Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology

BACKGROUND: To evaluate the utilization of point-of-care ultrasound(POCUS) for the assessment of emergency department(ED) patients with musculoskeletal symptoms and the impact of musculoskeletal POCUS on medical decision-making and patient management in the ED.METHODS: This was a retrospective review of ED patients presenting with musculoskeletal symptoms who received a POCUS over a 3.5-year period. An ED POCUS database was reviewed for musculoskeletal POCUS examinations used for medical decision-making. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of musculoskeletal POCUS on patient management in ED. RESULTS: A total of 264 subjects(92 females, 172 males) and 292 musculoskeletal POCUS examinations were included in the fi nal analysis. Most common symptomatic sites were knee(31.8%) and ankle(16.3%). Joint effusion was the most common fi nding on musculoskeletal POCUS, noted in 33.7% of the patients, and subcutaneous edema/cobblestoning was found in 10.2% of the patients. Muscle or tendon rupture was found in 2.3% of the patients, and 1.9% of the patients had joint dislocation. Bursitis or bursa fluid was found in 3.4% of patients, and tendonitis/tendinopathy was found in 2.3%. Twenty percent of them were ultrasound-guided musculoskeletal procedures, and most of them(73.3%) were arthrocentesis. Of the included studies, all except three either changed or helped guide patient management as documented in the patients' medical records.CONCLUSION: Our study fi ndings illustrate the utility of POCUS in the evaluation of a variety of musculoskeletal pathologies in the ED.

Musculoskeletal Ultrasonography for the Assessment of Combined Drug Therapy for Rheumatoid Arthritis

Background: To evaluate the effect of treatment on musculoskeletal ultrasound (MSUS) and explore whether MSUS are associated with therapeutic response in rheumatoid arthritis (RA) patients treated with Tofacitinib in combination with methotrexate (MTX). Methods: We enrolled 102 RA patients treated with Tofacitinib in combination with MTX from a multicenter, exploratory, short-term, prospective and observational ultrasound cohort study of patients who received biologic or targeted synthetic disease-modifying antirheumatic drug (DMARD) therapy. We evaluated the patients’ clinical disease activity and musculoskeletal ultrasound (MSUS) scores. The serum concentrations of two venous blood inflammatory indicators were evaluated (c-reactive protein [CRP], erythrocyte sedimentation rate [ESR]) by multiplex bead assays at baseline, 3, and 6?months: the change over 6?months was defined as the P value. Before MSUS score treatment, an associate chief physician tested the wrist joints of each patient at the first treatment, and the attending physician with 3 years of MSUS experience and 7 years of work experience also performed semi-quantitative scores on the same RA patients and tested the consistency of the results. Results: Tofacitinib in combination with MTX significantly improved the clinical disease activity and MSUS score over 6?months. Serum ESR and CRP were significantly elevated at 6?months after the Tofacitinib in combination with MTX introduction (P P P Conclusions: MSUS scores may be useful for predicting RA patients’ therapeutic responses to abatacept.

Comparative study for predictability of type 1 gastric variceal rebleeding after endoscopic variceal ligation:High-frequency intraluminal ultrasound study

BACKGROUND The efficacy of endoscopic ultrasonography for the follow-up of gastric varices treated with endoscopic variceal ligation(EVL)has not been established.AIM To evaluate the diagnostic correlation of esophagogastroduodenoscopy(EGD)and high-frequency intraluminal ultrasound(HFIUS)for type 1 gastric varices(GOV1)after EVL and to identify the predictability for rebleeding of EGD and HFIUS.METHODS In liver cirrhosis patients with GOV1,we performed endoscopic follow-up using EGD and HFIUS synchronously after EVL for hemorrhage from GOV1.Endoscopic grading and red color signs were analyzed using EGD,and the largest variceal cross-sectional areas were measured using HFIUS.In addition,1-year follow-up was performed.Variceal rebleeding was defined as the presence of hematemesis,hematochezia,or melena without other evidence of bleeding on endoscopic follow-up.RESULTS In 26 patients with GOV1,variceal cross-sectional areas on HFIUS of GOV1 was poorly correlated with EGD grading of GOV1(r=0.36).In 17 patients who completed the 1-year follow-up,variceal cross-sectional areas on HFIUS was a good predictor of subsequent rebleeding,whereas EGD grading was not a predictor of subsequent rebleeding.CONCLUSION HFIUS measurement is more predictive of GOV1 rebleeding than EGD grading,so HFIUS measurement may be necessary for endoscopic follow-up after EVL in patients with GOV1.

