Publications by authors named "Maija Radzina"

30 Publications

  • Page 1 of 1

Post-COVID-19 Liver Injury: Comprehensive Imaging With Multiparametric Ultrasound.

J Ultrasound Med 2021 Jul 9. Epub 2021 Jul 9.

Department of Infectology, Rīga Stradiņš University, Riga, Latvia.

Objectives: This study aimed to define patterns of liver injury after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using multiparametric ultrasound (mpUS) in a variable patient population with differing severities of COVID-19.

Methods: Ninety patients were enrolled into the study: 56 had SARS-CoV-2 3-9 months prior to enrolment; 34 served as a clinically healthy control group. All patients underwent an mpUS evaluation of the liver (elastography, dispersion and attenuation imaging). Seventy-six patients had abdominal magnetic resonance (MR) and noncontrast enhanced thoracic computed tomography (CT) scans performed at the same day. All patients were screened for biochemical markers of liver injury.

Results: Liver elasticity, viscosity, and steatosis values were significantly altered in patients after COVID-19, with particularly higher fibrosis scores compared to the control group (P < .001). Increased biochemical markers of liver injury correlated with changes in mpUS (P < .05), but not with findings on CT or MR findings. Seventeen of 34 hospitalized patients had a moderate or severe course of the disease course with more pronounced changes in mpUS. Increased body mass index was found to influence liver injury and correlated with more severe forms of COVID-19 (P < .001).

Conclusions: COVID-19 can cause liver injury observable using mpUS. More severe forms of COVID-19 and patient obesity are related to increased values of liver damage observed. In comparison to MRI and CT, mpUS appears to be more sensitive to involvement of liver parenchyma. Further research is warranted to establish this promising method for evaluating post-COVID-19 liver involvement in the aftermath of the pandemic.
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http://dx.doi.org/10.1002/jum.15778DOI Listing
July 2021

Preoperative Multiparametric Ultrasound and Fine Needle Aspiration Cytology evaluation of parotid gland tumors: which is the best technique?

Med Ultrason 2021 Jun 10. Epub 2021 Jun 10.

Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy.

Aims: To evaluate the pre-surgical diagnostic value of Multiparametric Ultrasound (MPUS) and Fine Needle Aspiration Cytology (FNAC) in differentiating parotid gland tumors, comparing the results with histology.

Materials And Methods: The study enrolled 84 patients with parotid gland lesions surgically treated in a single tertiary center and evaluated by MPUS. Each patient underwent FNAC. Histological examination was considered the gold standard.

Results: Histology identified 62 benign tumors and 22 malignancies. In the differential diagnosis between malignant and benign lesions, B-mode Ultrasound (US), Color-Doppler US, Contrast-Enhanced US (CEUS), Elastography (USE) and FNAC showed the following values of sensitivity: 82%, 81%, 86%, 77%, 73% respectively; specificity: 97%, 61%, 95%, 71%, 97% respectively; PPV: 90%, 43%, 86%, 50%, 89% respectively; NPV: 93%, 90%, 95%, 88%, 91% respectively; and accuracy: 89%, 71%, 90%, 78%, 84% re-spectively.

Conclusions: CEUS proved to be a valid and accurate method for identifying malignant tumors of parotid gland; the combination of B-mode US with CEUS showed similar diagnostic accuracy, but better sensitivity than CEUS taken alone. USE did not improve the diagnostic performance of the B-mode US, alone or in association with CEUS; however, it revealed the highest diagnostic accuracy in the differentiation between benign lesions. FNAC demonstrated lower values in comparison with CEUS and with USE. Therefore, according to our study, MPUS could be proposed as a valid alternative to FNAC.
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http://dx.doi.org/10.11152/mu-3068DOI Listing
June 2021

How to perform shear wave elastography. Part I.

Med Ultrason 2021 May 4. Epub 2021 May 4.

Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.

We recently introduced a series of papers describing how to do certain techniques. This article is the first part of a review of shear wave elastography (SWE). It reports the principles and interpretation of the technique and describes how to optimize it. Normal values, pitfalls and artefacts for the examination of liver, breast. thyroid and salivary gland with shear wave elastography are presented. The manuscript provides specific tips for applying SWE as part of a diagnostic US examination.
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http://dx.doi.org/10.11152/mu-3217DOI Listing
May 2021

Ultrasound Curricula of Student Education in Europe: Summary of the Experience.

