A Quantitative Method to Measure Skin Thickness in Leg Edema in Pregnant Women Using B-Scan Portable Ultrasonography: A Comparison Between Obese and Non-Obese Women

Yanagisawa, Nami; Koshiyama, Masafumi; Watanabe, Yumi; Sato, Sayaka; Sakamoto, Shinichi

doi:10.12659/msm.911799

Cited by 11 publications

(34 citation statements)

References 22 publications

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“…However, the quantification of extravascular fluid overload via ultrasound has rarely been studied in adults and never previously attempted in infants with CHD ( 26 , 35 ). Yanagisawa et al used ultrasound to evaluate for skin edema in pregnant women and was able to manually measure the depth of subcutaneous edema ( 26 ). A study by Eisenbeiss et al demonstrated that subcutaneous tissue thickness increased following fluid infusion and can be measured by ultrasound in healthy adult volunteers ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…The most utilized methods for assessing fluid overload include trending daily weights, net fluid balance, physical examination findings, and CVP measurements, all of which can be imprecise and can falsely represent a patient's fluid status due to the inherent inaccuracies in data collection and challenges distinguishing between intraand extra-vascular fluid overload (4,(15)(16)(17). Ultrasound, a fast and painless imaging modality that uses benign sound waves instead of ionizing radiation, has been studied in adults as a non-invasive measurement of fluid status by assessing the distensibility of vascular structures or extravascular fluid accumulation (18)(19)(20)(21)(22)(23)(24)(25)(26). MuscleSound, Inc., a Denver based ultrasound software company, has recently developed automated ultrasound measurements of skeletal muscle layers in the adult population that could be used to measure post-operative changes in subcutaneous edema and extravascular fluid overload (27)(28)(29)(30).…”

Section: Introductionmentioning

confidence: 99%

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Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

et al. 2021

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Purpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in infants and assess the intra- and inter-user variability.Methods: Prospective cohort study of neonates (≤30 d/o) and infants (31 d/o to 12 m/o) undergoing cardiac surgery and neonatal controls. Skin ultrasound was performed on four body sites at baseline and daily post-operatively through post-operative day (POD) 3. Subcutaneous tissue depth was manually measured. Intra- and inter-user variability was assessed using intraclass correlation coefficient (ICC).Results: Fifty control and 22 surgical subjects underwent skin ultrasound. There was no difference between baseline surgical and control neonates. Subcutaneous tissue increased in neonates starting POD 1 with minimal improvement by POD 3. In infants, this pattern was less pronounced with near resolution by POD 3. Intra-user variability was excellent (ICC 0.95). Inter-user variability was very good (ICC 0.82).Conclusion: Point-of-care skin ultrasound is a reproducible and reliable method to measure subcutaneous tissue in infants with and without congenital heart disease. Acute increases in subcutaneous tissue suggests development of skin edema, consistent with extravascular fluid overload. There is evidence of skin edema starting POD 1 in all subjects with no substantial improvement by POD 3 in neonates. Point-of-care ultrasound could be an objective way to measure extravascular fluid overload in infants. Further research is needed to determine how extravascular fluid overload correlates to clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

et al. 2021

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“…Of these methods, only a physical examination may not be able to make a quantitative measurement of lymphedema. Ultrasonography, particularly portable ultrasonography, is easy to use and a very convenient tools for checking the degree of lymphedema [51]. Ultrasonography can easily detect increased skin thickness, increased subcutaneous tissue thickness, and increased subcutaneous echogenicity [52,53].…”

Section: Discussionmentioning

confidence: 99%

“…We recently showed that portable B-scan ultrasonography was able to quantitatively measure the increased thickness of the skin of the leg in pregnant women [51]. The skin thickness of the legs in pregnant women with edema was significantly increased compared with that in pregnant women without edema (6.4 ± 0.3 mm vs. 4.6 ± 0.4 mm) ( n = 98; p = 0.0001).…”

Section: The Diagnosismentioning

confidence: 99%

Development and Themes of Diagnostic and Treatment Procedures for Secondary Leg Lymphedema in Patients with Gynecologic Cancers

et al. 2019

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Patients with leg lymphedema sometimes suffer under constraint feeling leg heaviness and pain, requiring lifelong treatment and psychosocial support after surgeries or radiation therapies for gynecologic cancers. We herein review the current issues (a review of the relevant literature) associated with recently developed diagnostic procedures and treatments for secondary leg lymphedema, and discuss how to better manage leg lymphedema. Among the currently available diagnostic tools, indocyanine green lymphography (ICG-LG) can detect dermal lymph backflow in asymptomatic legs at stage 0. Therefore, ICG-LG is considered the most sensitive and useful tool. At symptomatic stage ≥1, ultrasonography, magnetic resonance imaging-lymphography/computed tomography-lymphography (MRI-LG/CT-LG) and lymphosintiography are also useful. For the treatment of lymphedema, complex decongestive physiotherapy (CDP) including manual lymphatic drainage (MLD), compression therapy, exercise and skin care, is generally performed. In recent years, CDP has often required effective multi-layer lymph edema bandaging (MLLB) or advanced pneumatic compression devices (APCDs). If CDP is not effective, microsurgical procedures can be performed. At stage 1–2, when lymphaticovenous anastomosis (LVA) is performed, lymphaticovenous side-to-side anastomosis (LVSEA) is principally recommended. At stage 2–3, vascularized lymph node transfer (VLNT) is useful. These ingenious procedures can help maintain the patient’s quality of life (QOL) but unfortunately cannot cure lymphedema. The most important concern is the prevention of secondary lymphedema, which is achieved through approaches such as skin care, weight control, gentle limb exercises, avoiding sun and heat, and elevation of the affected leg.

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“…11,13 The skin’s thickness normally ranges between 0.5 to 3 mm, 8,14 but can be abnormally thick or thin when affected by disease processes. 5,15 Without this normalization step, skin stiffness estimates would be confounded by skin thickness at different anatomic locations, time points, and disease stages. Therefore, an accurate measurement of thickness is necessary to generate unbiased estimates of skin elasticity with ultrasonic SWE.…”

Section: Introductionmentioning

confidence: 99%

Semi-automated weak annotation for deep neural network skin thickness measurement

et al. 2021

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Correctly calculating skin stiffness with ultrasound shear wave elastography techniques requires an accurate measurement of skin thickness. We developed and compared two algorithms, a thresholding method and a deep learning method, to measure skin thickness on ultrasound images. Here, we also present a framework for weakly annotating an unlabeled dataset in a time-effective manner to train the deep neural network. Segmentation labels for training were proposed using the thresholding method and validated with visual inspection by a human expert reader. We reduced decision ambiguity by only inspecting segmentations at the center A-line. This weak annotation approach facilitated validation of over 1000 segmentation labels in 2 hours. A lightweight deep neural network that segments entire 2D images was designed and trained on this weakly-labeled dataset. Averaged over six folds of cross-validation, segmentation accuracy was 57% for the thresholding method and 78% for the neural network. In particular, the network was better at finding the distal skin margin, which is the primary challenge for skin segmentation. Both algorithms have been made publicly available to aid future applications in skin characterization and elastography.

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A Quantitative Method to Measure Skin Thickness in Leg Edema in Pregnant Women Using B-Scan Portable Ultrasonography: A Comparison Between Obese and Non-Obese Women

Cited by 11 publications

References 22 publications

Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

Development and Themes of Diagnostic and Treatment Procedures for Secondary Leg Lymphedema in Patients with Gynecologic Cancers

Semi-automated weak annotation for deep neural network skin thickness measurement

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