Journal of Clinical Ultrasound最新文献

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.

Introduction: The primary objective of this study is to assess the diagnostic accuracy of multimodal ultrasound, including microvascular flow imaging (MVFI), shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS), in conjunction with the breast imaging reporting and data system (BI-RADS) for non-mass breast lesions (NMLs).

Methods: A total of 100 patients who received treatment in our hospital from April 2021 to June 2024 were retrospectively collected. All patients had complete pre-operative ultrasound BI-RADS, MVFI, SWE, and CEUS. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated; the diagnostic efficacy of the methods was compared, and the diagnostic performance of the subjects was plotted.

Results: The agreement between the BI-RADS-MVFI-SWE-CEUS alone and the pathological results was very high, with a Kappa value of 0.806. The area under the curve (AUC) of the combined diagnosis of MVFI-SWE-CEUS and BI-RADS-MVFI-SWE-CEUS was 0.885 (p < 0.001) and 0.922 (p < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of BI-RADS-MVFI-SWE-CEUS for the diagnosis of NMLs were higher than those of the diagnosis alone (p < 0.05), with 95.24%, 89.19%, 93.75%, 91.67%, and 93%, respectively.

Conclusion: The combination of multimodal ultrasound and BI-RADS provides a significant improvement in the diagnostic accuracy and sensitivity for NMLs, offering a more comprehensive and reliable diagnostic tool for evaluating NMLs.

Objective: To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant endometrial diseases by analyzing the early arterial vascular architecture on CEUS images.

Methods: A prospective study was conducted at the Sichuan Integrative Medicine Hospital to enroll 70 suspected endometrial lesion patients with a mean age of 42.5 ± 8.2 years (range 27-69 years). The patients underwent conventional ultrasound and CEUS examinations, and pathological examinations were obtained through surgery or curettage. They were divided into the benign group and malignant group according to their pathological types. The CEUS image features were analyzed, and the sensitivity, specificity, positive predictive value, and other parameters were compared between the two groups by carefully observing the early enhancement images and comparing the differences in the vascular architecture, including the shape of the vessels, the number of vessels, and the vessel diameter.

Results: There were significant differences in vascular shape, number, and diameter between the two groups. The difference in vascular morphology was highly statistically significant (p < 0.001). The "vascular supply" was used for the diagnosis of malignant diseases of the endometrium with a high sensitivity of 95.8%, specificity of 77.5%, positive predictive value of 71.8%, and accuracy of 84.4%. When the maximum inner diameter exceeded 1.5 mm, the sensitivity and specificity for the diagnosis of malignant lesions were 95.8% and 82.5%, respectively, with a positive predictive value of 76.6% and an accuracy of 87.5%. When the average inner diameter exceeded 1.22 mm, the sensitivity for the diagnosis of malignant endometrial lesions was 87.5%, the specificity was 80%, and the accuracy was 82.8%.

Conclusions: The utilization of CEUS vascular architecture holds significant clinical value in the diagnosis of both benign and malignant endometrial diseases, thereby warranting further comprehensive investigation.

Purpose: This study aimed to assess the impact of delivery mode combinations after the second birth on maternal pelvic floor differences using transperineal ultrasound.

Methods: A total of 266 women were enrolled in this study. According to the different delivery modes of two births, women were categorized as repeat vaginal birth (RVB), vaginal birth after cesarean section (VBAC), cesarean section after vaginal birth (CAVB), and repeat cesarean section (RCS) groups. Univariate analysis was performed to compare levator hiatus area (LHA-V), bladder neck-symphyseal distance on Valsalva (BSD-V), bladder neck descent (BND), and the occurrence of pelvic organ prolapse (POP) among the four groups. Multiple linear regression analysis was performed to identify factors associated with LHA-V.

Results: BSD-V in the RVB, VBAC and CAVB groups was lower and their BND was greater than the counterparts in the RCS group (p < 0.05). The VBAC group exhibited a significantly lower BSD-V and greater BND compared to the CAVB group. The prevalence of POP was the highest in the RVB group and the lowest in the RCS group. LHA-V was the only ultrasound parameter statistically different in all pairwise comparisons among the four groups. The multiple linear regression analysis results demonstrated a significant relationship between LHA-V and different delivery modes of two births, neonatal weight, BND, uterine and perineal body position on Valsalva.

Conclusion: For women with both modes, vaginal birth after cesarean section exhibited significantly lower BSD-V, greater BND and larger LHA-V, with a higher prevalence of POP compared to the reverse sequence. Meanwhile, LHA-V was identified as a sensitive ultrasound indicator for differentiating pelvic floor outcomes across delivery mode combinations.

Objective: To assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) for detecting abdominal metastases in patients with gastrointestinal stromal tumors (GISTs), with a comparison to conventional ultrasonography (US) and contrast-enhanced computed tomography (CE-CT).

Methods: This retrospective study enrolled 53 patients with pathologically confirmed abdominal metastases from gastrointestinal stromal tumors (GISTs), who underwent US, CEUS, and CE-CT examinations at our institution between January 2022 and January 2025. The diagnostic performance of CEUS was systematically evaluated and compared with US and CE-CT according to pathological diagnostic criteria.

