- Email: [email protected]
Fusion of Real-Time Us with Ct Images to Guide Selective Lumbosacral Nerve Root Interventional Therapy
S184
Ultrasound in Medicine and Biology
illustrate reproducible methods of hydrodissection for upper torso deep nervous structures including the stellate ganglion, brachial plexus, cervical nerve roots and paravertebral spaces, and to gather preliminary data related to an analgesic effect and efficacy of D5W without lidocaine as the primary injectate in hydrodissection for those conditions. Methods: A formal letter of exemption allowing retrospective chart review was obtained from the International Cellular Medicine Society Institutional Review Board. (ICMS-IRB). Consecutive charts were reviewed for patients who received hydrodissection of stellate ganglion, brachial plexus, cervical nerve roots, or paravertebral spaces as a treatment method for neuropathic pain, using D5W exclusively, with lidocaine used for skin blebs only. Chart selection continued until data from 100 treatments was available for analysis. Methods of hydrodissection utilized on patients in this consecutive patient data collection were illustrated with use of anatomical diagrams, ultrasound images and videos. The primary measure for a potential intraprocedural analgesia effect of D5W hydrodissection was the mean difference between pretreatment pain and immediate (5 minute) post-treatment pain in points as measured on a 0-10 Numerical Rating Scale (NRS). The patients were followed-up at two-month post-treatment to inquire about further need for treatment and to obtain a final 0-10 NRS pain level to monitor for treatment efficacy. Data were analyzed using PASW 18 (Predictive Analytics 180 Software 18.0.0, IBM). Descriptive statistics (mean 6 standard deviation) were reported at baseline and at each session for NRS. Cumulative improvement in patient’s pain levels over time was determined by calculating the mean difference between pre-treatment patient pain measured at time 0 and posttreatment pain measured 2 months after the last clinic visit. The percentage of cases achieving more than 50% and more than 75% improvement in pain was calculated. Results: A retrospective chart review was performed of treatment results from 100 hydrodissection treatments in 26 consecutive cases (25 patients; one receiving treatment bilaterally) 51614.7 years of age, with neuropathic pain duration of 16612.2 months and initial numerical rating scale for pain (NRS 0-10) of 8.361.3 points. The mean percentage of analgesia during each treatment session was 88.169.8% with injection of D5W without anesthetic. NRS pain levels changed from 8.361.3 pre-treatment to 1.960.9 two months after the last treatment for a point change improvement of 6.461.7 points. Patients received 3.862.6 treatments over 9.767.8 months from 1st treatment to 2-month-post-treatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half (13/26). An analgesic effect of D5W injection is confirmed by this study and a cumulative pain reduction is suggested. Conclusions: This article has illustrated potentially-reproducible methods of hydrodissection for stellate ganglion, brachial plexus, cervical nerve roots and paravertebral spaces, provides data supporting a consistent analgesic effect of D5Wand suggests a potentially sustainable clinical benefit in patients with chronic upper back/thorax pain of neuropathic origin. The mechanism of analgesia may relate to an indirect (allosteric) effect on the TRPV1 cation channel, hyperpolarization of normoglycemic C fibers, correction of local neural hypoglycemia, or undiscovered, likely multiple, mechanisms. The well-developed chronic constriction injury model, which results in neuropathic pain and neural swelling, is the primary rationale behind hydrodissection of nerves to release the nerve from suspected local neural compression, particularly for those nerves with fascicular nerve swelling or an increase in overall neural volume. The frequency of neural edema and the long-term efficacy of nerve hydrodissection in neuropathic pain, in contrast to anesthetic low volume nerve block, are important foci of future research in neuropathic pain conditions. OPT14-002 Platelet-Rich Plasma Versus 5% Dextrose for Mild-to-Moderate Carpal Tunnel Syndrome Ming-Jen Ke, Yung-Tsan Wu, Tsung-Yen Ho, Tsung-Ying Li, Liang-Cheng Chen Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taiwan
