Journal of Clinical Ultrasound最新文献

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is the classic phenotype of arrhythmogenic cardiomyopathy. ARVC in twins have been reported rarely. Herein, we report an unusual case of young monozygotic twins with early disease onset presenting different course of disease progression and clinical manifestations. Echocardiography with multiparameters was used for the diagnosis, screening, and follow-up of the disease for the family. Cardiac magnetic resonance revealed the fibrosis distribution in the right ventricular with late gadolinium enhancement. DSG2 mutation was found in the family members, which confirmed the final diagnosis of ARVC.

Background: Ultrasound lung surface motion measurement is valuable for the evaluation of a variety of diseases. Speckle tracking or Doppler-based techniques are limited by the loss of visualization as a tracked point moves under ribs or is dependent.

Methods: We developed a synthetic lateral phase-based algorithm for tracking lung motion to overcome these limitations. To validate the technique, we generated simulated lung motion images. We also obtained lung ultrasound cines from a healthy volunteer and a mechanically ventilated COVID-19 patient. In the healthy volunteer, the respiratory pattern varied between breath-hold, regular, and rapid shallow breathing.

Results: The measured displacement was within 3% of the ground truth for simulated cines. In both the healthy volunteer and COVID-19 patients, measured displacement was greatest in the lower and lateral zones of the lung when the ipsilateral side was compared. In the healthy volunteer, when the respiratory pattern was varied, measured displacement was greater in regular breathing compared to rapid shallow breathing and compared to breath-hold patterns in both the upper and lower lung zones.

Conclusion: Estimation of lung surface displacement using a synthetic lateral phase-based approach is feasible. Future human studies should validate this approach against a direct measurement of lung surface movement.

Cancer in pregnancy has an incidence of approximately 1:1000, and cases of sarcoma in pregnancy are rare, with only a few described in the literature. This case report describes a 32-year-old pregnant woman who noticed an approximately 3.0 cm nodule on her left flank in the second trimester of pregnancy. Initially, it was diagnosed as a lipoma. The lesion grew progressively and after 5 months, at 25 weeks' gestation, the lesion became painful, bulky, with areas of necrosis and infection, and emitted a foul odor. Magnetic resonance imaging described the lesion as a heterogeneous mass measuring 12.0 × 10.0 × 9.6 cm on the left posterolateral abdominal wall, involving subcutaneous tissue and abdominal muscles. Oncologic treatment with neoadjuvant chemotherapy was initiated, and 1 month later, at 29 weeks, obstetric ultrasound revealed fetal growth restriction (FGR). During one of the fetal vitality assessments, oligohydramnios and umbilical artery Doppler with reverse diastolic flow were observed, leading to an emergency cesarean section at 31 weeks. The newborn died 4 days after delivery. Chemotherapy continued, and after the third cycle, the lesion was completely excised. Anatomopathologic examination and immunohistochemistry were consistent with embryonal rhabdomyosarcoma. The patient was referred for adjuvant radiotherapy to supplement treatment. This case report discusses aspects related to the frequency of sarcoma in pregnancy, diagnostic difficulties, the frequency of fetal vitality assessments, and possible therapeutic approaches during pregnancy.

Objective: To explore the effectiveness of contrast-enhanced ultrasound (CEUS) and high-frequency ultrasound (HFUS) in evaluating the efficacy of wrist intervention for rheumatoid arthritis (RA) patients.

Methods: This prospective study enrolled rheumatoid arthritis (RA) patients experiencing wrist swelling and pain at the Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, over the period from October 2021 to June 2024. All patients were given 1 mL of compound betamethasone injection under ultrasound guidance, and the characteristics of wrist synovium CEUS and HFUS before and after treatment were compared.

Results: A total of 49 patients (37 females, 53.45 ± 14.9 years) were enrolled. Peak intensity (PI) was highly correlated with the 28-joint disease activity score (r = 0.798, p < 0.01). The display rate of CEUS for synovium of wrist joints was 100% 2 weeks after treatment, while the display rate of PDUS for synovial blood flow was reduced to 65.31% (p < 0.05). Receiver operating characteristic curve analysis revealed that the CEUS had an area under the curve (AUC) of 0.792 (95% CI: 0.666-0.918, p < 0.001) in predicting the therapeutic effect, with sensitivity and specificity of 52.2% and 96.2%, respectively. Moreover, HFUS had an AUC of 0.722 (95% CI: 0.577-0.867, p = 0.008) in predicting the therapeutic effect, with sensitivity and specificity of 56.5% and 84.6%, respectively.

Conclusion: CEUS and HFUS might be supplemental strategies in evaluating the therapeutic effect for RA patients.

