Journal of Clinical Ultrasound最新文献

Background: To report the implementation across Fetal Medicine units and the agreement between first and second trimester referral scans in the identification of fetal anomalies in cases referred for the expert assessment of the fetal anatomy in the first trimester following the publication of the national guidelines in Italy.

Methods: This multicenter, retrospective study aimed to evaluate the implementation and diagnostic performance of first-trimester referral ultrasound (US) in identifying fetal anomalies, following the introduction of national guidelines in Italy. The analysis included singleton pregnancies referred to nine specialized Fetal Medicine centers between 11⁺⁰ and 13⁺⁶ weeks' gestation due to increased risk for structural anomalies. Risk was defined as either a nuchal translucency (NT) measurement ≥ 3.5 mm or suspicion of a structural anomaly at initial screening. Only cases undergoing referral US within the specified gestational window were included. Diagnostic accuracy was assessed by comparing findings from first-trimester referral US with those from follow-up referral US performed either at 14-16 weeks or at 19-21 weeks.

Results: Out of 344 referred cases, 322 (93.6%) underwent first-trimester referral US within the appropriate timeframe. After excluding miscarriages and terminations, 136 cases were evaluated again at 19-21 weeks and 207 at 14-16 weeks. The agreement between the 11⁺⁰-13⁺⁶ week and 19-21 week scans was 85.3%, with a sensitivity of 82.0%, specificity of 88.0%, positive predictive value (PPV) of 84.7%, and negative predictive value (NPV) of 85.7%. Agreement between the early and 14-16 week scans was 91.3%, with sensitivity, specificity, PPV, and NPV of 90.7%, 92.1%, 93.9%, and 88.2%, respectively.

Conclusion: The study demonstrates successful implementation of national first-trimester referral US guidelines in Italy. When performed by experienced operators using a standardized protocol, first-trimester anatomy assessment is feasible and provides high diagnostic accuracy, enabling early detection of structural fetal anomalies.

The frozen elephant trunk procedure represents a major advance in treating complex thoracic aortic pathologies involving the arch and proximal descending aorta by enabling single-stage hybrid repair. Among available devices, the E-vita Open Plus prosthesis has emerged as a leading solution due to its advanced design features, enhancing procedural safety, technical precision, and long-term outcomes. Essential to the procedure is multidetector computed tomography angiography (CTA), which serves as the gold standard imaging modality for preoperative planning, postoperative assessment, and long-term surveillance. The E-vita Open Plus prosthesis, when paired with advanced perfusion strategies such as early distal aortic perfusion and selective antegrade cerebral perfusion, has demonstrated reduced neurologic complications and enhanced durability. This review explores the integral role of CTA in guiding all phases of the FET procedure using the E-vita Open Plus. Preoperatively, CTA provides high-resolution anatomical detail for prosthesis sizing, identifying dissection planes, and assessing involvement of supra-aortic branches. Postoperatively, it enables accurate evaluation of graft position, patency, and complications such as endoleaks, distal stent-induced new entry tears, graft kinking, or malposition. Serial CTA surveillance also provides essential insights into aortic remodeling, particularly in evaluating true lumen expansion and false lumen thrombosis-key predictors of favorable long-term outcomes. Clinical outcomes from high-volume centers report encouraging survival and reintervention-free rates. This review synthesizes the evolving evidence and underscores CTA's important role in optimizing patient selection, procedural planning, and outcome evaluation in contemporary FET surgery.

Introduction: Prenatal assessment of facial morphology offers valuable insights into craniofacial malformations and aneuploidies, characterized by distinct craniofacial features. This study aimed to evaluate the correlation between twelve facial measurements across the three levels of the face and the predictive value of cranial biometric parameters such as biparietal diameter (BPD) and head circumference (HC).

Methods: Data were extracted from obstetrical records and included twelve facial measurements across upper, middle, and lower facial levels, as well as biometric parameters such as BPD and HC. Correlation analyses between each measurement and BPD/HC and multiple linear regression models were constructed to evaluate the predictive value of BPD and HC.

Results: Correlation analyses revealed weak but significant associations (r < 0.25) between most facial variables and both BPD and HC, with BPD showing stronger and more consistent relationships. In regression models, BPD emerged as a significant predictor of facial dimensions in the upper and middle levels (p < 0.001), while HC showed fewer significant associations.

Conclusions: HC appears to be a stronger predictor of these differences in facial dimensions than BPD. Further validation in larger, prospective cohorts is recommended to confirm these associations and enhance clinical applicability.

Purpose: Evaluation of intra- and inter-observer variability of middle cerebral artery (MCA) pulsatility index (PI) in pregnancies complicated by fetal growth restriction (FGR) compared to normally grown controls and literature review.