Volume 43, Number S1, 2017 Objectives: Although current conservative treatments are helpful for most patients with mild-to-moderate carpal tunnel syndrome (CTS), the cochrane review and large population-based study only concluded their short-term or limited efficacy. Hence, it is critical to develop a novel approach for mild-to-moderate CTS. In 2017, we have demonstrated that ultrasound-guided perineural injection with PRP or D5W is an effective and worthwhile intervention for patients with mid-tomoderate CTS. However, the comparsion of perineural PRP and D5W injection has not been investigated in a single study. Methods: This is a prospective, randomized, double-blind, head-to head comparative study. Forty-three patients with bilateral CTS were randomized into PRP and D5W groups. PRP group received one-dose 3cc PRP injection and one-dose 3cc D5W injection to another wrist of the same patient as D5W group. The primary outcome is visual analog scale (VAS) and secondary outcomes include Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, electrophysiological study of the median nerve, and finger pinch strength. The evaluation was performed pretreatment as well as on the 1st, 3th, and 6th after the injection. Results: A total of 43 patients (43 wrists in each group) completed the study. The PRP group had a significantly noticeable reduction of VAS score, BCTQ and CSA of median nerve than the D5W group (P,0.05). Moreover the improved trend between two groups seem more significant in moderate CTS. Conclusions: This study shows PRP is more effective than D5W for patients with mild-to moderate CTS. OPT14-003 Fusion of Real-Time Us with Ct Images to Guide Selective Lumbosacral Nerve Root Interventional Therapy Zhiqiang Li,1 Ligang Cui,1 Jinrui Wang,1 Shuiqing Li2 1 Department of Ultrasound, Peking University Third Hospital, China, 2 Department of Pain, Peking University Third Hospital Objectives: To investigate the safety and efficacy of fusion of real-time US with CT images guidance selective lumbosacral nerve root interventional therapy. Methods: The main purpose of this study was to compare the total puncture time and X-ray fluoroscopy times between two ways to guide nerve root therapy. The study was approved by institutional review board, and written informed consent was obtained from each patient. 60 patients with unilateral lumbar 4, lumbar 5 and sacral 1 radiculopathy were included(mean age, 63.4 years; range, 47-79 years). The patients were divided into two groups of 30 cases and received single-US guidance or US-CT fusion imaging guidance target nerve root puncture respectively. X-ray fluoroscopy was used to adjust the location of the puncture needle and the total puncture time and X-ray fluoroscopy times were both recorded. After X-ray fluoroscopy and electrical stimulation confirming the needle tip around the target nerve root, the pain physician continued the same follow-up treatment for two groups, including the drug injection and pulsed radiofrequency ablation treatment, and the VAS (visual analogue scale) score of 60 patients before and after treatment were recorded overall. Results: All 60 patients were completed puncture and following drug injection and pulsed radiofrequency ablation treatment successfully. Puncture needle reaching the target position verified by X-ray fluoroscopy and induced the corresponding innervation of the sensory and motor response, no obvious complications.In single-US group, the total time of puncture was 9-21 min, the mean (16.9 6 2.6) min, and the number of X-ray fluoroscopy were 4-8 times, mean (6.0 6 1.0) times. In fusion Imaging group, the total time of puncture was 13-18min, the mean (15.7 6 1.3) min; fusion imaging time was 4-8min, mean (6.2 6 1.0) min; registration error was 2.8-5mm, average (4.0 6 0.59) mm; the distance between the needle tip last showed by ultrasound and the target was 1.2-2.2cm, average (1.60 6 0.23) cm; and the number of X-ray fluoroscopy were 3-5 times, mean (3.9 6 0.8) times. The total time of puncture and the number of X-ray fluoroscopy of the fusion Imaging
Abstracts group were less than that of the single-US group, and the difference was statistically significant (p,0.05). The VAS score of both two groups before and after treatment has a significant difference (p,0.001), but there was no significant difference between the two groups. Conclusions: Compared with the single-US group, the fusion imaging group can reduce the total time of puncture and the number of X-ray fluoroscopy. The VAS score of both two groups after treatment were significantly lower than those before treatment, confirming the feasibility and effectiveness of fusion imaging technique in the selective lumbosacral nerve root interventional therapy. OPT14-004 Ultrasound-Guided Dextrose Injection Treatment for Refractory Chronic