Ultrasound Int Open 2020 Jun 31;6(1):E25-E33. Epub 2020 Aug 31.

Department of Radiological, Oncologic and Anatomo-pathologic Sciences, University of Rome La Sapienza, Roma, Italy.

Despite the increasing role of ultrasound, structured ultrasound teaching is only slowly being integrated into the curricula of medical schools and universities all over Europe. To survey the current situation at European universities regarding the integration of ultrasound in student medical education and to report on models of student ultrasound training from selected European universities. A questionnaire survey focusing on the implementation of curricular ultrasound education was sent out to the 28 presidents of the national ultrasound societies of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), who were asked to distribute the questionnaires to the medical universities of their countries. Overall, 53 questionnaires were returned from 46 universities in 17 European countries. In most of the universities (40/46 universities, 87%), the theoretical background of ultrasound is taught. However, in only a minority of universities is ultrasound integrated in anatomy courses (8/46 universities, 17%) or basic science courses (16/46 universities, 35%). Practical skills in ultrasound are taught in 56% of the universities (26/46 universities) and tested in a practical exam in seven of the responding universities (15%). The number of hours in which ultrasound was taught ranged from one to 58 (mean, seven). The respondents reported that lack of time and limited faculty funding were major hurdles. According to our survey, only a minority of European universities has integrated ultrasound into the preclinical curriculum thus far. Future EFSUMB initiatives will continue to promote the introduction of ultrasound as an integrative part of the core curriculum of student medical education, and the preparation of proper teaching material.
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http://dx.doi.org/10.1055/a-1183-3009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458842PMC
June 2020

Performance of EU-TIRADS in malignancy risk stratification of thyroid nodules: a meta-analysis.

Eur J Endocrinol 2020 Sep;183(3):255-264

Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.

Objective: Several thyroid imaging reporting and data systems (TIRADS) have been proposed to stratify the malignancy risk of thyroid nodule by ultrasound. The TIRADS by the European Thyroid Association, namely EU-TIRADS, was the last one to be published.

Design: We conducted a meta-analysis to assess the prevalence of malignancy in each EU-TIRADS class and the performance of EU-TIRADS class 5 vs 2, 3 and 4 in detecting malignant lesions.

Methods: Four databases were searched until December 2019. Original articles reporting the performance of EU-TIRADS and adopting histology as reference standard were included. The number of malignant nodules in each class and the number of nodules classified as true/false positive/negative were extracted. A random-effects model was used for pooling data.

Results: Seven studies were included, evaluating 5672 thyroid nodules. The prevalence of malignancy in each EU-TIRADS class was 0.5% (95% CI: 0.0-1.3), 5.9% (95% CI: 2.6-9.2), 21.4% (95% CI: 11.1-31.7), and 76.1% (95% CI: 63.7-88.5). Sensitivity, specificity, PPV, NPV, LR+, LR- and DOR of EU-TIRADS class 5 were 83.5% (95% CI: 74.5-89.8), 84.3% (95% CI: 66.2-93.7), 76.1% (95% CI: 63.7-88.5), 85.4% (95% CI: 79.1-91.8), 4.9 (95% CI: 2.9-8.2), 0.2 (95% CI: 0.1-0.3), and 24.5 (95% CI: 11.7-51.0), respectively. A further improved performance was found after excluding two studies because of limited sample size and low prevalence of malignancy in class 5.

Conclusions: A limited number of studies generally conducted using a retrospective design was found. Acknowledging this limitation, the performance of EU-TIRADS in stratifying the risk of thyroid nodules was high. Also, EU-TIRADS class 5 showed moderate evidence of detecting malignant lesions.
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http://dx.doi.org/10.1530/EJE-20-0204DOI Listing
September 2020

Accuracy of Ga-PSMA-11 PET/CT and multiparametric MRI for the detection of local tumor and lymph node metastases in early biochemical recurrence of prostate cancer.

Am J Nucl Med Mol Imaging 2020 15;10(2):106-118. Epub 2020 Apr 15.

