Falkowski Anna L, Jacobson Jon A, Freehill Michael T, Kalia Vivek
Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Orthop J Sports Med. 2020 Feb 12;8(2):2325967119901017. doi: 10.1177/2325967119901017. eCollection 2020 Feb.
Portable ultrasound machines are now common, used for point-of-care applications and needle guidance for percutaneous procedures; however, the effectiveness of portable ultrasound in evaluation of the musculoskeletal system has not been fully assessed.
To prospectively evaluate the use of portable hand-held ultrasound in comparison with conventional cart-based ultrasound in evaluation of the musculoskeletal system.
Cohort study (diagnosis); Level of evidence, 2.
In this institutional review board-approved, prospective study, 100 consecutive patients with informed consent were imaged through use of both portable and cart-based ultrasound equipment using 12-5 MHz linear transducers. Agreement in ultrasound diagnosis was documented along with expected clinical changes in management if there was disagreement (definitely no, probably no, uncertain, probably yes, definitely yes). Imaging details of disagreement cases were recorded, and descriptive statistics were calculated.
There were 42 male and 58 female patients (mean ± SD age, 53 ± 13 years) imaged over a time period of 20 months. Anatomic areas scanned were the shoulder (n = 30), elbow (n = 11), hand and wrist (n = 15), hip (n = 10), knee (n = 11), foot and ankle (n = 12), and others (n = 11). Scanning with conventional ultrasound revealed abnormality in 92% of patients. Agreement in diagnosis made between portable versus cart-based ultrasound was found in 65% of patients. In the 35% of patients with discordant results, the change in diagnosis resulted in no change in clinical management in 46%, probably no change in 29%, uncertain change in 14%, probable change in 11%, and definite change in 0%. The diagnoses changing management (4%; 4/100) included nondetection of a satellite nodule (n = 1), ganglion cyst (n = 1), hernia (n = 1), and underestimated tendon tear (n = 1).
When compared with conventional cart-based ultrasound, a musculoskeletal diagnosis using portable hand-held ultrasound was concordant or was discordant without clinical relevance in 96% (96/100) of patients. Knowledge of benefits and limitations of portable hand-held ultrasound will help determine areas where specific types of ultrasound equipment can be used.
便携式超声仪现已普及，用于床旁检查以及经皮操作的穿刺引导；然而，便携式超声在肌肉骨骼系统评估中的有效性尚未得到充分评估。
前瞻性评估便携式手持超声与传统台式超声在肌肉骨骼系统评估中的应用。
队列研究（诊断）；证据等级，2级。
在这项经机构审查委员会批准的前瞻性研究中，100例连续纳入且签署知情同意书的患者，使用12 - 5MHz线性探头，分别通过便携式和台式超声设备进行成像。记录超声诊断的一致性情况，若存在不一致（肯定否、可能否、不确定、可能是、肯定是），则记录预期的临床管理变化。记录不一致病例的成像细节，并计算描述性统计数据。
在20个月的时间里，对42例男性和58例女性患者（平均年龄±标准差，53±13岁）进行了成像检查。扫描的解剖部位包括肩部（n = 30）、肘部（n = 11）、手和腕部（n = 15）、髋部（n = 10）、膝部（n = 11）、足和踝部（n = 12）以及其他部位（n = 11）。使用传统超声扫描发现92%的患者存在异常。便携式超声与台式超声诊断一致的患者占65%。在35%结果不一致的患者中，诊断改变导致临床管理无变化的占46%，可能无变化的占29%，不确定变化的占14%，可能有变化的占11%，肯定有变化的占0%。改变管理的诊断（4%；4/100）包括未检测到卫星结节（n = 1）、腱鞘囊肿（n = 1）、疝（n = 1）以及肌腱撕裂低估（n = 1）。
与传统台式超声相比，96%（96/100）的患者使用便携式手持超声进行肌肉骨骼诊断时，结果一致或不一致但无临床相关性。了解便携式手持超声的优缺点将有助于确定可使用特定类型超声设备的领域。
