Journal of Clinical Ultrasound最新文献

This review was done to assess the diagnostic accuracy of transcranial Doppler (TCD) or electroencephalogram (EEG) accuracy for delayed cerebral ischemia (DCI) in adults with aneurysmal subarachnoid hemorrhage. MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science were searched from inception to April 2025. Two reviewers independently screened studies, extracted 2 × 2 diagnostic data, and assessed the risk of bias using QUADAS-2. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR⁺, LR^-), diagnostic odds ratios (DOR), and area under the hierarchical summary receiver-operating characteristic curve (AUROC) were estimated via bivariate random-effects models. Fifty-two studies (38 TCD; 14 EEG), encompassing 1278 DCI-positive and 3033 DCI-negative assessments, met inclusion. For TCD, pooled sensitivity was 0.79 (95% CI: 0.71-0.85) and specificity 0.82 (0.75-0.87), with LR⁺ 4.3 (3.1-6.1), LR^- 0.26 (0.19-0.36), DOR 17 (9-31), and AUROC 0.87 (0.84-0.90). EEG yielded sensitivity 0.92 (0.83-0.97) and specificity 0.70 (0.58-0.80), with LR⁺ 3.1 (2.1-4.6), LR^- 0.11 (0.05-0.27), DOR 27 (9-83), and AUROC 0.89 (0.86-0.91). Deek's tests showed no publication bias. TCD and EEG both demonstrate strong diagnostic accuracy for DCI after aneurysmal subarachnoid hemorrhage. EEG offers superior sensitivity and rule-out value, while TCD provides balanced rule-in and rule-out performance.

Purpose: To correlate the spleen's shear wave elastography (SWE) with the severity of acute pancreatitis (AP) and the outcome.

Methods: In this IRB-approved prospective study, 38 patients with a diagnosis of AP were enrolled. Patients were taken up for 2D-SWE of the spleen, which was measured in kPa. Mean SWE values of the spleen were compared with the severity of AP according to the Modified Marshall score and intervention using the Kruskal-Wallis test.

Results: Splenic stiffness increased progressively with the severity of acute pancreatitis. Among the three splenic regions, the lower pole showed the most consistent association with disease severity, demonstrating significantly higher stiffness in patients with severe forms of pancreatitis (p = 0.042). Higher overall splenic SWE values were also observed in patients who required more invasive management, such as necrosectomy or surgical drainage, compared with those managed conservatively or with percutaneous drainage. No significant relationship was noted between splenic SWE and demographic factors, etiology of pancreatitis, or splenic vascular changes.

Conclusion: A significant positive association was seen between SWE values of the lower pole of the spleen and the severity of the Modified Marshall severity score. There was a significant positive association between the overall SWE values of the spleen and the nature of the intervention, which was highest in patients who underwent necrosectomy or surgical drainage.

A 27-year-old primigravida with monochorionic diamniotic (MCDA) twin pregnancy underwent fetoscopic laser photocoagulation at 17 + 1 weeks' gestation for Quintero stage II twin-twin transfusion syndrome (TTTS). On postoperative day 20, transabdominal ultrasound identified a cystic anechoic structure adjacent to the anterior uterine wall. Subsequent magnetic resonance imaging (MRI) demonstrated a 2-mm fistulous tract extending from the recipient twin's amniotic sac to the extrauterine cavity, consistent with amniotic sac herniation. Parental concerns prompted induced labor at 23 weeks, with follow-up imaging showing restoration of normal uterine architecture and uterine integrity. Due to contraceptive failure, the patient experienced an unplanned pregnancy and delivered a live infant vaginally within 1 year. The case highlights the critical role of comprehensive imaging modalities for diagnosing subtle postoperative complications. Advanced sonographic techniques and MRI facilitate the accurate detection of rare complications such as uterine dehiscence and amniotic sac herniation to optimize perinatal outcomes.

Prenatal diagnosis of unicuspid aortic valve (UAV) is exceptionally rare. UAV diagnosis can be achieved prenatally via ultrasound; however, it becomes challenging when UAV coexists with a large cardiac rhabdomyoma (CR) occupying significant left ventricular cavity space. The diagnosis of UAV deformity proves particularly challenging due to two compounding pathophysiological factors: altered hemodynamics prevent detection of characteristic high-velocity antegrade flow across the stenotic valve and mechanical compression exerted by a sizable rhabdomyoma further obscures typical diagnostic features. We report a case of fetal UAV associated with CR.

Metanephric adenoma (MA) is a rare primary renal epithelial tumor classified as a metanephric neoplasm. Its clinical symptoms and imaging features are non-specific, making preoperative diagnosis challenging and often leading to misdiagnosis as renal cell carcinoma (RCC). This report details the contrast-enhanced ultrasound (CEUS) findings of a 54-year-old male patient with a MA: 15 s after contrast agent injection, the lesion showed heterogeneous hypoenhancement, exhibiting progressive enhancement. The contrast agent began to fade at 50s, resulting in lower enhancement. Combined with a literature review, it aims to provide more comprehensive information for the imaging diagnosis of MA.

Objective: This study aimed to investigate the variations in junctional zone (JZ) ultrasonographic parameters using three-dimensional transvaginal ultrasound (3D-TVS) across different age groups and evaluate their diagnostic potential for adenomyosis.

Methods: We conducted a retrospective analysis of 120 patients who underwent 3D-TVS examinations. Participants were categorized into adenomyosis and healthy control groups, with the control group further stratified into three age-based subgroups (20+, 30+, and 40+ years). Quantitative JZ parameters were meticulously measured, including maximum thickness (JZmax), minimum thickness (JZmin), thickness difference (JZdif, calculated as JZmax - JZmin), myometrial thickness adjacent to JZmax, and the ratio of JZmax to adjacent myometrial thickness. Statistical comparisons were performed among groups, and receiver operating characteristic (ROC) curves were constructed to determine the area under the curve (AUC) müllerian values for adenomyosis diagnosis.

Results: Age-stratified analysis revealed no statistically significant differences in JZ parameters among control subgroups (p > 0.05), indicating minimal age-related variations in JZ characteristics. Compared to healthy controls, adenomyosis patients demonstrated significantly elevated values in JZmax, JZmin, JZdif, and the myometrial thickness adjacent to JZmax (p < 0.05). ROC analysis yielded AUC values of 0.85 for JZmax, 0.84 for myometrial thickness adjacent to JZmax, 0.79 for JZdif, and 0.76 for JZmin. Optimal diagnostic performance was achieved at JZmax ≥ 0.45 cm, demonstrating 77% sensitivity and 89% specificity.

Conclusion: 3D-TVS with 3D reconstruction technology enables clear visualization of uterine coronal section and accurate quantification of JZ parameters. These findings support the clinical utility of 3D-TVS in the diagnostic evaluation of adenomyosis.

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.