Center of Urology, Pauls Stradins Clinical University Hospital Riga, Latvia.

Anatomical and functional imaging plays a decisive role for detection and staging, of prostate cancer both primarily and post-treatment. While multiparametric MRI offers anatomic imaging with excellent soft tissue contrast, hybrid imaging based on positron emission tomography in combination with computed tomography (PET/CT) contributes functional imaging capacities. Since Ga-PSMA-11 was expected to be more efficient than the prior Choline-based PET radiotracers, it was the aim of the study to evaluate the diagnostic performance of the Ga-PSMA-11 PET/CT and multiparametric MRI in patients with recurrent prostate cancer and low PSA levels. 32 out of a cohort of 128 prostate cancer patients with biochemical relapse were referred for Ga-PSMA-11 PET/CT, MRI and bone scintigraphy. According to the histopathologically or clinically defined reference standard all results were classified as true positive, false positive, true negative or false negative. Local recurrence was present in 11/32 patients, lymph node metastases - in 13/32 patients and, bone metastases - in 6/32 patients. Against the standard of reference, sensitivity, specificity and accuracy for local recurrence of PET/CT were 63.6 %; 73.7%; 77.8%, respectively. MRI reached 90.9%; 94.7%; 92.3%, respectively. For local lymph node metastases PET/CT - 83.3%; 80.0% and 90.6%, respectively. MRI - 41.7%; 94.4%; 72.0%, respectively. For evaluation of bone metastases in PET/CT - 83.3%; 92.0%; 71.0%, respectively. Bone scintigraphy - 50.0%; 84.0%; 77.4%, respectively. In conclusion, mpMRI offered the better diagnostic accuracy in the detection of local recurrence and while PSMA PET/CT was superior in the detection of distant and lymph node metastases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218697PMC
April 2020

Medical Student Ultrasound Education, a WFUMB Position Paper, Part II. A consensus statement of ultrasound societies.

Med Ultrason 2020 May;22(2):220-229

Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland Ultrasound Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Ultrasound is becoming a fundamental first-line diagnostic tool for most medical specialties and an innovative tool to teach anatomy, physiology and pathophysiology to undergraduate and graduate students. However, availability of structured training programs during medical school is lagging behind and many physicians still acquire all their ultrasound skills during postgraduate training.There is wide variation in medical student ultrasound education worldwide. Sharing successful educational strategies from early adopter medical schools and learning from leading education programs should advance the integration of ultrasound into the university medical school curricula. In this overview, we present current approaches and suggestions by ultrasound societies concerning medical student educa-tion throughout the world. Based on these examples, we formulate a consensus statement with suggestions on how to integrate ultrasound teaching into the preclinical and clinical medical curricula.
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http://dx.doi.org/10.11152/mu-2599DOI Listing
May 2020

US-Elastography for Breast Lesion Characterization: Prospective Comparison of US BIRADS, Strain Elastography and Shear wave Elastography.

Ultraschall Med 2020 Apr 24. Epub 2020 Apr 24.

Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy.

Purpose:  To evaluate the diagnostic performance of strain elastography (SE) and 2 D shear wave elastography (SWE) and SE/SWE combination in comparison with conventional multiparametric ultrasound (US) with respect to improving BI-RADS classification results and differentiating benign and malignant breast lesions using a qualitative and quantitative assessment.

Materials And Methods:  In this prospective study, 130 histologically proven breast masses were evaluated with baseline US, color Doppler ultrasound (CDUS), SE and SWE (Toshiba Aplio 500 with a 7-15 MHz wide-band linear transducer). Each lesion was classified according to the BIRADS lexicon by evaluating the size, the B-mode and color Doppler features, the SE qualitative (point color scale) and SE semi-quantitative (strain ratio) methods, and quantitative SWE. Histological results were compared with BIRADS, strain ratio (SR) and shear wave elastography (SWE) all performed by one investigator blinded to the clinical examination and mammographic results at the time of the US examination. The area under the ROC curve (AUC) was calculated to evaluate the diagnostic performance of B-mode US, SE, SWE, and their combination.

