scholarly journals Contrast Enhanced Ultrasound Compared to CT and MRI in Clinical Decision Making Regarding New Renal Masses

2021 ◽  
Vol 233 (5) ◽  
pp. e230
Author(s):  
Garth M. Sherman ◽  
Blake Nazzarin ◽  
Nanda Thimappa ◽  
Katie Murray ◽  
Naveen Pokala
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Contrast Enhanced Ultrasound ◽  
Renal Masses ◽  
Contrast Enhanced ◽  
Ct And Mri

scholarly journals How to perform Contrast-Enhanced Ultrasound (CEUS)

2018 ◽  
Vol 04 (01) ◽  
pp. E2-E15 ◽  
Author(s):  
Christoph Dietrich ◽  
Michalakis Averkiou ◽  
Michael Nielsen ◽  
Richard Barr ◽  
Peter Burns ◽  
...  
Keyword(s):  
Decision Making ◽  
Personal Experience ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Ultrasound Contrast Agents ◽  
Contrast Enhanced Ultrasound ◽  
Technical Parameters ◽  
Ultrasound Contrast ◽  
Published Evidence ◽  
Contrast Enhanced

Abstract“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.

scholarly journals Association of Surgical Delay and Overall Survival in Patients With T2 Renal Masses: Implications for Critical Clinical Decision-making During the COVID-19 Pandemic

Urology ◽  
2021 ◽  
Vol 147 ◽  
pp. 50-56
Author(s):  
Kevin B. Ginsburg ◽  
Gannon L. Curtis ◽  
Devin N. Patel ◽  
Wen Min Chen ◽  
Marshall C. Strother ◽  
...  
Keyword(s):  
Decision Making ◽  
Overall Survival ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Renal Masses ◽  
Surgical Delay

scholarly journals Contrast-Enhanced Ultrasound for Assessing Abdominal Conditions in Pregnancy

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 675
Author(s):  
Thomas Geyer ◽  
Johannes Rübenthaler ◽  
Matthias F. Froelich ◽  
Laura Sabel ◽  
Constantin Marschner ◽  
...  
Keyword(s):  
Contrast Agents ◽  
Pregnant Women ◽  
Clinical Decision Making ◽  
Imaging Modality ◽  
Clinical Decision ◽  
Renal Angiomyolipoma ◽  
Contrast Enhanced Ultrasound ◽  
Vein Thrombosis ◽  
Contrast Enhanced ◽  
Level 3

Background and objectives: Native ultrasound is the most common imaging modality in obstetrics. The use of contrast-enhanced ultrasound (CEUS) during pregnancy has not been officially approved by leading societies for obstetrics and ultrasound. The present study aims to monitor the safety and diagnostic performance of CEUS for assessing abdominal issues in five pregnant women. Materials and Methods: Five pregnant patients who underwent a total of 11 CEUS examinations between June 2020 and October 2020 were included (mean age: 34 years; mean time of pregnancy: 21 weeks). All CEUS scans were interpreted by one experienced consultant radiologist (EFSUMB Level 3). Results: Upon contrast application, no maternal nor fetal adverse effects were observed. Moreover, no fetal contrast enhancement was observed in any patient. CEUS helped to diagnose renal angiomyolipoma, pyelonephritis, necrotic uterine fibroid, gallbladder polyp, and superior mesenteric vein thrombosis. Conclusions: In our study, off-label use of CEUS showed an excellent safety profile allowing the avoidance of ionizing radiation exposure as well as contrast agents in case of CT or use of gadolinium-based contrast agents in case of MRI. CEUS is a promising diagnostic instrument for facilitating clinical decision-making and improving the management of pregnant women.

scholarly journals Incidentally Detected Liver Metastases during Pancreas Contrast-enhanced Ultrasound

2021 ◽  
Author(s):  
Dan Zuo ◽  
Ji-Jiang Qian ◽  
Yi Dong ◽  
Wen-Ping Wang ◽  
Xiao-Fan Tian ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Predictive Value ◽  
Clinical Decision Making ◽  
Late Phase ◽  
Clinical Decision ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Multiple Imaging ◽  
Liver Scan ◽  
Histopathological Results