Musculoskeletal Pain: A Retrospective Case Series Yen Chou, Hong-Jen Chiou, Yung-Hui Lin Department of Radiology, Taipei Veterans General Hospital, Taiwan Objectives: Management of refractory musculoskeletal pain is challenging for clinicians with numerous available treatment options including physiotherapy, physical modalities, pharmacologic and needling interventions but lack of evidence based consensus. Dextrose injection (Prolotherapy) emerged as a promising, cost-effective treatment for chronic musculoskeletal pain of various etiologies, supported by positive outcomes in many clinical studies and systemic reviews. This retrospective case series aims to evaluate the efficacy of ultrasound-guided dextrose trigger point injections for various musculoskeletal pain syndrome refractory to other alternative treatments. Methods: We searched for ultrasound guided injection procedures performed from August 2015 to April 2016 in our reporting database and Picture archiving and communication system (PACS), treated with ultrasound-guided injection of 15% dextrose for chronic musculoskeletal symptoms that persisted for more than one month. We reviewed basic profiles of patients, the initial presentation with specified site and duration, physical findings, diagnostic ultrasound findings, severity of symptoms as documented by visual analogue scale (VAS), immediate response after treatment, response reported by patient on follow-up visit one month after treatment. If the patient was not present to the clinic for follow-up, we interviewed the patient by telephone and the treatment response reported by patient or caregiver was also documented. We excluded patients who did not receive post-treatment re-evaluation at clinic or by telephone interview. Results: 45 consecutive patients received ultrasound-guided 15% dextrose injections. The mean age of treated subjects was 56.6. All the treated patients returned to our clinic for follow-up or repeated treatment. 8 of 45 subjects (24.4%) reported complete resolved symptoms at treated site. 36 of 45 (80.0%) subjects reported greater than 50% improvement of their symptoms. The mean pre-treatment and post-treatment visual analogue scale (VAS) score is 7.0 and 2.44 (p , 0.001), indicating overall 65.0% reduction in symptom severity. There were no significant reported immediate adverse reactions or complications following the intervention. Conclusions: Ultrasound guided 15% dextrose injection for treating localized musculoskeletal pain syndromes refractory to other alternative treatments showed remarkable responses, significantly reducing symptom intensities in the majority of treated subjects in one month after single injection. Our experience is consistent with available scientific evidence that dextrose injection is a safe, inexpensive, and efficient treatment. Poster Session PPT14-001 Application of Contrast-Enhanced Ultrasound in the Evaluation of Prognosis of Acute Kidney Injury in Critically Ill Patients Dong Wang,1 Xiang Jing,1 Lei Xu2
1 2
S185
Department of Ultrasound, Tianjin Third Central Hospital, China, Department of Intensive Care Unit, Tianjin Third Central Hospital
Objectives: Evaluation of renal function in critically ill patients by contrast-enhanced ultrasonography, and to determine the relationship between contrast-enhanced ultrasound and renal function in patients with acute kidney injury. Methods: 60 patients with acute renal injury (AKI) in Tianjin Third Central Hospital from January, 2015 to December,2016 were selected as A group, at the same time, 30 healthy volunteers were selected as B group. Laboratory examinations such as renal function, cystatin C and other indicators were measured and the creatinine clearance rate was calculated in 24h. Real time contrast-enhanced ultrasound was performed on all the patients with Philips iU22 ultrasound diagnostic apparatus. The ultrasound contrast agent was SonoVue. The software(Q-lab) calculates the intensity of the echo signal of the contrast agent in the region of interest and generates the time intensity curve(TIC). Quantitative parameters of contrast-enhanced ultrasound were obtained: Peak intensity (PI), time to peak time (TTP), area under the curve (AUC), time of arrival (AT), slope of the rising curve(A). According to the results of A group and B group compared with contrastenhanced ultrasound, were divided into negative and positive. All patients in the A group received comprehensive therapy including continuous hemofiltration. According to whether the patients need renal replacement therapy, renal function and urine volume recovery, the A group patients were divided into the treatment group, the improvement group and the ineffective group. Pearson chi square test was used to analyze the relationship between the results of CEUS and the prognosis of the treatment group. Results: 1.Of the 60 selected cases, there were 26 cases in the treatment group(43.3%), the improvement group of 19 cases(31.7%), the invalid group of 15 cases, (25%). There was no significant difference in creatinine clearance rate and cystatin between the cured group, the improvement group and the ineffective group (P,0.05). 