Results:  Histological examination revealed 47 benign and 83 malignant breast lesions. The accuracy of SR was statistically significantly higher than SWE (sensitivity, specificity and AUC were 89.2 %, 76.6 % and 0.83 for SR and 72.3 %, 66.0 % and 0.69 for SWE, respectively, p = 0.003) but not higher than B-mode US (B-mode US sensitivity, specificity and AUC were 85.5 %, 78.8 %, 0.821, respectively, p = 1.000).

Conclusion:  Our experience suggests that conventional US in combination with both SE and SWE is a valid tool that can be useful in the clinical setting, can improve BIRADS category assessment and may help in the differentiation of benign from malignant breast lesions, with SE having higher accuracy than SWE.
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http://dx.doi.org/10.1055/a-1134-4937DOI Listing
April 2020

Contrast-Enhanced Ultrasound for Musculoskeletal Applications: A World Federation for Ultrasound in Medicine and Biology Position Paper.

Ultrasound Med Biol 2020 06 2;46(6):1279-1295. Epub 2020 Mar 2.

Department of Internal Medicine, Caritas Hospital, Bad Mergentheim, Germany.

This World Federation for Ultrasound in Medicine and Biology position paper reviews the diagnostic potential of ultrasound contrast agents for clinical decision-making and provides general advice for optimal contrast-enhanced ultrasound performance in musculoskeletal issues. In this domain, contrast-enhanced ultrasound performance has increasingly been investigated with promising results, but still lacks everyday clinical application and standardized techniques; therefore, experts summarized current knowledge according to published evidence and best personal experience. The goal was to intensify and standardize the use and administration of ultrasound contrast agents to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2020.01.028DOI Listing
June 2020

Performance of contrast-enhanced ultrasound (CEUS) in assessing thyroid nodules: a systematic review and meta-analysis using histological standard of reference.

Radiol Med 2020 Apr 22;125(4):406-415. Epub 2020 Jan 22.

Department of Imaging Diagnostics, Policlinico Umberto I, University Sapienza, Rome, Italy.

Background: The present study was undertaken to systematically review the literature on the reliability of using contrast-enhanced ultrasound (CEUS) to assess thyroid nodules. To avoid the potential bias in studies using a cytological standard of reference, here we aimed to meta-analyze data from studies adopting histological diagnosis as the gold standard.

Methods: A comprehensive literature exploration of PubMed and Scopus was conducted. The search was updated until June 2018 and references of the retrieved articles screened. Only original articles reporting the histological follow-up of nodules previously undergone CEUS evaluation were eligible for inclusion. Pooled sensitivity, specificity, PPV, and NPV of CEUS were calculated by DerSimonian and Laird method (random-effects model).

Results: The literature search retrieved 1885 articles, and 14 were included for the study. There were Chinese, Italian, German, and Austrian authors. All studies used SonoVue. The overall number of reported nodules was 1515, of which 775 were classified as positive at CEUS and 740 as negative. Pooled sensitivity, specificity, PPV, and NPV of CEUS were 85% (95% CI 83-88), 82% (95% CI 77-87), 83% (95% CI 77-88), and 85% (95% CI 81-88), respectively. Moderate inconsistency was present for specificity and PPV. There was publication bias for sensitivity and NPV.

Conclusions: CEUS reaches good performance in discriminating between malignant and benign thyroid lesions.
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http://dx.doi.org/10.1007/s11547-019-01129-2DOI Listing
April 2020

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018.

Ultraschall Med 2019 Aug 25;40(4):425-453. Epub 2019 Jun 25.

Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.

This manuscript describes the use of ultrasound elastography, with the exception of liver applications, and represents an update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography.
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http://dx.doi.org/10.1055/a-0838-9937DOI Listing
August 2019

Prospective Evaluation of Semiquantitative Strain Ratio and Quantitative 2D Ultrasound Shear Wave Elastography (SWE) in Association with TIRADS Classification for Thyroid Nodule Characterization.

Ultraschall Med 2019 Aug 28;40(4):495-503. Epub 2019 May 28.

Department of Radiology, Sapienza-University of Rome, Rome, Italy.

Purpose:  To evaluate the diagnostic performance of strain ratio elastography (SRE) and shear wave elastography (SWE) alone and in combination with Thyroid Imaging Reporting and Data System (TIRADS) classification parameters to improve differentiation between benign and malignant thyroid nodules.