Application Value of High-Frequency Ultrasound and Contrast-Enhanced Ultrasound in Patients with Knee Osteoarthritis with Different TCM Syndromes

Objective: To explore the application value of high-frequency ultrasound and contrast-enhanced ultrasound in different syndrome types of knee osteoarthritis, and to provide more imaging evidence for clinical diagnosis and treatment. Method: Sixty patients with KOA were selected according to TCM classification, which were mainly divided into Qi stagnation and blood stasis type and cold-dampness blockage type. All knee joints were routinely examined by high frequency ultrasound, and those with synovial hyperplasia were examined by contrast-enhanced ultrasound. High frequency ultrasound is the examination of synovium, cartilage and collateral ligament of knee joint based on two-dimensional ultrasound. Contrast-enhanced ultrasound (CEUS) refers to the contrast examination of synovium in knee joint patients with synovial hyperplasia. Result: Among them, the suprapatellar sac effusion and synovial thickening of Qi stagnation and blood stasis type were more obvious than those of cold-dampness arthralgia type (P < 0.05), and the degree of wear of the intercondylar cartilage of cold-dampness arthralgia type was more obvious than that of Qi stagnation. The blood stasis type is heavier and the meniscus bulge is higher (P < 0.05). The radiography of synovial hyperplasia showed that the area under the curve of Qi stagnation and blood stasis type was higher than that of cold dampness arthralgia type (P < 0.05), and the peak time was significantly shorter than that of cold dampness arthralgia type. There was no statistical difference in effective peak gradient and onset time of type (P > 0.05). Conclusion: To a certain extent, the high-frequency ultrasound and contrast-enhanced ultrasound performance of knee osteoarthritis can be used as a dialectical reference for different TCM syndrome types.

Development of a High-frequency Ultrasound System for High-speed Image Scanning

High-frequency image technique has been widely applied in medical diagnosis recently. For high voltage protection, high speed stage and trigger control circuitry are difficult to implement a high-frequency ultrasound imaging system. In this study, we utilized a linear servo with high noise tolerance and a novel multi-depth expression method to overcome those issues in developed high-speed image system. B-mode image of the chicken phantom by 25 MHz transducer shows the resolution of lateral and axial resolutions are up to 123 μm and 59 μm respectively. In addition, the experiment demonstrates that the axial resolution and depth of field (DOF) can be improved by time gain compensation(TGC) and multi-depth method. The results indicate that the proposed system could achieve over 24 fps for 1 mm scan distance and 100 lines per frame. In the future, the developed system is potential for other clinical applications such as ophthalmology and dermatology.

Efficacy evaluation of high-frequency ultrasound in the treatment of diabetic peripheral neuropathy with α-lipoic acid combined with traditional Chinese medicine package treatment

