Liver tumor ablation assisted by image fusion Sheng-Nan Lu Journal of Medical Ultrasound 2019 27(2):61-62

Sonographic estimation of amniotic fluid volume using the amniotic fluid index and the single deepest pocket in a resource-limited setting Geofery Luntsi, Falmata Ali Burabe, Prince Ame Ogenyi, Joseph Dlama Zira, Nwobi Ivor Chigozie, Flavious Bobuin Nkubli, Maikudi Dauda Journal of Medical Ultrasound 2019 27(2):63-68 Objective: To determine the normal value of amniotic fluid (AF) volume among pregnant women in a Northern Nigerian population and to determine if there is a relationship between AF index (AFI) and single deepest pocket (SDP) with anthropometric variables. Materials and Methods: A prospective cross-sectional study was conducted among singleton pregnant women at late second and third trimester attending the antenatal clinic in Abubakar Tafawa Balewa Teaching Hospital, Bauchi, from December 2016 to April 2017. The mean AFI and SDP were measured by sonography. Ethical approval was obtained from the institution and informed consent was sought for from all the participants. Descriptive statistics, i.e. mean, standard deviation, and correlation coefficient, were used for the analysis. Results: A total of 206 women, aged between 18 and 40 years, with fetal gestational ages between 22 and 39 weeks were included in the study. The values for AFI in the study ranged from 12 to 28.7 cm, with a mean value of 19.84 ± 3.64 cm, and SDP ranged from 3.7 to 9.1 cm with a mean value of 6.04 ± 1.12 cm. This study found a weak relationship between the anthropometric variables and AFI and SDP and a strong relationship between AFI and SDP with a correlation coefficient of R = 0.901 and P = 0.014. Conclusion: This study found the mean values for AF volume using AFI and SDP in the studied population to be 19.84 ± 3.64 cm and 6.04 ± 1.12 cm, respectively; a strong positive relationship between AFI and SDP; and a negative relationship between body mass index with AFI and SDP.

Ultrasonic assessment of optic nerve sheath to detect increased intracranial pressure Mohammad Ghasem Hanafi, Mohammadreza Maleki Verki, Sima Norouzi Parei Journal of Medical Ultrasound 2019 27(2):69-74 Purpose: Increased intracranial pressure (ICP) is one of the prevalent symptoms of trauma, especially traumatic headache, which requires quick action for the diagnosis and treatment. The optic nerve sheath diameter (ONSD) is a newly proposed technique for the detection of an increase in ICP. The aim of this study was to assess the efficacy of this new diagnostic method in patients with increased ICP induced by trauma. Methods: This prospective study was conducted between December 2016 and February 2017. The patients with traumatic headache and who had been diagnosed with increased ICP using clinical signs and computed tomography scan were compared to the voluntary healthy group. In each patient, measurements were performed employing ultrasound three times on each eye in an axial region, and the mean of these sizes was obtained as the ONSD. Results: A total of 112 participants were examined. The mean ONSD measurement of the patients and the voluntary healthy group was 6.01 ± 0.76 and 3.41 ± 0.56 mm in the right eye, 6.11 ± 0.75 and 3.39 ± 0.54 mm in the left eye, and 6.06 ± 0.75 and 4.02 ± 1.07 mm in both sides, respectively. The ONSD in the right and left sides had high and significant correlation in the patients (r = 0.929, P < 0.000) and voluntary healthy (r = 0.630, P < 0.000) group. The mean ONSD of one of the patients was 6.24 ± 0.56 mm, and in another patient with no clinical sign of increased ICP, the mean ONSD was 4.61 ± 0.09 mm. Conclusions: Ultrasound performed on the diaphragm of the optic nerve with acceptable sensitivity can detect patients with an increase in ICP and can be efficacious in expediting the action needed to reduce ICP. Due to the sensitivity and specificity of the ultrasound and high accuracy of the diameter of optic nerve sheath in detecting increase in ICP, as well as considering the fact that ultrasound is a noninvasive and available technique; it can be performed at the patient's bedside.

