Journal of Clinical Ultrasound最新文献

Introduction: Right diaphragmatic excursion is a reliable and reproducible technique used in intensive care to assess diaphragmatic function. The aim of this study was to investigate the relationship between the appearance of diaphragmatic motion and the etiological diagnosis of patients admitted to the emergency department with acute respiratory failure (ARF).

Materials: A prospective, observational, and multicenter pilot study was conducted. All adult patients admitted in the emergency department with ARF were included. The different visual patterns of diaphragmatic motion were analyzed according to the three main etiologies of ARF encountered in emergency departments.

Results: A total of 39 adult patients were included. We observed a different visual pattern in patients with pneumonia. A sum of plateau times of less than 0.2 s predicted that the main diagnosis was pneumonia, with sensitivity = 89% 95%CI [52%; 100%], specificity = 87% 95%CI [69%; 96%].

Conclusion: Our study seems to show that the shape of diaphragmatic motion in patients with ARF secondary to pneumonia is different from that in patients with exacerbation of chronic obstructive pulmonary disease or acute heart failure.

Trial registration: ClinicalTrials.gov: NCT04591509.

Fetal liver calcifications (FLCs) are isolated or multiple areas of increased echogenicity in the fetal liver, with an estimated prevalence of 5-10 per 10 000 births. However, their clinical importance remains still unclear. Although they are often linked to infections, chromosomal disorders, thrombotic events, or tumors, isolated FLCs generally have a favorable outcome. This article aims to present a case of a 29-year-old pregnant woman with a low-risk cfDNA test, who presented for the first trimester screening scan at our hospital at 12 weeks of pregnancy. The morphology scan at 20 weeks and 5 days revealed a normal fetal size with areas of increased echogenicity in the liver. No other fetal issues were identified. The patient was monitored throughout her pregnancy at our center, receiving genetic counseling and tests for detecting cystic fibrosis, STORCH (syphilis, cytomegalovirus, herpes virus 1;2, rubella, and toxoplasma), fetal echocardiography, and MRI, all of which were normal. At 35 weeks and 6 days, the patient gave birth to a healthy male, and all subsequent postnatal examinations confirmed the baby's health. This article aims to offer comprehensive insights into the management and postnatal outcomes of isolated FLCs, based on a review of the literature.

Klippel-Trénaunay-Weber syndrome (KTW) is a rare congenital disease, representing a challenge in prenatal diagnosis due to overlapping characteristics with other syndromes and no specific genetic markers known to date. We have collected all the cases present in the literature on the prenatal diagnosis of KTW, emphasizing common ultrasound findings that can guide the clinician and genetics to the prenatal counseling. Thus, we collected all the information about the postnatal prognosis and the necessity for treatment. Our review of 44 cases highlights the typical common features: hemihypertrophy, predominantly affecting the right leg, with cystic lesions extending to the trunk or upper limbs and rare internal organ involvement. Prenatal complications, including hydrops and polyhydramnios, emphasize the need for a careful ultrasound follow-up. Despite no identified genetic mutation, genetic counseling and invasive testing are recommended. Mortality rate due to a severe complication known as Kasabach-Merritt syndrome, underlines the importance of early diagnosis and accurate management strategies. Prenatal diagnosis of KTW, guided by ultrasound findings and genetic counseling, could help with informed decision-making and optimal care planning.

The use of artificial intelligence (AI) platforms is revolutionizing the performance in managing metadata and big data. Medicine is another field where AI is spreading. However, this technological advancement is not amenable to errors or fraudulent misconducts. International organization and recently the European Union have released principles and recommendations for an appropriate use of AI in healthcare. In prenatal ultrasound diagnosis, the use of AI in daily practice is having a revolutionary impact. Notwithstanding, the diagnostic enhancement should be regulated, and AI applications should be developed to guarantee correct imaging acquisition and further postprocessing.

Purpose: Non-invasive tests are increasingly demanded for diagnosing and prognostication of chronic kidney disease (CKD). Shear-wave elastography (SWE), an emerging technique for measuring tissue stiffness, shows promise for distinguishing between individuals with different stages of renal fibrosis. This study aimed to compare the diagnostic accuracy of two-dimensional SWE (2D-SWE) and conventional ultrasound for detecting CKD, employing renal biopsy as the gold standard.