Objective:To use high-frequency ultrasound to evaluate the efficacy ofα-lipoic acid combined with traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN),so as to provide a basis for clinical medication and evaluation of therapeutic effect.Methods:From December 2018 to December 2019,110 patients with DPN who met the inclusion and exclusion criteria were divided into observation group and control group according to different treatment plans.The control group was treated withα-lipoic acid,and the observation group was treated withα-lipoic acid combined with traditional Chinese medicine encapsulation treatment,and used high-frequency ultrasound,nerve conduction velocity and serological examination to comprehensively evaluate the effectiveness of the two treatment methods.Results:The mean amplitude of glycemic excursions(MAGE)value of the observation group and the control group after treatment was significantly lower than before treatment(P<0.05);After treatment,the SCV of the ulnar nerve,median nerve,and common peroneal nerve in the two groups was significantly faster than before treatment(P<0.05).Similar to SCV,the MCV of the three nerves measured after treatment in the two groups was significantly faster than before treatment(P<0.05).Compared between the groups after treatment,the three kinds of nerve SCV and MCV in the observation group were significantly faster than those in the control group(P<0.05).The cross-sectional area(CSA)value of the ulnar nerve,median nerve and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).Compared with the control group after treatment,the three nerves CSA in the observation group was significantly lower than that in the control group(P<0.05).Abnormal ultrasound performance:The proportion of abnormal ultrasound performances of the ulnar nerve,median nerve,and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).The composition ratio of internal echo reduction and ambiguity in the observation group after three nerve treatments was significantly lower than that in the control group after treatment(P<0.05).In the correlation analysis,the three kinds of nerve CSA before and after treatment were negatively correlated with SCV and amplitude(P<0.05),and positively correlated with latency(P<0.05).Conclusion:The combination ofα-lipoic acid and Chinese medicine encapsulation technology has a good effect on the treatment and repair of DPN nerve damage,and can be routinely applied in clinical treatment.High-frequency ultrasound can intuitively observe changes in peripheral nerves and can be used to evaluate the prognosis of DPN.

Analysis of High-Frequency Ultrasound in the differential Diagnosis of Lumps in Foot and Hand

Objective:To investigate the ultrasonogram characteristics of common lumps in hand and foot,pursuing for greater understanding of hand and foot lumps.Methods:65 cases of ultrasonographic characteristics of lumps in hand and foot were retrospectively analyzed,including the location,size,shape,boundary,internal echo and posterior echo,surrounding relationship and blood flow.Results:Among 65 cases,there were 26 cases of tendon sheath cyst,16 cases of tenosynovitis giant cell tumor,10 cases of hemangioma,4 cases of tendon sheath fibroma,3 cases of epidermoid cyst,2 cases of Schwannoma,2 cases of fibrolipoma,1 case of angiolipoma and 1 case of neurofibroma.The preoperative and postoperative pathological diagnoses of 45 cases,accounting for 69.23%,were consistent,3 cases(4.62%)were misdiagnosed,which included that 2 cases of tenosynovitis giant cell tumor were misdiagnosed as tendon sheath cyst,1 case of neurofibroma as epidermoid cyst,and the preoperative diagnosis of the rest 17 cases(26.15%)were indefinite.Conclusion:The high-frequency ultrasound can diagnose properties of lumps in foot and hand well,providing diagnosis basis for further treatment in clinic.

Clinical Value of Musculoskeletal Ultrasound in Rehabilitation After Flexor Tendon Rupture Repair of the Hand

Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected from among patients who underwent flexor tendon rupture repair of the hand in Yancheng Third People’s Hospital from May 2018 to May 2020;the patients were randomly divided into the control group(routine hand rehabilitation training)and the experimental group(musculoskeletal ultrasound and targeted hand rehabilitation training based on examination results)by die roll,with 34 cases in each group;the hand rehabilitation of the two groups were compared.Results:The excellent and good rate of the total active motion(TAM)of the experimental group(94.44%)was significantly higher than that of the control group(69.44%)(P<0.05);before treatment,there was no significant difference in the diameter and degree of stenosis of the artery in the finger between the two groups(P>0.05);after treatment,the degree of stenosis and the diameter of the artery of the experimental group were significantly better than those of the control group(P<0.05).Conclusion:For patients treated with flexor tendon rupture repair of the hand,the use of musculoskeletal ultrasound in the rehabilitation process can significantly improve the functional recovery of the hand;therefore,it is worthy of in-depth research,promotion,and application in clinical rehabilitation.

