SIÊU ÂM ĐÀN HỒI VỎ THẬN

SCREENING for CIRRHOSIS

Recent guidelines are right to recommend screening high risk patients for cirrhosis, say liver specialists Mark Hudson at Freeman Hospital, Newcastle upon Tyne, and Nick Sheron at Southampton General Hospital.

 They say liver disease will probably overtake heart disease to become the commonest cause of death in working age people in the next year or so, mainly because it develops without signs or symptoms and options to tackle alcohol and obesity -- the commonest causes of liver disease -- are limited. Yet technologies to identify early liver disease exist, they say, and are supported by the National Institute for Health and Care Excellence (NICE). NICE recommends that men and women drinking alcohol at potentially harmful levels -- more than 50 and 35 units a week, respectively -- be offered a test (transient elastography) to exclude cirrhosis. This equates to about 2.25 million people in England and Wales. They point out that few GPs currently have access to this test, "so it is not going to happen overnight." However, because the lifetime cost of treating liver disease is between £50,000 and £120,000, "this approach is likely to be cost effective," they write. "We will need properly controlled trials, and these studies are in preparation," they say. "However, the burden of liver disease is such that doctors cannot simply sit in their ivory towers waiting for patients with liver disease to come and find them." But other experts argue that despite recent recommendations from NICE, "insufficient evidence supports a screening programme for cirrhosis." Liver specialists Ian Rowe at the University of Leeds, and Gideon Hirschfield at Birmingham University's Liver Research Centre, say "for a successful screening programme the test used must be simple, cheap, and, most importantly, accurate." Yet the test proposed to screen for cirrhosis has been shown to perform poorly in people suspected to have alcohol related liver disease, leading to many healthy people being incorrectly labelled as having cirrhosis and subject to further medical intervention, which comes with risk of physical and mental harm. Also, the test "is not widely available and would require huge up-front investment to establish it in community settings," and "is probably not cost effective," they warn. As such, they believe that implementation of screening for cirrhosis "would inevitably lead to disinvestment in other, more effective interventions, risking the overall health of the population." Instead, they say resources should be targeted at managing risk factors for common liver diseases, such as alcohol consumption and obesity, as well as investing in well designed trials that evaluate the clinical and cost effectiveness of screening strategies.

 Story Source: Materials provided by BMJ .
 Note: Content may be edited for style and length.

PNEUMOTHORAX DETECTION: CDI and PDI

Color and Power Doppler Sonography for Pneumothorax Detection - Richards - 2017 - Journal of Ultrasound in Medicine - Wiley Online Library

http://onlinelibrary.wiley.com/doi/10.1002/jum.14243/full

Abstract

The use of B- and M-mode sonography for detection of pneumothorax has been well described and studied. It is now widely incorporated by sonographers, emergency physicians, trauma surgeons, radiologists, and critical care specialists worldwide. Lung sonography can be performed rapidly at the bedside or in the prehospital setting. It is more sensitive, specific, and accurate than plain chest radiography. The use of color and power Doppler sonography as an adjunct to B- and M-mode imaging for detection of pneumothorax has been described in a small number of studies and case reports but is much less widely known or used. Color and power Doppler imaging may be used for confirmation of the presence or absence of lung sliding detected with B-mode sonography. In this article, we examine the physics behind Doppler sonography as it applies to the lung, technique, an actual case, and the past literature describing the use of color and power Doppler sonography for the detection of pneumothorax.

Conclusions

It is surprising that the use of color or power Doppler as an adjunct to B- and M-mode detection of pneumothorax is not more widely incorporated or broadcast. Neither is included, or even considered, in several recent lung sonographic protocols for trauma and critical care, such as SESAME (sequential emergency sonography assessing the mechanism or origin of severe shock of indistinct cause), BLUE (bedside lung ultrasound in emergencies), and FALLS (fluid administration limited by lung sonography).[16, 17] Furthermore, Doppler sonography is not mentioned in several recently published guidelines and reviews.[18-20] We believe that color or power Doppler sonography as an adjunct to B- and M-mode sonography for diagnosis of pneumothorax represents a technical innovation of which sonographers should be aware.

Elastography, color Doppler US avoid breast biopsies

By Erik L. Ridley, AuntMinnie staff writer

July 7, 2017 -- Adding elastography and color Doppler to B-mode ultrasound can significantly decrease the number of false positives when screening women with dense breasts, avoiding as many as two-thirds of unnecessary biopsies, according to research published online June 21 in Radiology.

The group also concluded that BI-RADS category 3 and 4A masses that are negative for cancer on both elastography and color Doppler ultrasound could be downgraded to BI-RADS category 2 and recommended for routine screening.

In a prospective multicenter study, researchers found that combining elastography and color Doppler ultrasound with B-mode ultrasound more than doubled the modality's positive predictive value (PPV) in women with dense breasts. What's more, more than two-thirds of unnecessary biopsies could be avoided without sacrificing any sensitivity, according to senior author Dr. Woo Kyung Moon of Seoul National University Hospital.

The group also concluded that BI-RADS category 3 and 4A masses that are negative for cancer on both elastography and color Doppler ultrasound could be downgraded to BI-RADS category 2 and recommended for routine screening.

