ultimately die from their cancer from the many patients with low-risk, potentially indolent thyroid cancer who may be at greater risk from harm from the treatments. 
...

According to this model, between 2003 and 2013, at least 6,594 individuals 65 and above - disproportionately women and patients with comorbidities - were diagnosed with thyroid cancer due to increased use of thyroid ultrasound.

"A major strength of this study was our ability to use two complementary databases (Medicare and SEER-Medicare) to evaluate area-level imaging and area-level incidence of thyroid cancer over time," 

Patients age 65 and above was an appropriate cohort because older adults have both the largest change in thyroid cancer incidence and the greatest risks from downstream treatments. Similar trends in thyroid cancer incidence are seen in younger adults, so it is plausible that these findings are generalizable to adults under 65.

Three clinicians who were not involved in the study share the authors' advice for judicious use of thyroid ultrasound.

Dr. Ronald N. Cohen, an associate professor of medicine at the University of Chicago in Illinois, said by email, "We should be using American Thyroid Association guidelines to decide which thyroid nodules should actually be biopsied, as we do not need to biopsy every one. Instead, we need to focus on those nodules and patients that seem to be at higher risk of clinically significant thyroid cancers."

Dr. Arti Bhan, an endocrinologist at Henry Ford Health System in Detroit, noted by email, "These findings confirm data from other such studies that point to excess use of imaging modalities, which has resulted in an epidemic of thyroid cancer in the US and other parts of the world."

"Even though there may be a true rise in the incidence of thyroid cancer due to factors not yet elucidated, the vast majority of these incidentally detected cancers are low-risk," she added.

Dr. Bhan recommends that doctors "use guidelines provided by major medical societies regarding thyroid nodules so detected."

Given the data from this study, she said, "physicians can reassure patients that not all thyroid nodules need to be worked up and that non-invasive follow-up over time may be sufficient for the vast majority of incidentally detected nodules."

Dr. Cary N. Mariash, a professor of clinical medicine at Indiana University School of Medicine in Indianapolis, advised by phone, "Before ordering an ultrasound, one should think about what the ultimate consequence might be. Are you doing an ultrasound on someone who might not have any significant thyroid cancer, but once you do it, you're headed down the road to biopsy and perhaps surgical intervention?"

"The consequences really need to be thought through before the ultrasound is ordered," he concluded.

SOURCE: https://bit.ly/2P2fE0h

J Clin Endocrinol Metab 2018.

Kỹ thuật mới đo tốc độ truyền âm để phát hiện u vú

Innovations in ultrasound imaging improve breast cancer detection

Hình = Kỹ thuật siêu âm mới cho thấy rõ khối u vú màu vàng (hình bên P). Bên T, hình siêu âm qui ước khó đọc được. © Orçun Göksel / ETHZ

Hình siêu âm thường khó đọc dù gọn và nhiều thông tin hơn cộng hưởng từ và an toàn hơn X-quang.​
Nhóm từ ETH Zurich đã đưa ra một cách thức mới với dạng nguyên mẩu (prototype) để phát hiên ung thư vú dựa vào tốc độ truyền âm,  và đã công bố trên  tạp chí  Physics in Medicine and Biology.

Measuring the speed of sound, not the quantity [Đo bằng tốc độ truyền âm, không bằng định lượng]

Đầu dò siêu âm truyền sóng âm vào cơ thể, sóng phản âm khác nhau vì cơ quan và mô có đặc điểm vật lý khác nhau. Máy phân tích các hồi âm và dựng lại bên trong cơ thể thành hình 3 chiều được gọi là hình siêu âm.

Thường, máy đo cường độ sóng âm dội lại. Nhưng nhóm Zurich lấy thêm một thông số đặt tên là echo duration [độ dài siêu âm]. Cách thức mới này tạo ra hình có tăng cường tương phản giúp chẩn đoán ung thư; không chỉ phát hiện ung thư mà còn giúp phân biệt lành ác.