Purpose: The purpose of current study was to investigate the value of the late-phase enhancement features of pancreas contrast-enhanced ultrasound (CEUS) in the detection of liver metastases in patients with pancreatic ductal adenocarcinomas (PDAC).Methods: From October 2020 to March 2021, 86 patients were prospectively enrolled. The gold standard of liver metastatic and PDAC lesions were based on histopathologically diagnoses and multiple imaging modalities results. B-mode ultrasound (BMUS) was performed to detect suspected liver metastases before CEUS. During the late phase of pancreas CEUS, the entire liver was scanned again to detect hypoenhanced liver metastases. Liver metastases were confirmed by biopsy and histopathological results. The number and size of liver metastases detected by BMUS and during CEUS late phase were recorded and compared.Results: Suspected liver metastases were detected in 14 patients by BMUS (n = 23). During the late phase of CEUS, hypoenhanced liver metastases were detected in 23 patients (n = 87). When compared with BMUS, whole-liver scan during the late phase of CEUS detected more isoechoic, small, or superficially located lesions. Compared with BMUS, the specificity, sensitivity, positive predictive value, and negative predictive value of CEUS in diagnosing of liver metastases in PDAC patients were significantly improved (96.72% vs. 100%, 48% vs. 92%, 85.71% vs. 100%, and 83.10% vs. 96.83%, respectively) (P < 0.05).Conclusion: The late phase whole liver scan during CEUS of pancreas helps to detect more liver metastases, which is important for further clinical decision-making.

Utilization and contemporary results of renal mass biopsy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 623-623
Author(s):  
David Cahn ◽  
Caitlin Lim ◽  
Rosaleen Parsons ◽  
Benjamin T. Ristau ◽  
Alexander Kutikov ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Resection ◽  
Renal Mass ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Performance Characteristics ◽  
Published Data ◽  
Renal Masses ◽  
Poor Grade ◽  
Renal Mass Biopsy

623 Background: Renal mass biopsy (RMB) for localized renal masses (RM) is being re-evaluated to improve risk stratification and minimize morbidity from over-treatment. We review our institutional experience with RMB to identify performance characteristics and highlight opportunities to improve management. Methods: Using our prospectively maintained database, we identified patients who underwent core RMB +/- fine needle aspiration (FNA). We describe performance characteristics and assess pathologic concordance. Using the University of Michigan (UM) algorithm, we reviewed the potential that RMB influenced therapeutic decision-making. Results: We noted 374 RMBs performed from 1999-2015 (66% within last 5 years). Core RMB (+/- FNA) was performed in 65.2% (244/374) of cases, of which 41% (99/244) underwent surgical resection. Initial core RMB was non-diagnostic in 9% (9/99) of surgical cases and subsequently diagnosed with RCC. RCC diagnosed on core RMB that underwent surgical resection demonstrated histologic and grade concordance of 94.3% and 62.5%. All discordant grades were upgraded at surgery. 11% of all RMB were benign and no surgical intervention occurred. In our cohort, 19% of all RMB patients treated surgically had tumors classified as favorable or intermediate < 2cm using the UM algorithm and might otherwise have been candidates for AS. Conversely, 42% of all surgically treated patients had UM favorable characteristics but had tumors > 4cm and therefore underwent surgical resection based on size criteria in the context of RMB results. Conclusions: RMB is effective in the evaluation of RM with minimal morbidity. Our histologic/grade concordance is consistent with published data and underscores that RMB harbors clinical uncertainties. Clinical management pathways incorporating RMB may decrease over-treatment but also may risk under-treatment based on poor grade concordance. Using the UM algorithm, 30% of lesions in our cohort were AS candidates after RMB (over-treatment risk). Conversely, 18% of surgically treated lesions were UM AS candidates after RMB and upgraded on final pathology, demonstrating the risk of under treatment. RMB may be considered in patients where results would influence clinical decision-making.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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