YẾU TỐ ẢNH HƯỞNG CHẨN ĐÓAN XƠ HOÁ Ở VIÊM GAN B MẠN CỦA KỸ THUẬT ARFI

MEDIC MEDICAL CENTER and ULTRASOUND DIAGNOSIS in VIETNAM- Dr NGUYỄN QUÝ KHOÁNG

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 (Đóng góp của Medic 1986-2016) BS NGUYỄN QUÝ KHOÁNG

S W ELASTO into PLAQUE IMAGING from E C R 2016

ELASTOGRAPHY OFFERS NEW INSIGHTS INTO PLAQUE IMAGING

ELASTOGRAPHY OFFERS NEW INSIGHTS INTO PLAQUE IMAGING

Elastography has been used for many years to differentiate malignant from benign lesions, especially in the breast or liver. Experience in carotid artery disease is limited, but recent studies have shown that elastography may help to stratify plaque and reduce the risk of unnecessary surgery, as a Greek expert will show during a New Horizons session today at the ECR.

Stroke is one of the leading causes of death in developed countries; one third of cases are fatal and survival can come with considerable disabilities. In Europe alone, experts estimate that there are one million new ischaemic strokes per year and they expect this number to rise by 12% by 2020, as the population ages1. A wide spectrum of carotid artery diseases can lead to stroke, but atherosclerosis accounts for a significant percentage – about 20 to 30% of cases. Stenosis is typically a cause for atherosclerosis and is now being measured using ultrasound in symptomatic patients, who are usually treated with atherectomy. But it is not so clear how asymptomatic patients should be managed, according to Dr. Nikos Liasis, medical director of Affidea Greece, a pan-European medical service provider specialising in diagnostics investigations, clinical laboratories and cancer treatment services. “Despite many randomised clinical trials, there is a surprising lack of consensus regarding the treatment of asymptomatic patients,” he said ahead of his presentation during the session today. There is widespread agreement among physicians that many procedures are probably being performed with risks that are higher than the risk of the actual indications. “Ninety-two per cent of all atherectomies in the U.S. are undertaken in asymptomatic patients. On average, we operate on 16 patients to prevent one stroke in just five years, so we perform surgery on 15 people who may not need it, which is quite a high risk,” he said. The degree of stenosis is not the only predictive parameter for myocardial infarction or stroke. Therefore it has become crucial to be able to understand and stratify plaque morphology. The majority of myocardial infarctions and strokes are actually caused by plaque rupture. Thanks to histological findings, physicians know that unstable, vulnerable plaques, which are prone to rupture and distal embolisation, are those with a large lipid core and intraplaque haemorrhage. Inflammation is also a high risk factor for plaque rupture. Researchers have tried to establish whether it would be suitable to use ultrasound in everyday clinical practice to stratify plaque morphology, but the results combined with histopathological findings were poor. Liasis and his team at Affidea Greece, together with the University of Athens Medical School and the National Technical University of Athens, decided to conduct a prospective study in order to determine the contribution of ultrasound elastography to the description of plaque morphology. “Ultrasound elastography is based on the principle that so tissue deforms more than hard tissue. So plaques that are hard and stable deform less than so, vulnerable plaques,” he said. So far the few available papers on the topic focused on either shear wave or strain elastography. In his study, Liasis has compared both techniques against histopathological findings and he will present his results today. He estimates that the potential of both techniques for stratifying plaque is significant, and that they may be complementary in many ways as they offer information that is not accessible through B mode or Doppler flow and other US techniques. “Elastography enables the detection of the fibrous cap, the thickness or thinness of which is an indication of plaque instability, but it remains challenging to spot with traditional ultrasound. It also provides information about plaque smoothness and more accurate information on what is outside of the plaque. We have all the features that are characteristics of plaque morphology and which make plaque unstable,” he said. Elastography offers other benefits to consider for daily practice; it is radiation free, accessible and widely available. Furthermore, it does not require any patient preparation and the costs are low. Examination times are short compared with MRI and, unlike CT, there are no allergy risks linked to contrast agents use. However a number of technical limitations remain to be overcome and reproducibility is still challenging. “When plaque is calcified, we are not able to describe it because of the acoustic shadow. Our biggest disadvantage is subjectivity. Reproducibility is still an issue, but using appropriate examination protocols may help,” Liasis said. It will also be necessary to adapt the technique, which has been developed for lesions in superficial organs, to small pulsating vessels. “We need more prospective studies to evaluate its potential. US elastography in carotid plaque imaging is only a few years old. But our research is very promising to describe plaque,” he concluded.

