Abstract
Real-time ultrasound demonstration of uterine isthmus contractions during pregnancy
Farràs A, Catalán S, Casellas A, et al. Am J Obstet Gynecol. Epub ahead of print 20 July 2023. DOI: 10.1016/j.ajog.2023.07.025.
This is a prospective study examining the change in cervical length (CL) over time following voiding prior to transvaginal assessment of the cervix in pregnancy. Contractions of the uterine isthmus were noted in 43% of patients, which shortened the CL measurement. These contractions could last up to 20 minutes after voiding. There is a useful video available which demonstrates this effect.
First-trimester choroid-plexus-to-lateral-ventricle disproportion and prediction of subsequent ventriculomegaly
Prasad S, Di Fabrizio C, Eltaweel N, et al. Ultrasound Obstet Gynecol 2023; 62: 234–240.
Measurements of the ventricles and choroid plexus were taken at the first trimester scan, using the standard “butterfly” view that is routinely assessed for the presence of brain tissue and to rule out acrania. The ventricles and choroid plexus were measured in length, width, and area, to assess changes in ratios between the measurements. This retrospective study found that in 683 singleton pregnancies, 102 fetuses had ventriculomegaly on follow-up, and the ratio of fetal choroid-plexus-to-lateral ventricle/head ratio were found to be low in the effected group compared to the control group. The team propose that the measurements could be performed routinely at the first trimester scan, and if found to be abnormal, either a transvaginal scan could be performed to further assess brain anatomy and/or a 16-week scan to assess all anatomy at an earlier stage in the effected fetus.
Diagnostic and interventional US of the wrist and hand: quadrant-based approach
Flores DV, Murray T and Jacobson JA. RadioGraphics. Epub ahead of print 27 July 2023. DOI: 10.1148/RG.230046.
The authors of this teaching paper propose a logical approach to ultrasound assessment of the wrist and hand. There are some excellent images and examples of pathologies, along with useful tips of where to scan to assess the different nerves and compartments. A good paper for those starting their musculoskeletal ultrasound training.
Understanding the downstream effects of the COVID-19 pandemic on sonographers and vascular technologists: healthcare heroes’ kryptonite!
Evans KD, Weikle AN, Fukumura YE, et al. J Diagn Med Sonogr. Epub ahead of print 5 July 2023. DOI: 10.1177/87564793231185297.
As part of a longitudinal study to look at sonographers’ (including vascular technologists) well-being, there were some questions on how COVID-19 had affected their system of work. The qualitative data were examined, and the results showed that American sonographers felt unsupported by managers and administration and suffered from post-traumatic stress disorder, which had a negative effect on their physical and mental health.
Ultrasound LI-RADS visualization scores on surveillance ultrasound for hepatocellular carcinoma: a systematic review with meta-analysis
Kang JH, Kim NH, Kim DH, et al. Ultrasound Med Biol 2023; 49: 2205–2212. DOI: 10.10.1016/j.ultrasmedbio.2023.07.008.
LI-RADS (liver imaging reporting and data system) is used to help quantify liver masses and alongside a number, a visualization score is given, from A (well) seen to C (severe limitations). Because it is difficult to image the liver parenchyma in patients with a fatty liver or a very heterogenous liver, the group were interested in assessing how many patients fell into group C. In this meta-analysis, only 6.9% of patients were given the poorest visualization score of C. Most patients with this score had cirrhotic livers, non-alcoholic fatty liver disease, and obesity.
Did stopping ultrasound surveillance during COVID-19 result in an increase of the dialysis access thrombosis rate?
Allsop K and Smith L. J Vasc Access. Epub ahead of print 9 June 2023. DOI: 10.1177/11297298231180326.
At the authors Renal Unit, ultrasound is routinely used to assess the arteriovenous fistula (AVF) or arteriovenous graft (AVG) to ensure patency and suitability for dialysis usage. During COVID-19, the nurses running this service were redeployed, and no surveillance ultrasound scans were performed from April 2020 to March 2021. Thrombosis rates from the year before (April 2019 to March 2020) were compared to the no surveillance scan year. In the non-surveillance year, 59 patients out of 3511 patients had clots (1.68%), compared to 1.2% of patients in the previous year (44/3656). The service has now resumed.
The definition, diagnosis, and symptoms of the uterine niche—a systematic review
Klein Meuleman SJM, Min N, Hehenkamp WJK, et al. Best Pract Res Clin Obstet Gynaecol 2023; 90: 102390. DOI: 10.1016/j.bpobgyn.2023.102390.
As more than 1 in 5 pregnancies result in a cesarean section (CS), many women are found to have a uterine niche where the CS scar has failed to heal fully. This paper discusses the symptoms that the patient may present with. The authors recommend the best way to identify a uterine niche as being transvaginal ultrasound and sonohysterography, which allows accurate measurement of the myometrial thickness.
The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review
Avolio PP, Lughezzani G, Anidjar M, et al. World J Urol. Epub ahead of print 9 August 2023. DOI: 10.1007/s00345-023-04521-w.
MRI (magnetic resonance imaging) is now the preferred route for identification of abnormal areas within the prostate gland to biopsy, rather than the previously used transrectal ultrasound (TRUS). With micro-ultrasound, which is high-frequency ultrasound (29 MHz), the resolution is about 70 microns, which allows improved identification of anatomy and abnormalities present within the prostate gland prior to biopsy. There are the usual limitations when using ultrasound, and further research is needed, but this technique could aid the clinician.
Natural history of endometriosis in pregnancy: ultrasound study of morphology of deep endometriosis and ovarian endometrioma
Bean E, Knez J, Setty T, et al. Ultrasound Obstet Gynecol. Epub ahead of print 13 July 2023. DOI: 10.1002/uog.26310.
Endometriotic nodules often become decidualized during pregnancy, this makes their appearance change, as they increase in size, become echogenic, and show increased vascularity on color Doppler. The risk is that they are then thought to be cancerous and further imaging or invasive procedures are undertaken to assess. This research involving 65 women who presented in early pregnancy were followed up at their routine maternity ultrasound scans and measurements of endometriomas, endometriotic nodules were performed by the same clinical fellow; some patients also had a follow-up scan post-natally. The research found that decidualization mostly occurred in the first trimester and all endometriomas and nodules decreased in size in the third trimester, with some resolving completely.
Lung ultrasound in acute and chronic heart failure: a clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI)
Gargani L, Girerd N, Platz E, et al. Eur Heart J Cardiovasc Imaging. Epub ahead of print 14 July 2023. DOI: 10.1093/ehjci/jead169.
Good descriptions of the appearances of different pathologies found when performing lung ultrasound. The tables included in this paper could easily be printed off as an aide memoire for users.