Medical Ultrasonics

Clinical application of stress echocardiography for valvular heart disease Abstract Stress echocardiography is widely used to assess several cardiovascular diseases, including ischemic heart disease, valvular heart disease (VHD), heart failure, congenital heart disease, and pulmonary hypertension. In valvular heart disease with asymptomatic severe or symptomatic non-severe status, stress echocardiography plays a central role in the management. As of 2017, the updated American College of Cardiology/American Heart Association and European Society of Cardiology/European Association for Cardio-Thoracic Surgery VHD guidelines recommended stress testing to (1) confirm symptoms and (2) evaluate the hemodynamic response to exercise. In patients with undetermined VHD severity in the presence of low-flow status, it can also be helpful to determine whether the VHD is severe based on flow-dependent changes in response to stress. The clinical indications of stress echocardiography in VHD have expanded with growing evidence for prognosis and being an early marker for interventions. As a result, demand has increased in major cardiology societies for the standardization of stress echocardiography in VHD. Echocardiographic centers should be aware of the clinical potential of stress echocardiography to ensure its optimal application and performance in VHD. This article reviews the clinical application of stress echocardiography, including dobutamine, semisupine bicycle, treadmill, and leg-positive pressure for VHD patient management, and focuses on the current consensus regarding the use of stress echocardiography in VHD. Stress echocardiography is safe and should be encouraged, especially in heart valve clinics, to understand the complex mechanism in asymptomatic patients.

Expectations for contrast-enhanced ultrasonography

Cross-sectional understanding/research across clinical disciplines and integration of basic and clinical research

Ultrasound-guided injection and the pie crust technique for the treatment of symptomatic bipartite patella Abstract Purpose This study aimed to investigate the results of a new treatment procedure (ultrasound-guided injection and the "pie crust" technique for lengthening of capsular tendon structures) for symptomatic bipartite patella. Methods We retrospectively investigated patient outcomes following the treatment of symptomatic type III bipartite patella with our new technique. Fifteen knees in 14 boys (mean age, 13.0 ± 1.7 years) were included. The procedure involved the injection of 1% lidocaine (2 mL) and triamcinolone acetonide (5 mg) between the patella and fragment. We then punctured 10 sites from one skin puncture to extend lateral capsular tendon structures. The patients were clinically assessed using the Victorian Institute of Sports Assessment (VISA) score before and 1 week, 1 month, and 3 months after the procedure. Patients were also evaluated for complications. Results The average VISA score was 45.7 ± 4.7 before treatment, 70.6 ± 7.3 at 1 week post-treatment, 84.4 ± 16.6 at 1 month post-treatment, and 88.6 ± 18.3 at 3 months post-treatment. The VISA score improvement from before the procedure to 1 week after the procedure was significant (P < 0.01). There were no complications in any of the patients, who returned to sports at a mean of 4.2 ± 2.1 weeks after the procedure. However, two patients (three knees) had poor results and could not return to action; thus, they underwent surgical treatment 4 months after the ultrasonographic procedure. Conclusions This novel method is a potential treatment option for the management of symptomatic bipartite patella in outpatient clinics.

The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis Abstract Purpose Our aim was to determine the accuracy of ultrasound (US) examination-based testicular torsion diagnosis in adult patients with acute scrotal pain. Methods A comprehensive electronic search was performed using internet retrieval systems up to 5 August 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The quality of eligible studies was assessed using Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2). The diagnostic value of ultrasound in patients with testicular torsion was evaluated using pooled estimates of sensitivity, specificity, likelihood ratio, and diagnostic odds ratio, as well as the summary receiver operating characteristics curve. Results Twenty-six studies with 2116 patients were included in the study. Overall diagnostic sensitivity was 0.86 [95% confidence interval (CI) 0.79–0.91] and specificity was 0.95 (95% CI: 0.92–0.97). Subgroup analysis of prospective studies showed pooled sensitivity of ultrasound for testicular torsion was 0.94 (95% CI 0.83–0.98), and pooled specificity was 0.98 (95% CI 0.94–1.00). Recent studies after 2010 showed diagnostic sensitivity of 0.95 (95% CI 0.84–0.99) and specificity of 0.98 (95% CI 0.93–0.99). Conclusions This meta-analysis demonstrated that ultrasound represents an effective imaging modality for diagnosing testicular torsion in adult patients with acute scrotal pain.

Echocardiography and cancer therapeutics-related cardiac dysfunction Abstract Cancer therapeutics-related cardiac dysfunction (CTRCD) has become a leading cause of morbidity and mortality for cancer survivors, with the mortality rate for patients with CTRCD reportedly being as high as 60% by 2 years after treatment. Although early detection of subclinical left ventricular (LV) dysfunction is essential for delaying progression to heart failure (HF) in patients with a history of using cardiotoxins, assessment of such dysfunction can be challenging. CTRCD may present initially as asymptomatic LV dysfunction and ultimately as symptomatic HF, which can occur even decades after discontinuation of the treatment. Once CTRCD has developed, the mortality rate is very high, because CTRCD is believed to be refractory to conventional pharmacological therapy and to be associated with a poor prognosis. Thus, there has been a growing interest in early detection of CTRCD by means of global longitudinal strain (GLS) assessed by two-dimensional speckle-tracking echocardiography, because it is a more sensitive and robust parameter for detecting subclinical LV dysfunction than other conventional LV functional parameters such as LV ejection fraction. This article reviews the utility of GLS for early detection of cardiotoxicity in patients during and after cancer chemotherapy, and future perspectives for the management of such patients.