Methods: From May 2020 to October 2023, this prospective study included 30 healthy volunteers and 169 patients with CKD who had undergone 2D-SWE and conventional ultrasound of both kidneys. Cortical and medullary stiffness, cortical pixel intensity, renal length, parenchymal and cortical thickness, interlobar artery peak systolic velocity, end-diastolic velocity (EDV), and resistive index were measured. The diagnostic accuracy of 2D-SWE and conventional ultrasound was compared using the receiver operating characteristic curve (ROC) and Delong test.

Results: For diagnosing CKD, the area under the ROC (AUC) of cortical stiffness (0.96 [95% CI, 0.93, 0.99]) was significantly higher than that of all conventional ultrasound parameters, including EDV (0.78 [95% CI, 0.71, 0.86]) and cortical thickness (0.74 [95% CI, 0.67, 0.80]). The sensitivity of cortical stiffness (91%) was significantly higher than that of EDV (68%) and cortical thickness (53%). No significant difference was found in the specificity of cortical stiffness (96%) compared to that of EDV (79%) and cortical thickness (100%).

Conclusion: Two-dimensional SWE showed higher diagnostic accuracy than that of conventional ultrasound for detecting CKD.

This meta-analysis examined the diagnostic accuracy of Sonazoid-enhanced ultrasonography (SZ-CEUS) in discriminating malignant from benign focal liver lesions (FLLs) and HCC from non-HCC FLLs. Finding relevant studies required a rigorous PubMed, EMBASE, and other database search. To distinguish malignant from benign FLLs, SZ-CEUS had a pooled sensitivity of 94% (95% CI: 0.91-0.95) and specificity of 84% (95%: 0.78-0.89). HCC distinction had 83% sensitivity and 96% specificity (95% CI: 0.80-0.85 and 0.95-0.97). SZ-CEUS accurately distinguishes malignant from benign FLLs and HCC from non-HCC lesions, especially smaller HCC lesions.

This meta-analysis evaluated the effects of ultrasound-guided (USG) and landmark-guided (LMG) injections of corticosteroids into the shoulder joint cavity of patients with shoulder pain. The PubMed database was searched for articles (January 1, 2004-December 31, 2023) comparing USG and LMG injections of corticosteroids for the treatment of adult shoulder pain. Two authors independently performed data extraction and appraisal. The outcome measures collected were visual analogue scale (VAS) score and VAS score change at 1 and 6 weeks postinjection and range of motion (ROM) at 6 weeks postinjection. Thirteen studies including 656 patients were reviewed (USG and LMG groups, 328 patients each). The VAS score at 1 week postinjection and the ROM in abduction at 6 weeks postinjection were statistically different, but there were no statistically significant differences in other outcomes. This meta-analysis indicated that USG corticosteroid injection may have a better effect than LMG corticosteroid injection for early-stage shoulder pain and abduction in the mid- to long-term, but does not affect later shoulder pain or other ROMs.

Purpose: This study aims to investigate the interobserver variability in the quantitative assessment of liver fat content using ultrasound attenuation imaging technology (USAT).

Methods: This prospective, single-center study included 96 adult patients who were either diagnosed with or suspected of having metabolic dysfunction-associated steatotic liver disease. Independent observers, blinded to each other's assessments, evaluated hepatic steatosis visually and through USAT measurements. Separate measurements were taken at five intercostal and subcostal sites, and the median values of these measurements were recorded. The correlation between USAT measurements and visual steatosis grades was examined using Spearman's correlation test. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate the interobserver variability of USAT measurements.

Results: Interobserver agreement for USAT measurements was excellent for the intercostal examination and good for the subcostal examination (p < 0.001). Body mass index did not significantly affect the level of interobserver agreement. Interobserver variability in Bland-Altman plots of USAT measurements was within the 95% limits of agreement. USAT measurements correlated very strongly with the visual degree of hepatic steatosis, both intercostal and subcostal (p < 0.001). USAT measurements were also significantly different between different visual degrees of hepatic steatosis (p < 0.001).

Conclusion: In the assessment of hepatic steatosis, USAT measurements obtained from the intercostal space showed excellent agreement in terms of interobserver reproducibility.

Cystic neutrophilic granulomatous mastitis (CNGM) is a rare inflammatory breast disease, with a distinct histological pattern characterized. Although it shares clinical and radiological features with other types of granulomatous mastitis, it can sometimes be difficult to distinguish from breast cancer. We report a case of CNGM misdiagnosed as malignant.