Journal of Clinical Ultrasound最新文献

Primitive neuroectodermal tumors (PNETs) are rare and aggressive, typically occurring in bones and soft tissues. This report describes a 12-year-old Chinese girl with primary pulmonary PNET invading the left atrium. She presented with right chest pain, shortness of breath, and dry cough for two months. Contrast-enhanced CT and PET-CT revealed a lung mass involving the left atrium. Transthoracic echocardiography showed a heterogeneous mass extending into the left atrium via the right inferior pulmonary vein. Needle biopsy diagnosed primary pulmonary PNET. Combination chemotherapy, monitored by echocardiography, reduced the tumor size, followed by surgical resection. Five years post-diagnosis, there was no recurrence.

Purpose: This study aims to evaluate the effect of the number of needle movements within a thyroid nodule during fine-needle aspiration biopsy (FNAB) on cytopathological outcomes and the need for repeat biopsy.

Methods: A total of 115 nodules in 101 patients (86 females and 15 males; mean age of 52.39 ± 11.9 years) were included. Biopsies were performed without applying negative pressure; instead, a series of forward and backward needle movements were used to sample different areas within the nodule. The number of these movements was recorded. Patients were divided into two groups: Group 1 (≤ 10 intranodular movements) and Group 2 (> 10 intranodular movements). Cytopathological outcomes were compared between groups.

Results: The mean diameter of the biopsied nodules was 19.68 ± 9.64 mm (range 5-62 mm). Group 1 included 68 nodules (59.1%), while Group 2 included 47 nodules (40.9%). The rate of atypia of undetermined significance (AUS) was significantly lower in group 1 (p = 0.041). Additionally, the need for repeat biopsy was significantly lower in group 1 (p = 0.010).

Conclusion: Excessive intranodular needle movements during FNAB of thyroid nodules were associated with higher rates of AUS and increased likelihood of repeat biopsy. The number of intranodular needle movements may be a critical factor influencing FNAB outcomes.

Objective: This study aimed to evaluate the cardioprotective effects of total flavonoids of Dragon's blood (TFDB) on myocardial ischemia-reperfusion injury (MIRI) using advanced ultrasound imaging techniques.

Methods: Twenty-four healthy New Zealand rabbits were randomly divided into observation (TFDB treatment) and control groups (n = 12 each). The observation group received TFDB (180 mg/kg) orally for 14 days prior to model establishment, while the control group received physiological saline. MIRI was induced via ligation and recanalization of the left anterior descending coronary artery. Hemodynamic parameters, including heart rate (HR) and left ventricular systolic pressure (LVSP), were recorded at baseline (t0), immediate reperfusion (t1), and subsequent intervals up to 120 min (t5).

Results: Successful MIRI modeling was confirmed in 10 rabbits per group. TFDB-treated rabbits demonstrated significantly higher HR and LVSP at t4 and t5 (p < 0.05). Serum creatine kinase-MB and lactate dehydrogenase levels were significantly lower in the TFDB group at t4 and t5 (p < 0.05). At t5, the TFDB group showed significantly higher circumferential strain and ejection fraction values (p < 0.05). Ultrasound microbubble imaging revealed significantly higher video intensity and myocardial blood flow (A × β) in the TFDB group at t5 (p < 0.05).

Conclusion: TFDB demonstrated significant cardioprotective effects in MIRI. Ultrasound microbubble imaging combined with speckle tracking technology provides an effective approach for assessing these cardioprotective effects.

Purpose: Aortic coarctation (CoA) is a congenital structural anomaly with one of the lowest detection rates among heart diseases. Improving diagnostic rates allows for the centralization of high-risk cases in hospitals with pediatric cardiac surgery facilities, thereby reducing neonatal mortality and morbidity. This study aims to evaluate new diagnostic protocols to enhance the clinical and outpatient management of suspected CoA cases.

Methods: A retrospective analysis was conducted, focusing on various echocardiographic parameters to identify the most predictive indicators for CoA.

Results: A total of 184 cases with a prevalence of right-sided heart sections were identified, with 128 patients meeting the inclusion criteria. Of these, 15 cases of CoA were confirmed postnatally, representing 11.7% of the cohort. Among these, 80% showed early echocardiographic signs of CoA. The ratio of pulmonary valve (PV) to aortic valve (AV) diameters emerged as the most reliable parameter, especially in early gestation, while the z-score of the aortic isthmus was also a strong predictor.

Conclusion: The use of simple, reliable echocardiographic parameters can improve the detection rate of high-risk CoA cases, enabling better clinical management and improved neonatal outcomes in both the short and long term.

We report a case of a 1-day-old female neonate presenting with a prenatal ultrasound-detected 12-week-old left neck mass causing respiratory distress. Prenatal ultrasound revealed a 3.3 × 1.8 × 0.9 cm cystic mass posterior-lateral to the left thyroid lobe, anterior to the common carotid artery, with poor sonic transmission and floating echogenic particles. During the surgical procedure, we found the cyst embedded between the sternocleidomastoid muscle, cervical sheath, and trachea, adherent to surrounding tissues. Histopathology confirmed a thyroglossal duct cyst (TDC). Postoperative recovery was uneventful with no recurrences at 6-month follow-up.

