Journal of Clinical Ultrasound最新文献

Objective: To investigate the correlation between two-dimensional speckle tracking echocardiography (2D-STE) measurements and the Gensini score in coronary artery disease (CAD) patients, to explore the relationship between left ventricular (LV) strain and the severity of CAD, and to determine the predictive value of LV strain for CAD severity.

Methods: A total of 128 CAD patients and 32 healthy controls were included. The severity of CAD was represented by the Gensini score on the basis of coronary artery angiography (CAG) findings. All the subjects underwent echocardiography for routine measurement of standard echocardiographic parameters and 2D-STE strain parameters. We further divided all patients into three groups according to the tertiles of the Gensini score: the mild group, with a Gensini score ≤ 16 (43 cases); the moderate group, with a Gensini score > 16 and ≤ 50 (41 cases); and the severe group, with a Gensini score > 50 points (44 cases).

Results: The analyses revealed that global longitudinal strain (GLS), global circumferential strain (GCS), twist and torsion decreased significantly. Correlation analyses revealed positive correlations between GLS and GCS and the Gensini score (r = 0.741 and 0.562, respectively; p < 0.05). Whereas twist and torsion were negatively correlated with the Gensini score (r = -0.570 and -0.565, respectively; p < 0.05). The multiple stepwise regression analysis revealed that GLS and twist were independently associated with the Gensini score (all p < 0.001). Receiver operating characteristic (ROC) curve analysis of GLS and twist for predicting moderate to severe CAD yielded areas of 0.914 and 0.823, respectively, whereas that for the combination of the two parameters was 0.934. The optimal cut-off value for GLS was -18.85%.

Conclusion: GLS and twist were independently correlated with the Gensini score. GLS showed greater discrimination, whereas the combination of GLS and twist yielded better performance in predicting CAD severity. Assessments of strain parameters appear to be feasible in the echocardiographic examination of CAD patients.

Ectopic pregnancies are implanted outside the normal location within the uterus; mostly (about 95%) within the fallopian tube but might also rarely be seen within abnormal locations in the uterus, in the ovaries, peritoneal cavity, or even retroperitoneally. These pregnancies are particularly challenging to diagnose. The outcome in most ectopic pregnancies is guarded unless an early diagnosis is made and dealt with by an experienced multidisciplinary team. The management of rare ectopic pregnancies is further complicated by difficulties in diagnosis, delay in diagnosis, and greater risk of bleeding. This paper describes the rare ectopic pregnancies that the authors have seen in their practice, the presentation, pitfalls in diagnosis, the clues that might lead to the correct diagnosis, and the outcomes in these cases are discussed. An algorithmic approach is presented that might improve the diagnostic accuracy.

Primary breast angiosarcoma (PBA) is an exceptionally rare and aggressive vascular malignancy, accounting for less than 0.04% of all breast cancers. It is characterized by rapid growth, high recurrence rates, and poor prognosis, often leading to diagnostic and therapeutic challenges. We report the case of a 41-year-old woman presenting with a rapidly enlarging left breast mass following trauma, initially misdiagnosed as granulomatous mastitis. Multimodal imaging, including ultrasound, contrast-enhanced ultrasound (CEUS), and magnetic resonance imaging (MRI), revealed features consistent with a vascular tumor, which was confirmed as PBA through histopathological and immunohistochemical analysis. The patient underwent a core needle biopsy followed by mastectomy. This case highlights the importance of advanced imaging techniques and histopathological evaluation in diagnosing PBA, as well as the need for early recognition and surgical intervention to improve outcomes. Further studies are required to establish standardized diagnostic and treatment protocols for this rare malignancy.

Accessory Cavitated Uterine Malformation (ACUM) can be misdiagnosed as other uterine pathologies, such as Müllerian anomalies, adenomyosis, or fibroids. In the present case series, we report on data of eleven cases of ACUM. The mean age at diagnosis was 24.5 years. Nine patients presented with abdominal pain, one patient complained of infertility, and one patient was asymptomatic. One patient had a bilateral lesion. The average maximum lesion size was 26 mm. Ultrasound characteristics of the twelve lesions showed cystic lesions located in the uterine cornual region, containing ground glass or anechoic content. Imaging, particularly gynecological ultrasound, plays a fundamental role in identifying this condition.