Value of additional ultrasound examination in patients with equivocal computed tomography findings of acute appendicitis: Comparison with computed tomography reassessment Ji Ye Sim, Hyuk Jung Kim, Suk Ki Jang, Jae Woo Yeon, Byeong Geon Jeon, Young Rock Ha, So Ya Paik, June Sik Cho Journal of Medical Ultrasound 2019 27(2):75-80 Objectives: The objective of this study was to find the diagnostic values of additional ultrasound (US) in patients with equivocal computed tomography (CT) findings of acute appendicitis, compared to CT reassessment. Materials and Methods: Patients with equivocal CT findings of acute appendicitis (n = 115), who underwent the US, were included in the study. Two abdominal radiologists reviewed CT scans independently. They analyzed CT findings and made a diagnosis of acute appendicitis. The patients were categorized into positive and negative appendicitis based on the previous US reports. The diagnostic performance, interobserver agreement of CT findings, and appendicitis likelihood were calculated. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US (100%, 92.1%, 79.5%, and 100%, respectively) were higher than those of CT reassessment (reviewer 1: 51.9%, 87.5%, 56.1%, and 85.6%; reviewer 2: 66.7%, 85.2%, 58.1%, and 89.3%, respectively). In the coexistent inflammation group, the sensitivity, specificity, PPV, and NPV of US (reviewer 1: 100%, 98%, 91.5%, and 100%; reviewer 2: 100%, 98%, 87.7%, and 100%, respectively) were higher than those of CT reassessment (reviewer 1: 27.3%, 94.1%, 49.9%, and 85.8%; reviewer 2: 14.3%, 98.0%, 50.5%, and 88.9%, respectively). Conclusion: In patients with equivocal CT findings of acute appendicitis, US shows better diagnostic performance than CT reassessment, and helps differentiate with periappendicitis.

Safety of perfluorobutane (Sonazoid) in characterizing focal liver lesions Yi-Hong Chou, Ja-Der Liang, Shen-Yung Wang, Shih-Jer Hsu, Jui-Ting Hu, Sien-Sing Yang, Hsin-Kai Wang, Tien-Ying Lee, Chui-Mei Tiu Journal of Medical Ultrasound 2019 27(2):81-85 Background: The purpose of this study was to report the safety of perfluorobutane (Sonazoid) as a vascular-phase imaging agent in characterizing focal liver lesions (FLLs). Materials and Methods: From May 2014 to April 2015, a total of 54 individuals who received Sonazoid contrast-enhanced ultrasound (CEUS) were enrolled at 5 hospitals of 4 medical centers. All individuals were included in safety evaluation. A prospective study to evaluate the adverse effect (AE) incidences after intravenous administration of Sonazoid. Results: Sonazoid was well tolerated. Treatment-emergent adverse events (TEAEs) representing AE were recorded for 13 (24.1%) patients. The most common AE was abdominal pain (9.3%), followed by heart rate irregularity (5.6%). The majority of these patients (69.2%) experienced TEAEs that were mild in intensity. Sonazoid causes no significant AEs after intravenous injection. The only noteworthy AEs are related to tolerable myalgia (3.7%), abdominal pain (1.9%), and headache (1.9%). None of the 54 patients showed serious adverse effects. Conclusion: Sonazoid shows good safety and tolerance of intravenous use during CEUS of the liver for evaluation of FLLs.

Sonographic evaluation of the achilles tendon and plantar fascia of type 2 diabetics in Nigeria Babalola Ishmael Afolabi, Oluwagbemiga Oluwole Ayoola, Bukunmi Michael Idowu, Babatope A Kolawole, Adeleye Dorcas Omisore Journal of Medical Ultrasound 2019 27(2):86-91 Background: The aim of this study is to compare the Achilles tendon (AT) thickness (ATT) and plantar fascia (PF) thickness (PFT) of diabetics with and without peripheral neuropathy (PN) to that of a control population. Materials and Methods: B-mode sonography of the AT and PF was done. Correlation analysis was used to determine the relationship between ATT and PFT with demographic data such as body mass index, duration of diabetes, and presence of PN. A multivariate regression was used to construct models for determining the thicknesses. Results: Eighty type 2 diabetics were recruited and categorized into groups based on the presence or absence of PN (Groups A and B, respectively). Group A constituted 57 participants while there were 23 in Group B. Eighty controls constituted Group C. Mean values of 6.08 ± 0.65, 5.08 ± 0.48, and 4.57 ± 0.57 mm (P < 0.001) of the right ATT were obtained in Groups A to C while values of 1.95 ± 0.35, 1.88 ± 0.39, and 1.44 ± 0.20 mm (P < 0.001) were obtained for the right PFT. Conclusion: The presence of PN and factors such as diabetes duration can affect the thickness of AT and PF.

