Journal of Clinical Ultrasound最新文献

Objective: To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant endometrial diseases by analyzing the early arterial vascular architecture on CEUS images.

Methods: A prospective study was conducted at the Sichuan Integrative Medicine Hospital to enroll 70 suspected endometrial lesion patients with a mean age of 42.5 ± 8.2 years (range 27-69 years). The patients underwent conventional ultrasound and CEUS examinations, and pathological examinations were obtained through surgery or curettage. They were divided into the benign group and malignant group according to their pathological types. The CEUS image features were analyzed, and the sensitivity, specificity, positive predictive value, and other parameters were compared between the two groups by carefully observing the early enhancement images and comparing the differences in the vascular architecture, including the shape of the vessels, the number of vessels, and the vessel diameter.

Results: There were significant differences in vascular shape, number, and diameter between the two groups. The difference in vascular morphology was highly statistically significant (p < 0.001). The "vascular supply" was used for the diagnosis of malignant diseases of the endometrium with a high sensitivity of 95.8%, specificity of 77.5%, positive predictive value of 71.8%, and accuracy of 84.4%. When the maximum inner diameter exceeded 1.5 mm, the sensitivity and specificity for the diagnosis of malignant lesions were 95.8% and 82.5%, respectively, with a positive predictive value of 76.6% and an accuracy of 87.5%. When the average inner diameter exceeded 1.22 mm, the sensitivity for the diagnosis of malignant endometrial lesions was 87.5%, the specificity was 80%, and the accuracy was 82.8%.

Conclusions: The utilization of CEUS vascular architecture holds significant clinical value in the diagnosis of both benign and malignant endometrial diseases, thereby warranting further comprehensive investigation.

Background and aims: The rising prevalence of metabolic dysfunction-associated steatohepatitis (MASH) and the arrival of medical treatments have highlighted the need for accurate, accessible, and cost-effective methods for hepatic steatosis quantification. This study evaluates the performance of ultrasound-derived fat fraction (UDFF) for diagnosing and quantifying hepatic steatosis using MRI-derived proton density fat fraction (MRI-PDFF) and liver biopsy as reference standards. UDFF was also compared with the controlled attenuation parameter (CAP).

Materials and methods: A total of 114 patients with chronic liver disease were prospectively included. All patients underwent UDFF and MRI-PDFF; 78 patients also had liver biopsy. CAP measurements were available for 104 patients. The correlation of UDFF with MR-PDFF and the area under the receiver operating characteristic curve (AUC) of UDFF for steatosis were calculated and compared with CAP. Factors influencing UDFF measurements were evaluated through multivariate analysis.

Results: UDFF demonstrated a moderate to strong correlation with MRI-PDFF (r = 0.60 [0.46; 0.71], p < 0.001) and a moderate correlation with liver biopsy (η = 0.31). The AUCs for UDFF in diagnosing steatosis (≥ grade 1) were 0.79 (MRI-PDFF reference) and 0.82 (biopsy reference), outperforming CAP for moderate (grade 2) steatosis (p = 0.043). UDFF consistently overestimated steatosis by 5% compared to MRI-PDFF. Parietal thickness > 30 mm was the only factor influencing measurement accuracy. UDFF had no measurement failures, unlike CAP, highlighting its robustness.

Conclusion: Although the correlation between UDFF and MR-PDFF is moderate to strong, this prospective study does not provide results as good as those of the few previous studies evaluating the UDFF technique. These results highlight the importance of standardizing techniques and measurements in order to position US steatosis quantification tools in the management of patients with MASLD and MASH.

Retroperitoneal extra-adrenal paragangliomas are rare neuroendocrine tumors that frequently arise in a confined anatomical space bordered by the right side of the abdominal aorta, the left side of the inferior vena cava, and the posterior aspect of the horizontal part of the duodenum (hereafter referred to as the duodenum-adjacent aortocaval region). Although ultrasonography (US) is a noninvasive and useful modality for initial diagnosis, detailed imaging characteristics of such tumors have not been sufficiently reported. This report aimed to describe the anatomical location and ultrasonographic features of three cases of retroperitoneal extra-adrenal paraganglioma, with a focus on blood flow evaluation using superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS). We retrospectively analyzed B-mode US, SMI, CEUS, computed tomography (CT), magnetic resonance imaging (MRI), and ¹²³I-MIBG scintigraphy findings in all three cases. In every case, tumors were located in the duodenum-adjacent aortocaval region. US revealed well-defined, hypoechoic, oval-shaped masses with heterogeneous internal structures. SMI showed abundant intratumoral blood flow, while CEUS demonstrated contrast enhancement. SMI under contrast enhancement revealed blood flow that was not visible with conventional SMI. Our findings indicate that retroperitoneal extra-adrenal paragangliomas exhibit characteristic morphology and vascularity on US. The combined use of SMI and CEUS may further enhance diagnostic accuracy and contribute to US as an important noninvasive diagnostic tool. Moreover, when a mass is identified in the duodenum-adjacent aortocaval region, paraganglioma should be considered in the differential diagnosis.