Application Value of Musculoskeletal Ultrasound in DAA-THA with Conjoined Tendon Repair

Objective:To observe the ultrasonographic characteristics of conjoined tendon repair in direct anterior approach for total hip arthroplasty(DAA-THA),and to evaluate the efficacy of musculoskeletal ultrasound in determining the healing after joint tendon repair.Methods:A total of 60 patients who required primary total hip arthroplasty in Yulin Orthopedic Hospital of Chinese and Western Medicine from July 2020 to July 2021 were selected;the patients were divided into two groups,an observation group,group A(n=30),and a control group,group B(n=30),according to different intraoperative methods.There was no significant difference in gender,age,and diagnosis between the two groups.Direct anterior approach was used for both the groups.For group A,the joint capsule and conjoined tendon(superior gemellus,obturator internus,and inferior gemellus)were repaired in situ,whereas for group B,only the joint capsule was repaired in situ,while the conjoined tendon was not repaired.The healing of the tendon was observed.Results:(1)in terms of diagnosis,after conjoined tendon repair,26 cases in group A showed good tendon continuity,good tension,and a small amount of effusion echo around,three cases showed partial interruption of tendon echo,low echo,or no echo inside with insufficient structural clarity,and a case showed complete interruption;in group B,all 30 cases had continuous interruption,poor tension,tendon retraction,and thickening;the healing rate of group A’s conjoined tendon repair was 96.67%;(2)in terms of prognostic assessment,one month after the surgery,the Harris score of group A was significantly higher than that of group B(P<0.05);however,there was no significant difference in the terms of the Harris score between the two groups 3-6 months after surgery(P>0.05);the effective tension of conjoined tendon and the effective muscle strength of group A were significantly higher than those of group B(P<0.05).Conclusion:Musculoskeletal ultrasound has high diagnostic value in the healing of conjoined tendon and provides dynamic clinical observation after conjoined tendon repair in DAA-THA;it is proven that DAA-THA with conjoined tendon repair on the premise of reconstructing the joint capsule can well restore its tension,enhance its muscle strength,significantly improve early joint stability and joint function,as well as facilitate the rapid recovery of patients.

Musculoskeletal ultrasound to evaluate the efficacy of acupuncture: a review

Acupuncture is a typical example of Traditional Chinese Medicine and has been used in China for hundreds of years to treat a wide range of illnesses. However, in the clinic, issues and deficiencies were primarily seen in four areas: loss of accuracy in the operation process;difficulty understanding the depth of acupuncture;difficulty using reinforcing and reducing techniques;and lack of a clear dynamic effect of acupuncture points following acupuncture. Musculoskeletal ultrasonography may quantitatively evaluate the acupuncture location and display the distribution of small nerves near and within the fascia of the acupuncture point in real time. The subjects were asked how they felt about receiving Qi when the needle body reached different depths and different tissues. The Qi obtained from an acupuncture point and the connective tissue of the fascia can be further understood by combining the physiological response of the acupuncture point with the anatomical structure,which offers a new method for defining the nature of the acupuncture point and standardizing the acupuncture point.

Preliminary Application of High-Frequency Ultrasound in the Differentiation of Pemphigus and Bullous Pemphigoid:An Observational Study

Objective:Ultrasonography is a diagnostic imaging technique used to visualize subcutaneous body structures for identification of possible pathologies.In this study,we aimed to explore the clinical significance of high-frequency ultrasound in differentiating the location of blisters between pemphigus and bullous pemphigoid.Methods:Eighteen patients were recruited in Department of Dermatology,Zhongda Hospital from 2020 to 2021 and divided into a pemphigus group(n=8)and a bullous pemphigoid group(n=10)according to the diagnostic criteria for each.Ultrasonographic images were collected using a 50-MHz high-frequency ultrasound system.The indexes of ultrasonic evaluation were the layer(epidermis or dermis),size,shape,internal echo,and boundary of the blister.Categorical variables are expressed as n(%),and differences were compared using Fisher’s exact test.Results:The ultrasonographic images in the pemphigus group showed an intraepidermal semi-arc or irregular anechoic or hypoechoic areas.The inferior borders were situated above the characteristic thin linear hyperechoic bands of the epidermis.A linear hypoechoic band was present at the dermoepidermal junction in some cases.In the ultrasonographic images of the bullous pemphigoid group,the linear hyperechoic bands of the epidermis were continuous and intact.An oval fluid anechoic area(subepidermal blister)was present immediately below the bands.The location of the blisters in the ultrasonographic images was significantly different between the 2 groups(P<0.001).Conclusion:High-frequency ultrasound can be used as an auxiliary means to differentiate the location of blisters between pemphigus and bullous pemphigoid.