Materials And Methods:  In this prospective study benign (n = 191) and malignant (n = 52) thyroid nodules were examined with high-resolution ultrasound (US) features using the TIRADS lexicon and SRE semiquantitative and SWE quantitative findings using histology or cytology as the gold standard with a 12-month follow-up. Sensitivity (Se), specificity (Sp) and the area under the ROC curve (AUROC) were used to evaluate the diagnostic performance of each feature and combinations of the methods.

Results:  TIRADS score showed a sensitivity of 59.6 %, a specificity of 83.8 % with an AUROC of 0.717, a PPV of 50.0 % and an NPV of 88.4 %. SRE yielded the highest performance with a sensitivity of 82.7 %, a specificity of 92.7 % with AUROC of 0.877, a PPV 75.4 % and an NPV of 95.2 %. SWE (kPa) had a sensitivity and specificity of 67.3 % and 82.7 %, respectively, with an AUROC of 0.750, a PPV of 51.5 % and an NPV of 90.3 %. Differences were significant for SRE only but not for SWE.

Conclusion:  Ultrasound elastography may improve thyroid nodule discrimination. In particular, SRE has a better performance than TIRADS classification, while their combination improves sensitivity.
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http://dx.doi.org/10.1055/a-0853-1821DOI Listing
August 2019

Medical Student Ultrasound Education, a WFUMB Position Paper, Part I, response to the letter to the Editor.

Ultrasound Med Biol 2019 07 11;45(7):1857-1859. Epub 2019 Apr 11.

University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA.

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http://dx.doi.org/10.1016/j.ultrasmedbio.2019.02.020DOI Listing
July 2019

Ultrasonography of the Lung.

Rofo 2019 Oct 4;191(10):909-923. Epub 2019 Apr 4.

University of Latvia, Faculty of Medicine, Riga, Latvia.

Background:  High diagnostic accuracy, increasing clinical experience and technical improvements are good reasons to consider lung ultrasound (US) for the assessment of pleural and pulmonary diseases. In the emergency room and in intensive care, it is well acknowledged, but application in other settings is rare. The aim of this review is to update potential users in general radiology about the diagnostic scope of lung US and to encourage more frequent use of this generally underestimated lung imaging modality.

Method:  Literature review was done independently by the two authors in MEDLINE (via PubMed) covering a time span from 2002 until 2017 using free text and Medical Subject Headings/MeSH. Article selection for the bibliography was based on consensus according to relevance and evidence.

Results And Conclusion:  The technical prerequisites include a standard ultrasound unit with a suitable transducer. Pleural effusion and pneumothorax, atelectasis, interstitial edema, pneumonia, exacerbated chronic obstructive pulmonary disease/asthma and pulmonary embolism can be distinguished by particular ultrasound signs, artifacts and their combinations. A highly standardized selection of access points and terminology for the description of imaging findings contributes to high diagnostic accuracy even in challenging patients and settings. Besides the assessment of acute respiratory failure in the emergency room, lung US may be used for monitoring interstitial fluid accumulation in volume therapy and for the diagnosis of pneumonia or the assessment of pleural effusion and pleurisy in a routine outpatient setting. Last but not least, the increasing concerns about medical radiation exposure warrant a more extensive use of this sometimes underestimated modality as a cost-, time- and radiation-saving alternative or valuable adjunct to the standard imaging modalities.

Key Points:   · Lung US is a safe, quick and readily available method with options for dynamic imaging of respiratory function.. · Proper selection of technical parameters customized to the clinical question and standardized terminology for the precise description and interpretation of the imaging signs regarding patient history determine its diagnostic accuracy.. · In dyspnea lung US differentiates pneumothorax, lung edema, pneumonia, pulmonary embolism, atelectasis and pleural effusion.. · In intensive care, lung US allows monitoring of lung ventilation and fluid administration.. · It saves radiation exposure in serial follow-up, in pregnancy and pediatric radiology..

Citation Format: · Radzina M, Biederer J, Ultrasonography of the Lung. Fortschr Röntgenstr 2019; 191: 909 - 923.
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http://dx.doi.org/10.1055/a-0881-3179DOI Listing
October 2019

The Use of Handheld Ultrasound Devices - An EFSUMB Position Paper.