Purpose: This study aimed to develop a preoperative logistic regression model to predict sentinel lymph nodes (SLN) metastasis risk in clinical T1 stage (cT1, diameter ≤ 2 cm) breast cancer patients using ultrasound (US) and contrast-enhanced ultrasound (CEUS) characteristics.

Methods: Consecutive patients with primary cT1 breast cancer from June 2018 to May 2024 who have undergone breast CEUS examination and subsequent breast surgeries with SLN biopsies were retrospectively enrolled. Histopathological results following surgical resection were considered the gold standard. The patients were randomly classified into training and validation sets in a 7:3 ratio for the development and validation of the logistic regression, respectively. Univariable analysis and multivariable logistic regression analysis were performed to identify independent indicators of SLN status. We developed Model_1 (solely based on conventional US characteristics) and Model_2 (integrating conventional US and CEUS characteristics) to predict SLN metastasis (present vs. absent) and further the number of metastatic SLN (≤ 2 vs. > 2). The additive prediction effect of CEUS characteristics was also discussed by comparing the predictive performance of Model_1 and Model_2.

Results: In the final analysis of 383 patients, multivariable analysis identified tumor size, hyperechoic halo, positive axillary nodes, perfusion defect, enhancement order, penetrating vessel, and crab claw-like enhancement as independent indicators of SLN status. In the validation set, for predicting SLN metastasis (present vs. absent), the AUCs of Model_1 and Model_2 were 0.70 and 0.80, respectively. For predicting SLN metastasis (≤ 2 vs. > 2), the AUCs of Model_1 and Model_2 were 0.75 and 0.88, respectively. Both models were well-calibrated, and the addition of CEUS features significantly improved the predictive performance of Model_2 compared to Model_1.

Conclusion: The Model_2, using US and CEUS characteristics from cT1 breast cancer patients, effectively predicts SLN metastasis and the number of metastatic SLNs. This model aids clinicians in assessing SLN metastasis risk and making informed decisions about axillary surgery.

Background: To summarize prenatal sonographic characteristics of imperforate anus, investigate contributing factors for diagnostic errors, and explore strategies to improve diagnostic precision for imperforate anus.

Methods: A retrospective analysis was conducted on 19 pregnant women with missed or misdiagnosed imperforate anus (involving 20 fetuses). Summarize the prenatal ultrasound characteristics of these missed and misdiagnosed cases, compare the results of prenatal ultrasound and postpartum diagnosis, analyze the main reasons and technical bottlenecks for missed and misdiagnosed cases, and explore strategies to improve the diagnostic accuracy of fetal imperforate anus.

Results: Among the 13 missed cases of imperforate anus, all (100%, 13/13) exhibited a pseudo "target sign" on the perineal transverse view during the missed diagnosis. None of these cases underwent detailed perineal sagittal and coronal scanning during the initial ultrasound. Among the seven misdiagnosed cases, three cases (42.86%, 3/7) showed an unclear "target sign" without sagittal and coronal planes evaluation. Two cases (28.57%, 2/7) displayed a pseudo "target sign," while the remaining two cases (28.57%, 2/7) showed a clear "target sign." In these seven cases, sagittal views in four cases revealed interrupted mucosal hyperechoic lines, later attributed to compression by fetal buttock fat (three cases) or a perianal mass (one case). Among the 13 fetuses with imperforate anus, there were a total of 10 cases of low type, two cases of high type, and one case of intermediate type.

Conclusion: Although prenatal diagnosis of imperforate anus is challenging, it is feasible. Standardized scanning and distinguishing between true and pseudo "target sign" are crucial. Additionally, multi-section continuous scanning of the anus is helpful to display the overall appearance of the anal canal and improve diagnostic accuracy.

