Echoes Incidence of additional treatments in women treated with MR-guided focused US for symptomatic uterine fibroids: Review of 138 patients with an average follow-up of 2.8 years. Gorny KR, Borah BJ, Brown DL, et al. J Vasc Interv Radiol 2014;25:1506–12 This single-centre study found that MR-guided focused US as a method of treatment for fibroids was just as effective as other uterus-sparing treatments, such as myomectomy and uterine artery embolisation. Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee. Richenberg J, Belfield J, Ramchandani P, et al. Eur Radiol 2014. Epub ahead of print. DOI 10.1007/s00330-014-3437-x New guidance from a team appointed by the ESUR may help standardise management of testicular microlithiasis, which varies greatly between centres and indeed, individuals. In isolation, microlithiasis does not warrant annual ultrasound surveillance. However, it is recommended for those with microlithiasis and other risk factors, such as a personal or family history of tumour, maldescent, orchidopexy and testicular atrophy. First-trimester fetal cardiac examination using spatiotemporal image correlation, tomographic ultrasound and color Doppler imaging for the diagnosis of complex congenital heart disease in high-risk patients. Turan S, Turan OM, Desai A, et al. Ultrasound Obstet Gynecol 2014;44:562–7 Using their 4D technique and colour Doppler in 164 highrisk fetuses, this team found that only two cases of congenital heart disease were missed in the first trimester to be later detected in the second trimester, giving them 91% sensitivity and 100% specificity. However, they emphasise that high-quality 2D imaging of the four-chamber view remains key to successful volume acquisition. Diagnostic accuracy of abdominal ultrasound in the screening of esophageal varices in patients with cirrhosis. Sort P, Muelas M, Isava A, et al. Eur J Gastroenterol Hepatol 2014;26:1335–41 The authors claim that, in the right hands, abdominal ultrasound may be a reliable method for detecting oesophageal varices in patients with compensated cirrhosis, thus potentially negating the need for approximately 40% of endoscopies. Avoiding endoscopy would surely be welcomed by both patient and clinician alike. Three-step sequential positioning algorithm during sonographic evaluation for appendicitis increases appendiceal visualization rate and reduces CT use. Chang ST, Jeffrey RB, Olcott EW. Am J Roentgenol 2014;203:1006–12 Ultrasound 2015; 23: 70–71
In ultrasound, if you cannot find the elusive appendix you cannot comment on it. After introducing a three-step systematic evaluation technique, these researchers found that visualisation of the appendix was much improved. Before implementation, detection rate was 31% but increased to over 52% after implementation. Increased success using ultrasound to diagnose appendicitis meant that the need for abdominal CT in both children and adults was reduced significantly. Factors that affect efficacy of ultrasound surveillance for early stage hepatocellular carcinoma in patients with cirrhosis. Del Poggio P, Olmi S, Ciccarese F, et al. Clin Gastroenterol Hepatol 2014;12:1927–33 This team looked at the value of ultrasound surveillance for detecting hepatocellular carcinoma in patients with cirrhosis over a 22-year time period. They found that ultrasound was effective if intervals between scans were not more than six months. Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound? Piessens S, Healey M, Maher P, et al. Aust NZ J Obstet Gynaecol 2014;54:462–8 Looks like it. After just a week of additional training at an expert centre, these researchers found that sonographers who have already a general ability in transvaginal ultrasound were able to detect, with similar diagnostic accuracy to that of experts, endometriosis affecting sites including bowel, vagina and rectouterine pouch. This paper gives hope to us all whose ability in this area is limited to spotting endometriomas. The effect of thoracic ultrasound for the detection of pneumothorax on medical decision making in trauma patients in the out-of-hospital setting. Jones RA, Tabbut M, Emerman C, Stout S. Ann Emergency Med 2014;64(Suppl. 1):S30–S31 Results from this small study suggested that after a short training period, clinical staff can use point-of-care ultrasound ‘in the field’ to reduce significantly their suspicion for pneumothorax in trauma patients. This may, in turn, avoid unnecessary thoracic emergency procedures being performed before the patient reaches hospital. Contrast-enhanced voiding urosonography with a secondgeneration ultrasound contrast agent for diagnosis of vesicoureteric reflux in 1350 children: the experience of a single centre. Papadopoulou F, Ntoulia A, Darge K. Arch Dis Child 2014;99:A198–A199 This team used SonoVue during voiding urosonography to investigate reflux and urethral pathology in 1350 children. They found no serious adverse effects as a consequence of
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.......................................................................................................................... using SonoVue administered intravesically and suggested that the minor adverse effects experienced were probably down to the catheterisation procedure rather than the microbubbles. A novel, low-cost reusable ultrasound phantom for chest drain insertion. Hunter K, Willers J, Hews J, et al. Anaesthesia 2014;69:19 Most phantoms cost an absolute fortune so I’m delighted to see that this team is both innovative and frugal. Having ‘designed’ primitive training aids for novices myself from Chinese takeaway tubs filled with gel, olives and green beans, I’m greatly impressed by these authors’ use of items including exercise bands, electrical cable and upholstery foam to produce a much more sophisticated phantom of the thorax. I hope they inspire other trainers to be similarly imaginative. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. Van Calster B, Van Hoorde K, Valentin L, et al. BMJ (Online) 2014;349:g5920
Data from nearly 6000 women in 10 different countries have directed this international team of experts to develop a new risk prediction model for ovarian cancer. Their model is based on three clinical and six ultrasound predictors and discriminates well between malignant and benign lesions. I think we’ll be hearing more about the ADNEX model in the near future. Uterine artery Doppler in high-risk pregnancies at 23–24 gestational weeks is of value in predicting adverse outcome of pregnancy and selecting cases for more intense surveillance. Li N, Ghosh G, Gudmundsson S. Acta Obstet Gynecol Scand 2014;93:1276–81 This retrospective study of 645 women with high-risk pregnancies found that there was a strong correlation between second trimester abnormal uterine and umbilical artery Doppler traces and preeclampsia but not other hypertensive disorders.