Results: CEUS showed significantly higher sensitivity than US (88.68% vs. 45.28%; p < 0.05). Notably, CEUS achieved comparable performance to CE-CT (sensitivity: 88.68% vs. 94.34%; p > 0.05). No statistically significant differences were observed between CEUS and CE-CT in lesion perfusion characteristics, including enhancement pattern (p > 0.05), intensity (p > 0.05), and homogeneity (p > 0.05).

Conclusions: CEUS demonstrates superior diagnostic performance to US in detecting abdominal metastases from GISTs, with efficacy comparable to CE-CT. Given its radiation-free nature and procedural simplicity, CEUS represents a valuable imaging modality for the clinical assessment of GIST metastases.

Objectives: This meta-analysis evaluated the diagnostic value of carotid contrast ultrasonography (CEUS) for disease activity in Takayasu arteritis (TAK).

Methods: Systematic reviews were conducted in PubMed, Embase, Cochrane Library, and Web of Science using the following search terms: Takayasu Arteritis, aortic arch syndrome, pulseless disease, contrast-enhanced ultrasound, contrast-enhanced ultrasonography, and CEUS. Studies published from the beginning up until October 2024 were collected. Two researchers performed screening, full-text review, and data extraction. The QUADAS-2 tool was used to assess the risk of bias. A random-effects model was used for the meta-analysis.

Results: Nine articles involving 498 patients and 704 carotid artery examinations were included in the study. The combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve of CEUS for detecting TAK disease activity were 0.80 (0.76-0.83), 0.71 (0.67-0.74), 3.87 (2.41-6.21), 0.31 (0.22-0.42), 21.87 (11.32-42.23), and 0.8941, respectively.

Conclusion: The assessment of TAK activity using CEUS has certain sensitivity and specificity; as a result, it can be used to judge the condition of patients with TAK and the treatment effect to provide a more comprehensive and reliable objective basis for clinical treatment.

We report a rare case of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome accompanied by simultaneous adenomyosis and leiomyoma in rudimentary uterine remnants. A 35-year-old woman presented with progressive lower abdominal pain and underwent diagnostic imaging. The initial ultrasound erroneously suggested an adnexal mass, but subsequent imaging revealed bilateral uterine remnants-one with adenomyotic changes and the other harboring a leiomyoma. Laparoscopic excision confirmed these pathological findings. This case suggests the importance of regular gynecological imaging examinations for MRKH patients and challenges the conventional belief in the non-functional nature of Müllerian remnants. Furthermore, our findings underscore the diagnostic utility of transabdominal ultrasound in accurately identifying complex uterine anomalies.

Primary mesenteric malignant yolk sac tumor (YST) is clinically rare, with challenges in preoperative diagnosis and poor prognosis. This article reports a case of a 34-year-old female with primary YST originating from the transverse mesocolon. The patient presented with an asymptomatic abdominal mass, markedly elevated AFP (31 252 ng/mL), and imaging findings of a well-circumscribed solid mass. The diagnosis was confirmed via laparoscopic surgical resection and pathological examination. This case aims to explore the multimodal diagnostic strategies, therapeutic controversies, and prognostic characteristics of mesenteric YST, providing clinical insights for the identification of this rare tumor.

Background and aims: The rising prevalence of metabolic dysfunction-associated steatohepatitis (MASH) and the arrival of medical treatments have highlighted the need for accurate, accessible, and cost-effective methods for hepatic steatosis quantification. This study evaluates the performance of ultrasound-derived fat fraction (UDFF) for diagnosing and quantifying hepatic steatosis using MRI-derived proton density fat fraction (MRI-PDFF) and liver biopsy as reference standards. UDFF was also compared with the controlled attenuation parameter (CAP).

Materials and methods: A total of 114 patients with chronic liver disease were prospectively included. All patients underwent UDFF and MRI-PDFF; 78 patients also had liver biopsy. CAP measurements were available for 104 patients. The correlation of UDFF with MR-PDFF and the area under the receiver operating characteristic curve (AUC) of UDFF for steatosis were calculated and compared with CAP. Factors influencing UDFF measurements were evaluated through multivariate analysis.

Results: UDFF demonstrated a moderate to strong correlation with MRI-PDFF (r = 0.60 [0.46; 0.71], p < 0.001) and a moderate correlation with liver biopsy (η = 0.31). The AUCs for UDFF in diagnosing steatosis (≥ grade 1) were 0.79 (MRI-PDFF reference) and 0.82 (biopsy reference), outperforming CAP for moderate (grade 2) steatosis (p = 0.043). UDFF consistently overestimated steatosis by 5% compared to MRI-PDFF. Parietal thickness > 30 mm was the only factor influencing measurement accuracy. UDFF had no measurement failures, unlike CAP, highlighting its robustness.

Conclusion: Although the correlation between UDFF and MR-PDFF is moderate to strong, this prospective study does not provide results as good as those of the few previous studies evaluating the UDFF technique. These results highlight the importance of standardizing techniques and measurements in order to position US steatosis quantification tools in the management of patients with MASLD and MASH.