Nguyên lý của cách thức mới rất đơn giản: mật độ [density] và độ cứng [rigidity] của mô xác định vận tốc sóng âm. Vì khối u cứng hơn mô xung quanh nhất là u ác. Sóng âm truyền đi trong mô ác tính trung bình nhanh hơn 3 % so với mô lành, và trong u lành nhanh hơn 1,5%.

A simple change of software [Thay đổi đơn giản phần mềm]

Trong thử nghiệm lâm sàng, nhóm Zurich chứng minh hiệu quả của prototype trong phát hiện u vú trong khám thường qui giúp có quyết định chính xác hơn và tránh sinh thiết không cần thiết. Hình dễ đọc hơn hình siêu âm qui ước.

Kỹ thuật này có thể dùng với bất kỳ máy siêu âm nào vì vấn đề đổi mới chỉ là phần mềm. Một dạng máy khai thác tốc độ truyền âm vừa mới đưa ra thị trường, nhưng còn cồng kềnh và hạ tầng mắc tiền- phần cơ thể muốn khám phải được nhúng trong nước đã khử khí [degassed water].

Nhóm đang tiếp tục thử nghiệm lâm sàng với bệnh lý gan và bệnh cơ do lão hóa.

Lịch sử bệnh Ung thư

• http://ykhoasaigon73.blogspot.com/2016/12/lich-su-benh-ung-thu-lan-theo-dau-vet.html

Ultrasound helps predict ovarian cancer risk.

By Kate Madden Yee, AuntMinnie.com staff writer

November 12, 2018 -- Ultrasound can help characterize ovarian masses -- specifically simple cysts versus complex ones -- which can then help physicians predict a woman's risk of ovarian cancer and avoid unnecessary surveillance, according to a study published online November 12 in JAMA Internal Medicine.

The study findings could help women avoid ongoing follow-up of simple cysts, which can prompt unnecessary biopsies and specialty referrals, wrote a team led by Dr. Rebecca Smith-Bindman of the University of California, San Francisco.

"Historically, surgical exploration and resection of all identified ovarian masses represented the standard of care, and as many as 5% to 10% of women have undergone a surgical procedure for a suspected ovarian [mass]; most of these procedures did not diagnose cancer," the authors wrote.

Increased use of transvaginal pelvic ultrasound has led to the identification of more ovarian masses, and the standard of care has been to biopsy them. But most ovarian masses are benign, Smith-Bindman's team noted. So the group explored whether ovarian cancer risk could be quantified with ultrasound according to the characteristics of the masses.

"We sought to identify features predicting with a high level of certainty that an ovarian mass is benign and thus does not require surveillance," they wrote.

The study included 72,093 women who underwent pelvic ultrasound between January 1997 and December 2008. The team analyzed the data in April 2017. Out of the total study cohort, 210 women were diagnosed with ovarian cancer. Forty-nine of these women were younger than 50, and 161 were 50 years or older.

The most common finding in women with ovarian cancer was a complex cystic mass, identified in 63.3% of those younger than 50 and in 55.9% of those 50 and older. In fact, having a complex cystic mass increased by eightfold the likelihood of cancer in women across both age groups, the researchers wrote.

"Women with complex cysts or solid masses have elevated relative risk of ovarian cancer, whereas women with simple cysts have low relative risk of ovarian cancer," the authors wrote.

Clinicians have justified the surveillance of simple cysts because ovarian cancer has a high mortality rate and tends to present as a cystic disease on ultrasound, Smith-Bindman and colleagues noted. But while surveillance may not seem harmful, it can trigger unnecessary imaging, false-positive results, overdiagnosis, and unnecessary surgery, the authors wrote.

"Given the high prevalence of simple cysts, their lack of association with ovarian cancer, and no elevated risk compared with women with normal ovaries, incidental and asymptomatic simple cysts should be considered normal and frequent findings in women of any age and ignored," they concluded.