2. In the cured group, CEUS was positive in 7 cases and negative in 19 cases. In the improved group, CEUS was positive in 8 cases and negative in 11 cases, and in the negative group, CEUS was positive in 13 cases and negative in the 2 cases.3. The results of CEUS were significantly correlated with renal prognosis (X2513.516 P50.001). Conclusions: The results of this study show that there is a significant correlation between CEUS and renal prognosis of patients with AKI. This application can be used as a new method to evaluate the prognosis of renal function in patients with AKI, and to guide the early intervention treatment of AKI patients. PPT14-002 Application of Pulsed Wave Tissue Doppler Image (TDI) in Iatrogenic Right Coronary Ostial Stenosis and Acute Right Heart Failure during Aortic Valve Replacement: A Case Report and Literature Review An-Hsun Chou, Min-Wen Yang, Meng-Ling Hsieh Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan Objectives: Iatrogenic coronary ostial stenosis (ICOS) is a rare but potential fatal complication of valve surgery, with estimated instance of 0.3% to 5%. Here, we present a case of RCA ostium stenosis and consequent right heart failure, which is diagnose by TEE intraoperatively. Methods: A 69-year-old woman, with severe aortic stenosis, was admitted to hospital for elective aortic valve replacement. The resting ECG showed normal sinus rhythm. Preoperative coronary angiography revealed patent LM and insignificant narrowing of LAD, LCx, and RCA. The systolic function of both ventricles were adequate, without noticeable asynergy or hypokinesia. During operation, the aortic valve was approached via mini-sternotomy and aortotomy. A 21-mm porcine bioprosthesis (St. Jude Medical EpicTM) was implanted after aortic valve excised. After discontinuing the cardiopulmonary bypass (CPB),
Ultrasound in Medicine and Biology
illustrate reproducible methods of hydrodissection for upper torso deep nervous structures including the stellate ganglion, brachial plexus, cervical nerve roots and paravertebral spaces, and to gather preliminary data related to an analgesic effect and efficacy of D5W without lidocaine as the primary injectate in hydrodissection for those conditions. Methods: A formal letter of exemption allowing retrospective chart review was obtained from the International Cellular Medicine Society Institutional Review Board. (ICMS-IRB). Consecutive charts were reviewed for patients who received hydrodissection of stellate ganglion, brachial plexus, cervical nerve roots, or paravertebral spaces as a treatment method for neuropathic pain, using D5W exclusively, with lidocaine used for skin blebs only. Chart selection continued until data from 100 treatments was available for analysis. Methods of hydrodissection utilized on patients in this consecutive patient data collection were illustrated with use of anatomical diagrams, ultrasound images and videos. The primary measure for a potential intraprocedural analgesia effect of D5W hydrodissection was the mean difference between pretreatment pain and immediate (5 minute) post-treatment pain in points as measured on a 0-10 Numerical Rating Scale (NRS). The patients were followed-up at two-month post-treatment to inquire about further need for treatment and to obtain a final 0-10 NRS pain level to monitor for treatment efficacy. Data were analyzed using PASW 18 (Predictive Analytics 180 Software 18.0.0, IBM). Descriptive statistics (mean 6 standard deviation) were reported at baseline and at each session for NRS. Cumulative improvement in patient’s pain levels over time was determined by calculating the mean difference between pre-treatment patient pain measured at time 0 and posttreatment pain measured 2 months after the last clinic visit. The percentage of cases achieving more than 50% and more than 75% improvement in pain was calculated. Results: A retrospective chart review was performed of treatment results from 100 hydrodissection treatments in 26 consecutive cases (25 patients; one receiving treatment bilaterally) 51614.7 years of age, with