Hand-Held Portable Versus Conventional Cart-Based Ultrasound in Musculoskeletal Imaging

Abstract

Background: 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. Purpose: To prospectively evaluate the use of portable hand-held ultrasound in comparison with conventional cart-based ultrasound in evaluation of the musculoskeletal system. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: 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. Results: 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). Conclusion: 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.

Performance of a Handheld Ultrasound Device to Assess Articular and Periarticular Pathologies in Patients with Inflammatory Arthritis

“…This study had some limitations. First, the number of patients assessed in this study was relatively small, but as this was a first exploratory study for the use of a HHUS device in IA patients, these numbers were acceptable and in line with other, comparable studies [ 6 , 7 , 8 , 9 ]. Second, in our study, image evaluation by the blinded reader was performed with static images, whereas ultrasound video recordings would have more reliably reflected the setting of an ultrasound examination.…”

“…Despite a maximum frequency of 10 MHz, the HHUS device showed high accuracy in B mode in detecting pathological findings even for small joints, which are often affected in IA patients and for this reason are included in most established US-scoring systems for arthritis [ 23 , 24 ]. Some studies already evaluated the accuracy of HHUS devices for MSUS [ 6 , 7 , 8 , 9 ]. However, these studies only focused on the sensitivity assessment of degenerative changes without systematically evaluating pathologies found in IA, e.g., signs of erosions or synovitis.…”

“…However, our study also revealed the absolute inadequacy of the PD mode of the Butterfly iQ device for detecting hypervascularisation in joints and periarticular structures. This limitation seems to be a general problem of HHUS devices at present, thus this shortcoming also applies to other portable devices [ 9 ]. Because PD mode has become an essential component of MSUS for assessing and monitoring acute inflammation [ 25 , 26 , 27 ], improvements in PD mode sensitivity are absolutely necessary to enable the use of HHUS devices in daily rheumatology practice.…”

“…Some studies have already shown the good applicability of HHUS devices for musculoskeletal ultrasound (MSUS) examinations, e.g., for hemarthrosis and local degenerative changes such as tendinopathies. [ 6 , 7 , 8 , 9 ]. However, the use of HHUS devices in rheumatology to systematically assess structural joint damage and inflammatory extent in inflammatory arthritis (IA) has not been evaluated to date.…”

The Emerging Era of Interventional Imaging in Rheumatology: An Overview During the Coronavirus Disease-2019 (COVID-19) Pandemic

“… 85 Both US-guided botulinum toxin and steroid injection were effective in the treatment of plantar fasciitis . 86 Injection of Morton neuroma under US guidance provides a significant improvement compared to blind injection. 87 …”