Objective: To evaluate the predictive value of ultrasound-assessed cervical volume for successful labor induction in late preterm and term pregnancies with an unfavorable cervix and to compare its performance with cervical length.

Methods: This prospective study included 350 singleton pregnancies at ≥ 34 weeks of gestation undergoing labor induction with an unfavorable cervix. Cervical length and cervical volume were measured by transvaginal ultrasound prior to induction, with cervical volume calculated using a cylindrical geometric model. Successful induction was defined as vaginal delivery within 24 h. Receiver operating characteristic curve analysis and multivariable logistic regression were performed to assess predictive performance and identify independent predictors after adjustment for maternal age, body mass index, parity, and gestational age.

Results: Labor induction was successful in 222 patients (63.4%). The successful induction group had significantly higher Bishop scores, shorter cervical lengths, and smaller cervical volumes (all p < 0.001). Cervical volume showed a positive correlation with cervical length and a negative correlation with Bishop score. Cervical length ≤ 33 mm (AUC = 0.836) and cervical volume ≤ 29.8 cm³ (AUC = 0.798) predicted induction success, with comparable predictive performance. Both cervical length (aOR = 0.78, 95% CI: 0.73-0.84) and cervical volume (aOR = 0.93, 95% CI: 0.90-0.97) were independent predictors of successful induction, while multiparity was a strong positive predictor. Similar findings were observed in term and late preterm subgroups.

Conclusion: Cervical volume is an independent predictor of labor induction success in late preterm and term pregnancies with an unfavorable cervix and demonstrates predictive performance comparable to cervical length.

This study provides preliminary reference values for thyroid volume and stiffness in asymptomatic infants. Thyroid volume increased with age, while stiffness remained stable until 180 days and increased thereafter. Shear wave elastography may serve as a valuable, non-invasive tool for early thyroid assessment and monitoring in infancy.

Pulmonary artery intimal sarcoma (PAIS) is a rare and highly aggressive malignancy. Due to nonspecific clinical symptoms, imaging features, and laboratory findings, PAIS is frequently misdiagnosed as pulmonary embolism (PE), leading to delayed diagnosis and poor prognosis. Multimodal imaging, including echocardiography, Positron Emission Tomography-Computed Tomography (PET/CT), and histopathology, is critical for accurate diagnosis. We present a case of PAIS with atypical manifestations, aiming to improve early clinical recognition and emphasize the role of a multimodal approach in early diagnosis for PAIS 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.

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.

Introduction: This study aimed to evaluate the diagnostic value of ultrasonography in distinguishing early acute gangrenous appendicitis (AGA) from uncomplicated acute appendicitis (UAA).

Methods: This retrospective observational study was conducted at a tertiary teaching hospital in Changsha Central Hospital, including 305 patients with AGA and 398 patients with UAA, confirmed through surgical and pathological examination. Univariate analyses of clinical and ultrasonographic data were followed by multivariate logistic regression modeling to identify significant risk factors for AGA.

Results: Univariate analysis revealed significant intergroup differences in sex, age, symptom duration, leukocyte count, neutrophil percentage, outer appendiceal diameter, peri-appendiceal mesentery thickness, appendicolith obstruction, intra-appendiceal fluid echogenicity, intra-appendiceal gas, appendiceal wall anomalies, and peri-appendiceal fluid. Multivariate analysis identified male sex (odds ratio [OR] = 1.788, p = 0.014), age ≥ 44 (OR = 2.174, p = 0.002), symptom duration ≥ 32 h (OR = 2.396, p < 0.001), neutrophils ≥ 84% (OR = 2.615, p < 0.001), peri-appendiceal mesentery thickness ≥ 7 mm (OR = 5.302, p < 0.001), intra-appendiceal fluid with poor ultrasound penetration (OR = 2.025, p = 0.004), appendicolith obstruction (OR = 2.030, p = 0.020), and appendiceal wall anomalies (OR = 16.772, p < 0.001).

Conclusion: Ultrasonographic findings like appendiceal wall anomalies, intra-appendiceal gas, and peri-appendiceal fluid offer high specificity for diagnosing early AGA, while peri-appendiceal mesentery thickness ≥ 7 mm demonstrates high sensitivity. Combining ultrasound with clinical evaluation facilitates AGA diagnosis and informed treatment decisions.