Dr. Woo Kyung Moon of Seoul National University Hospital.

"Elastography and color Doppler ultrasound are useful for the evaluation of breast masses detected at screening ultrasound in women with dense breasts," Moon told AuntMinnie.com. "Reducing the false-positive findings at screening ultrasound by the combined use of elastography and color Doppler ultrasound may facilitate implementation of screening ultrasound for women with dense breasts."

PPV shortcomings

Performed as an adjunct to mammography, screening ultrasound can increase the sensitivity and detection rate of early cancers while also reducing the number of interval cancers in women with dense breasts. However, the modality suffers from low positive predictive value, with a substantial number of false-positive findings that cause unnecessary biopsies or short-interval follow-ups. Ultrasound's diagnostic accuracy can be improved by incorporating elasticity and vascularity information from a breast mass along with the morphological assessment of B-mode ultrasound, Moon said.

The researchers sought to test their hypothesis that diagnostic accuracy and PPV of screening ultrasound in dense breasts could be improved with the addition of elastography and color Doppler ultrasound. In the prospective, multicenter study conducted at 10 academic breast centers between November 2013 and December 2014, they recruited asymptomatic women with dense breasts who were referred for screening ultrasound. Eligible women had a newly found breast mass on conventional B-mode ultrasound screening; they then received elastography and color Doppler ultrasound.

All ultrasound examinations were performed by one of 20 breast radiologists with two to 25 years of experience with breast ultrasound and color Doppler ultrasound, as well as two to five years of experience with elastography. The bilateral whole-breast screening ultrasound studies were performed using an Aixplorer system (SuperSonic Imagine) with a 15-4 MHz linear transducer or an EUB or Hi Vision ultrasound scanner (Hitachi) with a 14-6 MHz linear transducer.

Over the course of the study, 1,021 breast masses with a mean size of 1 cm (range, 0.3-3 cm) were found in 1,021 women. Of these masses, 68 were malignant, and 58 were invasive cancers: There were 12 ductal carcinomas in situ, 47 invasive ductal carcinomas, five invasive lobular carcinomas, two mixed invasive ductal and lobular carcinomas, one mucinous carcinoma, and one adenoid cystic carcinoma.

Better performance

Adding elastography and color Doppler significantly improved the performance of the screening ultrasound exam.

B-mode ultrasound with elastography, color Doppler for breast imaging
	B-mode ultrasound alone	B-mode ultrasound + elastography and color Doppler ultrasound
Area under the curve	0.87	0.96
Specificity	27%	76.4%
Positive predictive value	8.9%	23.2%

The differences were all statistically significant (p < 0.001). Sensitivity was not affected by the addition of elastography and color Doppler.

What's more, the use of elastography and color Doppler ultrasound could have avoided 471 (67.1%) of 696 unnecessary biopsies for nonmalignant lesions, according to the researchers.

"BI-RADS category 3 and 4A masses that showed results negative for cancer at both elastography and color Doppler ultrasound can be downgraded to BI-RADS category 2 and recommended for routine screening," Moon said.

The researchers found variability in the improvement of diagnostic performance among the 10 academic breast centers, Moon noted. In the next phase of research, the team wants to "focus more on the education and training issues related to the combined use of elastography and color Doppler ultrasound with B-mode ultrasound," he said.

SWE of MCP SYNOVIUM in RA

Abstract

Introduction

Shear-wave elastographic ultrasound (SW-EUS) assesses the stiffness of human tissues. It is used in liver, thyroid and breast imaging but has not been studied in synovium. Soft tissues have a slower shear-wave velocity (SWV) than stiff tissues. We hypothesised that rheumatoid arthritis (RA) patients would have softer synovium than controls and this could be quantified with a slower SWV. We also assessed whether SWV varied with disease activity.

Methods

Nine patients with RA were consecutively recruited and matched with five controls. Participants underwent clinical assessment, blood sampling, grey scale ultrasound (GSUS), power Doppler ultrasound and SW-EUS of MCP joints 2–5 on the dominant hand.

Results

Average age was 60. Mean RA disease activity (DAS28-ESR) was moderate at 3.65. Patients with RA had lower maximum synovial SWV than controls (6.38 m/s vs. 6.99 m/s P = 0.042). Negative Pearson's correlation coefficients (PCC) were observed between maximum SWV and disease activity markers including GSUS graded synovial thickness (PCC = −0.57, P = 0.03) and ESR (PCC = −0.46, P = 0.095). Intra- and interobserver reliability was good with intraclass correlation coefficients (ICC) of 0.66 and 0.58, respectively, for quantitative maximum SWV and ICC > 0.80 for colour scale rated SWV.

Conclusion

This is the first pilot study of SW-EUS in synovium. Maximum synovial SWV was significantly lower in RA than controls. There was a negative correlation between maximum SWV and GSUS synovial thickening. Further study is warranted to confirm the role of SW-EUS in diagnosing and assessing disease activity in RA.

PEDIATRIC SPINE ULTRASOUND

SWE for MSK Ultrasound

NEW ULTRASOUND SCORING SYSTEM for THYROID NODULES