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Thứ Tư, 19 tháng 2, 2014

MRElastography for Liver Diseae


Clinical Applications of Magnetic Resonance Elastography Growing

By Rob Goodier
 February 12, 2014
 
NEW YORK (Reuters Health) - Physicians have used Magnetic Resonance Elastography (MRE) to evaluate liver disease for the past five years, but a lengthening list of other applications for the imaging technology are coming on line, researchers say.
"I believe that the most likely application to be adopted next in clinical practice will be to use MRE to evaluate brain tumors preoperatively," Dr. Richard Ehman, a radiologist at Mayo Clinic and president and CEO of Resoundant Inc. in Rochester, Minnesota, told Reuters Health by email.
"Our preliminary experience is that MRE provides a reliable preoperative assessment of meningioma stiffness, which is extremely valuable information for surgical planning," Dr. Ehman said.
Dr. Ehman presented data from his work with MRE on February 4 at the American Society of Mechanical Engineering's third annual conference on Nanoengineering for Medicine and Biology in San Francisco, California.
Based on MR imaging, MRE gathers data from acoustic shear waves as they pass through and interact with the body. The result is maps showing the mechanical characteristics of the tissue - properties such as stiffness, viscosity, and anisotropy - or how its properties change from different angles.
Data from 4000 patients suggest that MRE is at least as accurate as liver biopsy for diagnosis of liver fibrosis, and it may be safer, more comfortable, and less expensive, Dr. Ehman wrote in conference materials.
Other applications under study include preoperative brain tumor analysis, analysis of the skeletal muscle, heart, and lungs, and diagnosis of breast and prostate cancer.
The findings are "very exceptional," said Dr. Jerry Lee, health sciences director at the U.S. National Cancer Institute, who attended the conference but is not involved in MRE research.
"I think it is a real life demonstration of how mechanical engineering theories are being applied to human disease right now," Dr. Lee told Reuters Health.

Thứ Sáu, 14 tháng 2, 2014

ULTRASOUND for ROUTINE LUMBAR PUNCTURE



Abstract
Objectives
The objective was to determine if use of ultrasound (US) by emergency physicians (EPs) to localize spinal landmarks improves the performance of lumbar puncture (LP).
Methods
This was a prospective, randomized, controlled study conducted in a county teaching hospital. Subjects, adults 18 years of age or older who were to receive LPs for routine clinical care in the emergency department (ED), were randomized either to undergo US localization of the puncture site or to have the puncture site determined by palpation of spinal landmarks. Primary outcomes were the number of needle insertion attempts and success of the procedure. Secondary outcomes were pain associated with the procedure, time to perform the procedure, number of traumatic taps, and patient satisfaction with the procedure.
Results
One-hundred patients were enrolled in the study, with 50 in each study group. There were no significant differences between the two groups in terms of age, sex, body mass index (BMI), indication for LP, or ease of palpation of landmarks. For both primary outcomes and secondary outcomes there were no significant differences between those undergoing US localization and those with palpation alone.
Conclusions
These data do not suggest any advantage to the routine use of US localization for LP insertion, although further study may be warranted to look for benefit in the difficult to palpate or obese patient subgroups.