Lee Mitchell, Roberts J Mark, Chen Luke, Chang Silvia, Hatala Rose, Eva Kevin W, Meneilly Graydon S
Departments of Medicine (M.L., J.M.R., L.C., R.H., K.W.E, G.S.M.) and Radiology (S.C.) and Center for Health Education Scholarship (R.H., K.W.E.), Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
J Ultrasound Med. 2014 Jul;33(7):1225-30. doi: 10.7863/ultra.33.7.1225.
Physical examination can identify palpable splenomegaly easily, but evaluating lesser degrees of splenomegaly is problematic. Hand-carried ultrasound allows rapid bedside assessment of patients. We conducted this study to determine whether hand-carried ultrasound can reliably assess spleen size.
Patients with varying degrees of splenomegaly were studied. Two sonographers blindly measured spleen size in each patient using either a hand-carried or conventional ultrasound device in random order. Sonographers completed a data sheet indicating the adequacy of the image, clinical measurements of enlargement, and confidence in their observations.
Sixteen patients (10 male and 6 female; mean age ± SEM, 60 ± 4 years) were recruited. Image quality was adequate or better in all scans with conventional ultrasound and in 15 of 16 scans with hand-carried ultrasound. The greatest longitudinal measurement recorded was statistically equivalent across ultrasound techniques, with mean values of 16.4 cm (95% confidence interval, 14.8-18.0 cm) for conventional ultrasound and 15.8 cm (95% confidence interval, 14.1-17.4 cm) for hand-carried ultrasound. The correlation between measurement techniques was r = 0.89 (P < .0001). Sonographers were somewhat or very confident in the outcomes of all scans with conventional ultrasound and in 15 of 16 cases with hand-carried ultrasound. In general, it took longer for sonographers to obtain images with hand-carried ultrasound.
We have shown that hand-carried ultrasound can be used at the point of care by trained individuals to diagnose splenomegaly. However, hand-carried ultrasound images were less likely to be judged excellent, were accompanied by less diagnostic certainty, and took longer to obtain.
体格检查能够轻松识别可触及的脾肿大，但评估程度较轻的脾肿大存在问题。手持式超声可在床边对患者进行快速评估。我们开展本研究以确定手持式超声能否可靠地评估脾脏大小。
对不同程度脾肿大的患者进行研究。两名超声检查人员使用手持式或传统超声设备，以随机顺序对每位患者的脾脏大小进行盲测。超声检查人员填写一份数据表，注明图像质量、肿大的临床测量值以及对其观察结果的信心程度。
共招募了16名患者（10名男性和6名女性；平均年龄±标准误，60±4岁）。所有使用传统超声的扫描以及16次使用手持式超声扫描中的15次，图像质量均为足够或更好。两种超声技术记录的最大纵向测量值在统计学上相当，传统超声的平均值为16.4厘米（95%置信区间，14.8 - 18.0厘米），手持式超声的平均值为15.8厘米（95%置信区间，14.1 - 17.4厘米）。测量技术之间的相关性为r = 0.89（P <.0001）。超声检查人员对所有使用传统超声的扫描结果以及16例使用手持式超声扫描中的15例结果有些或非常有信心。一般来说，超声检查人员使用手持式超声获取图像所需时间更长。
我们已表明，经过培训人员可在床边使用手持式超声诊断脾肿大。然而，手持式超声图像被判定为优秀的可能性较小，诊断确定性较低，且获取图像所需时间更长。