Sonoelastography in the musculoskeletal system:Current role and future directions

Ultrasound is an essential modality within musculoskeletal imaging, with the recent addition of elastography. The elastic properties of tissues are different from the acoustic impedance used to create B mode imaging and the flow properties used within Doppler imaging, hence elastography provides a different form of tissue assessment. The current role of ultrasound elastography in the musculoskeletal system will be reviewed, in particular with reference to muscles, tendons, ligaments, joints and soft tissue tumours. The different ultrasound elastography methods currently available will be described, in particular strain elastography and shear wave elastography. Future directions of ultrasound elastography in the musculoskeletal system will also be discussed.

肌骨超声进修医师的教学实践探索

继续教育是提高超声医师亚专业技术能力的重要途径和手段,肌骨超声发展迅速,临床应用范围不断拓展,已成为临床多学科重要的影像学评估手段,但目前我国肌骨超声尚未得到普遍推广,很多基层医院的医师对肌骨超声一知半解。肌骨超声有自身的特殊性,集解剖、病理、临床及超声为一体,除对解剖结构进行诊断外,还涉及功能评估,因此教学难度大。进修学习是快速掌握肌骨超声的重要手段。文章结合多年肌骨进修医师的带教经验,将肌骨进修医师培训分4个阶段:相关理论知识学习、规范化操作学习、临床常见疾病学习和临床观摩及患者检查。文章分别总结了每一阶段的教学特点、侧重点和带教方法,兼顾基础知识、技能操作和临床思维培养,以更好地提升进修医师的继续教育质量。

基于经筋理论的膝骨关节炎患者“筋结点”超声解剖学特征分析与针刀治疗的疗效评价研究

目的:借助可视化肌骨超声深入剖析膝骨关节炎患者膝关节局部经筋病灶点的病理特征,并综合评价弓弦平衡针刀法与常规针刺法治疗膝骨关节炎的疗效差异,为今后针刀精准辨位定点及安全入路研究提供客观参考依据。方法:将120例膝骨关节炎患者随机分为针刀治疗组和针刺对照组,每组60例。针刀治疗组进行弓弦平衡针刀法治疗,每周2次;针刺对照组选取犊鼻、内膝眼、阳陵泉、梁丘、鹤顶,及局部阿是穴进行针刺,同时根据不同的证型进行配穴加减,每周3次。2组均以3周为1个疗程,治疗3个疗程。根据肌骨超声下“筋结点”的精确定位、层次解剖、回声特点深入剖析经筋病灶点的超声影像学特征,采用股直肌羽状角、肌纤维横断面积、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)综合评价2组疗效差异。结果:治疗后,2组患者WOMAC评分、股直肌羽状角、平均肌纤维厚度、弹性应变率、IL-1β、TNF-α水平,及膝关节疼痛程度、僵硬、日常活动能力方面较治疗前均显著改善(P <0.05);其中,针刀治疗组在提升股直肌羽状角、增加肌纤维厚度、降低弹性应变率、降低致炎致痛因子水平方面优于针刺对照组,差异有统计学意义(P <0.05);与正常膝关节超声解剖结构相比,患者膝关节各针刀松解点(筋结点)处呈现出不同程度回声增强,同时伴有滑膜增厚、增生、关节腔积液、滑囊积液等典型超声影像学特征。结论:肌骨超声能够精准呈现膝骨关节炎患者膝关节经筋病灶点的解剖位置、解剖层次等超声病变特征,证实弓弦平衡针刀法的安全性和有效性,为针刀医学的标准化、规范化研究提供重要参考依据。