Fast adaptive beamforming through a cascade structure for ultrasound imaging Abstract Purpose A major limiting factor for applying a minimum variance (MV) beamformer in medical ultrasound imaging is its high computational complexity. This paper introduces a new fast MV beamforming method with almost the same capabilities as the standard MV. Methods The fast beamformer is implemented using a cascade structure. At the first stage, the echo signals received from the points far from the main axis are strongly suppressed using a fixed-weight beamformer. At the second stage, after spatially decimating the output of the first stage, an MV-based adaptive beamformer is used to eliminate the echo signals from the points adjacent to the focal point. The greatest advantage of the proposed method is that the second beamformer can be a low-complexity implementation of MV such as beamspace (BS) MV to further reduce the complexity, resulting in a superfast MV. Results The resulting beamformers were evaluated through both simulation and experimental data, and it was verified that the method was competitive with standard MV and BS methods at a lower computational cost. Conclusion The new fast and superfast MV methods are capable of obtaining the same results as the MV and BS-MV, at a significantly lower computational cost.

Investigating the minimum distance between the finger flexor tendons and distal radius during wrist and finger positions in healthy people Abstract Purpose Rupture of the flexor pollicis longus (FPL) and index flexor digitorum profundus (FDP2) tendons often occurs after locking plate fixation for distal radius fracture. This study aimed to determine the shortest tendon-radius distances of different hand positions. Methods Fifty-nine hands of 30 healthy volunteers were studied. Distances between the FPL or FDP2 and distal radius were calculated in six wrist positions: 30° palmar flexion, neutral, 30° dorsiflexion, 60° dorsiflexion, maximum dorsiflexion, and 40° ulnar deviation with three finger positions (full extension and flexion of fingers, full flexion of the thumb or index finger, and full extension of the other four fingers). The shortest distance between the FPL or FDP2 and distal radius was noted. Results The shortest distance between the FPL and distal radius was during maximum wrist dorsiflexion with isolated thumb flexion. The distance between the FDP2 and distal radius was shortest with all-finger flexion in 30° wrist dorsiflexion. Conclusions It is necessary to measure the distance between the FPL and distal radius in maximal wrist dorsiflexion with full flexion of the isolated thumb, as the shortest distance was observed with flexion of the isolated thumb. On the contrary, we recommend measuring the distance between the FDP2 and distal radius in 30° wrist dorsiflexion with flexion of all fingers.

Range-ambiguity artifact in abdominal ultrasound Abstract Range-ambiguity artifacts (RAAs) are an erroneous mapping of returning echoes into a composite picture. The purpose of this review was to illustrate the mechanism of RAAs and to present the diagnostic problems caused by RAAs. RAA features differ slightly from organ to organ. At the level of the urinary bladder, RAAs take the form of a cloud-like, ill-demarcated, immobile, echogenic area, and the depth of the echogenic area differs depending on the pulse repetition frequency (PRF). This form is referred to as "static RAA" in this review. There are two key ultrasound characteristics of RAAs at the level of the liver: (a) the depth of RAAs change according to the PRF, and (b) RAAs move in accordance with the cardiac cycle. This form is referred to as "mobile RAA" in this review. At the level of the gallbladder, RAAs take the form of fine echogenic lines in the gallbladder. This phenomenon is actually a combination of two phenomena: a ring-down artifact and RAA. This form is referred to as "complex RAA (searchlight phenomenon)" in this review. The easiest way to reduce RAAs is to change the image depth. Sufficient knowledge of RAAs can prevent misdiagnosis of erroneously displayed returning echoes as real pathologic changes.

Diagnosis of anomalous origin of the right coronary artery from the pulmonary artery by echocardiography Abstract Purpose To review the imaging characteristics and evaluate the diagnostic value of echocardiography for diagnosing anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). Methods We retrospectively reviewed the echocardiographic records and compared these images with operative findings in six children with ARCAPA. Results ARCAPA was characterized by dilation of the left coronary artery, inappropriate origin of the right coronary artery from the pulmonary artery, and collaterals within the interventricular septum. The associated malformations included atrial septal defect in four cases. Four of six cases were diagnosed correctly, while the remaining two cases were misdiagnosed: one of fistula between the pulmonary artery and the left coronary artery and another of ARCAPA diagnosed intraoperatively in one case of atrial septal defect. Conclusion ARCAPA can be diagnosed by echocardiography but is prone to misdiagnosis. This malformation should be distinguished from coronary artery fistula.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com