Perspective Chapter: Recent Advances in Musculo-Skeletal Ultrasound

Medical imaging specialists continue to explore better ways of demonstrating pathology and anatomy of the musculo-skeletal system. The continuous quest is fuelled by the desire to improve diagnostic yield, perform procedures more quickly and accurately, reduce risks to patient or operator, achieve better cost efficiency and utilize less complex methodologies. In many instances, musculoskeletal ultrasound acts as a screening, diagnostic tool but also guide and monitor therapeutic interventions. The paper outlines the use of ultrasound in the imaging of peripheral nerve disorders, traumatic and atraumatic joint disorders, Doppler techniques such as super micro vascular Imaging and sono-elastography. Refinements in probe technology and application of digital and novel proprietary software, have continued to improve the resolution of ultrasound images and with finer details on a scale not previously possible. With increasing experience and standardization of protocols, Musculoskeletal ultrasound will continue to play a great role in the diagnostic work-up and treatment of related disorders.

Feasibility of ovarian preservation as a stage in correcting the quality of life in young patients after gynecologic surgeries.

e17560 Background: The purpose of the study was to analyze the structure and activity of the blood flow in the preserved ovaries after gynecologic surgeries. Methods: We monitored 50 patients (mean age 35.8±0.5 years) using sonography after ovary-sparing hysterectomy for benign, precancerous and preinvasive malignant uterine diseases. For revascularization, the preserved ovaries were attached to the lateral wall of the small pelvis or to the base of round ligaments of the uterus. Results: Ovarian hypertrophy was recorded in 3 women during the first year of the follow-up; the ovaries returned to the initial size without correction by 24 months. By the third year of observation, 94% of women had normal gonadal sizes, and only 2 women had ovarian hypoplasia. During the entire observation period (3 years), in 91% of cases, we could visualize the regular maturation of follicles in the preserved ovaries, which indicated the preservation of ovulatory function. The use of Doppler techniques during 24 months of the follow-up demonstrated that the blood circulation in the attached ovaries after hysterectomy was decreased on the average by 20.3%, compared to the intact ovaries. Conclusions: After the critical period of hysterectomy, the blood flow in the ovaries in almost all patients remains sufficient during the first 2-3 years, stimulating the regular growth of follicles and maintaining the gonadal activity. The quality of life of the operated patients during the first three years of follow-up remains optimal without additional correction with hormone replacement therapy.

Echography in liver transplantation: a literature review

Liver transplantation is rightly considered the only radical treatment for terminal chronic liver diseases and patients with acute liver failure. However, despite the accumulated experience in the management of patients in this group, the level of complications development remains at a fairly high level. The success of the correction of emerging pathological conditions largely depends on the timing of their diagnosis. Since complications developing after liver transplantation most often do not have specific clinical and biochemical manifestations, the use of imaging research methods plays a key role in assessing the state of the transplanted organ at all stages of the postoperative period. Among all instrumental methods, ultrasound examination using Doppler techniques, carried out hourly directly in the intensive care unit, with an accuracy of 97 % and a specificity of up to 100 %, makes it possible to detect vascular post-transplant complications as soon as possible. Their timely correction avoids the loss of the graft. The use of dynamic observation contributes to differential diagnosis in identifying non-vascular complications at different stages of the postoperative period. The use of modern techniques greatly expands the possibilities of echography. Thus, the use of contrast enhancement not only shortens the study time, but also increases the sensitivity of Dopplerography in assessing the patency of the vascular bed, especially in patients with decreased central hemodynamics. The use of ARFI-elastography techniques in patients in the late postoperative period makes it possible to objectively assess the severity of hepatic graft fibrosis.