自由跤运动员专项训练时的血流限制对其肌肉力量和形态的影响

目的:探讨4周自由跤专项训练时,血流限制对女子自由跤运动员肌肉力量以及身体成分、肢体围度、肌肉厚度的影响。方法:将20名专项训练经历在5年以上的北京队一线女子自由跤运动员随机分为加压组和对照组。两组受试者使用相同的专项训练内容,加压组训练时在上肢或下肢佩戴加压带进行血流限制。比较两组受试者4周训练前后肌肉力量以及身体成分、肢体围度和肌肉厚度的变化。结果:4周训练后,1)与训练前相比,加压组和对照组的身体成分均无显著性变化(P>0.05),但加压组出现骨骼肌量增加、脂肪量减少的趋势,加压组体重增加了0.57%,骨骼肌量增加了4.10%,脂肪量下降了1.48%;2)与训练前相比,加压组右上臂紧张围增加(P<0.05),其余围度指标均无显著性变化(P>0.05),加压组上臂围度增加幅度大于对照组;3)与训练前相比,加压组放松状态下的肱二头肌厚度、放松和紧张状态下的大腿前侧肌肉厚度增加(P<0.05),且放松状态下的肱二头肌和大腿前侧肌肉厚度增加幅度较大(26.59%和22.36%);训练后,加压组放松状态下的肱二头肌厚度、放松和紧张状态下的大腿前侧肌肉厚度高于对照组(P<0.05);4)与训练前相比,加压组左膝屈和右膝伸峰值力矩增加(P<0.05),且加压组增加幅度(6.00%和8.87%)大于对照组(5.42%和0.00%);5)与训练前相比,加压组深蹲、卧推、卧拉的最大静力增加(P<0.05);训练后,加压组的卧推最大静力(70.63 kg)显著高于对照组(51.07 kg)(P<0.05),且加压组提升幅度(9.45%)高于对照组(0.46%)。结论:4周自由跤专项训练结合血流限制干预,在保持运动员体重的同时,提高了上下肢主要肌肉的体积,提高了深蹲、卧推和卧拉等的最大力量和局部关节力量,效果优于传统专项训练。

基于肌骨超声观察经筋排针刺法治疗慢性非特异性腰背痛的临床疗效

目的基于肌骨超声观察经筋排针刺法治疗慢性非特异性腰背痛的临床疗效。方法将136例慢性非特异性腰背痛患者随机分为常规针刺组和经筋排刺组,每组68例。常规针刺组行常规针刺治疗,经筋排刺组行经筋排刺法治疗。观察两组治疗前后日本骨科协会评分(Japanese Orthopaedic Association scores,JOA)、Oswestry功能障碍指数(Oswestrydisability index,ODI)评分、疼痛视觉模拟量表(visualanalog scale,VAS)评分以及肌骨超声静息状态和最大等长收缩状态多裂肌厚度的变化。比较两组临床疗效。结果治疗后,两组JOA、ODI和VAS评分以及最大等长收缩状态多裂肌厚度均较治疗前改善(P<0.05),经筋排针刺组静息状态多裂肌厚度优于治疗前(P<0.05)。相关性分析显示,治疗后最大等长收缩状态多裂肌厚度与治疗后JOA评分呈正相关(P<0.05),与VAS评分呈负相关(P<0.05);治疗后静息状态多裂肌厚度与随访时JOA评分呈正相关(P<0.05)。经筋排刺组总有效率优于常规针刺组(P<0.05)。结论经筋排针刺治疗慢性非特异性腰背痛疗效优于常规针刺,可有效缓解疼痛。肌骨超声多裂肌厚度可以作为慢性非特异性腰背痛疗效评价的依据。

