Assessment of the inferior vena cava collapsibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on healthy volunteers

Abstract

Purpose Assessment of the inferior vena cava (IVC) respiratory variation may be clinically useful for the estimation of fluid-responsiveness and venous congestion; however, imaging from subcostal (SC, sagittal) region is not always feasible. It is unclear if coronal trans-hepatic (TH) IVC imaging provides interchangeable results. The use of artificial intelligence (AI) with automated border tracking may be helpful as part of point-of-care ultrasound but it needs validation. Methods Prospective observational study conducted in spontaneously breathing healthy volunteers with assessment of IVC collapsibility (IVCc) in SC and TH imaging, with measures taken in M-mode or with AI software. We calculated mean bias and limits of agreement (LoA), and the intra-class correlation (ICC) coefficient with their 95% confidence intervals. Results Sixty volunteers were included; IVC was not visualized in five of them (n = 2, both SC and TH windows, 3.3%; n = 3 in TH approach, 5%). Compared with M-mode, AI showed good accuracy both for SC (IVCc: bias − 0.7%, LoA [− 24.9; 23.6]) and TH approach (IVCc: bias 3.7%, LoA [− 14.9; 22.3]). The ICC coefficients showed moderate reliability: 0.57 [0.36; 0.73] in SC, and 0.72 [0.55; 0.83] in TH. Comparing anatomical sites (SC vs TH), results produced by M-mode were not interchangeable (IVCc: bias 13.9%, LoA [− 18.1; 45.8]). When this evaluation was performed with AI, such difference became smaller: IVCc bias 7.7%, LoA [− 19.2; 34.6]. The correlation between SC and TH assessments was poor for M-mode (ICC = 0.08 [− 0.18; 0.34]) while moderate for AI (ICC = 0.69 [0.52; 0.81]). Conclusions The use of AI shows good accuracy when compared with the traditional M-mode IVC assessment, both for SC and TH imaging. Although AI reduces differences between sagittal and coronal IVC measurements, results from these sites are not interchangeable.

Effect of pre-infusion of hypertonic saline on postoperative delirium in geriatric patients undergoing shoulder arthroscopy: a randomized controlled trial

“…Hypovolemic patients can be treated with fluid challenge therapy to increase cardiac output and optimize systemic tissue perfusion [ 37 ]. Studies have shown that the use of artificial intelligence to assess inferior vena cava variations from subcostal and trans-hepatic imaging can be used to predict fluid responsiveness [ 38 , 39 ]. We will address this shortcoming and improve it in future studies.…”

The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review

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Cost-effectiveness analysis of transarterial chemoembolization combined with lenvatinib as the first-line treatment for advanced hepatocellular carcinoma

“…In addition, the collapsibility of the inferior vena cava, a major conduit for deoxygenated blood returning to the heart, can be evaluated using subcostal and trans-hepatic ultrasound imaging. This assessment modality exhibits the potential for assessing the fluid status of patients with advanced HCC, warranting further investigation in this area ( Sanfilippo et al, 2023 ; Zawadka et al, 2023 ).…”