neuropathic pain duration of 16612.2 months and initial numerical rating scale for pain (NRS 0-10) of 8.361.3 points. The mean percentage of analgesia during each treatment session was 88.169.8% with injection of D5W without anesthetic. NRS pain levels changed from 8.361.3 pre-treatment to 1.960.9 two months after the last treatment for a point change improvement of 6.461.7 points. Patients received 3.862.6 treatments over 9.767.8 months from 1st treatment to 2-month-post-treatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half (13/26). An analgesic effect of D5W injection is confirmed by this study and a cumulative pain reduction is suggested. Conclusions: This article has illustrated potentially-reproducible methods of hydrodissection for stellate ganglion, brachial plexus, cervical nerve roots and paravertebral spaces, provides data supporting a consistent analgesic effect of D5Wand suggests a potentially sustainable clinical benefit in patients with chronic upper back/thorax pain of neuropathic origin. The mechanism of analgesia may relate to an indirect (allosteric) effect on the TRPV1 cation channel, hyperpolarization of normoglycemic C fibers, correction of local neural hypoglycemia, or undiscovered, likely multiple, mechanisms. The well-developed chronic constriction injury model, which results in neuropathic pain and neural swelling, is the primary rationale behind hydrodissection of nerves to release the nerve from suspected local neural compression, particularly for those nerves with fascicular nerve swelling or an increase in overall neural volume. The frequency of neural edema and the long-term efficacy of nerve hydrodissection in neuropathic pain, in contrast to anesthetic low volume nerve block, are important foci of future research in neuropathic pain conditions. OPT14-002 Platelet-Rich Plasma Versus 5% Dextrose for Mild-to-Moderate Carpal Tunnel Syndrome Ming-Jen Ke, Yung-Tsan Wu, Tsung-Yen Ho, Tsung-Ying Li, Liang-Cheng Chen Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taiwan
Volume 43, Number S1, 2017 Objectives: Although current conservative treatments are helpful for most patients with mild-to-moderate carpal tunnel syndrome (CTS), the cochrane review and large population-based study only concluded their short-term or limited efficacy. Hence, it is critical to develop a novel approach for mild-to-moderate CTS. In 2017, we have demonstrated that ultrasound-guided perineural injection with PRP or D5W is an effective and worthwhile intervention for patients with mid-tomoderate CTS. However, the comparsion of perineural PRP and D5W injection has not been investigated in a single study. Methods: This is a prospective, randomized, double-blind, head-to head comparative study. Forty-three patients with bilateral CTS were randomized into PRP and D5W groups. PRP group received one-dose 3cc PRP injection and one-dose 3cc D5W injection to another wrist of the same patient as D5W group. The primary outcome is visual analog scale (VAS) and secondary outcomes include Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, electrophysiological study of the median nerve, and finger pinch strength. The evaluation was performed pretreatment as well as on the 1st, 3th, and 6th after the injection. Results: A total of 43 patients (43 wrists in each group) completed the study. The PRP group had a significantly noticeable reduction of VAS score, BCTQ and CSA of median nerve than the D5W group (P,0.05). Moreover the improved trend between two groups seem more significant in moderate CTS. Conclusions: This study shows PRP is more effective than D5W for patients with mild-to moderate CTS. OPT14-003 Fusion of Real-Time Us with Ct Images to Guide Selective Lumbosacral Nerve Root Interventional Therapy Zhiqiang Li,1 Ligang Cui,1 Jinrui Wang,1 Shuiqing Li2 1 Department of Ultrasound, Peking University Third Hospital, China, 2 Department of Pain, Peking University Third Hospital Objectives: To investigate the safety and efficacy of fusion of real-time US with CT images guidance selective lumbosacral nerve root interventional therapy. Methods: The main purpose of this study was to compare the total puncture time and X-ray fluoroscopy times between two ways to guide nerve root therapy. The study was approved by institutional review board, and written informed consent was obtained from each patient. 