1 Data gathered by Brainomix, Oxford University h‑ps://ec.europa.eu/easme/en/ sme/4065/brainomix-limited BY MÉLISANDE ROUGER 

ARFI CÁC TUYẾN BỌT VÀ TUYẾN GIÁP ở MEDIC CENTER

ARFI CÁC TUYẾN BỌT và TUYẾN GIÁP ở MEDIC CENTER

  

Gần đây siêu âm đàn hồi bắt đầu được áp dụng vào lâm sàng để khảo sát u, bệnh tự miễn và bệnh nhiễm trùng của tuyến giáp và các tuyến bọt.

Những khảo sát riêng lẽ về siêu âm đàn hồi của  tuyến giáp và các tuyến bọt ghi nhận không có khác biệt theo tuổi và phái tính ở người trưởng thành. Tuy nhiên khảo sát siêu âm đàn hồi tuyến giáp và các tuyến bọt trong điều kiện bình thường và khảo sát  cùng lúc và trên cùng người được khám thì chưa có thông tin.

 Chúng tôi có ý định:

1/ tìm tương quan độ sinh echo của tuyến giáp và các tuyến bọt.

2/ tìm khác biệt giữa sinh echo tuyến giáp và tuyến mang tai trên cùng cá thể.

3/ định lượng độ đàn hồi tuyến giáp và các tuyến bọt .

Qua khảo sát 68 [34 nam, 34 nữ] cá nhân cùng lúc tuyến giáp và các tuyến bọt trong tình trạng khỏe mạnh, chúng tôi có kết quả như sau :

Giá trị trung bình vận tốc của sóng biến dạng ở mô tuyến giáp là = 1,58 ± 0,17m/s [ở nghiên cứu của NPB Quân và cs là:1,47 ± 0,41 m/s. Không có sự khác biệt vận tốc này với nhóm tuổi, nhưng có khác biệt với giới (p nhỏ hơn 0,05)].

Giá trị trung bình vận tốc của sóng biến dạng ở mô tuyến dưới hàm bình thường là 1,47± 0,015m/s [ ở nghiên cứu của AF Badea là =1,82 ± 0,41m/s cho cả 2 tuyến P và T].

Giá trị trung bình vận tốc của sóng biến dạng ở mô tuyến mang tai bình thường là 1,42 ± 0,015m/s  so với 1,54 ± 0,6 m/s ở nghiên cứu của I.Badea].

Khác biệt về độ đàn hồi tuyến giáp bình thường và các tuyến mang tai và dưới hàm không có ý nghĩa thống kê ( p nhỏ hơn 0,0001).

Tài liệu tham khảo chính:

Nguyễn Phước Bảo Quân, Nguyễn Hữu Thịnh: Bước đầu nghiên cứu siêu âm đàn hồi mô tuyến giáp ở người bình thường bằng phương pháp tạo hình và đo vận tốc sóng biến dạng qua kỹ thuật ARFI

Alexandru Florin Badea, Attila Tamas Szora, Elisabeta Ciuleanu, Ioana Chioreanu, Grigore Băciuţ, Monica Lupşor Platon, Radu Badea: ARFI quantitative elastography of the submandibular glands. Normal

measurements and the diagnosis value of the method in radiation submaxillitis.

Iulia Badea, Attila Tamas-Szora, Ioana Chiorean, Maria Crisan, Elisabeta Ciuleanu, Grigore Baciut, Mindra Badea: Acoustic Radiation Force Impulse quantitative elastography: a new  noninvasive technique for the evaluation of parotid glands.  A preliminary study in controls and in patients with irradiated nasopharyngeal carcinoma.

SHEAR WAVE ELASTOGRAPHY from APLIO 500 TOSHIBA on LIVER FIBROSIS

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Patient's Platelet Count can Increase the Risk for Hematoma in Liver Biopsy

Image-guided liver biopsy is safe, but not risk-free

By Erik L. Ridley, AuntMinnie staff writer

February 11, 2016 -- While major adverse events from liver biopsy guided by ultrasound or CT are extremely rare, variables such as the patient's platelet count can increase the risk for hematoma from the procedure by as much as fourfold, according to a large retrospective analysis performed at the Mayo Clinic in Rochester, MN.

ULTRASOUND for D V T CAUSE a PULMONARY EMBOLISM

ULTRASOUND for D V T CAUSE a P E

http://www.auntminnie.com/index.aspx?sec=sup&sub=ult&pag=dis&ItemID=113323

CHÚC TẾT 2016

CHÚC MỪNG NĂM MỚI BÍNH THÂN 2016 AN KHANG THỊNH VƯỢNG.