Hazel Edwards DOI: 10.1177/1742271X14565086
In ultrasound, if you cannot find the elusive appendix you cannot comment on it. After introducing a three-step systematic evaluation technique, these researchers found that visualisation of the appendix was much improved. Before implementation, detection rate was 31% but increased to over 52% after implementation. Increased success using ultrasound to diagnose appendicitis meant that the need for abdominal CT in both children and adults was reduced significantly. Factors that affect efficacy of ultrasound surveillance for early stage hepatocellular carcinoma in patients with cirrhosis. Del Poggio P, Olmi S, Ciccarese F, et al. Clin Gastroenterol Hepatol 2014;12:1927–33 This team looked at the value of ultrasound surveillance for detecting hepatocellular carcinoma in patients with cirrhosis over a 22-year time period. They found that ultrasound was effective if intervals between scans were not more than six months. Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound? Piessens S, Healey M, Maher P, et al. Aust NZ J Obstet Gynaecol 2014;54:462–8 Looks like it. After just a week of additional training at an expert centre, these researchers found that sonographers who have already a general ability in transvaginal ultrasound were able to detect, with similar diagnostic accuracy to that of experts, endometriosis affecting sites including bowel, vagina and rectouterine pouch. This paper gives hope to us all whose ability in this area is limited to spotting endometriomas. The effect of thoracic ultrasound for the detection of pneumothorax on medical decision making in trauma patients in the out-of-hospital setting. Jones RA, Tabbut M, Emerman C, Stout S. Ann Emergency Med 2014;64(Suppl. 1):S30–S31 Results from this small study suggested that after a short training period, clinical staff can use point-of-care ultrasound ‘in the field’ to reduce significantly their suspicion for pneumothorax in trauma patients. This may, in turn, avoid unnecessary thoracic emergency procedures being performed before the patient reaches hospital. Contrast-enhanced voiding urosonography with a secondgeneration ultrasound contrast agent for diagnosis of vesicoureteric reflux in 1350 children: the experience of a single centre. Papadopoulou F, Ntoulia A, Darge K. Arch Dis Child 2014;99:A198–A199 This team used SonoVue during voiding urosonography to investigate reflux and urethral pathology in 1350 children. They found no serious adverse effects as a consequence of
Edwards
Ultrasound
71
.......................................................................................................................... using SonoVue administered intravesically and suggested that the minor adverse effects experienced were probably down to the catheterisation procedure rather than the microbubbles. A novel, low-cost reusable ultrasound phantom for chest drain insertion. Hunter K, Willers J, Hews J, et al. Anaesthesia 2014;69:19 Most phantoms cost an absolute fortune so I’m delighted to see that this team is both innovative and frugal. Having ‘designed’ primitive training aids for novices myself from Chinese takeaway tubs filled with gel, olives and green beans, I’m greatly impressed by these authors’ use of items including exercise bands, electrical cable and upholstery foam to produce a much more sophisticated phantom of the thorax. I hope they inspire other trainers to be similarly imaginative. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. Van Calster B, Van Hoorde K, Valentin L, et al. BMJ (Online) 2014;349:g5920
Data from nearly 6000 women in 10 different countries have directed this international team of experts to develop a new risk prediction model for ovarian cancer. Their model is based on three clinical and six ultrasound predictors and discriminates well between malignant and benign lesions. I think we’ll be hearing more about the ADNEX model in the near future. Uterine artery Doppler in high-risk pregnancies at 23–24 gestational weeks is of value in predicting adverse outcome of pregnancy and selecting cases for more intense surveillance. Li N, Ghosh G, Gudmundsson S. Acta Obstet Gynecol Scand 2014;93:1276–81 This retrospective study of 645 women with high-risk pregnancies found that there was a strong correlation between second trimester abnormal uterine and umbilical artery Doppler traces and preeclampsia but not other hypertensive disorders.
Hazel Edwards DOI: 10.1177/1742271X14565086