Augmenting the signal processing–based mitigation techniques for removing wind turbine and radar interference

The interference between wind turbine generators and radar is now being considered as one of the major deterrents towards seeking clearance for new wind energy project. The windfarm developers have to seek clearance from Civil Air Traffic Control and Defence Department certifying that the windfarms will not create interference with radars. The tower of wind turbine generator along with blades presents a large radar cross section to radars, thus creating static clutter; moreover, rotation of wind turbine generator blades creates Doppler ambiguities which confuse radar operators. Many radar designers have proposed mitigation techniques to overcome this issue; however, each technique has its own limitation. The study takes a two-pronged approach to address the issue of wind turbine generator static clutter due to tower and blades and the resolution of Doppler ambiguities through signal processing–based mitigation techniques. In addition, the study also suggests the use of micro-Doppler techniques for signature identification of wind turbine generator blades for eliminating their effect during the radar signal processing. The article presents a step-by-step mitigation technique to resolve the wind turbine generator and radar interference issue.

Cardiac catheterization

Cardiac catheterization allows the invasive acquisition of haemodynamic data using direct and indirect pressure measurements and oxygen saturations, and provides anatomical information using contrast angiography. Right heart catheterization used to be a routine part of an invasive cardiac study. The increased accessibility and accuracy of non-invasive imaging (in particular, echocardiography and Doppler techniques), however, has reduced the need to perform right heart catheterization. This chapter describes the principal uses of cardiac catheterization, the basics of pressure waveforms, equipment required, accessing the left and right heart, left and right heart pressures and waveforms, how to perform calculations, and the techniques of ventriculography and aortography.

Novel Echocardiographic Biomarkers in the Management of Atrial Fibrillation

Purpose of Review Atrial fibrillation (AF) is the most common arrhythmia in adults. The number of patients with AF is anticipated to increase annually, mainly due to the aging population alongside improved arrhythmia detection. AF is associated with a significantly elevated risk of hospitalization, stroke, thromboembolism, heart failure, and all-cause mortality. Echocardiography is one of the key components of routine assessment and management of AF. Therefore, the aim of this review is to briefly summarize current knowledge on “novel” echocardiographic parameters that may be of value in the management of AF patients. Recent Findings Novel echocardiographic biomarkers and their clinical application related to the management of AF have been taken into consideration. Both standard parameters such as atrial size and volume but also novels like atrial strain and tissue Doppler techniques have been analyzed. Summary A number of novel echocardiographic parameters have been proven to enable early detection of left atrial dysfunction along with increased diagnosis accuracy. This concerns particularly experienced echocardiographers. Hence, these techniques might improve the prediction of stroke and thromboembolic events among AF patients and need to be further developed and disseminated. Nonetheless, even the standard imaging parameters could be of significant value and should not be discontinued in everyday clinical practice.

Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup

Background. Tubal patency testing is an essential part of female subfertility evaluation. Traditionally, hysterosalpingography (HSG) was the first step to evaluate tubal patency. However, during the past decade Hysterosalpingo-Contrast Sonography (HyCoSy) was introduced in order to avoid radiation exposure and Hysterosalpingo-Foam Sonography (HyFoSy) has been developed as a safe and less painful alternative. Objectives and Rationale. The aim of this narrative review is to provide an overview of the currently available HyFoSy literature and related clinical aspects. Search Methods. A literature search was conducted using PubMed and Embase from the introduction of HyFoSy to March 2019. Unfortunately, a meta-analysis was not possible due to a too small number of studies, being mutually incomparable for the various subjects of clinical aspects, even for the reliability as a test for tubal patency. Outcomes. Nine small studies concluded that the accuracy and effectiveness as a test for tubal patency of 2D- and 3D-HyFoSy are comparable or even better than HSG or HyCoSy. With or without using Doppler techniques, 3D-HyFoSy does not seem to offer benefits above real-time 2D-HyFoSy. Five studies reported on pain and discomfort during HyFoSy, concluding that HyFoSy is a well-tolerated, less painful procedure compared to HSG, without a need for the use of analgesics. There are suggestions about an increased pregnancy rate in the first three cycles after the procedure but in no studies pregnancy outcome after HyFoSy was compared with other or no intervention. Wider Implications. HyFoSy is a promising and safe alternative for HSG with regard to accuracy and effectiveness. HyFoSy lacks radiation and iodine exposure and is a well-tolerated and less painful procedure than HSG, without the need for analgesics. However more research is needed to make clear statements regarding a therapeutic effect of HyFoSy.