Fibromuscular dysplasia (FMD) is a rare, non-atherosclerotic vascular disease affecting medium to large arteries, especially the renal and internal carotid arteries (ICAs). The string-of-beads appearance, indicative of alternating areas of stenosis and dilatation, is a key imaging feature typically observed in the distal ICAs. Diagnosing FMD in critically ill patients poses challenges due to the risks associated with traditional imaging methods such as computed tomography angiography (CTA), magnetic resonance angiography, and digital subtraction angiography. We report a case of a 74-year-old woman diagnosed with stroke who required mechanical ventilation in the intensive care unit. Initial Doppler ultrasound revealed a fibrolipid plaque at the left internal carotid artery but could not assess the distal ICAs. Using a transoral approach with an endocavitary transducer, we visualized the distal ICAs, revealing the classic string-of-beads pattern and elevated peak systolic velocities indicative of stenosis. CTA confirmed these findings. The transoral ultrasound approach offers a non-invasive, bedside alternative for assessing the distal portions of the ICAs, making it particularly beneficial in critically ill patients. This case underscores the potential of this technique for timely diagnosis of FMD, warranting further research into its broader applicability in routine evaluations of suspected cases.

We report the case of a 28-year-old female patient (gravida 2, para 1) who underwent a cesarean section after 33 weeks of pregnancy due to severe preeclampsia. The placenta was deeply embedded in the myometrium. Localized myometrial ischemia occurred following repair and suturing of the myometrium at the placental attachment site.

Purpose: The purpose of this study is to propose new ultrasound scores to assess inflammatory bowel disease (IBD) activity and to analyze their accuracy in assessing disease severity. In addition to this, to validate that intestinal ultrasound can be used as a follow-up tool for the assessment of IBD.

Methods: One hundred and thirty-six adult IBD patients who underwent intestinal ultrasound. Patients were divided into two groups based on colonoscopic findings: 93 patients with UC, 43 patients with CD. UC patients and CD patients were divided into active and inactive groups based on colonoscopic findings, respectively. After forming scores, cut-off values, sensitivity, and specificity were calculated using receiver operating characteristic (ROC) analysis, respectively.

Results: Both in UC patients and in CD patients, bowel wall thickness (BWT) and vascular index (VI) were much higher in the active group compared with the inactive group, CEUS mode III, IV, CDFI grades 3-4, fat wrapping, and lost stratification were more likely to imply active disease. In UC patients only, Young's modulus value was much higher in the active group compared with the inactive group.

Conclusion: The new intestinal ultrasound scores can be used to assess UC and CD activity and may be useful in identifying severe endoscopic activity in IBD.

Background: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels to evaluate the efficacy of colorectal cancer liver metastasis (CRCLM) treatment is still rare.

Purpose: To investigate the predictive value of DCE-MRI combined with serum CEA and CA 19-9 concerning the efficacy of comprehensive treatment for CRCLM.

Materials and methods: A total of 120 patients with CRC were retrospectively recruited using convenience sampling between May 2019 and March 2024. After treatment, they were divided into two groups according to the treatment efficacy: responders (86 cases) and non-responders (34 cases), and their clinical data were collected for comparison.

Results: Before treatment, there were statistically significant differences between the groups in terms of the proportion of positive CEA (χ² = 17.364, p < 0.001), the proportion of positive CA 19-9 (χ² = 23.639, p < 0.001), the rate constant of a contrast agent from the vascular to the interstitial compartment (K_trans) (χ² = 2.341, p = 0.023), and the rate constant between the extravascular extracellular space (EES) (K_ep) (χ² = 2.556, p = 0.011). The values of K_trans, K_ep, CEA, and CA 19-9 reflected a certain degree of predictive value for the efficacy of comprehensive treatment in patients with CRCLM (p < 0.05). The combination of the four measurements is better than any single value, with an area under the curve of 0.898 (95% CI: 0.833, 0.922).

Conclusion: Dynamic contrast-enhanced magnetic resonance imaging, CEA, and CA 19-9 have predictive value for the early efficacy of comprehensive treatment for CRCLM.

Objective: This study was aimed to assess the predictive validity of internal os distance (IOD) in mid-trimester scan for the prediction of third-trimester low-positioned placenta, and to define a cut-off of IOD at which third-trimester low-positioned placenta could be identified, see the association of placental site (anterior/posterior), previous history of cesarean section with abnormal location of placenta in third trimester and see the maternal and neonatal outcomes.

Methods: It was a prospective cohort study of women with low-positioned placenta (IOD < 20 mm) at mid-trimester anomaly scan followed up in third trimester till birth. Relative risks for a low-positioned placenta in the third-trimester were calculated for women with posterior versus anterior, low-lying placenta versus placenta previa and positive versus negative history of cesarean section. Multilevel likelihood ratios and corresponding ROC curves for different ranges of IOD were calculated.

Results: Women with posterior placenta had a high risk of low positioned placenta compared to anterior placenta (9.28% vs. 0.74%); RR 1.45, similarly women with placenta previa had high risk compared to low lying placenta (68.57% vs. 1.69%); RR 6.51, so did the women with previous cesarean section (9.41% vs. 5.87%); RR 1.47.

Conclusions: 93.42% placenta which were low positioned in mid trimester were normally situated in third trimester. The cut-off for IOD in anterior placenta was -40 mm and in posterior placenta was 14.3 mm. IOD measurement and interpretation seems promising.