Journal of Clinical Ultrasound最新文献

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.

Objective: This study aims to classify fetal interrupted aortic arch (IAA) and its associated intracardiac and extracardiac malformations. Additionally, it seeks to summarize the genetic characteristics of IAA fetuses through copy number variation sequencing (CNV-seq) and whole exome sequencing (WES).

Methods: We conducted a retrospective analysis of 156 fetuses diagnosed with IAA via fetal echocardiography at Beijing Anzhen Hospital, Capital Medical University, between August 2010 and December 2023. Of these, 24 cases underwent genetic testing. Ultrasound images from these cases were analyzed to determine the type of IAA and to assess associated intracardiac and extracardiac malformations. Genetic abnormalities were evaluated using CNV-seq and WES.

Results: Among the 24 IAA cases, 8 (8/24, 33.3%) were classified as Type A IAA, while 16 (16/24, 66.7%) were classified as Type B IAA. All cases exhibited associated malformations, with 18 (18/24, 75.0%) presenting solely with intracardiac defects and 6 (6/24, 25.0%) exhibiting both intracardiac and extracardiac defects. Of the 24 cases undergoing CNV-seq and WES, 12 (12/24, 50.0%) yielded positive genetic findings. The detection rate for fetuses with only intracardiac malformations was 33.3% (6/18), whereas it was 100.0% (6/6) for those with extracardiac malformations. Positive findings included three cases (3/12, 25.0%) of aneuploidy, six cases (6/12, 50.0%) of copy number variation (CNV), and three cases (3/12, 25.0%) of single nucleotide variants (SNVs).

Conclusion: This single-center study found that all IAA fetuses were associated with cardiac malformations, with a significant likelihood of concurrent extracardiac anomalies. The prevalence of genetic abnormalities was notably high, particularly for CNV. Therefore, prenatal imaging indicating IAA strongly recommends further genetic testing using CNV-seq and WES.

Congenital cataracts occur in approximately 1 in 5000 live births and may present as an isolated anomaly or as part of a broader constellation of anomalies. Identifying the etiology of congenital cataracts enables accurate prognostic counseling, assessing recurrence risk, and guiding medical management. Detailed fetal anatomy scans, family history, exposure history, and the presence or absence of additional anomalies must be used to help guide diagnostic testing and management. We describe three very different cases of prenatally diagnosed cataracts: congenital cytomegalovirus (CMV) infection, Walker-Warburg syndrome, and a case with a strong family history of congenital cataracts.

Ovarian mixed germ cell tumors are a relatively rare type of reproductive system malignancy. The initial symptoms typically include abdominal pain, bloating, and pelvic masses, primarily affecting children and adolescents. Ultrasound remains the primary imaging modality for ovarian tumors, usually showing solid hypoechoic masses with abundant blood flow within the adnexal region. This article focuses on a case report of a teenage patient with an ovarian mixed germ cell tumor complicated by hepatic metastasis.

We conducted a focused review of prenatally diagnosed apparently isolated septum pellucidum agenesis with available follow-up. Across nine series including 112 fetuses, septal optic dysplasia (SOD) was ultimately confirmed in 21 cases (18.8%), but only 43% were suspected before birth, usually on the basis of optic nerve hypoplasia, while 57% were diagnosed postnatally. Truly isolated cases generally showed favorable neurodevelopment. Our accompanying case illustrates a rare association with 15q13.3 microduplication and highlights that prenatal suspicion of SOD may also arise from endocrine-related sonographic markers. These findings emphasize diagnostic challenges and the value of integrated imaging and genetics.

IgG4-related hepatic inflammatory pseudotumor (IgG4-HIPT) represents a rare hepatic manifestation of IgG4-related disease (IgG4-RD) and is frequently misdiagnosed at initial presentation. We report the case of a 58-year-old man with a history of autoimmune pancreatitis (AIP) who presented with incidentally detected multiple hepatic lesions. Serum IgG4 was markedly elevated to 7546.6 mg/L. Contrast-enhanced ultrasound (CEUS) suggested cholangiocarcinoma, contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (CEMR) favored hepatic abscesses, while ¹⁸F-FDG PET-CT supported an inflammatory process. As the patient declined biopsy, a clinical diagnosis was made based on prior IgG4-RD, serological findings, and multimodal imaging features, and empirical immunosuppressive therapy was initiated. Subsequent follow-up demonstrated significant lesion regression. Although histopathological confirmation was unavailable, the constellation of clinical, serological, and imaging findings was consistent with a presumptive diagnosis of IgG4-related hepatic inflammatory pseudotumor. This case offers important insights into the imaging differentiation and noninvasive management of IgG4-HIPT.

Objectives: To evaluate real-time ultrasound-guided intratumoral lauromacrogol + pingyangmycin for pediatric peripheral primitive neuroectodermal tumors (pPNET) refractory to chemotherapy.

Methods: Five tumor lesions in three children from our institution were treated under real-time ultrasound guidance. Color Doppler and contrast-enhanced ultrasound assessed tumor hemodynamics and size pre- and post- injection.

Results: Pre-injection, all tumors showed rich blood flow (mixed arteriovenous signals). Post-injection contrast ultrasound revealed significantly reduced arterial-phase blood supply. At 4-week follow-up, all five tumors showed statistically significant volume reduction (p < 0.05) and reduced tumor-related pain. No adverse reactions such as bleeding and pain occurred during injection.

Conclusion: Ultrasound-guided intratumoral lauromacrogol + pingyangmycin injection effectively reduces tumor blood supply, destroys local vasculature, and shrinks tumor volume in end-stage pediatric pPNET. It is a safe and effective local palliative treatment.