Ultraschall Med 2019 02 28;40(1):e1. Epub 2019 Mar 28.

Department of Internal Medicine 2, Caritas-Krankenhaus, Bad Mergentheim, Sino-German Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

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http://dx.doi.org/10.1055/a-0881-5251DOI Listing
February 2019

The Use of Handheld Ultrasound Devices - An EFSUMB Position Paper.

Ultraschall Med 2019 Feb 21;40(1):30-39. Epub 2018 Dec 21.

Department of Internal Medicine 2, Caritas-Krankenhaus, Bad Mergentheim, Sino-German Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

The miniaturization of ultrasound equipment in the form of tablet- or smartphone-sized ultrasound equipment is a result of the rapid evolution of technology and handheld ultrasound devices (HHUSD). This position paper of the European Federation of Societies in Ultrasound and Medicine (EFSUMB) assesses the current status of HHUSD in abdominal ultrasound, pediatric ultrasound, targeted echocardiography and heart ultrasound, and we will report position comments on the most common clinical applications. Also included is a SWOT (Strength - Weaknesses - Opportunities - Threats) analysis, the use for handheld devices for medical students, educational & training aspects, documentation, storage and safety considerations.
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http://dx.doi.org/10.1055/a-0783-2303DOI Listing
February 2019

Medical Student Ultrasound Education: A WFUMB Position Paper, Part I.

Ultrasound Med Biol 2019 02 27;45(2):271-281. Epub 2018 Nov 27.

University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus Georgia, USA.

The introduction of ultrasound into medical student education is well underway in many locations around the world, but is still in its infancy or has yet to begin in others. Proper incorporation of ultrasound education into medical training requires planning and resources, both capital and human. In this article, we discuss the state of the art of ultrasound in medical education throughout the world, as well as various methodologies utilized to improve student education and to incorporate ultrasound into every facet of training. Experiences from various educational systems and available evidence regarding the impact of ultrasound education are summarized. Representing multiple societies and specialties throughout the world, we discuss established modern as well as novel education structures and different successful approaches.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2018.09.017DOI Listing
February 2019

Endovascular thrombectomy in anterior circulation stroke and clinical value of bridging with intravenous thrombolysis.

Acta Radiol 2019 Mar 6;60(3):308-314. Epub 2018 Jun 6.

1 Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Riga, Latvia.

Background: Bridging treatment with intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in acute ischemic stroke is applied under the assumption of benefits for patients with large vessel occlusion (LVO). However, the benefit of this additional step has not yet been proven.

Purpose: To compare procedural parameters (procedural time, number of attempts), complications, and clinical outcome in patients receiving EVT vs. patients with bridging treatment.

Material And Methods: In this prospective study all patients had acute anterior cerebral circulation occlusion and were treated with EVT. All patients were selected for treatment based on clinical criteria, multimodal computed tomography (CT) imaging. Eighty-four patients were treated with bridging IVT followed by EVT; 62 patients were treated with EVT only.

Results: Bridging therapy did not influence endovascular procedure time ( P = 0.71) or number of attempts needed ( P = 0.63). Bleeding from any site was more common in the bridging group (27, 32%) vs. the EVT group (12, 19%) ( P = 0.09). Functional independence modified Rankin Scale after 90 days was slightly higher in the bridging group (44%) vs. the EVT group (42%) ( P = 0.14). Mortality did not differ significantly at 90 days: 17% in the bridging group vs. 21% in EVT alone ( P = 0.57). Both treatment methods showed high recanalization rates: 94% in the bridging group and 89% for EVT alone.

Conclusion: Bridging treatment in LVO did not show benefits or elevated risks of complications in comparison to EVT only. The bridging group did not show significantly better neurological outcome or significant impact on procedural parameters vs. EVT alone.
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http://dx.doi.org/10.1177/0284185118780897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378397PMC
March 2019

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Short Version).

Ultraschall Med 2018 Apr 6;39(2):154-180. Epub 2018 Mar 6.

Urology, AMC University Hospital, Amsterdam and Signal Processing Systems, Eindhoven University of Technology, The Netherlands.

The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.
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http://dx.doi.org/10.1055/s-0044-101254DOI Listing
April 2018

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version).

