Detection of therapeutically relevant diagnoses made by sonography of the upper abdomen: Portable versus high-end sonographic units - A prospective study

Aim: To compare the efficiency of a portable sonographic unit with a high-end unit used for sonographic examinations of the upper abdomen to detect therapeutically relevant diagnoses and to answer clinical questions. Methods: Over a period of five years, 575 patients were examined by four examiners as part of the daily routine work. Patients without known diagnoses were examined first with the portable SonoSite 180 system, with documentation of the findings and diagnoses, and immediately thereafter with the high-end Philips HDI 5000 system. Subsequently, any discrepant findings and diagnoses were recorded. The assessment was confined to therapy-demanding diagnoses and to the resolution of the clinical question (major findings) as well as to other therapeutically relevant findings (minor findings). Results: Of the 575 data sets (duplicated examinations), 574 could be evaluated. The major findings coincided in 447 (78%) of 574 cases and were discrepant in 121 (22%) cases in which the major findings were solely detected with the high-end Philips HDI 5000 system and missed with the portable SonoSite(R) 180 system. Findings of the upper abdomen coincided in 252 (85%) of 297 cases and were undetectable with the portable unit in 44 (15%) cases. For 166 intestinal examinations, the proportion of coinciding major findings was 58% (96 of 166 cases), with 42% (71 of 166 cases) overlooked with the portable unit. For examinations of the pleura, the findings coincided in 99 (89%) of 111 cases. The findings of emergency examinations coincided in 138 (75%) of 185 cases, with 47 (25%) findings exclusively detected with the HDI 5000 system. In emergencies without intestinal involvement, the findings coincided in 105 (89%) of 118 cases. Conclusion: As expected, the high-end unit is markedly superior to the portable sonographic unit, especially for clinical questions requiring a high physical resolution, as needed for gastrointestinal structures, biliary system and pancreas. The portable unit provided its best results for examinations of the pleura and for emergency examinations as long as the gastrointestinal tract is excluded. For the routine use of portable sonographic units, it is important to know the limitation of the particular unit.