Conjoined twins are an extremely uncommon type of pregnancy that carries high morbidity and mortality. Identical twins united in utero are known as conjoined twins. Incidence varies from 1 in 50 000 to 1 in 100 000 live births. The prognosis is determined by the vitality of the shared organs, the severity of associated congenital anomalies, and the location and extent of fusion of the shared organs. Due to the elevated level of risk associated with this situation, it is crucial to prioritize early diagnosis, management, and delivery. Conjoined twins can be classified into different types based on the location of anatomical fusion. One of the most prevalent types is thoracopagus. Thoraco-omphalopagus comprises 75% of the conjoined twins. We are presenting a case of prenatal detection of thoraco-omphalopagus conjoined twins using two-dimensional ultrasound at 14 weeks of pregnancy, followed by posttermination follow-up.

Myeloid sarcoma (MS) is a rare solid malignant tumor formed by the proliferation and infiltration of primitive granulocytes or immature myeloid cells in extramedullary tissues. MS is usually associated with acute myeloid leukemia. MS can occur in any part of the body, and this case involves multiple occurrences in the lower leg. There are currently few reports on the ultrasonic manifestations of MS. In this case, the initial ultrasound findings suggested a benign lesion, which was inconsistent with the patient's known history of AML. However, the decision to perform a biopsy led to the correct diagnosis of MS. This case highlights the deceptive ultrasound features of MS and underscores the critical importance of histological confirmation in cancer patients with any new mass, regardless of its benign imaging appearance.

Aim: To assess the utility of three-dimensional speckle-tracking echocardiography (3D-STE) in detecting coronary artery microcirculation dysfunction (CMCD) with non-obstructive coronary artery (INOCA) disease.

Materials and methods: Twenty-one patients diagnosed with INOCA were enrolled and underwent echocardiography and [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography ([¹⁸F]FDG PET/CT) myocardial metabolic imaging, which is used as the gold standard for diagnosing CMCD. Further, a total of 357 myocardial segments across these 21 participants were categorized into the control group and the CMCD group according to the results of [¹⁸F]FDG PET/CT. Subsequently, 2D regional systolic peak longitudinal strain (2D-RLS), 2D regional systolic peak circumferential strain (2D-RCS), regional systolic peak 3D main strain (R3D strain), longitudinal strain (3D-RLS), circumferential strain (3D-RCS), and radial strain (3D-RRS) of the left ventricle were assessed. At last, the receiver operating characteristic (ROC) curves of 3D-STE parameters were calculated to evaluate the diagnostic value of 3D-STE for CMCD.

Results: The absolute value of total R3D strain is decreased in the CMCD group (p < 0.05). In addition, R3D and 3D-RLS in the CMCD group exhibited a significant reduction in the basal, middle, and apical segments compared to the control group (p < 0.05). No difference was observed in 2D strain parameters between the CMCD group and the control group. Among all strain parameters, the R3D strain in the apical segments had the highest diagnostic efficacy, with an optimal cutoff of -41.5 (sensitivity, 88.4%; specificity, 80.5%).

Conclusion: Our findings indicate that the 3D-STE could serve as an advantageous diagnostic instrument for discriminating individuals with CMCD.

Objectives: To investigate which patient characteristics, ultrasound operator certification level, and thoracic ultrasound (TUS) examination findings are associated with a TUS-induced change in clinical management in adult intensive care unit (ICU) patients.

Design: Post hoc analysis of a prospective international observational study (UltraMan study) on the impact of thoracic ultrasound on clinical management of critically ill patients. The first TUS examinations of each patient included in the study were included in this analysis. Multivariable logistic regression was performed to identify which patient characteristic(s), operator certification level, or TUS-related factors were significantly associated with a change in management.

Interventions: None.

Measurements and main results: The first TUS examinations of each of the 534 patients were included in this analysis. TUS led to management changes in almost half of the patients in whom a TUS was performed (44.6%). TUS-induced management changes were significantly associated with patient characteristics. Specifically, a medical history of cardiovascular disease demonstrated a significant association (OR: 1.73; 95% CI: 1.12-2.68). In terms of TUS examination findings, hypovolemia demonstrated a significant association with a change in management (OR: 2.05; 95% CI: 1.10-3.80). No significant association was found between ultrasound operator certification level and changes in management driven by TUS.

Conclusions: This study indicates that TUS was associated with management changes in 44.6% of ICU patients, with stronger associations in those with cardiovascular disease and hypovolemia, and no detectable effect of operator certification in adjusted analyses. As a post hoc analysis of an observational cohort, these findings warrant cautious interpretation and underscore the importance of competency-based training and quality assurance.