Journal of Clinical Ultrasound最新文献

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.

This case report presents an uncommon presentation of Crohn's disease (CD) complicated by an anal-Bartholin-perineal fistula. Notably, ultrasound was the initial imaging modality to demonstrate suspicious fistulous tract features in this case. Definitively, trans-fistula contrast-enhanced ultrasound (TF-CEUS) clearly visualized the fistula, providing real-time dynamic architectural details that were critical for diagnosis. TF-CEUS emerged as a valuable diagnostic adjunct in this case, offering novel insights into evaluating complex perianal fistulous disorders in CD, particularly when conventional imaging modalities like MRI yield inconclusive results.

Purpose: The time-averaged mean of the maximum velocity (TAMMV) in both intracranialinternal carotid artery (iICA) and extracranial (eICA) and hematological variables in sickle cell disease (SCD) patients was investigated.

Methods: Transcranial Doppler Imaging (TCDI) was performed with a 1-3 MHz phased-array and Linear 3.3-10 MHz transducers for both ICA. Patients were divided into three groups according to age and genotype. Blood parameters were determined using routine methods. ANOVA and linear regression analyses were done.

Results: There were 59 patients, 24 males and 35 females (26 with HbSS, 29 HbSβ⁰, and 4 with HbSD). The average age ± SD for all patients was 10.8 ± 3.2 years. The average ± SD TAMMV for iICA was 72.4 ± 11.3 and for eICA was 63.4 ± 25.8 cm/s. There were no significant differences among patients with different genotypes. The iICA and eICA TMMAV according to age (average ± SD) for all were 72.4 ± 11.3 for iICA and 63.4 ± 25.8 for eICA. Age, platelet count, neutrophil count, LDH, and bilirubin showed no significant correlation with TAMMV in the iICA; however, it was significant in the eICA (p < 0.05).

Conclusion: A significant correlation was found between age and markers of SCD severity and TAMMV in the eICA, but not with iICA. Therefore, the former might be a more important indicator of vasculopathy in our patients.

Objective: The aim of this study was to evaluate the diagnostic utility of elasticity with shear wave elastography (SWE) technique and microvascularization with super microvascular imaging (SMI) technique in renal parenchymal scar areas developing as a result of vesicoureteral reflux (VUR) and to compare the effectiveness of these two methods in detecting damage in the renal parenchyma with the results of dimercaptosuccinic acid (DMSA) scintigraphy.

Materials and methods: Between July 2022 and July 2023, 40 patients diagnosed with VUR by voiding cystourethrogram (VCUG) and 31 patients in the control group were included in this prospective, unicenter study. The vascularity characteristics of all kidneys and the parenchymal stiffness levels were examined respectively with superb microvascular imaging and SWE by two independent radiologists.

Results: A statistically significant difference was found between the mean SWE and SMI values of normal renal parenchyma and renal scar tissue (p < 0.05). The mean SWE and SMI values of kidneys with scar tissue were found to be statistically higher than those of kidneys with VUR but without scar tissue (p < 0.05). Also, a relationship was found between the duration of VUR exposure and the formation of scar tissue in the kidneys. The sensitivity and specificity values for predicting the presence of scar tissue in the kidneys were determined as 73.7% and 70.5% with the SMI method, and 89.5% and 67.2% with the SWE method, respectively.

Conclusion: SWE and SMI techniques can be considered as complementary alternative methods in the follow-up of pediatric patients with VUR in whom scar tissue is detected in the kidneys with DMSA, as they are inexpensive, radiation-free, and useful methods for the detection and evaluation of scar tissue.