Abstract
I am delighted to introduce this Elastography special issue as the first Ultrasound issue of 2012. It features five excellent ultrasound elastography papers that clearly demonstrate the very different applications of ultrasound elastography including liver fibrosis, regional anaesthesiology and brain tumour resection, also demonstrating the large breadth of clinical specialists who all are using this exciting technology: anaesthetists, neurosurgeons, physicists and radiologists. The first paper in this issue by Hoskins introduces and reviews the principles of ultrasound elastography and will be of interest to those wishing to learn more about the different ultrasound elastography techniques and their respective merits. The second paper is by Cournane et al. which reviews the current status of elastography phantoms for training and quality assurance purposes. It is suggested that there is a need for further development of such phantoms in order to ensure that these new diagnostic techniques are validated. Jaffer et al. question whether ultrasound elastography of the liver is ready to replace biopsy. They provide an excellent review of the advantages, limitations and clinical relevance of the three most investigated ultrasound elastography methods for the accurate assessment of liver fibrosis: transient elastography, realtime elastography and acoustic radiation force impulse. Chakraborty et al. investigate the role of ultrasound elastography in the differentiation of brain tumours from normal brain tissue. They found that the technique had a sensitivity of 100% and a specificity of 75% at detecting that tumour had a different stiffness to the brain when compared with surgical findings. The authors recommend, however, that the technique be used in combination with conventional B-mode ultrasound due to its limited ability at identifying the brain-tumour interface and the quality of fluid-filled cysts.
Munirama et al. present the results from the first use of ultrasound elastography for regional anaesthesia in a Thiel cadaver model. It was found in this investigation that ultrasound elastography images were superior in visualizing dynamic spread of fluid as well as providing a better dose-response compared with B-mode, which offers the clinical user the potential to use smaller test doses that can be easily detected using ultrasound elastography. Learn more about this special elastography issue by reading the guest editorial by Pete Hoskins and William Svensson.
There may be more to fetal sexing than meets the eye. Well, that is the message from Edwards’ and Thomson's thought-provoking paper on using ultrasound to determine sex prenatally. In this special feature they discuss ambiguous genitalia and also highlight international concerns on the growing crime of gendercide.
Fernandez et al. present an interesting case where cranial ultrasound detected grey matter heterotopia in a neonate, which was later correlated with magnetic resonance imaging findings. They describe the sonographic signs and suggest an extended investigation beyond the white matter and cortex.
Two more articles are featured as part of the now-established ‘PoCUS Series’. Liteplo et al. describe the use of ultrasound for evaluating the hypotensive patient when every second counts. They review some of the suggested scanning protocols and algorithms. On the same theme, Pishe et al. discuss the value of ultrasound for the hypotensive patient when a cardiogenic cause is suspected.
Our new international editor is John Hossack who joined us last November. Originally from Scotland, John is a professor in biomedical engineering at the University of Virginia, Charlottesville, USA. His research interests lie in improving diagnostic confidence in medical ultrasound. He will work closely with us on all aspects of Ultrasound but will have a particular focus on managing overseas contributions. It is great to have him on board and we look forward to working with him.
Congratulations to Vivian Purnell from the Leigh Infirmary, Lancashire. She is the winner of the 2011 ‘BMUS best published paper by a student’ competition. There were two other excellent entries but Vivian's paper ‘Is bladder ultrasound indicated as part of the routine investigation for haematuria?’ just came out on top. You can read it in the November 2011 issue of Ultrasound. She wins a year's subscription to BMUS and £250 cash courtesy of The Royal Society of Medicine Press.
I hope you enjoy this special issue. Feel free to contact me with your comments.