A prospective evaluation of point of care ultrasound teaching in Switzerland Connor Byrne, Nico Kahl, Brian Knight, Monica Lee, Stephanie Morley, Shadi Lahham, Roland Bingisser, Maxwell Thompson, Inna Shniter, Victoria Valdes, John C Fox Journal of Medical Ultrasound 2019 27(2):92-96 Context: As the utility of point-of-care ultrasound (POCUS) continues to expand in the medical field, there is a need for effective educational methods. In Switzerland, medical education follows the European model and lasts 6 years, focusing on preclinical training during the first 2 years. No previous studies have evaluated the optimal time for teaching ultrasound in European medical education. Aims: The aim of this study is to provide ultrasound training to medical students in Switzerland at varying times during their clinical training to determine if the level of training plays a role in their ability to comprehend and to apply basic POCUS skills. Methods: We performed an observational study utilizing a convenience sample of Swiss medical students between July 11, 2016 and August 6, 2016. They were taught a 2-day POCUS course by five American-trained 1st-year medical students. Following this course, students were evaluated with written and clinical examination. Results: 100 Swiss medical students were enrolled in the study. A total of 59 of these students were early clinical students, and 41 students were late clinical students. A two-tailed t-test was performed and demonstrated that the late clinical students performed better than the early clinical students on the written assessment; however, no difference was found in clinical skill. Conclusion: Our data suggest that Swiss medical students can learn and perform POCUS after a 2-day instructional taught by trained 1st-year American medical students. No difference was found between students in early clinical training and late clinical training for the ability to perform POCUS.

Hepatic hemangioma in a cluster of Iranian population Amir Alam Kamyab, Kiara Rezaei-Kalantari Journal of Medical Ultrasound 2019 27(2):97-100 Introduction: Hemangioma is the most common benign lesion of the liver. It is mostly asymptomatic and may be found incidentally during cross-sectional liver or abdominal imaging. This study aimed to investigate the prevalence and clinical characteristics of hepatic hemangioma in an Iranian population. Materials and Methods: This retrospective study was conducted between July and November 2017 in Firoozgar Hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. The study population consisted of adult patients (>18 years) referred for transabdominal ultrasonography to ultrasound unit of the hospital. Results: Totally, 1985 patients were included in the study. There were 1282 women (64.5%) and 703 men (35.4%). A total of 47 hemangiomas were found in 41 patients. The prevalence of hemangioma was 2.04% in our study population. Four patients had more than one hemangioma; all of them were women. Twelve men (1.70%) versus 29 women (2.26%) found to have hemangioma. The mean age of patients with hemangioma was 47.65 ± 14.84 years. Thirty-four patients (82.9%) had hemangioma in their right lobe of the liver whereas seven patients (17.1%) had hemangioma in the left lobe of the liver. The mean diameter of hemangioma was 16.70 ± 8.42 mm. The mean diameter of hemangioma in women was 17.2 ± 9.33 mm and in men was 15.25 ± 4.91 mm (P = 0.495). Conclusion: Hepatic hemangioma is prevalent in the Iranian population. It is more prevalent among women and in the VII segment of the liver.

Focused ultrasound assists in diagnosis and management of difficult airway in Ludwig's angina Chang-Chih Shih, Jen-Chun Wang, Sy-Jou Chen, Yuan-Pin Hsu Journal of Medical Ultrasound 2019 27(2):101-103 Ludwig's angina is a rapidly progressive and life-threatening medical emergency. The mortality rate is about 8%. Management of the difficult airway in Ludwig's angina has been challenging for clinical physicians. We reported an otherwise healthy 49-year-old female, who visited our emergency department with progressive swelling of her chin, drooling, and dyspnea. Ludwig's angina with impending airway compromise was promptly identified. The precise anatomy of the distorted neck was accessed using ultrasound as an adjunct. Emergent tracheostomy was then established successfully within minutes. Physicians should consider using ultrasound as an adjunct to define anatomy before performing emergent surgical airways.

Intra-aortic balloon pump for cesarean hysterectomy and massive hemorrhage in a parturient with placenta accreta and pulmonary embolus Edward T Riley, Kulsum Akbar, Brendan Carvalho Journal of Medical Ultrasound 2019 27(2):104-106 During cesarean hysterectomy for a placenta accreta, a 36-year-old parturient underwent a massive resuscitation for profound bleeding and also suffered a pulmonary embolus leading to cardiac arrest. Chest compressions and epinephrine were required for resucitation. When surgery was complete, she was taken to the intensive care unit on an epinephrine infusion and inhaled nitric oxide but was brought back to the operating room after 3 h for surgical exploration. Echocardiography revealed a poorly contracting left ventricle, and an intra-aortic balloon pump was inserted. She gradually recovered full function and was discharged home after 35 days.