双能CT与肌骨超声联合应用对早期痛风的诊断价值

目的:探讨双能CT(DECT)与肌骨超声(MSUS)联合应用对早期痛风的诊断价值。方法:选取142例风湿科住院或门诊收治的高度疑似痛风患者为研究对象。所有患者均进行DECT、MSUS及关节液偏振光显微镜检查,分析DECT、MSUS单独及二者联合对尿酸盐沉积、关节积液、骨侵蚀及滑膜增厚的检出情况;以临床诊断为“金标准”,评价DECT、MSUS单独及二者联合检查对早期痛风的敏感度、特异度、阳性预测值、阴性预测值及准确度,并绘制诊断的受试者工作特征(ROC)曲线。结果:本研究中,诊断为痛风者111例,非痛风者31例。MSUS、DECT二者单独检查时,对尿酸盐沉积、关节积液及骨侵蚀检出率比较,差异均无统计学意义(P>0.05);MSUS对滑膜增厚的检出率高于DECT(P<0.05)。MSUS联合DECT对尿酸盐沉积、关节积液、骨侵蚀及滑膜增厚的检出率均高于二者单独检测(P<0.05)。以临床诊断为“金标准”,二者联合诊断时任一结果阳性即判定为阳性。结果显示:MSUS检查除敏感度外,诊断效能高于DECT,其余指标差异无统计学意义(P>0.05);联合检查的敏感度、阴性预测值及准确度均高于DECT单独检查(P<0.05)。ROC曲线显示,MSUS、DECT及二者联合检查的AUC值分别为0.845、0.776及0.848。结论:MSUS与DECT均对早期痛风有较高的诊断效能,且MSUS优于DECT,二者联合检查在不降低特异度的前提下,有更高的敏感度。

肌骨超声在附着点炎评估中的应用进展

附着点炎在健康成人及风湿免疫性疾病人群中发病率均较高,且其与部分风湿免疫性疾病患者的疾病活动度、生活质量均有一定的关系。目前已有较多共识建议关注风湿免疫性疾病患者附着点炎,并进一步强调了附着点的临床作用。肌骨超声作为目前评估外周附着点的首选影像学检查方法,为研究附着点炎开发了较多超声评分系统,但均存在一定不足。本文就附着点炎的评估方法、肌骨超声评估附着点炎的应用现状等进行综述,并对未来附着点炎超声评估研究进行了合理的展望。

肌骨超声与MRI对肩袖损伤的诊断价值比较

目的比较肌骨超声(US)与MRI对肩袖损伤的诊断价值。方法选取2020年12月至2022年3月于宜兴市人民医院接受治疗的57例疑似肩袖损伤患者作为研究对象,患者术前均接受肌骨US和MRI检查。以肩关节镜为金标准,对肌骨US和MRI检查结果进行McNemer检验,并采用Kappa检验评价肌骨US与MRI对肩袖损伤的诊断一致性。结果McNemer检验结果显示,肌骨US与MRI检查对肩袖损伤的诊断结果无显著差异(P=1.000),Kappa检验结果表明两者的诊断结果一致性较好(κ=0.846,P=0.000)。结论肌骨US可作为肩袖损伤诊断的首选检查方法,当肩关节US诊断不明确或外科手术前需要更详细的影像学资料时可以进行MRI检查。

3D解剖可视化软件在肘部超声教学中的应用

目的探讨3D解剖可视化软件在肘部超声教学中的应用效果。方法选取2022年1月1日—2023年10月31日于中山大学附属第五医院超声医学科实习及住培的学生34人作为研究对象,根据随机数表法,将所有学生随机分成2组:试验组和对照组分别17名。试验组在授课中加入3D解剖可视化软件辅助教学和操作练习,对照组使用二维图谱来进行传统教学。结课后以2组学生出科考核成绩来评价教学效果,以线上问卷的形式调查所有学生对两种教学方法的满意度,以此评价2组学生教学效果满意度是否存在差异。结果试验组出科成绩为(75.00±6.72)分,高于对照组的(62.94±19.25)分,差异有统计学意义(P<0.05),试验组在激发学习兴趣、有利于掌握肘部解剖结构、能提高肘部肌骨超声扫查手法、对教学模式的满意和教学效果评价方面的满意度均高于对照组[88.24%vs.47.06%,94.12%vs.23.53%,82.35%vs.41.18%,88.24%vs.41.18%,88.24%vs.47.06%],差异均有统计学意义(P<0.05)。结论3D解剖可视化软件应用在肘部超声教学中,有利于提高学生的学习兴趣和成绩,使学生熟练掌握肘部超声的诊断。