Methods: Prospective observational cross-sectional study. Singleton pregnancies between 26 and 40 weeks were included and divided into two groups based on fetal growth: fetal growth restricted and normally grown fetuses. Fetal growth restricted fetuses were divided into early and late FGR. Intra-and inter-observer variability were assessed by Intraclass Correlation Coefficient (ICC) and interpreted following the TRUST criteria and GRRAS guidelines.

Results: One hundred and fifty patients were included in the study. Forty-eight cases were complicated by FGR: 27 early-onset and 21 late-onset. 13/48 (27%) showed middle cerebral artery redistribution. Intra and interobserver reproducibility were "poor" in the appropriate for gestational age (AGA) fetuses. In the FGR group, the intraobserver reproducibility was "moderate" and interobserver reproducibility was "moderate/poor". Intraobserver reproducibility was "good" in early FGR and "moderate" in late FGR cases, while interobserver reproducibility was "moderate" in early FGR and "poor" in late FGR cases.

Conclusion: MCA PI Doppler repeatability is superior in FGR fetuses compared to AGA fetuses. MCA pulsatility index can be used with confidence in FGR, especially if early onset.

Objectives: To explore the contrast-enhanced ultrasound (CEUS) characteristics of hepatic perivascular epithelioid cell tumors (PEComas).

Methods: A retrospective analysis was conducted on eight patients with pathologically confirmed hepatic PEComas at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between November 2019 and October 2024. The CEUS characteristics of hepatic PEComas were summarized, and the correlation between pathological components and ultrasonographic manifestations was analyzed. A literature review was performed using PubMed to identify studies reporting CEUS features of hepatic PEComas.

Results: The study cohort comprised six females and two males, with a mean age of 48.12 ± 16.47 years. On conventional ultrasound (CUS), lesions were either hyperechoic (4/8) or hypoechoic (4/8), with hyperechoic lesions exhibiting a higher mean fat content (27.5% vs. 15%). Lesions with peripheral annular flow demonstrated a slightly higher mean vascular density compared to those without (14.2% vs. 10%). All lesions (8/8) exhibited marked hyper-enhancement in the hepatic arterial phase (HAP), with a mean time-to-enhancement of 12.25 ± 4.06 s and a mean time-to-peak of 20.88 ± 3.91 s. In the portal venous phase (PVP), lesions showed iso-enhancement (6/8) or hypo-enhancement (2/8), while in the delayed phase (DP), they displayed iso-enhancement (5/8) or hypo-enhancement (3/8), consistent with a "fast-in and slow-out" (FISO) enhancement pattern. The literature review identified 10 studies (comprising 20 lesions) published between 2006 and March 2025, which described CEUS characteristics of hepatic PEComas that were consistent with those observed in our cohort.

Conclusions: Hepatic PEComa is a rare liver tumor often detected incidentally. It typically demonstrates marked homogeneous hyper-enhancement during the HAP, followed by a "FISO" enhancement pattern. Preoperative diagnosis and differentiation between benign and malignant forms of hepatic PEComa remain challenging using CUS. CEUS provides additional diagnostic characteristics for hepatic PEComas and holds value in the differential diagnosis of focal liver lesions.

Background: Portal hypertension (PH) is a major complication of chronic liver disease (CLD) and often leads to life-threatening gastrointestinal bleeding. Splenic stiffness measurement (SSM) has recently emerged as a non-invasive marker for assessment of PH. However, baseline values of splenic stiffness in a healthy population remain relatively unexplored.

Objective: To determine the splenic stiffness in a cohort of the healthy population from North India and to establish reference values for future clinical applications.

Methods: This descriptive study was conducted in the Department of Radio-diagnosis in a tertiary care institute in North India. Patients with known chronic liver disease, splenomegaly, focal lesions in the liver or spleen, congestive heart failure, chronic kidney disease, or portal vein thrombosis, pregnant women, and pediatric patients (< 18 years of age) were excluded. Splenic stiffness was assessed using 2-D shear wave elastography (SWE). A total of 10 elastography readings were taken per patient, and the mean value was recorded.

Results: The study population comprised 52 males and 48 females with a M:F ratio of 1.08. In our study, mean splenic stiffness was 13.44 kPa (±1.96 SD) with a median of 13.5 kPa. The majority of participants had SSM between 10 and 16 kPa (91%). A significant difference was observed in mean SSM between men and women in our study.

Conclusions: This study provides splenic stiffness values in a cohort of healthy population in North India and can serve as a reference for non-invasive assessment of PH. Future studies should be performed focusing on multicenter trials with inter-observer variability assessment and comparison across different ultrasound equipment and ethnicities.