Ultraschall Med 2018 Apr 6;39(2):e2-e44. Epub 2018 Mar 6.

Urology, AMC University Hospital, Amsterdam and Signal Processing Systems, Eindhoven University of Technology, The Netherlands.

The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.
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http://dx.doi.org/10.1055/a-0586-1107DOI Listing
April 2018

How to perform Contrast-Enhanced Ultrasound (CEUS).

Ultrasound Int Open 2018 Jan 7;4(1):E2-E15. Epub 2018 Feb 7.

P.Stradina Clinical University Hospital, Diagnosic Radiology Institute, Riga, Latvia.

"How to perform contrast-enhanced ultrasound (CEUS)" provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for optimal CEUS performance. CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience. The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.
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http://dx.doi.org/10.1055/s-0043-123931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802984PMC
January 2018

Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure.

Ultrasound Med Biol 2018 Jan 7;44(1):14-36. Epub 2017 Nov 7.

Department of Nuclear Medicine, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany.

The recently published guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on interventional ultrasound (INVUS)-guided procedures summarize the intended interdisciplinary and multiprofessional approach. Herewith, we report on recommendations for interventional procedures for diagnosis and treatment of the thyroid gland.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2017.08.1889DOI Listing
January 2018

Ultrasound and ultrasound-related techniques in endocrine diseases.

Minerva Endocrinol 2018 Sep 5;43(3):333-340. Epub 2017 Sep 5.

Department of Radiology, Oncology, and Anatomy Pathology, Policlinico Umberto I, Sapienza University, Rome, Italy.

Ultrasound examination has become essential to evaluate morphology and size of several endocrine glands and detect the presence of lesions within these organs. Nevertheless, with the recent advances of ultrasound technology, we have opportunity to correlate the echostructure of thyroid, ovary, testis, parathyroids, etc. to their function. Thus, the ultrasound systems are in-office essential instruments for many clinical specialists. Herein we presented the most updated information about the use of ultrasound in specific endocrine-related issues, such as thyroid, parathyroid, adrenal gland, and testicle.
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http://dx.doi.org/10.23736/S0391-1977.17.02728-6DOI Listing
September 2018

Update on the role of ultrasound guided radiofrequency ablation for thyroid nodule treatment.

Int J Surg 2017 May;41 Suppl 1:S82-S93

Department of Surgical Sciences, Policlinico Umberto I, University Sapienza, Roma, 00185, Viale Regina Elena 324, Italy. Electronic address:

Thyroid nodules can be frequently detected in general population, most of them are benign, however malignant cases are rising in the past decades. Ultrasound (US) is the most common imaging modality to assess thyroid nodular lesions, plan patient work-up and guide minimally invasive treatment. The present review paper has been researched to evaluate the current status of radiofrequency ablation (RFA) treatment in order to evaluate indications, techniques, complications, limitations and outcome assessment in benign solid, partially cystic nodules and recurrent malignant nodules. RFA comparison with other ablation techniques has been provided as well. US guided Radiofrequency ablation has been proved to be effective and safe in cases of benign thyroid nodules and a promising treatment method alternative to surgery for patients with recurrent papillary thyroid cancer. It's major role lies in significant reduction of thyroid nodule mean volume and improvement of the patient symptoms. However, future multicenter studies are warranted to better clarify the multi-parametric patient selection criteria and evaluate RFA technique efficacy, advantages and limitations in the variety of thyroid nodular disease.
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http://dx.doi.org/10.1016/j.ijsu.2017.02.010DOI Listing
May 2017

Ascariasis imaging: pictorial essay.

Z Gastroenterol 2017 May 12;55(5):479-489. Epub 2017 May 12.

Department of Pediatrics, Caritas-Krankenhaus, Bad Mergentheim, Germany.

Ascariasis is not widespread in Europe, and the knowledge on how to diagnose and treat the disease is limited to some specialists. On the other hand, clinicians are facing an increasing number of immigrants from high-prevalence countries and are, therefore, challenged to update in this field of infectious diseases. Here we present current knowledge on this infection in 2 parts. The first part discusses clinical features and hot topics in ascariasis, and the second part presents imaging features of ascariasis as a pictorial essay.
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http://dx.doi.org/10.1055/s-0043-104781DOI Listing
May 2017

Thyroid Ultrasound: State of the Art. Part 2 - Focal Thyroid Lesions.