60 patients with unilateral lumbar 4, lumbar 5 and sacral 1 radiculopathy were included(mean age, 63.4 years; range, 47-79 years). The patients were divided into two groups of 30 cases and received single-US guidance or US-CT fusion imaging guidance target nerve root puncture respectively. X-ray fluoroscopy was used to adjust the location of the puncture needle and the total puncture time and X-ray fluoroscopy times were both recorded. After X-ray fluoroscopy and electrical stimulation confirming the needle tip around the target nerve root, the pain physician continued the same follow-up treatment for two groups, including the drug injection and pulsed radiofrequency ablation treatment, and the VAS (visual analogue scale) score of 60 patients before and after treatment were recorded overall. Results: All 60 patients were completed puncture and following drug injection and pulsed radiofrequency ablation treatment successfully. Puncture needle reaching the target position verified by X-ray fluoroscopy and induced the corresponding innervation of the sensory and motor response, no obvious complications.In single-US group, the total time of puncture was 9-21 min, the mean (16.9 6 2.6) min, and the number of X-ray fluoroscopy were 4-8 times, mean (6.0 6 1.0) times. In fusion Imaging group, the total time of puncture was 13-18min, the mean (15.7 6 1.3) min; fusion imaging time was 4-8min, mean (6.2 6 1.0) min; registration error was 2.8-5mm, average (4.0 6 0.59) mm; the distance between the needle tip last showed by ultrasound and the target was 1.2-2.2cm, average (1.60 6 0.23) cm; and the number of X-ray fluoroscopy were 3-5 times, mean (3.9 6 0.8) times. The total time of puncture and the number of X-ray fluoroscopy of the fusion Imaging
Abstracts group were less than that of the single-US group, and the difference was statistically significant (p,0.05). The VAS score of both two groups before and after treatment has a significant difference (p,0.001), but there was no significant difference between the two groups. Conclusions: Compared with the single-US group, the fusion imaging group can reduce the total time of puncture and the number of X-ray fluoroscopy. The VAS score of both two groups after treatment were significantly lower than those before treatment, confirming the feasibility and effectiveness of fusion imaging technique in the selective lumbosacral nerve root interventional therapy. OPT14-004 Ultrasound-Guided Dextrose Injection Treatment for Refractory Chronic Musculoskeletal Pain: A Retrospective Case Series Yen Chou, Hong-Jen Chiou, Yung-Hui Lin Department of Radiology, Taipei Veterans General Hospital, Taiwan Objectives: Management of refractory musculoskeletal pain is challenging for clinicians with numerous available treatment options including physiotherapy, physical modalities, pharmacologic and needling interventions but lack of evidence based consensus. Dextrose injection (Prolotherapy) emerged as a promising, cost-effective treatment for chronic musculoskeletal pain of various etiologies, supported by positive outcomes in many clinical studies and systemic reviews. This retrospective case series aims to evaluate the efficacy of ultrasound-guided dextrose trigger point injections for various musculoskeletal pain syndrome refractory to other alternative treatments. Methods: We searched for ultrasound guided injection procedures performed from August 2015 to April 2016 in our reporting database and Picture archiving and communication system (PACS), treated with ultrasound-guided injection of 15% dextrose for chronic musculoskeletal symptoms that persisted for more than one month. We reviewed basic profiles of patients, the initial presentation with specified site and duration, physical findings, diagnostic ultrasound findings, severity of symptoms as documented by visual analogue scale (VAS), immediate response after treatment, response reported by patient on follow-up visit one month after treatment. If the patient was not present to the clinic for follow-up, we interviewed the patient by telephone and the treatment response reported by patient or caregiver was also documented. We excluded patients who did not receive post-treatment re-evaluation at clinic or by telephone interview. Results: 45 consecutive patients received ultrasound-guided 15% dextrose injections. The mean age of treated subjects was 56.6. All the treated patients returned to our clinic for follow-up or repeated treatment. 8 of 45 subjects (24.4%) reported complete resolved symptoms at treated site. 36 of 45 (80.0%) subjects reported greater than 50% improvement of their symptoms. The mean pre-treatment and post-treatment visual analogue scale (VAS) score is 7.0 and 2.44 (p , 0.001), indicating overall 65.0% reduction in symptom severity. There were no significant reported immediate adverse reactions or complications following the intervention. Conclusions: Ultrasound guided 15% dextrose injection for treating localized musculoskeletal pain syndromes refractory to other alternative treatments showed remarkable responses, significantly reducing symptom intensities in the majority of treated subjects in one month after single injection. Our experience is consistent with available scientific evidence that dextrose injection is a safe, inexpensive, and efficient treatment. Poster Session PPT14-001 Application of Contrast-Enhanced Ultrasound in the Evaluation of Prognosis of Acute Kidney Injury in Critically Ill Patients Dong Wang,1 Xiang Jing,1 Lei Xu2