Ultrasound is essential for distinguishing malignant from benign thyroid nodules by identifying suspicious features like microcalcifications and macrocalcifications. Microcalcifications strongly indicate malignancy, while entirely calcified nodules ≥ 1 cm show an 18.4%-23.3% malignancy risk. However, not all hyperechoic lesions are calcifications. Misinterpretation of these lesions can lead to unnecessary invasive procedures like fine needle aspiration or core needle biopsy. This review highlights hyperechoic structures and lesions and their causes, helping distinguish true pathologic calcifications. Probe rotation, posterior shadowing assessment, swallowing tests, and integrating with other imaging modalities can also help to avoid misdiagnoses and ensure appropriate clinical decisions.

Intrahepatic cholangiocarcinoma (ICC) often mimics liver abscess in clinical presentation and imaging features, leading to misdiagnosis. We report a case of a 56-year-old male initially diagnosed with liver abscess. Multimodal imaging, including contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS), revealed rim-enhancing lesions, making definitive differentiation challenging. Ultrasound-guided biopsy confirmed the diagnosis of ICC. This case, combined with a literature review, systematically explores the key imaging features for differentiating ICC from liver abscess, analyzes potential reasons for misdiagnosis, and proposes an integrated diagnostic strategy emphasizing the crucial role of pathological confirmation, particularly in equivocal cases.

Introduction: To compare the ultrasonic flow imaging (SMI) and contrast-enhanced ultrasonography (CEUS) in evaluating leiomyoma microvessels and their clinical value.

Methods: 141 patients with uterine leiomyoma treated from March 2023 to March 2024 were retrospectively studied. They were divided into CEUS group (n = 70) and SMI group (n = 71) based on treatment-guiding methods. Blood flow parameters, blood flow grading, fibroid volume, volume reduction rate, and ablation rate were observed and compared. Kappa coefficients analyzed the consistency of blood-flow assessment, and Spearman's correlation analyzed the relationship between blood flow grading and parameters.

Results: Before treatment, no significant differences were found between the two groups (p > 0.05). After treatment, the SMI group had better results in blood flow parameters, grading, volume, reduction rate, and ablation rate (p < 0.05). The two methods had no significant difference in assessing blood flow grading after treatment (p > 0.05), but significant differences in assessing uterine fibroids. Their agreement on blood flow grading was general. Blood flow parameters were positively correlated with both groups (p < 0.05).

Discussion: Both SMI and CEUS can reflect fibroid microvessels and guide treatment, yet SMI is more effective, offering reference for clinical treatment selection.

Purpose/aims: Point-of-care ultrasound (POCUS) within the neonatal intensive care unit (NICU) is an emerging field that is being utilized with increasing frequency. Lung POCUS is employed with multiple validated uses, which include determining the need for surfactant in respiratory distress syndrome and the timing of appropriate extubation in neonates receiving mechanical ventilation. Previous data showed cardiorespiratory stability with other indications of POCUS, though it remains unclear whether this is observed in lung POCUS exams in intubated neonates. Our goal is to evaluate the cardiorespiratory stability of intubated neonates undergoing lung POCUS exams.

Methods: This was a prospective, IRB-approved, multisite study assessing the cardiorespiratory stability of lung POCUS exams. Vital signs data, including heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2), were collected before and after lung POCUS scans and were assessed for equivalence. Limits of equivalence were set beforehand.

Results: Vital signs equivalence for HR, RR, and SpO2 was demonstrated for lung POCUS exams performed prior to and following extubation. For the pre-extubation period, HR increased by 3.93 beats/min, RR increased by 2.31 breaths/min, and SpO2 increased by 0.26%. For the postextubation period, HR increased by 3.05 beats/min, RR decreased by -0.72 breaths/min, and SpO2 decreased by -0.42%.

Conclusion: Lung POCUS exams do not appear to affect the cardiorespiratory stability of intubated neonates, suggesting that lung POCUS can be performed without affecting cardiorespiratory stability within the NICU setting on critically ill neonates for diagnostic purposes.

Congenital cystic malformations of the posterior cranial fossa encompass Dandy-Walker malformation, Blake's pouch cyst, and arachnoid cyst, which are usually associated with increased cerebrospinal fluid in the posterior fossa. Although isolated cerebellar vermis hypoplasia courses with a normal posterior fossa volume and is not associated with a cyst, the smaller volume of the cerebellar vermis results in a relative increase in cerebrospinal fluid compared to the posterior fossa volume and is considered a differential diagnosis. Furthermore, mega cisterna magna, which is an anatomical variant, is also a differential diagnosis of these congenital malformations. Usually, these malformations are diagnosed through screening prenatal ultrasound. However, fetal magnetic resonance imaging (MRI) can confirm, change, or complement questionable findings and identify associated malformations. Therefore, fetal MRI plays an essential role in evaluating fetuses with suspected brain malformations. Manual MRI segmentation can facilitate the understanding of these congenital cystic posterior fossa malformations. Three-dimensional (3D) segmentation offers a spatial view of the abnormalities, as well as their relationships with adjacent anatomical structures, allowing a better multidisciplinary team approach. The aim of this article is to review the embryology of the posterior cranial fossa, discuss the fetal MRI protocol to evaluate the cystic posterior fossa malformations, and to illustrate the key MRI features of these malformations.