Med Ultrason 2017 Apr;19(2):195-210

Department of Internal Medicine 2, Caritas Hospital, Bad Mergentheim, Germany Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.
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http://dx.doi.org/10.11152/mu-999DOI Listing
April 2017

Thyroid Ultrasound: State of the Art Part 1 - Thyroid Ultrasound reporting and Diffuse Thyroid Diseases.

Med Ultrason 2017 Jan;19(1):79-93

Department of Internal Medicine 2, Caritas Hospital, Bad Mergentheim, Germany, Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.
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http://dx.doi.org/10.11152/mu-980DOI Listing
January 2017

EUS Needle Identification Comparison and Evaluation study (with videos).

Gastrointest Endosc 2016 Sep 10;84(3):424-433.e2. Epub 2016 Feb 10.

Cancer Institute of Sao Paulo University, Sao Paulo, Brazil.

Background And Aims: EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development.

Methods: Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices.

Results: There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001).

Conclusions: All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.
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http://dx.doi.org/10.1016/j.gie.2016.01.068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5570521PMC
September 2016

Vascular phases in imaging and their role in focal liver lesions assessment.

Clin Hemorheol Microcirc 2015 Sep;62(4):299-326

Med. Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany.

The incidental finding of a liver lesion with basic ultrasound is one of the most common clinical issues. Some of the liver lesions which present typical morphological B-mode features (e.g. cysts, typically localized focal fatty sparing/accumulations, hyperechoic hemangiomas) can be easily diagnosed by conventional ultrasound without the need of further diagnostic procedures. Others frequently necessitate further investigation with contrast-enhanced imaging techniques or biopsy in order to differentiate benign from malignant lesions and obtain a final diagnosis. This paper will discuss differences between vascular phases of different cross-sectional contrast-enhanced methods, as well as their subsequent benefits for focal liver lesions (FLLs) assessment, adding also a particular emphasis on small FLLs detection and characterization.
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http://dx.doi.org/10.3233/CH-151971DOI Listing
September 2015

Perfusion computed tomography relative threshold values in definition of acute stroke lesions.

Acta Radiol Short Rep 2013 24;2(3):2047981613486099. Epub 2013 Apr 24.

Radiology Department, Riga Stradins University , Riga.

Background: Perfusion computed tomography (CT) is a relatively new technique that allows fast evaluation of cerebral hemodynamics by providing perfusion maps and gives confirmation of perfusion deficits in ischemic areas. Some controversies exist regarding accuracy of quantitative detection of tissue viability: penumbra (tissue at risk) or core (necrosis).

Purpose: To define brain tissue viability grade on the basis of the perfusion CT parameters in acute stroke patients.

Material And Methods: A multimodal CT imaging protocol; unenhanced CT of the brain, CT angiography of head and neck blood vessels, followed by brain perfusion CT and 24 h follow-up brain CT was performed. Perfusion deficits were detected first visually, with subsequent manual quantitative and relative measurements in affected and contra-lateral hemisphere in 87 acute stroke patients.

Results: Visual perfusion deficit on perfusion CT images was found in 78 cases (38 women, 40 men; mean age, 30-84 years). Penumbra lesions (n = 49) and core lesions (n = 42) were detected by increased mean transit time (MTT) on perfusion CT maps in comparison to contra-lateral hemispheres. Cerebral blood volume (CBV) mean values in the penumbra group were increased in the penumbra group and decreased in the core group. Cerebral blood flow (CBF) values were decreased in penumbra and markedly decreased in core lesion.

Conclusion: Perfusion CT measurements are reliable in estimation of penumbra and core lesions in acute stroke patients, if relative threshold values are used. The most accurate parameter of hypoperfusion is increased MTT above 190%. Relative threshold values for irreversible lesion are CBF <30-40% and CBV <40% in comparison to contra-lateral hemisphere. Penumbra lesion is characterized by MTT increase and CBF decrease, while CBV shows variable values.
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http://dx.doi.org/10.1177/2047981613486099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736965PMC
August 2013
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