Bullous pilomatricoma (BP), a rare variant of pilomatricoma, accounts for approximately 2% of pilomatricoma cases. We present the case of a 19-year-old male with a painless, blister-like lesion on the left upper arm, diagnosed as BP based on histopathological examination. This report emphasizes the multimodal ultrasound features of BP, incorporating grayscale ultrasound, color Doppler flow imaging (CDFI), and shear wave elastography (SWE). Notably, to our knowledge, this is the first case to detail the SWE characteristics of BP, demonstrating a mean stiffness value of 52.0 kPa. Our findings indicate that BP can exhibit deceptively high stiffness on elastography, unlike other benign skin masses that appear less stiff, highlighting the importance of integrating multiple sonographic techniques for accurate preoperative assessment of skin tumors.

Image denoising is a crucial pre-processing technique in retinal optical coherence tomography image compression, but existing methods struggle with signal-dependent noise and do not consider hybridized low-contrast residual noise (HLRN), failing to gather information from images. Thus, the novel Smooth Gyrated Texel Quadrivium Network (SGTQN) is proposed to reduce noise and collect self-sufficient information. In the SGTQN, the novel Additive Ascombe Smooth Sifter converts Poisson noise into Gaussian noise using the Ascombe Transform and removes unwanted Gaussian noise and the HLRN by hybridized noise removal, thus effectively gathering useful information from the image. After denoising, existing segmentation methodologies neglect the retinal nerve deviation value, creating a poor self-explanatory image. Thus, a novel Improvised Gyrated Alexa Net incorporates the Standardized Gyrated Layer, which considers the deviation values, thus generating a self-explanatory segmented image. Furthermore, many existing compression methods failed to achieve a higher quality image due to their non-uniform compression. The Texel Quadrivium Convolutional Network modifies the pooling layer into a Texel Quadrivium Layer to perform uniform compression and uses adjuvant vector coordinates to generate a high-resolution compressed image. This proposed model provides high-quality image compression with reduced noise, with a high accuracy of 95% and a lower mean square error of 0.02.

Background: This study aimed to analyze the correlations between echocardiographic parameters of left and right ventricular systolic function-including myocardial work indices-and invasively measured stroke work index (SWI) in patients with advanced heart failure being evaluated for heart transplantation.

Methods: Twenty-seven consecutive patients with advanced heart failure who were admitted to a tertiary heart hospital for left and right heart catheterization were included. Echocardiographic evaluations were performed on the same day, prior to catheterization. For the left ventricle (LV), the correlations of LV ejection fraction (LVEF) by Biplane Simpson method, LV global longitudinal strain (LV-GLS), LV global constructive work (LV-GCW), LV global work index (LV-GWI), LV global wasted work (LV-GWW), and LV global work efficiency (LV-GWE) with LV-SWI were assessed. For the right ventricle (RV), correlations of tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV-GCW, RV-GWI, RV-GWE, and RV-GWW with RV-SWI were analyzed. Correlations were evaluated using Spearman's correlation coefficient.

Results: LVEF and LV-GLS were significantly correlated with LV-SWI (r: 0.63, p < 0.001; r: -0.61, p < 0.001, respectively). Among all parameters, LV-GCW demonstrated the strongest correlation with LV-SWI, followed by LV-GWI (r: 0.71, p < 0.001; r: 0.69, p < 0.001, respectively). For the RV, RV-GWI and TAPSE showed moderate correlations with RV-SWI (r: 0.43, p: 0.02; r: 0.42, p: 0.02, respectively). Other RV parameters did not demonstrate significant correlations with RV-SWI.

Conclusion: Among LV and RV systolic function parameters, myocardial work indices provide a more accurate estimation of ventricular systolic function than standard echocardiographic measures in patients with advanced heart failure.

Splenic angiosarcoma is an extremely rare and highly aggressive malignant vascular tumor with nonspecific clinical manifestations and variable imaging appearances. We report a case of a middle-aged male presenting with progressive upper abdominal discomfort and a large splenic mass accompanied by cardiophrenic lymphadenopathy and peritoneal involvement. Ultrasound, contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated aggressive imaging features highly suggestive of malignancy. Ultrasound-guided biopsies of both the splenic lesion and cardiophrenic lymph nodes revealed malignant vascular proliferation with spindle and epithelioid morphology, a high Ki-67 proliferation index, and diffuse endothelial marker positivity, confirming the diagnosis of splenic angiosarcoma. This case highlights the diagnostic value of CEUS combined with multimodal imaging in the early recognition and accurate diagnosis of malignant splenic vascular tumors.