1 2
S185
Department of Ultrasound, Tianjin Third Central Hospital, China, Department of Intensive Care Unit, Tianjin Third Central Hospital
Objectives: Evaluation of renal function in critically ill patients by contrast-enhanced ultrasonography, and to determine the relationship between contrast-enhanced ultrasound and renal function in patients with acute kidney injury. Methods: 60 patients with acute renal injury (AKI) in Tianjin Third Central Hospital from January, 2015 to December,2016 were selected as A group, at the same time, 30 healthy volunteers were selected as B group. Laboratory examinations such as renal function, cystatin C and other indicators were measured and the creatinine clearance rate was calculated in 24h. Real time contrast-enhanced ultrasound was performed on all the patients with Philips iU22 ultrasound diagnostic apparatus. The ultrasound contrast agent was SonoVue. The software(Q-lab) calculates the intensity of the echo signal of the contrast agent in the region of interest and generates the time intensity curve(TIC). Quantitative parameters of contrast-enhanced ultrasound were obtained: Peak intensity (PI), time to peak time (TTP), area under the curve (AUC), time of arrival (AT), slope of the rising curve(A). According to the results of A group and B group compared with contrastenhanced ultrasound, were divided into negative and positive. All patients in the A group received comprehensive therapy including continuous hemofiltration. According to whether the patients need renal replacement therapy, renal function and urine volume recovery, the A group patients were divided into the treatment group, the improvement group and the ineffective group. Pearson chi square test was used to analyze the relationship between the results of CEUS and the prognosis of the treatment group. Results: 1.Of the 60 selected cases, there were 26 cases in the treatment group(43.3%), the improvement group of 19 cases(31.7%), the invalid group of 15 cases, (25%). There was no significant difference in creatinine clearance rate and cystatin between the cured group, the improvement group and the ineffective group (P,0.05). 2. In the cured group, CEUS was positive in 7 cases and negative in 19 cases. In the improved group, CEUS was positive in 8 cases and negative in 11 cases, and in the negative group, CEUS was positive in 13 cases and negative in the 2 cases.3. The results of CEUS were significantly correlated with renal prognosis (X2513.516 P50.001). Conclusions: The results of this study show that there is a significant correlation between CEUS and renal prognosis of patients with AKI. This application can be used as a new method to evaluate the prognosis of renal function in patients with AKI, and to guide the early intervention treatment of AKI patients. PPT14-002 Application of Pulsed Wave Tissue Doppler Image (TDI) in Iatrogenic Right Coronary Ostial Stenosis and Acute Right Heart Failure during Aortic Valve Replacement: A Case Report and Literature Review An-Hsun Chou, Min-Wen Yang, Meng-Ling Hsieh Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan Objectives: Iatrogenic coronary ostial stenosis (ICOS) is a rare but potential fatal complication of valve surgery, with estimated instance of 0.3% to 5%. Here, we present a case of RCA ostium stenosis and consequent right heart failure, which is diagnose by TEE intraoperatively. Methods: A 69-year-old woman, with severe aortic stenosis, was admitted to hospital for elective aortic valve replacement. The resting ECG showed normal sinus rhythm. Preoperative coronary angiography revealed patent LM and insignificant narrowing of LAD, LCx, and RCA. The systolic function of both ventricles were adequate, without noticeable asynergy or hypokinesia. During operation, the aortic valve was approached via mini-sternotomy and aortotomy. A 21-mm porcine bioprosthesis (St. Jude Medical EpicTM) was implanted after aortic valve excised. After discontinuing the cardiopulmonary bypass (CPB),